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Frequently answered questions regaurding mental health and drug abuse and mental health.

Miscellaneous By: Behindblueyes
Health and fitness

I have noticed that many patients come to me with simliar questions about drug abuse and thier mental health, which leads me to believe there are more people wondering. I've decided to write a few Q&A.

Submitted:Sep 27, 2010    Reads: 53    Comments: 3    Likes: 1   

When talking with patients I noticed I come across questions like these very often....
When I use cocaine ( I am going to go with the example of cocaine however this is true for many and most strong stimulants) I feel sad afterwards why is that?
Cocaine acts on the mesoaccumbens dopamine pathway of the midbrain, extending from the ventral tegumental area to the nucleus accumbens. This pathway is also known as the reward pathway as it is the area of the brain that is activated when someone has a pleasurable experience such as eating, sex, or receiving praise, therefore causing the person to feel happy. Normally, when a neuron releases the neurotransmitter, dopamine, it travels acrose a gap (synapse) and attaches itsself to a receptor on a receiving neuron. The dopamine passes on the message of euphoria to the receiving neuron and then travels back over the synapse and its absorbed by the initial neurons reuptake valve. When cocaine is used it binds to the dopamine reuptake valves, thus blocking them from functioning. As a result, dopamine levels increase in the synapse, and consequently, the receiving neuron is continuously stimulated. This constant firing of the neurons leads to a feeling of euphoria. However, once the effects of the cocaine high run off the valves become unclogged and absorb the dopamine back up and because of the over abundance the brain adjusted and is now producing less dopamine, causing levels to drop far lower than they would normally be and this results in the user to become depressed, worried, sad, suicidal and fatigued. The high from cocaine last a half hour to an hour, however the effect on the brain and dopamine levels could last anywhere until the time the cocaine is out of your system (approx. 3days) to as long as a lifetime if permanent damage was done. doesnt seem worth it does it?
Why is it that we become addicted, is there a way to reverse the process?
Addiction is a neurologically based disease. For many years recovery specialists have compared alcoholism or addictions to a physical disease: like diabetes. In reality addictions are more closely related to a neurological disorder like Tourette's Syndrome* than they are to diabetes.
If the problems you suffer stem from severe alcoholism or addiction, you must accept that these problems are not primarily mental or free will issues. Addictions are not about will power. The problems facing addicts, alcoholics, and their families are miserable, disgusting, and infuriating. They are often hopelessly discouraging. But to imagine that an addict could change if he wanted to" is a serious misunderstanding of the long term dynamic of addictive disorder. The fact is precisely that an addict cannot change in the long run even if he wants to! That is the definition of addiction: "the loss of control over the use of a substance." It is important to understand that this loss of control is manifested not in terms of days or weeks, but in longer term behaviors: terms of months and years.
The reason addicts have lost control is because they have suffered permanent physical neurological changes based in their brains and nervous systems. The disorder manifests in long term obsessive-compulsive behaviors outside the realm of the addicts own control. It is true enough that the use of chemicals begins with chosen behavior. But if alcoholism or addiction develops, the problem has moved outside the realm of free choice. It has developed into a long term mental and physical neurological disorder. All the emotional 'feelings' involved in drug or alcohol seeking are based in neurology. Addiction is based in physical dependency created by altered neurotransmitter balances, and driven by millions upon millions of new living, functioning active neurological pathways which have been established to sustain the condition in the addicts brain. The new neurological pathways are permanently established, and they will not just disappear. The primary neurological disorder is only complicated by physical dependence on the substances. The physical dependence on the substances is secondary! Physical drug withdrawal does not change the underlying neurological addictive disorder. After drug withdrawal, long term overpowering cravings are predictable. These cravings are, in reality, spontaneous nerve impulses. Even in the longer term, overwhelming cravings are outside the addicts control.
