Brain Addiction Disorders

by Michael E. Abrams

Brain Addictive Drug Disorder (BADO) has captivated the world's best scholars and scientists in ascertaining the mechanisms of this neuronal-molecular process, initiated by placing a brain-addictive drug into the brain. The 1990s, the "decade of the brain" in around-the-world research, has produced a gusher of scientific, objective discoveries and databases to insatiable professional palates, allowing an intelligent, medical-management approach to once indefinable brain disorders.

Added to past years of animal and brain behavior experiments, scientific technology has developed a neuronalbiobehavioral foundation for brain-addiction disorders. Brain research of the 90s will be hailed a scientific milestone historically. For the first time in history, the fundamental underpinnings of the addiction-drug brain-disease process is discovered, giving a clearer pathway to treatments and potential cures. Furthermore, a connecting bridge is established between brain addiction disease and other major mesolimbic, brain disorders. Twentieth century medicine places behavioral disorders in the same management arena; however, by neuronal biochemical function, neuronal circuitry and mesolimbic anatomical location, all Axis I diagnoses are in the same household, using the same electrical, plumbing, air, and food resources as neuronal circuits and neurotransmitters. The scientific neuronal molecular and circuitry research technique for Axis I diagnoses are paralleled to brain-addiction disorders (BAD). Research techniques and goals are the same relative to finding common neuronal molecular pathways, genetic function and neuronal circuits that threaten the patient's behavior, thought process, well being and life.

Clinical Application, Bridging the Gaps

Through over twenty years of managing and treating patients with acute brain disorders, I cannot differentiate the primary brain disease in the emergency department or emergency setting. They all have similar abnormal signs, symptoms/behaviors and disordered thoughts. I have found better answers to the many previous perplexing questions regarding scientific medical treatment for brain-disordered patients. Additionally, I have scientific, objective, educational research materials to illustrate and teach other health professionals plus the general public about mesolimbic brain disorders.

Brain Addiction Center

The majority of brain-addicted patients, like most medical and nursing staff, have little or no specific knowledge about the center of the body's illness nor how the disease functions. Presently, there are few medical and nursing schools that have lectures and training on the neurobiology of addiction in their medical-nursing school curriculum. Yet primary-care and hospitalized patients have brain-addiction disorders that account for a significant percentage of office visits and hospitalizations.

Brain Addiction Center (BAC) is now identified as to name, location, neuronal circuits, neurotransmission functioning and abnormal syndromes. The BAC is located deep in the mid-brain called the mesocortical limbic or subcortical brain stem system.

The areas adversely affected by brain-addicting drugs involve the dopanergic neuron circuits that account for the addicting experiences. All neuropathic drugs of addiction activate the neurotransmitters and neuroreceptors in the meso cortical limbic areas to produce the following cascade and are the neurobiobehavioral foundation of brain addiction disease (BAD).

Clinical Correlates of Brain Addiction Disease and Neuronal Molecular Medicine

The intensive care patient with brain-addiction disease requires medical professionals with scientific knowledge of brain neurotransmitters, neuroreceptor sites and their function. It is necessary to know if the patient has severe delirium with psychosis, delusions, agitation and seizing, is totally incoherent with a modulating mental state with respiratory failure or major schizoaffective disorder. Caregivers must know if the patient is on mood stabilizing drugs, anti-psychotics and anti-depressants that affect all the same neurotransmitters and neuroreceptor sites in addictive brain disease. Scientific knowledge of neuronal molecular medicine, where these drugs work and why, is necessary to provide the best neuronal pharmaco therapies available. The neuronal foundation of brain addictive disorders help treat Stages I, II and III of the brain-disease process. Future research on Stage IV, craving, relapse medications and therapy will become available to block this chemical process.

The Pre-addicted Brain Addiction State

As human beings, with a mesolimbic, specialized brain unit to keep us alive by having desire to eat, drink, procreate and repeat pleasurable behaviors, we already have a pre-addicted state of being, homo-addictus. In the same vein, human beings have a spiritual-soul-religious component in their brains. Therefore, homo religio addictive brain disease has been called a "spiritual disease." So before the brain-addicted drug is taken by a person, all the presets for addiction to occur are present, and humans are very vulnerable to addiction states because the neurotransmittters, by genetic control, are primed for this neuroadaptation from the environment. The addictive reward and craving cycles are already operating and brain-addicting drugs fuel a potentially abnormal system already present in individuals with preclinical (pre-drug) genetic brain-addiction disorders.

