Young man with hands clasped together

Can the Science of Addiction Ease Compassion Fatigue? | Opinion

New estimates from the Centers for Disease Control indicate 74,000 Americans died from drug overdoses in 2017, a 10 percent increase over 2016.Responding to the epidemic, Pennsylvania has made commendable efforts to increase the availability and use of naloxone to reverse opioid overdoses.  The widespread use of naloxone is a linchpin to an emerging decline in overdose deaths in well-equipped communities. In the past four years, Pennsylvania police officers have saved more than 7,600 lives by administering this life-saving medicine. Emergency medical personnel have revived thousands more.

First responders often receive repeated overdose calls for the same address or person. Understandably, this may lead to frustration with the seemingly endless cycle of addiction and apparent unwillingness of many overdose survivors to accept desperately needed treatment. Empathy for those with substance use disorders may diminish over time, often leading to compassion fatigue.

As both a physician and a person in long term recovery from an opioid use disorder, I have perspective as a care provider and as someone whose rational brain was hijacked by this progressive disease. I speak from painful experience when I say I truly believed my use of prescription painkillers was under control, even when it became glaringly obvious to others that it was not.

Eventually, I came to realize that all the medical training in the world could not have prepared me for the battle I faced.

As a physician, it was important to understand what happened to my brain. What compelled me to act in ways incompatible with my values, to lie to others and myself? Why did I have zero insight into my behaviors and their consequences? Why was my thinking so distorted? Why couldn’t I just stop?

Scientific research provides many answers to these questions and suggests why someone who is revived multiple times with naloxone—facing death repeatedly—refuses interventions and continues the harmful use of drugs.

In the brain, directly above our eyes, the frontal lobe controls our executive functioning. This includes rational, logical thinking and decision-making in line with our goals and values, as well as considering consequences and controlling social behavior.

Compare this to the more primitive middle portion of the brain where our survival (fight-or-flight), emotional and reward systems reside.

This part of the brain evolved early in human development to keep us safe from ancient predators. It instinctively and instantaneously revs up the body, compelling us to flee as fast as we can from a serious threat. We don’t think about it; we just run. If we wait until the rational frontal lobe assesses the threat, we could certainly become a lion’s lunch.

The brain’s rational, critically-thinking frontal lobe and its emotional, fight-or-flight mid-brain communicate constantly. When they’re in balance, the frontal lobe acts as the brake pedal for impulses, while the mid-brain acts as the gas pedal, propelling us to act on fears and perceived threats.

3d image of the brain

As a substance use disorder progresses, this delicate brain balance is lost, and communication between these two parts of the brain is significantly impaired. The rational frontal brain can no longer manage the impulsive mid-brain. The result is all “go” and no “stop.”

For people with an advanced substance use disorder, anything or anyone that comes between them and their substance of choice is perceived as the lion—an imminent threat.

The midbrain takes over as the analytic frontal lobe goes offline, and impulsive, irrational behavior can ensue. This often results in denial, ambivalence to or refusal of treatment and even aggression toward first responders.

Consider this: Why do lifeguards in training learn defensive maneuvers? Because a drowning person deprived of oxygen will claw his or her way over the rescuer with a singleness of purpose: to reach the surface for life-sustaining oxygen. It’s not personal; it’s an understandable human instinct.

When opioids become people’s oxygen, much like the drowning person, they will do whatever necessary to get the desperately needed substance, leading to sustained addiction.

My own desperation, negative consequences and ultimate hopelessness brought me to a breaking point, until I finally became willing to seek help.

In treatment, the opioids were purged from my system, and my rational brain started coming back online. I was able to gain insight into my addiction and begin my journey in recovery. The persistent compassion and encouragement of family and friends was vital to this process.

I understand why people, particularly first responders and health care professionals, may develop compassion fatigue during this opioid epidemic.

Still, I encourage them to consider the science—the “why” of addiction—when interacting with someone struggling with a substance use disorder. They make an impact every time they respond to an overdose call or interact with an overdose survivor. Their words and body language matter.

For people with a substance use disorder, disparaging words only compound their overwhelming shame and hopelessness; compassionate words plant a seed of hope that can blossom into long-term recovery.

If you or someone you know is struggling with addiction, this 24-hour hotline, staffed by trained professionals, will put you in touch with local services and support: 1-800-662-HELP (4357).

Dr. Jennifer Zampogna, M.D. is the director of operations for Lawyers Concerned for Lawyers of Pennsylvania, a non-profit organization that assists lawyers, judges, their family members and law students who are struggling with mental health and/or substance use issues.

Original article here.

