Addiction: A Life Long Illness Not Lifestyle Choice – Similar to Harmful Investing?

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We are studying whether models of addictive brain disorders are applicable to self-harming investment behavior and later life disinhibited, self- harming investment behavior.

Addiction: A Life Long Illness Not Lifestyle Choice

February 28, 2011 

Addiction is a major health problem that costs as much as all other mental illnesses combined and about as much as cancer and cardiovascular disorders also.

At its core addiction is:

  • A state of altered brain function that leads to fundamental changes in behavior that are manifest by repeated use of alcohol or other drugs or engaging in activities such as gambling (impulsive and compulsive investing as well, ed)
  • These are usually resisted, albeit unsuccessfully, by the addict
  • The key features of addiction is therefore a state of habitual (impulsive/compulsive) behaviour such as drug taking or gambling that is initially enjoyable but which eventually becomes self-sustaining or habitual
  • The urge to engage in the behaviour becomes so powerful that it interferes with normal life often to the point of overtaking work, personal relationships and family activities
  • At this point the person can be said to be addicted: the addict’s every thought and action is directed to their addiction and everything (and others) else suffers. 

If the addictive behaviour is not possible e.g. because they don’t have enough money then feelings of intense distress emerge. These can lead to dangerously impulsive and sometimes aggressive actions.  

In the case of drug/alcohol addiction the situation is compounded by the occurrence of withdrawal reactions which cause further distress and motivate desperate attempts to find more of the addictive agent. This urge to get the drug may be so overpowering that addicts will commit seemingly random crimes to get the resources to buy more drug.  It has been estimated that about 70% of all acquisitive crime is associated with drug and alcohol use.

Addiction is driven by a complex set of internal and external factors.  The external factors are well understood:  the more access to the desired drug or behaviour e.g. gambling the more addiction there is. 

(In fact, it appears the inherited, family/genetic brain impairments and “broken”/abnormal brain circuits and processes causing addictive disease and the symptoms are pretty well understood and have been validated.  The addictive behaviors are symptoms of the disease – not the disease itself. ed)

The internal factors are less clear. Although most addiction is to alcohol and other drugs, addiction to gambling and other behaviours such as sex or shopping can occur. These tell us that the brain can develop hard-to-control urges independent of changing its chemistry with drugs.  

All addictions share a common thread in that they

  • are initially pleasurable activities, often extremely enjoyable
  • This results in these behaviours hijacking the brain’s normal pleasure systems so that naturally enjoyable activities such as family life, work, exercise become devalued and the more excessive addiction behaviours take over
  • However, not everyone who engages in drug use or gambling becomes addicted to them so clearly other factors are important. 

These are not yet understood but are now being actively studied.

  • Some people may be particularly sensitive to the pleasurable effects of alcohol, drugs or gambling, perhaps because of coming from deprived backgrounds
  • In others, addiction may occur because of an inability to adopt coping strategies
  • Others may have an underlying predisposition to develop compulsive behaviour patterns
  • Some unfortunate people may have several of these vulnerability factors and there are also genetic predispositions to some of them.

Also a significant amount of drug use is for self-medication, examples include cannabis for insomnia, alcohol to reduce anxiety, opioids for pain control etc. This therapeutic use can escalate into addiction in some people though by no means all. Not all drugs which are used for recreational purposes are addictive. LSD and magic mushrooms seem not addictive at all, and some have a low risk of addiction (MDMA/ecstasy; cannabis). The most addictive drugs are nicotine, heroin and crack cocaine plus metamfetamine (crystal meth) although this is not much used in the UK.

Just because some people – including leading politicians – have used drugs but stopped before they became addicted does not mean that anyone can stop that easily.  Starting to use drugs may be a lifestyle choice but once addiction sets in, choosing to stop is very much more difficult if not impossible.

We are beginning to understand how addictions start in the brain. 

  • The pleasurable or rewarding effects of addictions are mediated in the brain through the release of chemicals such as dopamine [by cocaine, amphetamines, nicotine] or endorphins [heroin] or both [alcohol]The pleasures are then laid down as deep-seated memories, probably through changes in other neurotransmitters such as glutamate and GABA that make memories
  • These memories link the location, persons and experiences of the addiction with the emotional effects
  • These memories are often the most powerfully positive ones the person may ever experience, which explains why addicts put so much effort into getting them again
  • When the memories re-occur, which is common when people are still using drugs or gambling, as well as when in recovery/abstinence, they are experienced as cravings.  These can be so strong and urgent that they lead to relapse.

