BLOG No. THIRTY

Welcome back to my blog on anxiety and depression. Today I want to begin the conversation about addictions. (No, not my Chardonnay—I can quit anytime I want!) Though I am no expert on addiction medicine, I would like to just “talk out loud” so to speak, and see if I can shed some light on a very complicated, but very treacherous subject.

The pleasure center of the brain is composed of the VTA (ventral tegmental area) and the NA (nucleus accumbens), which both lie deep in the brain.

Together, these two areas process rewards, unlike most of the airlines would say they do, but then never have a seat on the flight you want. But I digress.

So, when you bite into a piece of milk chocolate, or have an orgasm, or bite into a piece of chocolate and have an orgasm, (an oral-gasm), you are creating type one dopamine in the VTA, which then releases it into the NA, and to some degree, the prefrontal cortex.

When the NA is stimulated by dopamine, a feeling of pleasure is sensed by the patient.

A priest recognizes that he has a severe addiction to golf. After two weeks of straight rain, he wakes up on a Sunday morning to perfect sunshine. He realizes he has to golf. So he calls into his church and tells them he cannot come in, as he’s sick. Then he drives two hours away to a golf course, so no one will see him.

On the first hole, a par five, he hits the ball well. God and St. Peter are watching, and God flicks his finger. The priest is amazed when it flies 450 yards, bounces on the green, and goes into the hole. St. Peter asks God, “Why did you do that? He needs to be punished!”

“I did punish him,” God replies. “Who is he going to tell?”

So what does addiction have to do with anxiety and depression?

Well, research has shown us that patients who have a risk for addiction, have increased levels of impulsivity and compulsive behaviors. Hummmm. Obsessions and compulsions… why does that sound familiar? Oh yeah, previous blogs. And let’s see, the chemistry for OCD is what? If you said serotonin after reading the above blogs, stop voting, stop procreating, and don’t post on Facebook.

Of course, it is D2 dopamine chemistry.

And to drive the point home, an NIH study showed that the less D2 receptors there are, the more addiction. Conversely, the greater number of D2 receptors, the less addiction. Well, why would you have someone with lower numbers of D2 dopamine receptors? Great question. Let’s see if we can find a great answer.

Typically, in neuro-biology, the more a chemical is present, the less receptors are needed. Let’s say that you are a budding archer, and you only want to hit a target once to make you happy. But you only have one arrow. So you set up multiple targets all next to each other, so now you have 100 targets in front of you. Odds are, you’re going to hit one of those targets.

But now I give you 100 arrows. You can probably go back to one target. Eventually you will hit it. (Think of the targets as receptors and the arrows as D2 dopamine molecules).

So typically, low receptors mean high chemicals. And if the addiction patients have low D2 receptors, they probably have excessive D2 dopamine. And perhaps it is treatable? Although I don’t know of any studies that show by lowering D2 dopamine, you would increase receptors and lower addictive behavior, it might be time to design one. Just a thought.

Well, some dude in a robe and a beard just tapped my Chardonnay with his staff and now it looks like water. I guess it goes both ways. So until next time, when we talk more about addiction, this is Dr. G saying, keep the faith!