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Brain With Pills

Video: The Hijacker – Addiction

Substance use disorders (SUDs) affect tissue function in two main parts of the brain: the limbic system (responsible for basic survival instincts) and the prefrontal cortex (where decision-making and impulse control live).

Substance use activates the dopamine process in the survival center much more powerfully than natural rewards like food or sex. When repeated it can hijack the brain, making it think that the substance is the most important thing for survival.

Over time, more and more of the substance is needed to activate the same level of reward, causing the brain’s circuits to become increasingly imbalanced–eroding a person’s self-control and ability to make sound decisions, while producing intense impulses to seek and use the substance.

This is what it means when scientists say that addiction is a brain disease.

The good news – SUDs are preventable and treatable, and brain scans show that once an individual is in recovery, brain tissue can get better.

Original video posted here on

The animated series aims to expand public understanding about addiction and replace the myths and misinformation that keep substance use disorders (SUDs) from being treated like any other medical condition.

Educational episodes run two-to-three minutes and are meant to be consumed like “snack-packs” of key scientific information.

“ADDICTION” is animated by artist Patrick Smith and produced by the Addiction Policy Forum.

The content of each episode is the result of close collaboration between scientists, patients and families impacted by addiction, and members of our team.

A special thanks to the National Institute on Drug Abuse (NIDA) for the science highlighted in the series.

US News and World Report

Breaking Addiction’s Grip

Psychiatrist and public health official Lloyd Sederer discusses proven solutions to treat and prevent addiction. An opioid epidemic is ravaging the nation, and American families, public health officials and lawmakers are in search of solutions that can both stem the tide of legal and illegal drugs flooding their communities and provide effective, accessible methods to help release those hooked from the grip of addiction.

In his new book, psychiatrist and the chief medical officer of the New York State Office of Mental Health Dr. Lloyd Sederer, describes the scope of the challenges that make addiction so tough to shake, as well as research-tested methods for prevention and treatment. Sederer recently spoke with U.S. News about the path to recovery and why lawmakers should abandon failed policies. Excerpts:

The country is suffering one of its worst drug epidemics in the opioid crisis. How would you rate the Trump administration’s response?

Ineffective strategies have unfortunately had a bit of renaissance in the current administration. I like a quote from Winston Churchill: “You can rely on Americans to do the right thing after they’ve tried everything else.” We have the right things, and we have proof that they work. We’re just not using them because we’re spending so much energy – programmatic energy, policy, money – on two principally failed strategies, one I call control and the other, consequences.

Probably the most glaring example of control is Prohibition, trying to prevent people from getting what they want. Good luck with that; that failed miserably, but it did create an everlasting mafia. Then you fast forward a number of decades and [President Richard] Nixon coins the term “War on Drugs,” and that was carried forward by [President Ronald] Reagan. The idea was that you could actually wage war on substances.

Lately, it’s been – let’s amp up law enforcement to deal with the opioid epidemic, let’s amp up enforcement, let’s give more money to cops to arrest people. The attorney general says ‘let’s use our federal laws that make cannabis illegal, go to states where it’s a legal recreational drug and arrest those people and maximize this sentences.’ This is so dated and useless.

Consequences means scare tactics. ‘This drug’s going to kill you, this drug’s going to fry your brain!’ So this is public service announcements, media ads and sending cops or convicted felons to schools to scare kids. That’s totally ineffective and in fact the irony is when you use scare tactics with teenagers, they’re drawn to it. The teenage brain is neurologically wired towards novelty and risk.

Addiction Solution Book

Why do we keep returning to these strategies, if, as you say, they don’t work?  Some of it is ideological. Some of it is an example of just how ineffective government has been. There’s not a small number of people who believe, still, addiction is a weakness, it’s a character problem, and you don’t coddle people like that, you throw the hammer on them. The prospect of giving good money to people who didn’t do their share, that’s a very conservative position. Why should we support people who don’t contribute? And in this case, not only don’t contribute but deplete the public treasury, or steal or prostitute themselves, mostly to get a fix so they don’t go into withdrawal.

There are very strong moral forces, and this is a very puritanical country still. So this idea of coming down hard on drug users or drug dealers, execute them, as the president said in some talk not too long ago.

There’s also a touch of racism about this, because when you look at the demographics of people in prisons in the United States – we have the highest rate of imprisonment in the world by far – they’re people of color and poor people, and a good portion of them are there for nonviolent crimes. People don’t realize that the hammer will start to fall on Ohio, and Pennsylvania, and New Hampshire, and Vermont, and southern Massachusetts – epicenters of the opioid epidemic – which are white and middle America.

