Linden;
Compass of Pleasure |
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A key motivator of our lives, pleasure is central to learning, for you must find things like
food, water, and sex rewarding in order to survive and pass our genetic material to the next generation. |
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Many of our most important rituals involving prayer, music, dance, and meditation produce a kind of transcendent pleasure that has
become deeply ingrained
in human cultural practice. |
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Our legal
systems, our religions, our educational systems are all deeply concerned with controlling pleasure. |
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Jails are
bursting with people who have violated laws that proscribed certain forms of pleasure. |
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Most experiences in our lives that we find transcendent -- whether illicit vices or socially sanctioned ritual and
social practice as
diverse as exercise, meditative prayer or even charitable giving -- activate an anatomically and biochemically defined pleasure circuit in the brain. |
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Intrinsic pleasure
circuitry can be co-opted by artificial activators like cocaine or nicotine or heroin or alcohol. |
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Evolution
has hardwired us to
catch a pleasure buzz
from a wide variety of experiences from crack to cannabis, from meditation to masturbation, from Bordeaux to beef. |
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As societies and as individuals, we are hell-bent on achieving and controlling pleasure. |
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The dark side of pleasure is addiction., including tolerance (meetings successively
larger doses to get high), craving, withdrawal, and relapse. |
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Addiction
appears to be learning-driven
changes in neural
circuitry that are used to store memories in other brain regions. |
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We can be motivated by pleasure to achieve goals that are entirely arbitrary -- goals that
may or may not have an evolutionary adaptive
value. |
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Drug addicts
do not derive greater reward from getting high than non-addicts. The biology says no: They actually seem to want it more but like it less. |
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Understanding the biological basis of pleasure leads us to fundamentally rethink
the moral and legal aspects of addiction to drugs, food, sex, and gambling and the industries that manipulate these pleasures in the marketplace. |
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Brain imaging
studies show that giving
to charity, paying taxes, and receiving information about future events all activate the same neural pleasure circuit that's engaged by heroin or orgasm or fatty foods. |
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Understanding the molecular basis of enduring changes in the brain's pleasure circuitry holds great promise for developing
drugs and other therapies to help people break free of addictions of many sorts, to both substances and experiences. |
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Peter Milner
and James Olds in 1953 at McGill
University under the direction of psychologist Donald Hebb conducted experiments implanting electrodes deep in the brains of rats. |
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Milner and Olds discovered a pleasure center, a reward circuit, the activation of which was much
more powerful than any
natural stimulus. |
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Deep in the brain there is a group of
interconnected structures, all located near the base of the brain and distributed along the midline,
constituting the reward circuit. |
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The reward
circuit includes the ventral
tegmental area, the nucleus
accumbens, the medial
forebrain bundle, and the septum, as well as portions of the
thalamus and hypothalamus. |
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Anatomy of
a rat's pleasure circuit is very
similar to that of
humans. |
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When neurons in the ventral tegmental area
(VTA) are active, spikes travel along axons to terminals in the nucleus
accumbens, triggering the release of neurotransmitter dopamine. |
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Pleasure circuit in the brain of a rat (diagram) |
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Compass of Pleasure |
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Neurons of the VTA also send dopamine releasing axons to other brain regions, including the amygdala and the anterior cingulate cortex, which
are emotional centers;
the dorsal striatum,
involved in some forms of habit learning; the hippocampus, involved in memory for facts and events; and the prefrontal cortex, a region that controls judgment
and planning. |
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Synapse that uses the neurotransmitter dopamine (diagram) |
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Some of the
