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People who are addicted to nicotine, alcohol, street drugs, or psych drugs, or simply have addictive potential, may be lacking certain nutrients that the brain requires to manufacture the natural brain chemicals that are called neurotransmitters. The major neurotransmitters that affect mood, the ability to control one’s impulses, sleep quality, and behavior include serotonin, melatonin, GABA, dopamine, norepinephrine, and epinephrine (adrenalin) and can only be increased, despite what the drug companies have brainwashed us to believe (that their psych drugs can do that), through the ingestion of certain amino acid-containing foods and/or the ingestion of certain amino acid-containing nutritional supplements.
(The fact is that antidepressant drugs only temporarily increase the concentration of a neurotransmitter into the space between two nerves, where some of it is enzymatically destroyed, which results in its long-term depletion within the secreting nerve cell.)
People who have been physically or sexually abused, psychologically or spiritually traumatized, neglected, isolated, or labeled “mentally ill,” or are experiencing psychiatric drug adverse effects or the temporary mental anguish of drug withdrawal, have the seemingly inexplicably need to self-medicate their sadness, nervousness, nightmares, empty lives, or the effects of their drugs.
In reality—and here is where the potential for cure exists—they may not be able to produce enough of their essential neurotransmitters because of dietary deficiencies or the use of neurotransmitter-depleting drugs. Therefore, malnutrition or current or previous drug use (including drug withdrawal syndromes) is likely to contribute to an increased incidence of abnormal moods, behaviors, sleep disorders, artificial perceptions of pleasure or pain, and the likelihood of engaging in acts of apathy, rage, resentment, cruelty, or any of a multitude of forms of violence, including arson, theft, assault, murder and suicide.
The acute ingestion of alcohol (as well as prescription tranquilizers) temporarily and artificially increases the amount of calming neurotransmitters (ex: serotonin, GABA) into the synapses of certain brain nuclei. Dopamine, on the other hand, is the major neurotransmitter that can reliably cause natural and appropriate mood elevation as well as artificial “highs.” The dopamine molecule, when secreted in sufficient concentrations into the dopamine synapse, can cause such “highs” ranging all the way from mild pleasure and orgasm to, in the case of psychoactive drugs, dangerous mania and psychosis, and the most rapidly-acting artificial highs are obtainable through the administration of drugs that exhibit what are called dopamine-reuptake inhibitor or dopamine agonist functions.
and the Inevitable
Crashes That Follow
Unfortunately, for every artificial drug-induced “high” (ex: psychoactive drug-induced mania) there is also a predictable and inevitable “crash” that results in the individual feeling artificially “low” (psychoactive drug-withdrawal depression or fatigue). People with drug-induced highs and lows or other drug-induced behaviors can easily be misdiagnosed as having a mental illness such as depression, anxiety, mania, bipolar disorder, or psychotic disorder.
Chronic or even intermittent use of either legal or illicit brain-altering drugs, especially involving drugs that can cross the blood–brain barrier (ex: psychostimulants like caffeine, nicotine, cocaine, Adderall, Ritalin, methamphetamine, Fen/Phen, and Ecstacy; opioids such as codeine, oxycodone, and methadone; tranquilizers like marijuana, alcohol, and benzodiazepines like Valium, Xanax, Klonopin, and the misleadingly named “synthetic pot”; and a variety of drugs such as Tamiflu, Lariam, and drugs for weight loss, hypertension, cholesterol, and cardiac diseases). When the Physician’s Desk Reference mentions neurologic or psychiatric side effects to a drug, you know it got to the brain from the blood stream.
Many of the drugs on that short list can be expected to cause a depletion of the very neurotransmitters that are required for the drugs to work. In addition, there is predictable, albeit unintended micro-anatomic (and eventually even macro-anatomic) brain damage that can occur with the chronic use of many types of psychoactive drugs, especially when used in high doses for a lengthy period of time or in combinations. See my recent Duty to Warn column of April 13, 2012 entitled “Anatomy of an Epidemic: It Turns out that the Drugs Are the Problem” and check out the bibliography that was attached.
