Intro Class

Humans and Pleasure
Pleasure can come in a variety of forms
• In rituals (church, prayer, dance, meditation, etc.)
• In community with others
• Time with family or friends
• In solo activities
• In many areas that “we look forward to with anticipation”
Basic thing to ask clients… When you’re not on a substance, what do you like to do?
Pleasure activation comes in many forms…
• Exercise
• Food
• Substances
• Gambling
• Sex

• Society often sanctions or regulates pleasure
• This may be in an effort to control or to profit from pleasure
• Humans, may then try to sidestep those sanctions or regulations in the pursuit of pleasure
• Evolution has hard wired us to get a “pleasure buzz” from a variety of experiences

Pleasure and the Brain
• Experiences we find “pleasurable” or transcendent, activate a specific anatomically & biochemically defined area of the brain.
• The “Pleasure Circuit”
• Activities that bring about pleasurable experiences evoke neural signals in the pleasure circuit.

Pleasure and the Brain
• Is comprised of several structures in the brain
• Hippocampus-Lays down memories
• Amygdala-Creates a conditioned response to a certain stimuli, memory consolidation
• Prefrontal Cortex- Process new learning and motivation
• Ventral Tegmental Area- VTA is comprised of dopamine containing neurons
• Nucleus accumbens - controls the release of dopamine

VTA is compromised of dopamine containing neurons – nucleus accumbens, prefrontal cortex, amygdala, hippocampus

Dopamine
• A neurochemical transmitter
o Communicates between neurons
The pleasure circuit is activated in large part, by Dopamine

• Controls, regulates, and mitigates…
o Movement
o Emotional responses
o Reward center
o Pleasure center

What substances produce biggest release of dopamine?
• Cocaine, opiates/opioids, methamphetamine

What substances produce the second biggest release of dopamine?
• ETOH (alcohol) and cannabis

What substances produce the third biggest release of dopamine?
• Benzoid, atrium, Xanax, loraxopam

• Dopamine levels are very sensitive to changes or alterations
• Those changes can have a profound impact
• Some substances can trigger a flood of dopamine which “overwhelms” the pleasure circuit.
• Other substances cause a buildup of dopamine which then cause a “clogging up of dopamine”
• This clogging causes the axon to send more dopamine to the dendrite.
What is an example of lowered levels of dopamine? Parkinson’s Disease
• Characterized by limited range of movement & emotions, and tremors
• About 80% of Dopamine neurons die at the time symptoms appear
• Treatment is aimed at increasing levels of Dopamine (levodopa or Requip)
• Individuals treated with medications aimed at increasing Dopamine levels have shown a vulnerability to Impulse Control Disorders & addiction
• Research suggests from a 1% to 8% chance of developing an ICD following Dopamine therapy

What is an example of increased levels of Dopamine? Cocaine & Amphetamine
• These prevent Dopamine from being moved, so the Dopamine “builds up”, thus causing a flood of Dopamine to be released
• The brain will attempt to regulate this artificial increase in Dopamine
• Then the Dopamine levels become depleted, resulting in the “coming down” or “crash”

What activates the pleasure circuit? Social meaning, activities, sights, sounds, smells, emotions

Sequence of a Pleasurable Experience

  1. Immediate sensation of pleasure
  2. External and internal associations
  3. Assign value to the pleasurable experience
       What is important to find out with a client that is using substances? Find out why they’re using the specific substance they’re using

Vices or Virtues
• Brain imaging has indicated that both activate the pleasure circuit

Vices
• Substance
• Foods
• Orgasm
• Monetary reward

Virtues
• Meditation/prayer
• Exercise
• Charity
• Social approval

Humans are intrinsically driven to seek out pleasure.
Whether by accident or on purpose, this is often how we have discovered “abusable psychoactive drugs.”

Humans are pleasure-seeking creatures and our quest for pleasure is complex, eclectic, and multifaceted

A psychoactive drug is a chemical substance that changes brain function AND results in alterations in perception, mood, or consciousness…

They are generally placed in three categories…*
• Those that “depress” the central nervous system
• Those that “stimulate” the central nervous system
• Those that distort perceptions
*These are reserved for substances

However, there are many prescription medications that are classified as psychoactive…
• Antidepressants
• Anxiolytics
• Antipsychotics
• Mood stabilizers

However, not all psychoactive substances are abusable.
In order for them to be abusable, there has to be enough “pleasure” associated with them to result in taking more than generally prescribed therapeutically.

The most accurate term for psychoactive substances that are abusable are: abusable psychoactive substances

For those who engage in the use of abusable psychoactive substances for the experience of pleasure & they use without restraint, the potential outcome is dependency/addiction.
However, most people use substances appropriately.