dopamine released by VTA neurons into axon terminals at the nucleus accumbens can undergo reuptake into the axon terminal, where it will be recycled for later use. |
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Cocaine and
amphetamines block
the dopamine re-uptake
process, causing dopamine to linger in the synaptic cleft and thereby activating dopamine receptors more effectively. |
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Some psychoactive
drugs were, at least in part, by hijacking the pleasure circuit -- they artificially increase the effects of dopamine release from VTA neurons. |
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Parkinson's Disease, first described in 1817 by James Parkinson as the "shaking palsy", also involves symptoms of cognition and mood, which often precede the onset of movement disorders. |
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In untreated Parkinson's disease, chronically low levels of dopamine result in dialing down of the pleasure/reward circuit and a disinclination to seek novel experiences, and are associated with a reduced
risk of addiction. |
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Compass of Pleasure |
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In some Parkinson's
patients treated with
high doses of dopamine receptor agonists, the level of dopamine action, in both the pleasure
circuit and associated structures, is high, thereby dialing up the function of the pleasure circuit. This confers
increased vulnerability to impulse control
disorders and addiction. |
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Human societies strictly regulate pleasurable activities, and most
have a concept of vice that's applied to unregulated
indulgence in food,
sex, drugs, or
gambling. |
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The brain's
pleasure circuitry is
activated by "vice" stimuli: orgasm, sweet and fatty foods, monetary reward, and some psychoactive drugs. |
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The medial
forebrain dopamine circuit seems to be engaged by almost everything we find pleasurable. |
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The activity of the pleasure circuit in isolation results in a lifeless pleasure lacking color and depth. |
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What makes pleasure so compelling is that, through the interconnection of the pleasure circuit with other brain regions. It is adorned with memory, with associations and emotions and social meaning, with sights, sounds, and smells. |
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Transcendence and texture emerge from the web of associated sensations and emotions that the pleasure circuit engages. |
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All cultures used drugs that
influence the brain. |
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Drugs that influence the brain include mild stimulants like caffeine or drugs with potent euphoric effects like morphine. |
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Some drugs
that influence the brain carry a high risk of addiction, some do not, some alter perception, others mood, and some affect both. A few can kill when used in excess. |
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Our
national drug is alcohol. |
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Opium,
prepared from the poppy plant, was in use long before the time of Imperial Rome. |
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Evidence from the archaeological record place the early use of opium to places in Mesopotamia about 3000 BC. |
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Opium was widely consumed -- either by being
eaten, dissolved in wine, or inserted in the rectum -- for both medical and ritual purposes by the ancient Egyptians and by the Greeks soon thereafter. |
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An Egyptian
medical text from the year 1552 BC recommends opium as an aid to help small children sleep. |
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The famous Greek
physician Galen popularized the use of opium. |
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During the reign of Roman emperor Septimus Severus the distribution of opium became widespread with its adoption as a Roman recreational drug. |
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During the years following Septimus Severus, the poppy plant became a symbol of Rome, stamped upon its coins, and inscribed upon his temples, and woven into its religious practice. |
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By the census
of AD 312, opium could be procured in 793 different shops in Rome. |
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Ether is a highly volatile liquid that may
be produced by mixing sulfuric
acid with alcohol, as discovered by a German
chemist around 1540. |
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The inhalation of ether vapors leads to the effects that range from euphoria to stupor to unconsciousness. |
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Ether's volatility -- a liquid at room temperature but a gas at body temperature -- dramatically speeds its
effects. |
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Ether vapors
can be inhaled, but liquid ether can be swallowed. |
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The immediate