Many readers may be surprised at your description of why people begin using drugs: “People use drugs for a purpose. They work.” Do you believe the way we as a society views drugs is fundamentally mistaken?

I think that the two principal strategies, control and consequences, that have been used in this country for well over 100 years are indeed mistaken because they’re ineffective, and they’re very costly in terms of human lives and money. So until we move to solutions that are built on understanding the complex relationship between a person and a drug – that person’s biology, that person’s psychology, that person’s social setting and the drug – we’ll be trapped in the ineffective solutions that have gone on a very long time, and there are effective solutions.

What are the treatments that do work to reduce and treat addiction?

One of my activities, successful over the years, has been introducing depression measurement and intervention in primary care settings, an instrument that the patient fills out that quantifies your depression state, and if you have a number that’s in a moderate or very severe range, that goes into the medical record. What we need now is an analog to that for drinking and drug use.

Comprehensive treatment sounds like a slogan, but if you understand the brain in a simple way, there’s a circle in the brain that’s triggered by opioids, by tobacco, by having a baby or being a new mom or new dad, or seeing a rainbow. There’s a reward center in our brain, and that’s like the accelerator pedal for getting the brain going about something that feels good, that’s the pleasure center, and there’s a dopamine spike, and that leads to a cascade of other sections in the brain that are related to motivation, which is about wanting to get more about what made you feel good. And then there are areas of the brain that register memory by cues, smells, taste or vision. Each of those represents a touchstone for intervention. If you just focus on one area, just give people medication, or just give people psychotherapy, or help them with relapse prevention, each one of them helps, but each one of these interventions is additive to the other.

What sorts of broader policy recommendations would you suggest local and federal officials adopt?

When you think about public health – how we’ve made dramatic reductions in infectious diseases in the world, principally through vaccination and sanitation – the same principles of prevention, screening or early detection, early intervention, treatment and certain research apply.

It took a while for [Albert] Sabin to find the polio vaccine. It took a while to figure out how to keep people alive with HIV/AIDS. Good money went into that, and it paid off.

The prevention programs, aimed at elementary school kids, aimed at middle school kids, and their parents have been studied and they’re effective, but we don’t use them. And they’re not actually high cost programs, but they cost. And school budgets more or less can’t afford them, they have no money, they can’t buy supplies for their kids. So there has to be state and federal money to do that, not from bake sales.

This is a complex condition, and there are solutions, but you have to advocate for them. And that advocacy not only for your loved ones but who you vote for, because governments, elected officials, hew to what the voters demand. And that’s what voters have to start demanding, which is not lock them up, but prevent, screen, treat, and then put more money into research.

Original article here on

Brain Image on Computer

The Science of Addiction – “Get the Facts”

Get the facts about how addiction affects our bodies, our brains, and our behavior, while learning about the biological and psychological factors that often drive addiction.

What is addiction?

The National Institute of Drug Abuse (NIDA) defines addiction as a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences.1

In the United States, 8–10% of people over the age of 12 are addicted to alcohol or other drugs. That’s approximately 22 million people.(Cigarette smoking is also an addiction that kills people.)

Addiction is chronic—but it’s also preventable and treatable

When a disease is chronic, that means it’s long-lasting. It can’t be cured, but it can be managed with treatment. Other examples of chronic diseases include asthma, diabetes, and heart disease.

It is critical that treatment simultaneously addresses any co-occurring neurological or psychological disorders that are known to drive vulnerable individuals to experiment with drugs and become addicted in the first place. Otherwise, the best addiction treatment in the world alone is not effective for those with co-occurring illnesses.

Addiction is a disease

Respected institutions like the American Medical Association and the American Society of Addiction Medicine define addiction as a disease.3 Studies published in top-tier publications like The New England Journal of Medicine support the position that addiction is a brain disease.4

A disease is a condition that changes the way an organ functions. Addiction does this to the brain, changing the brain on a physiological level. It literally alters the way the brain works, rewiring its fundamental structure. That’s why scientists say addiction is a disease.

Although there is no cure for addiction, there are many evidence-based treatments that are effective at managing the illness. Like all chronic illnesses, addiction requires ongoing management that may include medication, therapy, and lifestyle change. Once in recovery from substance use disorder, a person can go on to live a healthy and successful life. Addiction is treatable, and recovery should be the expected outcome of treatment.

How does addiction change the brain?

The human brain is wired to reward us when we do something pleasurable. Exercising, eating, and other pleasurable behaviors directly linked to our health and survival trigger the release of a neurotransmitter called dopamine. This not only makes us feel good, but it encourages us to keep doing what we’re doing. It teaches our brains to repeat the behavior.5

Drugs trigger that same part of the brain—the reward system. But they do it to an extreme extent, rewiring the brain in harmful ways.