Is smoking weed really all that bad, does it even have and adverse affect on the brain?
OK, here is how I answer this one. Use of marijuana, is widley accepted in comparasion to other "harder" drugs, and I can see where people may think it is nothing serious because it is natural, and potheads arent violent just happy hungry sleepy right? Unfortunatly, no, marijuana in my eyes is one of the worst habits to get into. Let me explain, when one smokes marijuana it rapidly passes through the lungs along with the 400+ chemicals that are in it (yes there are approx 400-500 chemicals in your weed, many people like to believe there are 420 hence hence why the number 420 is commonly in association with marijuana). The tests that were conducted to find out how many chemicals are ingested while smoking marijuana used leaves removed directly from a marijuana plant. Therefore, there is probably much much more chemicals in those little baggies you buy off your corner guy who throws in a little who knows what to enhance his product. Hopefully that diminishes the idea of marijuana being natural, because I don't know about you but unless they start marketing some new organically grown weed I wouldnt call that natural.
Next on my list I am going to point out a personal observation that is clearly my opinion however, I find that many agree with me on this one. In talking to patients who abuse marijuana, I noticed distinct similarities in there personality traits and I am able to classify marijuana abusers into two categories. The first being the functional smoker, this is a person who seems to be unable to function before the use of marijuana. This type of smoker will wake up and use and then go about there day as normal as any sober person would, if they don't smoke marijuana I find that they are irritable, lathargic and or hyperactive, and generally less happy. From my experience this first group consist of a very small percentage of marijuana users, and I believe that futher pyschiatric evealuation is needed to reveal an underlying issue as to why the THC enables them to function normally. More than likley my theory is this person has some sort of personality dysfunction/disorder, that needs to be addressed, so they may go about fixing it in a different matter that is less detramental to thier health. I do sympathize with this type of patient, however I still do not condone there drug use, I just tend to be more understanding. Never the less like I said this is a very small group of patients, typically the marijuana users I see fall into my second category which is anyone who becomes unlike there normal functioning self upon smoking. This area covers a vast number of traits such as being paranoid, lazy, confused, dumb-founded, unable to concentrate, fidgety, uneasy, or zoned out, this also includes those who attempt to find meaning in the meaningless, or engage in frivolous conversation that seems "deep" or "heavy" to the individual while under the influence. These alternative traits, although fun to the individual, prove that marijuana is clearly just being used for there own enjoyment. Marijuana has been shown to decrease the ability to learn new information not only when the individual who smoked was high, but in some instances long after, and even indefinatly in some. Obviously, this study did not take my two groups into consideration, for the mere fact that it is my own opinion, however from what I have observed this effects the second group more so than the first.
Marijuana has recently been in the media due to the fact that certain states are using it for medicinal purposes in lieu of traditional medications. My opinion on this is, if you have stage four cancer smoke it up, on the contrary, if you have mild glaucoma, your most likley abusing the privlidge, and I am not saying this is wrong or right, it all depends on how the patient tolerates it and if the benefits outweigh the risks. I brought this issue up, not to state my opinion on medicinal marijuana, but to bring up another reason it should not be used for recreation. Aside from releiving pain and anxiety one of the main reasons marijuana is prescribed to those who suffer from cancer is to bring back there appetite, which is completley taken away during chemotherapy. Anything that can make a chemo patient want to eat, I would steer clear of if you have a regular appetite unless you want to gain massive amounts of weight.Lastly, I will address the affects on the brain from marijuana.