effects of drinking
ether are similar to those of produced by alcohol, but everything takes place more
rapidly; the stages of excitement,
mental confusion, loss of muscular control, and loss of consciousness follow each
other so quickly that they cannot be clearly
separated. |
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Recovery
from ether drinking
is extremely rapid. Ether drunks picked up by the
police on the street, were often completely sober by the time they reached the station, but suffered no hangovers. |
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Ether drinking spread rapidly throughout Ireland after 1845, and the substance could be purchased
from grocers, druggists, and even traveling salesmen. |
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Ether drinking in Ireland was finally curtailed in 1891. |
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The downside of ether drinking include a truly awful smell and taste, coupled with a strong burning sensation while the
foul stuff is going down. |
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Either drinking makes you drool, not to mention stimulating truly monumental burps and farts, which are laden with highly flammable ether vaporous. Severe
burns at either end of the alimentary canal were a common hazard. |
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Plant-based psychoactive
drugs are common
throughout the world. |
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Psychoactive drugs can be used in many different
social contexts: as medicine, as religious sacrament, as pure recreation, or to define oneself as part of a subgroup (elite, outsider, rebel, etc.). |
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Across cultures and over thousands of years of human history, people have consistently found ways to alter the functions of their brains, while cultural enforcers such as governments and religious institutions have
sometimes sought to regulate
the use of these substances. |
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Because most
psychoactive drugs
are derived from plant extracts (cannabis, cocaine, caffeine,
heroin, nicotine) or from simple recipes applied to plants (alcohol,
amphetamines) or fungi, they are widely available and widely used. |
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Animals in the wild will voluntarily and repeatedly consume psychoactive plants and fungi. |
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Birds, elephants, and monkeys have all been reported to enthusiastically
seek out fruits and berries that have fallen to the ground and undergone natural
fermentation to produce alcohol. |
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One psychiatrist believes that all creatures, from insects munching psychoactive plants to human children playing spinning games to get dizzy, have an inborn need for intoxication. |
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Stimulants,
which comprise a wide range of compounds that increase wakefulness and generally upregulate mental
function, include cocaine,
amphetamines, and
caffeine. |
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The sedatives are calming and sleep inducing, and cause discoordination and slow reaction times. |
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Sedatives
include alcohol, ether, barbiturates, the benzodiazepine tranquilizers
(such as Xanax). |
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The hallucinogens (substances like LSD) have as their primary action and the disruption of perception -- distorting vision, hearing, and other
senses. |
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Compass of Pleasure |
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Opiates
(including plant derived compounds like opium, morphine, and heroin as well as synthetic opiates) are sedatives, but deserve their own category because they produce a unique and potent euphoria (and capacity for pain relief), effects that are not shared by
other sedatives with a different
chemical action. |
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While alcohol at high doses is always a sedative (to the point where it
can be lethal), at lower doses it has a stimulating effect, particularly
in certain social contexts. |
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Nicotine
has a complex and subtle psychoactive effect, with mixed actions of a stimulant, a sedative, and a mild euphoric. |
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The popular
club drug ecstasy is
both a stimulant and
a weak hallucinogen
and has the additional quality of inducing a sense
of intimacy with
others. |
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Cannabis is
a sedative but also
has mild euphoric properties (more than nicotine but much less than heroin). |
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Antidepressant drugs, like the serotonin-specific
reuptake inhibitors (Prozac) or the dual-action
antidepressants, will lighten the mood of many
people, whether or not they suffer from depression. |
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While a certain
drug will always have
the same chemical action, that action is influenced by one's ongoing brain state in ways that can modulate its
effects. |