When someone takes a drug, their brain releases extreme amounts of dopamine—way more than gets released as a result of a natural pleasurable behavior. The brain overreacts, reducing dopamine production in an attempt to normalize these sudden, sky-high levels the drugs have created. And this is how the cycle of addiction begins.

Once someone is addicted, they’re not using drugs to feel good — they’re using drugs to feel normal

Studies have shown that consistent drug use severely limits a person’s capacity to feel pleasureat all.6 Over time, drug use leads to much smaller releases of dopamine. That means the brain’s reward center is less receptive to pleasure and enjoyment, both from drugs, as well as from every day sources, like relationships or activities that a person once enjoyed. Once the brain has been altered by drug use, it requires more and more drugs just to function at a baseline level.7

Withdrawal is a painful, whole-body experience

Withdrawal happens when a person who’s physically dependent upon a substance stops taking it completely: either in an attempt to quit cold turkey, or because they don’t have access to the drug. For pain-management and opioid users in particular, even if a user is not addicted, they can still become dependent on the medication, and they would still experience withdrawal. Someone in withdrawal feels absolutely terrible: depressed, despondent, and physically ill.

An addicted brain causes behavior changes

Brain imaging studies from drug-addicted individuals show physical, measurable changes in areas of the brain that are critical to judgment, decision making, learning and memory, and behavior control. Scientists believe that these changes alter the way the brain works, and may help explain the compulsive and destructive behaviors of addiction.8

A promising student might see his grades slip. A bubbly social butterfly might suddenly have trouble getting out of bed. A trustworthy sibling might start stealing or lying. Behavioral changes are directly linked to the drug user’s changing brain.

Cravings take over. These cravings are painful, constant, and distracting.9 The user starts seeking out drugs, no matter the consequences, often resulting in compulsive and destructive behaviors. Especially given the intensity of withdrawal symptoms, the body wants to avoid being in withdrawal at all costs.

What fosters addiction? Science says there are three main factors.

The first time a person tries alcohol or another drug, it’s a voluntary choice. But at some point during use, a switch gets flipped within the brain and the decision to use is no longer voluntary. As the Director of the National Institute on Drug Abuse puts it, their brains have been hijacked.

Anyone who tries a substance can become addicted, and research shows that the majority of Americans are at risk of developing addiction. Over 40% of 13–14 year olds, and over 75% of 17–18 year olds, report that they’ve tried alcohol. What’s more, 42% of 17–18 year olds report that they’ve tried illicit drugs.10

After initial exposure, no one chooses how their brain will react to drugs or alcohol. So why do some people develop addiction, while others don’t?

The latest science points to three main factors.

Three Main Factors Addiction

All this scientific evidence points to one bottom line: addiction is not a moral failing.

Addiction is not a choice. It’s not a moral failing, or a character flaw, or something that “bad people” do. Most scientists and experts agree that it’s a disease that is caused by biology, environment, and other factors.

Harmful consequences, shame, and punishment are simply not effective ways to end addiction. A person can’t undo the damage drugs have done to their brain through sheer will power. Like other chronic illnesses, such as asthma or type 2 diabetes, ongoing management of addiction is required for long-term recovery. This can include medication, behavioral therapy, peer-support, and lifestyle modifications.

Learn more about evidence-based prevention, treatment, and recovery methods.

1. National Institute on Drug Abuse. The Science of Drug Abuse and Addiction: The Basics.
2. Grant B, Saha TD, Ruan WJ. “Epidemiology of DSM-5 Drug Use DisorderResults From the National Epidemiologic Survey on Alcohol and Related Conditions–III.” The Journal of the American Medical Association, January 2016.
3. ASAM. Definition of Addiction. 
4. Volkow ND, Koob GF, McLellan AT. “Neurobiologic Advances from the Brain Disease Model of Addiction.” The New England Journal of Medicine, 28 January 2016.
5. “Drugs, Brains and Behavior: The Science of Addiction.” National Institute on Drug Abuse, July 2014.
6–7. Volkow ND, Koob GF, McLellan AT. “Neurobiologic Advances from the Brain Disease Model of Addiction.” The New England Journal of Medicine, 28 January 2016.
8. “Drugs, Brains and Behavior: The Science of Addiction.” National Institute on Drug Abuse, July 2014.
9. Volkow ND, Koob GF, McLellan AT. “Neurobiologic Advances from the Brain Disease Model of Addiction.” The New England Journal of Medicine, 28 January 2016.
10. Swendsen J, Burstein M, Case B. “Use and Abuse of Alcohol and Illicit Drugs in US Adolescents: Results of the National Comorbidity Survey–Adolescent Supplement. The Journal of the American Medical Association, April 2012.
11. The National Center on Addiction and Substance Abuse. Addiction Risk Factors.
12. “Drugs, Brains and Behavior: The Science of Addiction.” National Institute on Drug Abuse, July 2014.
13. “Drugs, Brains and Behavior: The Science of Addiction.” National Institute on Drug Abuse, July 2014.