Or, better yet, check out the peer-reviewed article authored by psychiatrist Peter R. Breggin in the International Journal of Risk & Safety in Medicine 23 (2011) 193-200, entitled “Psychiatric drug-induced Chronic Brain Impairment (CBI): Implications for long-term treatment with psychiatric medication,” or Dr. Breggin’s book “Brain-Disabling Treatments in Psychiatry: Drugs, Electroshock, and the Role of the FDA.”
Because of the reuptake pump inhibition mechanism of action of most drugs in the psycho-stimulant and antidepressant classes, we can predict why they stop working or cause dependencies, tolerance, and withdrawal symptoms when tapered down or stopped abruptly. Unfortunately, the way the brain was intended to work is seriously altered by the chronic over-stimulation (or suppression) of the receptor sites (or reuptake pumps) in the synapses because of the chemical tampering that keeps the nerve from functioning normally (by altering the normal manufacturing process, transportation, storage, release, recycling, and/or reuse of specific neurotransmitters).
The Similarities Between
I have heard many patients testify to the fact that both psychostimulants and the so-called “Selective” Serotonin Reuptake Pump Inhibitors (SSRIs) give them a sense of feeling temporarily “better than well” (as long as they keep on taking the drug). Both classes of drugs have as their base structure an amphetamine molecule (which consists of a benzene ring with an attached carbon side chain and any number of other chemical groups attached that affect how it works in the brain and body). However, usually the feeling of improvement tends to “poop out” far too soon, with the need to have the dose increased or a second or third drug added to maintain the effect or counter the inevitable adverse effects of the first drug.
The infamous psychostimulant drug cocaine and the other amphetamine-like drugs like Dexedrine, Methamphetamine, Ecstasy, Fen-Phen, Ritalin (methylphenidate), Adderall (a cluster of amphetamines), Straterra, Wellbutrin, and Vyvanse all have benzene rings as their base molecule. So do all the second generation so-called SSRI “antidepressants” like Prozac, Paxil, Zoloft, Luvox, Celexa, Lexapro, Effexor, and Pristiq.
These stimulating (often agitation-inducing, mania-causing, insomnia-inducing, potentially psychosis-producing) drugs work by artificially “goosing” certain mood-elevating neurotransmitters, especially dopamine, norepinephrine, and serotonin. But unfortunately, because of their brain-altering effects at the level of the synapses, they also, as mentioned above, deplete the stored-up natural brain chemicals.
And because of this depletion effect, especially in the case of dopaminergic drugs, there will occur the equally predictable sense of withdrawal or “poop-out” depression, fatigue, tiredness, cognitive disorders, and sometimes an urgent need for another quick fix or prescription refill, even the need for a higher and/or a more frequent dosing schedule, which leads to eventually having to take the drug just to avoid the crash symptoms rather than being able to achieve the increasingly unachievable high.
The Huge Problem
of Nicotine Addiction
A common example of this phenomenon is the addicted one to two pack per day smoker, who goes through withdrawal, exemplified by nicotine cravings every hour, day and night. Nicotine is a highly addicting, short-acting dopamine reuptake inhibitor drug. Its legendary addictability, which makes cure so difficult (and which, by the way, is NOT related to lack of willpower!), is directly related to the rapidity of absorption into the dopamine nerve cells of the brain (and heart and blood vessels, by the way) through the pulmonary and systemic circulation (versus the slower absorption through the gut).
The smoker inhales the cigarette smoke into the lungs, and hundreds of toxic chemicals, including the highly addictive nicotine, directly enter capillaries of the pulmonary circulation and rapidly enter the systemic circulation and thus the brain (and body). The nicotine crosses the blood-brain barrier (as it can the placental barrier in the case of a pregnant woman) in a matter of seconds. This rapid absorption of high doses of nicotine into the brain also can happen via the rich capillary system of the nasal (nose) mucosa—which is the mechanism of the highly addicting compounds cocaine, Ritalin, and radioactive depleted uranium dust, when they are snorted, smelled, or otherwise exposed to the capillary-rich mucosa. The major factor in the addictability (and the “high” produced) of such drugs is the rapidity of absorption into the brain. Mainlining (intravenous injection), snorting, or inhaling psycho-stimulant drugs are the three common mechanisms of absorption that produce the quickest and therefore the most addicting “highs.” If psycho-stimulants or other drugs are swallowed orally, the drug only reaches the brain slowly and therefore the same addicting “high” is not achieved, although addiction is still highly likely when the drug is taken chronically.