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People who are given morphine for pain relief typically report a lot of pain abatement and only a mild euphoria. Others taking the same dose of morphine recreationally will report a much higher degree
of euphoria. |
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The
stimulants cocaine and amphetamines enhance the effects of dopamine released from VTA neurons by blocking the reuptake of dopamine into axon terminals in the VTA target regions, thereby prolonging dopamine
action in the VTA
target regions and stimulating the pleasure circuit. (see p.17) |
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SSRI antidepressants like Prozac work by inhibiting the re-uptake of released serotonin. |
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The biochemical
function of the morphine
receptor was demonstrated in 1973. |
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Natural analogues of morphine are called endorphins. |
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A large
family of opioid
receptors with different
biochemical actions has been discovered,
accompanied by the description of a large number of endorphins. |
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The role of the endorphins/opioid system is multifaceted, being implicated in a variety of
functions including
pain perception, mood, memory, appetite, and neural control of the digestive system. |
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For tobacco, the key psychoactive ingredient is nicotine, which activates a subset of the receptors for the endogenous
neurotransmitter acetylcholine. |
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Heroin and
related drugs (morphine, OxyContin, methadone) produce indirect activation of the pleasure circuit by reducing release of the inhibitory
neurotransmitter GABA,
resulting in disinhibition of VTA dopamine neurons. (diagram) |
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Nicotine
produces a similar end result to morphine: It binds and activates receptors on the glutamate containing axon
terminals that contact VTA dopamine neurons. |
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When nicotine activates the specialized receptors
(alpha-7-containing nicotine acetylcholine receptors), this action increases glutamate release, producing greater excitation of the VTA neurons and increased dopamine release. |
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A whole range of psychoactive drugs up-regulate dopamine action in VTA target regions. |
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The psychoactive
drugs span a broad
segment of drug
taxonomy: from stimulants like cocaine and amphetamines, to sedative like alcohol, opiates like heroin, and to drugs of mixed action like nicotine and cannabis. |
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When humans are placed in a brain scanner and given an intravenous hit of cocaine or amphetamines or heroin, strong activation of the VTA and dopamine release in the VTA target regions is seen, and
the event peaks
precisely when the subjects report their pleasure
rush is strongest. |
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In habitual
drug use the repeated
barrage of the nucleus
accumbens, dorsal
striatum, and the prefrontal
cortex by the VTA
dopamine neurons produces changes in these target structures. |
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After five days of repeated
cocaine administration, they nucleus accumbens undergoes a series of
alterations. |
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One of the alterations of the nucleus
accumbens is an
increase in the level of the neurotransmitter dynorphin, one of a class of natural molecules called endorphins that have morphine-like effects. |
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Increased dynorphin release in the nucleus accumbens dampens the
electrical activity in this portion of the pleasure circuit (and thereby overrides activity in "upstream structures"
like the VTA). |
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Activity in the nucleus accumbens is further suppressed through another
mechanism -- LTD of
the glutamate-using
synapses that convey
information to the nucleus
accumbens from the hippocampus, the prefrontal cortex, and the amygdala. |
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Both the dynorphin and LTD
mechanisms producing changes in the nucleus
accumbens turn down
the gain on the pleasure
circuit and are likely to underlie early stages of addiction: tolerance and dependence. |
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In the absence of more cocaine, the action of the pleasure circuit is chronically suppressed, leading to
depression, lethargy, irritability, and inability to derive pleasure from other activities: the mental symptoms of drug dependence/withdrawal. |
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Compass of Pleasure |
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For an abstaining
addict, still further neuronal
changes occur. One of the most noticeable is in
the fine structure of
the main class of neurons in the nucleus accumbens, the medium spiny neurons, with their long, branching
dendrites covered with tiny dendritic spines,
where most of the synaptic
contacts from other neurons are received. |