A great deal of research has been conducted into the role of dopamine in addiction and we now know that:

  • the number of dopamine receptors seems to predispose to excessive pleasure responses from stimulant use
  • This excessive response is thought to initially occur in the reward centre of the brain – [the nucleus accumbens] – but then move into other areas where habits are laid down
  • This shift from voluntary (choice use) to involuntary (habit-use) explains a common complaint of addicts that they don’t want to continue with their addictions, and even that they don’t enjoy them anymore, but cant stop themselves
  • In this sense addiction can be seen as a loss-of-control over what starts out as a voluntary behavior.  

Thus addiction is not, as some like to suggest, simply a “lifestyle” choice. It is a serious, often lethal, disease caused by an enduring (probably permanent) change in brain function.

We know that:

  • personality traits especially impulsivity
  • predict excess stimulant use and in animals this can be shown to correlate with low dopamine and high opioid receptor levels.  Similarly in humans low dopamine and high opioid receptor levels in brain predict drug use and craving
  • These observations give new approaches to treatment, both psychological interventions such as behavioural control, and anti-impulse drugs such as those used for ADHD e.g. atomoxetine and modafinil, are being tested. 

For some addictions, especially heroin, the risk to the addict (life expectancy less than that from many cancers) and to society (from crime and infections), is so high that the prescription of substitute opioid drugs or even heroin itself saves lives and reduces crime. These substitute drugs are methadone and buprenorphine [Subutex]. 

As well as reducing crime and social costs by removing the need for addicts to commit offences to feed their habit, they also protect from accidental overdose and reduce risk of infections such as HIV and hepatitis.  Similar substitute pharmacological approaches exist for other addictions e.g. gammahydroxybutyrate (Alcover) and baclofen for alcohol addiction, and varenicline (Champix) for nicotine dependence.

Another major reason for relapse in addiction is stress. This may work through increasing dopamine release in brain so priming this addiction pathway or by interactions with other neurotransmitters such as the peptide substance P. As antagonists of these neurotransmitters are now available they are being tested in human addictions and may offer an alternative to substitution treatments.

More on Caffeine

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caffeine is a three–headed monster that yields both positive and negative effects.

Starting with the good:

  • caffeine can increase your short-term memory and alertness while also altering your overall mood
  • The caffeine in one cup of coffee can stimulate the central system as it simultaneously lowers blood sugar, thus creating a temporary lift
  • “caffeine taken two hours before exercise enhanced the performance of athletes in marathon running.

“people who drink coffee on a regular basis have up to 80% lower risks of developing Parkinson’s disease.”

On the contrary, caffeine does have a dark side.

  • Caffeinated foods can contribute to a person’s struggle with either weight gain or hunger
  • The stimulant itself is known to increase appetite, to increase cortisol levels, and to increase levels of insulin
  • Any of these factors may combine with a caffeine-induced stress that often affects the results of dieters, being that caffeine is a natural diuretic which can lead to water retention
  • Caffeinism, as it is often referred to, can come in waves of migraine headaches and sickness, which in turn can cause nervousness and a rapid heartbeat. 

No, Your Boss is Not a Psychopath

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Here is a good quick description of this serious brain impairment.  The economics are interesting.

What Symptoms Lead To Someone Being Classified A Psychopath?

  • A lack of empathy, guilt and remorse; callousness, impulsivity, promiscuity, hot-headedness and pathological lying, among others
  • Each of these traits is scored on the Hare Psychopathy Checklist, which is compiled from an interview and an extensive background report
  • The scale goes from 0 to 40. The average prisoner scores 22. We consider a score of about 30 as indicating that someone meets the criteria for the disorder
  • When someone scores 34 or higher, we find that we are dealing with a person who is fundamentally out of the ordinary. It is palpable in their clinical presentation. 
  • They are completely different from other inmates. And it turns out that their brains are different too, both in structure and in function.

Why Do You Use Prisoners As Your Subjects?

Individuals with psychopathy have a large impact on the criminal justice system.