The rapid absorption results in an un-physiologic concentration of large amounts of dopamine being suddenly released into the synapse, where it lingers far longer (because of the reuptake inhibition mechanism of action) than the few microseconds that nature intended. The normal micro-anatomy and physiology of the drugged synapse is altered, both short-term and long-term, and far too often the anatomic changes become permanent.
Nicotine (as well as cocaine, caffeine, Adderall, Ritalin, Effexor, Wellbutrin, etc.) is a very short-acting psycho-stimulant drug (unless sustained-release forms of the drugs are used), and thus the stimulating effect is relatively short-lived. Therefore, there is also a rapid withdrawal effect that occurs soon after the last cigarette is smoked (or synthetic chemical substance snorted or swallowed), and so the unfortunate addict (who might not have been told how hard it was to quit) has to light up again just to avoid the uncomfortable nicotine withdrawal symptoms that keep him hooked.
Most honest smokers will admit that the wonderful nicotine high they experienced in the beginning no longer occurs. Smoking is now continued to avoid feeling so bad during the hourly withdrawal symptoms that help to explain the disordered sleep and appetite loss that is so common in psycho-stimulant addicts. Indeed, they are going through withdrawal every hour of the day and night. Frequently waking up to smoke two or three cigarettes first thing in the morning (along with their caffeine fix) is often interpreted by many nicotine addicts as anxiety-reducing rather than what is the fact of the matter: the person is trying to self-medicate away the dysphoria (“feeling bad”) that accompanies most addictive drug withdrawal syndromes. I have often heard smokers say, “I feel calmer when I am smoking,” and they do, but they are medicating withdrawal and not being tranquilized. And the same can be said for many prescription drugs that mess around with the synapses of our brains.
What Can Be Done
with Chronic Drug
Use and Addiction?
What can be done about chronic drug use and addiction? That is the subject of a multi-billion dollar industry that is failing badly in its stated goals, primarily because there is a lack of understanding of the anatomy and physiology of addiction and ignorance about brain nutrition. One of the basic problems is that the drug industry has consistently made false claims (at the beginning of their marketing efforts and before long-term studies were done) that their drugs are not addicting.
In my clinical experience with hundreds of patients who came to see me primarily because they knew they had become dependent on and addicted to their psych drugs (which is an epidemic—see any of my recent columns, which are archived at www.duluthreader.com), each case needed to be individualized and therefore there was no one-size-fits-all treatment regimen. There are general principles that need to be understood, however. To the extent that I was successful in helping many of my patients quit or cut down on their addicting drugs, one of the essential aspects was dietary brain nutrient therapy, which is not something that can be transmitted in a series of 20-second sound bites—much less, as I found out, in a couple of 60-minute one-on-one clinic visits.
So, since this column is approaching the Reader’s hoped-for length limit and there is so much more to say, I will shamelessly mention that I am presenting a six-hour seminar for mental health practitioners and interested non-professionals on this very topic next Saturday, April 28, at the WITC Conference Center in Superior, WI, starting at 10 a.m. (See fliers around town and elsewhere in this issue of the Reader for registration details.)
The title of the seminar is “What Mental Health Practitioners and Their Patients Should Know About Psychiatric Drugs, Drug Addiction and Holistic Approaches for Treating Drug Withdrawal.” The seminar will be limited to 40 participants. Six CEU credits are available for professionals. The phone number to call for more information is 218-390-2991.
Dr. Kohls is a retired physician who practiced non-drug, holistic mental health care for many years in the Duluth, MN area.