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In rats that become addicted to cocaine, there is an overgrowth of dendritic spines so that these medium spiny neurons become super-spiny, allowing for increased excitation. |
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Each
individual synapse received by a medium spiny neuron under those LTP. This LTP doesn't just counteract the LTD seen
immediately after five days of cocaine -- it overshoots it, leading the synapse stronger than it was in the pre-drugs state. |
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The super-spiny
effect and the LTD
overshoot effect in the nucleus accumbens following a period of abstinence have been
suggested to underlie drug sensitization. |
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Current research is mostly
conducted with rats and mice,
as we can't yet measure the LTP and LTP
noninvasively. |
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There is great promise for developing therapies to help
people break addictions
that will suppress cravings and prevent sensitization and relapse and help recovering addicts stay drug-free. |
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The challenge will be to develop
drug addiction therapies
while not compromising
other aspects of the pleasure circuit involving crucial behaviors like eating
and sex. |
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Given the right
circumstances (which can include factors like high stress, early drug exposure or childhood abuse, poor social support, or genetic predisposition), anyone can become a drug addict. |
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Many of our most important historical figures have been drug addicts -- Aldous Huxley (alcohol, LSD), scientists like Sigmund Freud (cocaine) and hardcharging
military leaders and heads of state from Alexander
the Great (a massive
alcoholic) and Prince
Otto von Bismarck (who
typically drank two bottles of wine for lunch and topped it off with a little morphine in the evening). |
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From studies comparing identical and fraternal twins it is estimated that 40 to 60% of the variation in the risk
for addiction is contributed by genetic factors. |
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We are only in the early stages of understanding genetic
contributions to addiction. There is no single addiction
gene, and it is likely that a large number of the genes are
involved in this complex trait. |
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One tantalizing observation
concerns the gene for the D2
subtype of dopamine
receptor, a crucial component of the pleasure circuit. |
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A particular
variant of the D2
dopamine receptor gene results in reduced expression within the nucleus accumbens and dorsal striatum. Carriers of this variant are a significantly
more likely to become addicted
to alcohol, cocaine, or
nicotine. |
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In families with a strong history of alcoholism, brain scanning has revealed that
those family members
who were not alcoholics
had more D2 receptors
in the nucleus
accumbens and the dorsal
striatum. |
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Research studies suggest that elevated levels of
D2 receptor may be protective against certain forms of drug addiction. |
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Research studies suggest the D2 receptor as one target for new addiction therapies. |
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The long-lasting
changes in neural
circuits that are the result of repeated drug use, such as LTP and LTD and structural changes in neurons, can all be produced by one's experience
in the world as well. |
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Our genes and our neural circuits predispose us to certain behaviors, but our brains are malleable, and we can alter their neural circuits with experience. |
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Food and addictive drugs activate overlapping pleasure circuits in
the brain. |
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Humans who take drugs that increase basal dopamine signaling show reduced appetite, as well as reduced caloric intake and weight gain, whereas drugs that reduce dopamine signaling produced the opposite effects. |
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Chocolate
is an unusually good activator of brain pleasure centers. |
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Human ancestral diet was mostly
vegetarian, with very
little fat and very little sugar. |
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In the human
ancestral diet, sweet
flavors were rarely encountered -- it typically
occurred in ripe fruit
or wild honey. Meat was a rare luxury and was usually quite lean. For inland peoples, salty flavors were almost unknown. |
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As a result of the ancestral diet, humans are hardwired from birth to like certain tastes and smells, most notably those of sugar and fat,
but also salt. |
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Both humans and rats show much
greater activation of the VTA and dopamine release in VTA target regions when eating energy-dense fatty and sugary foods. |