The spiritual-religious sector in the brain is being studied by PET and functional MR neuronal imaging and is thought to be in the temporal lobes involving hippocampus and amygdala neurocircuitry, which play a large role in the glutamate/NMDA neuroexcitatory system for brain addictive disorders and thought disorders. The mind, the brain, the body and the soul all are experiences of neuronal chemical function and beg the question, "How does the mind think, and what lies beyond tomorrow?" The mind is a result of chemical reactivity, so manipulating neuronal and genetic chemicals can change the mind. Hopefully, brain-addictive disorders can be reversed in the future by genetic/DNA alteration therapy.

Neuronal Molecular Genetics

Brain-addictive disease pulls the body, the brain and the mind together in one fluid continuum, and further research will give the single underpinning process that will be very treatable and potentially curable. BAD revolves around a triangle of stress (environment), the addictive brain drug (toxin) and the host (genetically vulnerable brain). The right situation, gene expression and ABD concentration/frequency of use will turn on the BAD process. This helps explain why one dose of methamphetamine can change the brain and the person forever. Addictive brain disorders may be a genetic disorder!

Research shows that the brain is a very rapid neuroadaptive structure and is made up of over 100 billion cells with 70,000 of the 100,000 genes in the body, having some neurons (brain cells) with up to 10,000 communicating dendrites. One neuron can communicate with up to 50,000 other brain neurons. Brain cell transmission can occur at 270 miles per hour; it is very plastic, adapting to any challenge and surviving. These basic facts give an optimistic future view that brain-addiction disease occurs in the brain and by the brain; therefore, treatment of this disease lie within the brain. The brain learns how (neuroadapts) to addict itself, learns (neuroadapts) to have tolerance, so the brain can neuroadapt to a new neuronaltransmission process.

Twenty-first Century Scientific Language Describing Brain-Addiction Disorders

Neuronalbiobehavioral molecular research has pushed us out of the 19th-20th century mode of arguing about whether addiction is a disease, a choice or a willful misconduct. The terms "use," "abuse" and "substance abuse" will become passé, as the 21st century neurochemistry terminology gives us the scientific phrasing for addictive brain disorders. These old terms do not describe what goes on in the brain; their references are like calling a patient with coronary artery disease a "cholesterol abuser" and passing judgment on his/her cholesterol diet. I certainly can't save a patient's life with intravenous bias and moral fiber.

The Multiple Brain-Disordered Patient (MBDP)

Progressive brain research is quickly creating a new language to describe brain diseases. In the past, brain diseases were named after neuroscientists and/or physicians who described a set of behaviors, with the discovery of abnormal brain regions. We now can call a disease by the neuronal chemical deficit or abnormality. Psychiatric disease and brain-addiction disorders will blend into mesolimbic syndromes with neurocircuit, neurotransmission and genetic abnormality terminology.

FMR-PET-SPECT neuroimaging techniques, eliminating costly hospitalizations may do all future diagnoses. The dual-diagnosis term has been used for over fifteen years with little progress for hospitals, training or payment systems to treat this multiple brain-disordered patient.

Treatment professionals and the public need a major revision of learning about and understanding multiple brain-disordered patients. The average new psychiatric patient evaluation in this decade reveals multiple Axis I diagnoses in a large majority of patients. Experience reveals that up to eighty percent of new psychiatric evaluations will have primary brain-addictive-drug disorder also. There appears to be an increase in mood disorders and post-traumatic victimization stress disorders also.

Training programs for physicians focus on the addictive drug and its uses with acute symptoms, behaviors and how the body/organs are affected rather than on the brain disease created by the drugs. We have a long road ahead in teaching/training professionals and the public about addictive-drug brain disease in order to replace ignorance by American professionals and the general public. Multiple brain-disordered patients are often thought to be having Alzheimer's, strokes, epilepsy, or multiple sclerosis. These diseases are usually considered neuro or neurological, involving structural change of the brain. Psychiatric and addiction brain disorders involve abnormal neuronal circuits and neurotransmission; they may cause more disease morbidity than the neurological brain disorders, yet they are referred to as "mind" disorders.

