My friend, Jared, the PhD in school and neuro psych, also found me this article. (Besides the one we were working through previously, for which the starting point can be found here.) This article focuses specifically on how a person who is addicted to drugs thinks differently than the regular Joe Schmoe Public.
Let’s start with defining addiction at the cellular, neuron level. “Drugs alter normal brain structures and function in these regions[, those responsible for learning, memory, attention, reasoning and impulse control] producing cognitive shifts that promote continued drug use through maladaptive learning and hinder the acquisition of adaptive behaviors that support abstinence.” All that to say that drugs change the very cells of the brain. Here’s how.
The drugs alter the connections between the cells, called synapses.
The drugs induce the synaptic knobs (or the ends of the cells) to be more or less sensitive to the neurotransmitter (the cells’ messengers). To be more sensitive is called long term potentiation (LTP). To be less sensitive is called long term depression (LTD). Different drugs have different actions and amounts of change they create, as listed briefly in the below chart.
These varying changes lead to varying clinical pictures as they increase or decrease activity in certain parts of the brain:
— amphetamine: poor attention, impulse control, ability to recognize patterns, planning skills, ability to shift their attention and slow speech speed
— cocaine: poor ability to switch thinking from one topic to another
— ethanol aka alcohol: poor short term memory
— marijuana: poor attention, ability to switch thinking from one topic to another, ability to learn and retain new information, time estimation
— morphine, opioids: poor ability to switch thinking from one topic to another
— nicotine: poor short term memory, attention, ability to learn talking points, ability to associate a new response to a given stimulus, and simple math
What’s super scary is that these deficits don’t really go away by quitting. While the deficits do get some better by quitting and staying clean, the one-time abusers’ scores in those areas do not reach the normative levels of those that have never used drugs. And even worse, those deficits tend to get WORSE when you first quit. Which perpetuates a terrible cycle of relapse, because taking another drink or hit or whatever will alleviate that down turn in the deficits. This maladaptive behavior pattern keeps addicts locked into being addicts. Which is one of the many reasons they can’t just quit without support. The length of time an addict stays in that down turn phase varies depending on the drug, but can last MONTHS.
That is also the stage where an addict will turn up on my case load: when they’re at their worst. So add that on top of a neurologic problem and that’s a recipe for disaster. And it often is just that: a disaster. They have a hard time focusing on their rehab, because all the want is to get out of the hospital and get a hit, because they are convinced that doing so will alleviate their cognitive problem, which may or may not be true. Or perhaps they’ve been clean for years. But they may return to what they know: the drug gets rid of the cognitive problem, so they’re wanting to get their drug of choice again to alleviate those symptoms. And even if they do stick out their rehab, I’m working on a physiologically different brain than the average Joe Schmoe Public. At it’s core, addiction is a “pathology of learning.” If a person’s ability to learn and perform neural plasticity (restructuring of the brain that causes learning) is hindered, I would suspect my treatments aren’t going to be as effective. I depend of neural plasticity to make changes in a compromised neurologic system to bring about physical change. Maybe those efforts are being blocked by this maladaptive plasticity that has occurred due to the drugs.
Maybe not a “Eureka!” moment, but definitely something to ponder and take into consideration when designing my plan of care for those that have drugs in their history.