Lastly I have to address my favorite part, which is how marijuana effects the brain. Recently, studies have been conducted to take a really good look into the effects of THC on the brain. When someone smokes marijuana, THC passes into the bloodstream though pulmonary absorbsion at a rather swift rate, which then carries the chemical to the brain and other organs throughout the body.THC acts upon specific sites in the brain, called cannabinoid receptors, kicking off a series of cellular reactions that ultimately lead to the "high" that users experience when they smoke marijuana. Some brain areas have many cannabinoid receptors; others have few or none. The highest density of cannabinoid receptors are found in parts of the brain that influence pleasure, memory, thoughts, concentration, sensory and time perception, and coordinated movement. Not surprisingly, like I mention in my observation of roup two patients last paragraph, marijuana intoxication can cause distorted perceptions, impaired coordination, difficulty in thinking and problem solving, and problems with learning and memory. Research on the long-term effects of marijuana abuse indicates some changes in the brain similar to those seen after long-term abuse of other major drugs. For example, cannabinoid withdrawal in chronically exposed animals leads to an increase in the activation of the stress-response system and changes in the activity of nerve cells containing dopamine. Dopamine neurons are involved in the regulation of motivation and reward, and are directly or indirectly affected by all drugs of abuse.
So essentialy smoking marijuana along with causing lung/mouth/throat cancer, perminant lack of intellect, weight gain, paranoia, potential cardiac issues, invading your body with hundreds of chemicals, and making you smell funny, in the long run it has been proven to cause the same damage to the brain as the "hard" drugs do. I apologize for stretching this one out a bit I just find that it is the most common and most socially acceptable, and felt the need to stress the potential dangers.
Why are you looking at me that way, alcohol is legal, so what if there is red bull in it (or any caffeine for that matter)?!
Do not mix stimulants and depressants, Do not mix stimulants and depressants, Do not mix stimulants and depressants!!!! Redbull and vodka, Joose, four lokos and all that other mumbo jumbo that keeps you awake until the sun comes up is putting and unbelieveable strain on your cardiac muscle, and doing damage to your heart. I do not study cardiology so I won't ramble on about this too much, however you should know that when mixing ANY kind of stimulant with ANY kind of depressant you are throwing your heart for a loop, and it doesnt know weather to speed up or slow down causing you to develop an irregular heart rythm that could potentially become so irratic that it cannot reset itself, and that my friend can be fatal and I have seen it happen on a number of occasions when I did emergency room rotation. Although the heart is the main concern with this mixture, I have to throw my brain effects in there. Alcohol and caffeine aren't nessasarily any worse together than they are seperate when it comes to your brain, I mentioned this because patients do ask me about these types of drinks and I feel its important to subsidize the dangers it has on the heart. Also, I do like to inform my patients that both alcohol and caffeine negativley affect your brain weather you mix them or you ingest them seperatley.
Everyone who has ever been drunk knows the immediate effects alcohol has on the brain, difficulty walking, blurred vision, slurred speech, slowed reaction times, impaired memory, incresed emotions, you know, all of the things you have to call your friends and apologize for the next morning. While going out and having drinks is a common way our young society socializes and has fun, it still does cause damage to our brains and bodies. A few drinks every now and again shouldnt cause any long term damage, unless you are taking your drinking to far. Binging and getting so intoxicated that you blackout, pass-out, loose control of bodily functions or have a lapse in memory, is a sign that you have damaged brain cells. The higher you BAC (blood alc. content) decides how much of your brain is being affected by alcohol. The first to be affected is the part of your brain called the cerebral cortex, you will know your disrupting the functions of this portion of the brain when you begin to become more talkative, more self-confident, and less socially inhibited due to the alcohol depressing your behavioral inhibitory centers, also at this point the processing of information from the senses is slowed down causing you to have difficulty seeing, hearing, touching, tasting, and you will have a raised tolerance for pain. Lastly at this point your thought processes will be affected causing you to make poor judgments(Ideally you should cut yourself off here but hey your just starting to feel good where is the fun in that). The next part of the brain that gets disrupted is the limbic system. The limbic system consists of areas of the brain called the hippocampus and septal area. The limbic system controls emotions and memory. As alcohol affects this system, the person is subject to exaggerated states of emotion and memory loss (hopefully at this point you have a good friend to drive take you home, At this point it is crucial to stop drinking, you are now doing unreversable damage to a decent amount of brain cells). If you continue to drink, the next thing to go is your cerebellum and your coodination.You probably have heard the term "falling down drunk." This is the part of the brain that controls your balance.The cerebellum coordinates the movement of muscles. The brain impulses that begin muscle movement originate in the motor centers of the cerebral cortex and travel through the medulla and spinal cord to the muscles. As the nerve signals pass through the medulla, they are influenced by nerve impulses from the cerebellum. The cerebellum controls fine movements. For example, you can normally touch your finger to your nose in one smooth motion with your eyes closed; if your cerebellum were not functioning, the motion would be extremely shaky or jerky. As alcohol affects the cerebellum, muscle movements become uncoordinated.In addition to coordinating voluntary muscle movements, the cerebellum also coordinates the fine muscle movements involved in maintaining your balance. So, as alcohol affects the cerebellum, a person loses his or her balance frequently. (This is the embarrasing friend that no one wants to be around, well besides the guy who has still only reached the limbic system impairment is trying to fight him for being annoying, and the responsible girl who is way behind still in the cerebral cortex phase wont shut up about how obnoxious these two are.....sound familiar?). Anyway if your night doesnt end by the time your falling down, which Im not sure how your going to drink considering how difficult its going to become for you to make the connection between the drink and your mouth, but anyhow if you figure a way to manage it the last two parts of the brain to be affected are the hypothalamus/pituitary gland & the medulla if you reached this point and do not get to a hospital as soon as possible you will die because the medulla is the part of the brain that controls all of your involuntary vital reflexes such as the heart beat and breathing. Usually it is near impossible to reach this point by having mixed drinks or beer. I see this point reached mostly in severe alcoholics who drink liquor straight or young partiers who don't realize how many shots they have done in the past hour.
All I have to say is that caffiene effects the brain by POSSIBLY (not proven) Improving reaction time and enhancing the ability to process complex thoughts, however it has been proven to cause irritablity, headaches, and mood swings. Caffeine is addictive, and lack of sleep can do damage to the brain, but other than that enjoy your cup of coffee what the hell.
So anyway this was my little ramble after work today I needed to get all that out, im in good hopes that maybe at least one person will read. I study pyschoneuology so that is why everything pertains to the brain. I am not going to dwindle in other areas haha but feel free to comment and ask questions. I will not give out medical advise to anyone, however if you have a general question about neurological functions or pyschology or how the two amalgamate please feel free to ask.


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