Needs in Reality Perspective
• Freedom
• Love/belonging
• Survival
• Fun
• Power

Historical Substance Use
• Mesopotamia, 3000 BC, Opium was widely used• Egypt, 1552 BC, Opium was recommended as a sleep aid for children
• Rome AD, 170 Marcus Aurelius’ personal physician Galen, introduced Opium to the Roman nobility
• Ancient Roman coins had the poppy plant stamped on them
• 1830’s Ireland was awash in alcohol. Usually distilled from potatoes
• As a result of a many Irish taking “The Pledge” (1844), folks began consuming ether. (alcohol and sulfuric acid)
• The Bible is certainly replete with many examples of alcohol
Drugs
• Using abusable psychoactive drugs (or substances) can often be done safely
• However, they can cause three types of problems.
o Physiological Toxicity
o Behavioral Toxicity
o Misuse, Dependency, Addiction

What is another phrase for intoxication? “In a toxic amount”
Sequence of Using Drugs

  1. Use
  2. Misuse
  3. Dependency
  4. Addiction
       Toxicity- what happens when any chemical will damage the body or mind taken in sufficient quantity
       “The dose makes the poison”
       The substance can be toxic; but also what may result from the substance use
       Nicotine is the worst substance known to man
       Alcohol is the most abused substance

Physiological Toxicity- refers to the extent that a substance will damage a body’s system or combination of systems (i.e., alcohol, cocaine)
Behavioral Toxicity- refers to the extent that a substance brings about behavioral changes (i.e., MDMA, alcohol)
What is MDMA? ecstasy or molly

Dependency- Generally, it means that an individual “chooses” to continue because the effects of not using are too uncomfortable
Physical Dependency is usually reserved for those who develop withdrawal symptoms
Chemical Dependency is usually reserved for one is demonstrates diminished voluntary control (craving, intrusive thoughts, crowding out of other activities)

Addiction – the state or condition whereby an individual cannot stop (in spite of numerous, very significant, negative consequences)
• It may also include taking a substance in higher does and more often

Prime Effects & Side Effects
• Anyone using substance(s) to achieve “prime effects” must also endure “side effects”
• Anytime a substance is introduced into the brain/body, there are unwanted side effects
• Some may be minor, some not

Methamphetamine:
Prime Effects
• Wakefulness
• Rush
Side Effects
• Paranoia
• Depression
• Skin ulcers

Opioids:
Prime Effects
• Euphoria
• Feelings of warmth and peace
Side Effects
• Nausea/vomiting
• Respiratory depression
• Constipation

Alcohol:
Prime Effects
• Disinhibition
• Relaxation
Side Effects
• Depression
• Problems with motor coordination

Spice, K-2 (synthetic cannabionoid):
Prime Effects
• Sense of well-being
• Relaxation
Side Effects
• Brain Swelling
• Anxiety/Panic Attacks
• Paranoia

Why is the use of substances so widespread?
• Access; it’s normalized
• Used because of boredom and pain
Opposite of addiction is connection

In addition to pleasure activation…
• The effects of each individual substance’s psychoactive ingredients on the brain/body
• Substances will have the same chemical action, it will be mitigated & influenced by the setting
• In addition, the personality characteristics of the individual will have an impact on the effects of the substances
• Finally, the combinations of substances will have influences on the individual
Social context & mental state can have a profound impact (in addition to the effects of the pleasure circuit)

Individuals taking Morphine (for pain) will report pain abatement, but lower levels of euphoria.
While individuals taking the same dosage recreationally will report much higher levels of euphoria.

Pharmacology
As mentioned before, dose matters
As does…
• Weight, body type, food ingestion
• Genetics
• Previous mood
What else is in the substance (some mimic the substance; others potentiate the effects)
• Concentration of substance
• Substance combinations

Why would a substance react in one way to one person, and another way to others?
• We all have slight variations in our genes known as Single Nucleotide Polymorphisms (SNPs).
• Some of these SNPs influence how we respond to substances
• By analyzing SNPs, we can understand how to mitigate its effects (for those who are dependent or addicted)

The route of administration (ROA) is significant when examining effects
The common forms are…
• Enteral
• Parenteral
• Transdermal
• Intranasal
• Inhalation
Slowest – enteral because it has to get absorbed before it goes to the brain
Fastest – inhalation

Enteral- simply means that the substance via the gastrointestinal (GI) tract
• Oral, sublingual or rectal

Parenteral-simply means the injection directly into the body
• Subcutaneous, intramuscular (IM), intravenous (IV)

Transdermal- substance placed on the skin
• Morphine and nicotine patches

Intranasal- substance is introduced via the nasal cavity
• Snorting is the most common, sprayed (as in flu vaccine)

Inhalation- substance is introduced directly into the lungs using vaporized form