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Man's Arm Pushing Computer Buttons

In Pursuit of Pleasure, Brain Learns to Hit the Repeat Button

In a scientific first, researchers have observed in mice how the brain learns to repeat patterns of neural activity that elicit the all-important feel-good sensation. Until today, the brain mechanisms that guide this type of learning had not been measured directly.

This research offers key insights into how brain activity is shaped and refined as animals learn to repeat behaviors that evoke a feeling of pleasure. The findings also point to new strategies for targeting disorders characterized by abnormal repetitive behaviors, such as addiction and obsessive-compulsive disorder, or OCD.

The study, led by researchers at Columbia University’s Zuckerman Institute, the Champalimaud Centre for the Unknown and the University of California at Berkeley, was published today in Science.

“It’s no secret that we derive pleasure from doing things we enjoy, such as playing our favorite video game,” said Rui Costa, DVM, PhD, the paper’s senior author and the associate director and CEO of Columbia’s Zuckerman Institute. “Today’s results reveal that the brain learns which activity patterns lead to feel-good sensations, and reshapes itself to more efficiently reproduce those patterns.”

Man observing mice in lab“This discovery can help explain how we learn by repetition, and can also inform studies of disorders such as addiction and OCD, in which the feedback loop that links an action to a reward gets thrown out of whack,” he added.

Normally, doing something enjoyable triggers neurons, a type of brain cell, to release a chemical called dopamine. This release causes that feel-good sensation, evoking the desire to repeat an action again and again. A prime example of this are video games.

“When you move the game controller in exactly the right way to earn that high score, your brain remembers how it executed that action — which neurons get switched on, and in what pattern — so your brain can recreate that same move the next time you play,” said Dr. Costa, who also a professor of neuroscience and neurology at Columbia University Irving Medical Center. “After repeated attempts, your brain gets better at recreating that pattern of neural activity, and you get better at the game.”

To the team, this fact then begged the question: Could the brain be trained to learn the right pattern of neural activity normally involved in experiencing something enjoyable, and then replay that pattern at will to trigger a dopamine release?

In a series of experiments in mice, the researchers developed a computer program that connected the neural activity in the animals’ brains to musical notes, so that when one group of neurons switched on, a corresponding musical note played. Different patterns of neural activity yielded different combinations of notes. And when neural-activity patterns triggered the right arrangement of musical notes (arbitrarily determined by a computer), the scientists manually released dopamine in the animals’ brains.

The mice quickly learned which musical arrangement that, when played, caused a dopamine release and the feel-good sensation. Their brains then began to rewire themselves to play that song more often, thereby triggering the pleasure hit of dopamine.

“In essence, the mice learned to repeat the same pattern of brain activity that had been evoked previously by hearing those musical notes,” said Vivek Athalye, a doctoral candidate at Champalimaud and the paper’s co-first author.

The researchers noted that these findings are a striking example of Thorndike’s Law — a long-held principle of psychology stating that actions that lead to positive reinforcement are repeated more frequently. However, these findings likely represent the first time that this principle has been directly observed in the brain.

“In some ways, these results are entirely expected,” said Dr. Costa. “It makes sense that the brain would mimic the feeling of reward it gets from an enjoyable experience by producing the corresponding pattern of neural activity. But it had never been tested.”

This research also has important implications for addiction and OCD.

“If the brain’s neural-activity patterns are in overdrive, as is often the case for people with addiction or OCD, could we create a computer program that can help to retrain their brains and downshift this activity?” asked Dr. Costa. “This is something we’re actively exploring.”

Date: March 1, 2018  Source: The Zuckerman Institute at Columbia University

Original article here on

Online Course: What is Addiction? Tonight 6-7pm

The Addiction Policy Forum invites you to join them for a free online course “What is Addiction? Understanding the Brain Science of Addiction” TONIGHT, February 7th, 2018 from 6:00 PM to 7:00 PM EST with Dr. Maureen Boyle, Chief Scientific Officer at the Addiction Policy Forum.

Date: Wednesday, February 7, 2018
Time: 6–7 p.m. ET
Register for the free webinar here.


What is Addiction?