  • Between 15 and 35 per cent of prisoners in US jails meet criteria for the disorder
  • compared with about 1 per cent in the general population.

Why Is It So Important To Study Psychopaths?
In most places in the US, the way we treat psychopaths is to incarcerate them. We put antisocial people with antisocial peers, and guess what happens? They get more antisocial. It’s a system that doesn’t work

  • The estimated social cost of crime in the US is $2.3 trillion a year
  • psychopaths are thought to be responsible for 20 to 40 per cent of that. [Wow!]

Imagine if you could treat or remediate psychopathy. You would be able to save billions of dollars per year. The goal here is to use the very best science to understand and treat some of the most enigmatic and complex personality disorders that are associated with the worst crimes, to hopefully be able to prevent them.

How Is a Psychopath Usually Experienced?

  • Well, most psychopaths have a glibness and a superficial charm to them. It does sometimes happen that, if we don’t get a chance to read a case file before we do an interview, we might walk away thinking, “Wow, what a nice guy! I can’t believe he’s in here,” because, basically he hasn’t told you the truth about anything that has happened in his entire life.
  • Then when we actually do get a chance to look at the file, it’s like you are reading about a completely different person. When you see the person again, they’ll often say: “I didn’t want to talk about the old me; I thought I’d tell you about the new me.” So, I definitely find them clinically interesting and sometimes even entertaining, but not somebody I’d want to be friends with.

Are All Psychopaths Dangerous?
No. There are probably many psychopaths out there who are not necessarily violent, but are leading very disruptive lives in the sense that they:

  • are getting involved in shady business deals
  • moving from job to job
  • or relationship to relationship
  • always using resources everywhere they go but never contributing.

Such people inevitably leave a path of confusion, and often destruction behind them.

What About Those Who Manage To Forge Successful Careers?
Psychopathy, as I understand it:

  • Is not typically associated with long-term success
  • Rather, psychopaths normally get into so much trouble, are so impulsive and fail to consider how their behaviour impacts others, that it is unlikely they would become highly successful. Nevertheless, I don’t think it is impossible for an individual with psychopathy to have a “successful” career.

When One Pictures A Psychopath, The Image Is Almost Always Of A Man. What Do We Know About Psychopathic Behaviour In Women?
It’s estimated to be one-tenth as common. We don’t yet have a good understanding why it is so rare.

How Is A Better Understanding Of Psychopathy Going To Help Us Do Something About It?
That’s exactly the question: what medicines and/or therapies are likely to help? We certainly know that some forms of therapy have been shown to make psychopaths worse. Group therapy, for instance, in some studies has been shown to actually make psychopaths more likely to reoffend than if you didn’t treat them at all.

So it’s critical that we identify the psychopathic offenders and put them in a treatment programme that is made for them.

Do You Have Hope That Psychopathy Can Be Cured?
Absolutely. Brain imaging is just one tool to help us understand things. I don’t think it’s a panacea but it does help us to know that, yes, behaviour originates in the brain and yes, it’s malleable and treatable. So there’s a lot of hope.

Childhood Mental Health Problems Blight Adult Working Life

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ScienceDaily (Apr. 5, 2008) — Mental health problems in childhood blight adult working life, suggests research published ahead of print in Occupational and Environmental Medicine. And problems in working life are associated with mid life depression and anxiety.

Living in rented accommodation, having a longstanding illness, no qualifications, and no partner were all linked to depression and anxiety in mid life.

But so too were workplace stressors, including little control over decisions, low levels of social support, and high levels of job insecurity. These stressors doubled to quadrupled the risk of depression and anxiety.

Internalising behaviours in early childhood and adulthood strongly predicted poor quality working life, with many work stressors. Internalising behaviours are usually defined as depression or lack of concentration, as opposed to externalising behaviours, such as bullying and disruption.

Although mental health problems in early childhood and adulthood did not fully explain the mid life depression, these could have a knock-on effect, suggest the authors. Mental health problems in childhood could affect the ability to pass exams and gain qualifications, so blighting an individual’s prospects of getting well paid and satisfying work.

And people who have experienced mental illness early in their lives may also opt for less demanding, low status work, because it might be more manageable, but at the same time, less rewarding and more stressful.