Progressive neuronal molecular research can now identify the majority of abnormal circuits and location of the Axis I diagnoses plus the abnormalities in neurotransmitters and neuroreceptor site functions that are contained in the paramesocortical limbic system in the midbrain. This new perspective gives change to the nosology of brain disease as mesolimbic circuit transmission disorders with psychiatric and addiction symptoms. Psychiatry and addiction terms are becoming outmoded as treatment in acute psychiatric and addictive brain disorder units involves the use of neuronal pharmacotherapy aimed at abnormal neurotransmitters and neuroreceptors. The terms to describe psychiatric, mental health, behavioral or chemical dependency units need to embrace terminology as to their function, mainly neurotransmission intervention. These units will become neuroscience, neuronal molecular or bio-neuronal treatment units in the future, and physicians staffing these units will have training in mesocorticolimbic neuronal transmission (MCLNT) dysfunction, with little distinction among the problems of "mental health," "drugs" or "behavior." All these disorders are based on abnormal mechanisms in the MCLNT system. Whether the environment, infection, genetic changes, addictive drugs or post brain trauma cause the abnormalities, these patients need intervention. Bias, prejudice, ideologies, myths, ignorance, denial and attitudes will no longer exist in the American medical-psychiatric-addiction professional field. American health-care professionals who treat mesolimbic neurotransmission disorders via counselors or social workers, physicians, psychologists or para/allied medical professionals will have neuronal science training as part of their academic degree programs.

The majority of patients now and in the future may have more multiple brain-disorder diagnoses and require expertise with more scientific diagnostic and intervention skills from their providers. The changing knowledge base will change our nosology and give us a common scientific knowledge foundation to describe and treat individuals with a potentially malignant brain disorder. Patients with a diagnosis of "mind-brain disorder" need to be educated about their disorders using brain pictures, showing the patient the abnormalities and how treatment, medication, behavior change and life change can affect their brain disease. We also need to educate the public with the same intensity.

Brain Control Disorder

Addictive brain drugs get the brain's attention, captivate it, bring it to bondage, enslave it and then kill the brain. To understand an individual with a brain-addiction disorder, we must first look at the brain disease and secondly at the individual. Individuals may have multiple Axis I disorders, personality disorders (Axis II) and often Axis III (non mind-brain disorders). Personality and characteriologic aspects of a brain-addictive disorder (BADO) individual oftentimes cause treatment professionals to respond with negative behaviors and over-reaction instead of looking at the BADO individual's diseased brain. By understanding the brain's neuronal-biobehavioral aspects and the abnormal neuronal brain circuitry caused by the addicting brain-disease drug, assessment, treatment and management becomes enormously simplified with optimistic clarification for the treatment professional.

The individual, family and employer — BADO main symptoms and signs of the brain:

1. The mind (conscience, spirit, soul, attitudes, beliefs);

2. The thoughts (cognitive, memory, emotions and feelings);

3. The behaviors (obsessive-compulsive changed lifestyle, dress, activities and neglect thereof, violence, dyssocial);

4. The mood (elated, manic, psychotic, depressed, cyclothymic, suicidal);

5. The body phase: multiple actions on the individual's body organ functions, causing cell failure.
(Mind, brain, thoughts and behaviors become one neuronal molecular action, but for understanding of this electrochemical cascade, these functions are separated.
All of our thoughts, memories and actions are simply chemical reactions.)

In modern medicine, education and training are focused at the later stages of brain-addiction disorders (body-organ effects) when the addicting brain drug has caused often irreversible brain changes. Such changes preclude an individual's understanding of treatment; moreover, the treatment may be aimed at secondary body/organ effects of the brain addiction disorder and not targeted primarily at the brain disorder.

Conclusion:

It is important to recognize that neuronal research discoveries and reproducible objective data have given brain-addiction medicine renewed hope, scientific attitude and non-controversial space to discuss and teach, legislate, treat and adequately fund brain research and disease prevention. A public forum about brain addictive disorders from a scientific, neuronalbiobehavioral foundation should stimulate our brain circuits to say, "This is a highly significant stimulus; please repeat the stimulus, so I can learn." So be it!

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Michael E. Abrams board certified in Family Medicine and Addiction Medicine, was Director of Combined Medical Specialties at Broadlawns Medical Center in Des Moines, Iowa. His unexpected death occured in January 1999.