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Large, fast rising pleasure
signals are the most
rewarding and most
addictive. |
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The combination of fat and sugar is superaddictive, producing a significantly larger jolt to the pleasure circuit than either one given alone. |
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Unsafe drugs
are available that will reduce appetite and cause weight loss in a broad spectrum of patients. Drugs like amphetamines, which artificially stimulate midbrain dopaminergic reward circuit, are very effective but also highly addictive and have disastrous side effects. |
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|
Moderate stress will stimulate appetite and a wide variety of a mammals. |
|
3 |
Linden; Compass of Pleasure |
89 |
|
Moderate stress can cause weight gain and especially the addition of
abdominal body fat. |
|
0 |
Linden; Compass of Pleasure |
89 |
|
Results to date suggests there
is some stress-evoked biochemical signal that modifies the feeding and/or pleasure circuits to trigger overheating of comfort foods. |
|
0 |
Linden; Compass of Pleasure |
90 |
|
The adrenal
gland releases corticosterone, which along with its metabolites passes into the brain, where they contribute to the brain
responses to stress. |
|
1 |
Linden; Compass of Pleasure |
90 |
|
Behavioral strategies for stress reduction (like meditation or exercise) can reduce the amplitude of stress hormones surges and are thereby effective in reducing
stress triggered overheating. |
|
0 |
Linden; Compass of Pleasure |
90 |
|
While moderate
stress can trigger
overeating, severe
stress can have the opposite
effect, suppressing
appetite. |
|
0 |
Linden; Compass of Pleasure |
90 |
|
Stress is
often a trigger for
the use of certain drugs -- such as alcohol, heroin,
nicotine, cocaine, amphetamines -- that activate the pleasure circuit. |
|
0 |
Linden; Compass of Pleasure |
90 |
|
Stress
plays a particularly critical role in triggering relapse following a period of abstinence in addicts. |
|
0 |
Linden; Compass of Pleasure |
90 |
|
Relapsing addicts report a particularly stressful event as precipitating their return to drugs. |
|
0 |
Linden; Compass of Pleasure |
92 |
|
Food addiction shares many properties and
biological substrates with drug addiction, including a strong heritable component and triggering by stress. |
|
2 |
Linden; Compass of Pleasure |
92 |
|
Chronic exposure to some drugs can rewire the pleasure circuit, by changing synaptic structure and function. |
|
0 |
Linden; Compass of Pleasure |
95 |
|
In most
mammals besides humans, the female advertises her
fertility with clear
signals: unique sexual gestures and calls, odors, and swellings. |
|
3 |
Linden; Compass of Pleasure |
95 |
|
Human females
have concealed ovulation, so there is no obvious displays of a woman's ovulatory cycle. |
|
0 |
Linden; Compass of Pleasure |
95 |
|
Most human penis-vagina
intercourse is recreational. It is not timed to the ovulatory phase. It continues in situations when conception is
completely impossible, such as during pregnancy or after menopause. |
|
0 |
Linden; Compass of Pleasure |
95 |
|
Over 90% of
mammalian species are
highly promiscuous,
with both males and females having multiple sexual partners, even on the same day. |
|
0 |
Linden; Compass of Pleasure |
95 |
|
Humans tend
to be monogamous, or
at least serially monogamous. |
|
0 |
Linden; Compass of Pleasure |
102 |
|
In the throes of intense romance, changes in mood become magnified: the highs are higher, and if anything goes wrong (or the love is unrequited) and the lows are lower. |
|
7 |
Linden; Compass of Pleasure |
102 |
|
The intense,
euphoric pleasure that comes with falling in love corresponds to strong activation of the dopaminergic pleasure circuit --
the VTA and its
targets, like the caudate
nucleus. The pattern
of activation is similar
to responses to cocaine
or heroin. |
|
0 |
Linden; Compass of Pleasure |
102 |
|
Distortions
of critical faculties
relating to the beloved might result from a deactivation of the prefrontal cortex, a judgment center, as well as deactivation of the temporal poles and parietal temporal cortex, cortical regions involved in social cognition. |
|
0 |
Linden; Compass of Pleasure |
103 |
|
Deactivation
of certain portions of the prefrontal cortex is also found in obsessive/compulsive
disorder, which indeed shares
some aspects with new
love. |
|
1 |
Linden; Compass of Pleasure |
103 |
|
The intense, initial phase of romantic love typically lasts from
nine months to two years, to be replaced, in most
couples, by a less intense form of loving companionship. |
|
0 |
Linden; Compass of Pleasure |
103 |
|
A small
number of people report that their feelings for their partner are just as intense 10 or 20 years on as they were soon after they
first met. |
|
0 |
Linden; Compass of Pleasure |
103 |
|
Most long-term
lovers no longer showed strong activation of the VTA dopamine center -- the other brain changes were mostly intact, but the pleasure circuit no longer got the cocaine-like jolt. |
|
0 |
Linden; Compass of Pleasure |
104 |
|
A minority
of couples can indeed keep the glow of new love burning beyond the initial infatuation stage of a relationship. |
|
1 |
Linden; Compass of Pleasure |
|
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