Author: Anika

Polydrug Cocktails: Opiates and Alcohol

 

Heroin and alcohol: A deadly combination

 

Most people who overdose are under the influence of more than one drug. In 2003, the Drug Abuse Warning Network reported an average of 2.7 drugs in fatal overdose cases.

 

Importantly, in these cases, no single drug is usually present at a lethal dose. Rather it is the synergistic effects of combining the drugs that is lethal. And the majority of overdoses involve legal drugs. For example, a combination of opiates (heroin or prescription painkillers) and alcohol can be especially dangerous. Both suppress breathing, but by different mechanisms.

 

In the United States, prescription opiates are the cause for more deaths by overdose than any other single drug. Most of these deaths ultimately result from respiratory failure. A toxic opiate dose increases the inhibitory effect of GABA, which causes breathing to slow and eventually stop.

 

Alcohol overdoses occur mainly in two ways. First, by decreasing the excitatory effect of glutamate, alcohol causes unconsciousness. At high levels, it can also slow or stop breathing. Second, the body tries to rid itself of unabsorbed alcohol by emptying the stomach. If a person vomits while they are unconscious, they may inhale the vomit and compromise their breathing or even drown.

 

 

Normally, excitatory and inhibitory signals are in balance, and breathing is controlled and regular.

 

Under the influence of alcohol or opiates, excitatory and inhibitory signals are out of balance, suppressing the impulse to breathe.

 

Nicotine

 

 

Smoking cigarettes can kill by causing lung cancer, but it cannot lead to a nicotine overdose. However, it is possible to overdose on nicotine by using combinations of nicotine patches or nicotine gum and cigarettes at the same time. This combination puts much more nicotine into the body than smoking alone. Sometimes, nicotine can reach levels high enough to paralyze the muscles that control breathing or cause a heart attack.

 

Cocaine and Other Stimulants

 

Stimulants such as cocaine and methamphetamine trigger the release of the adrenaline-like hormone norepinephrine, which causes increased activity, increased heart rate and blood pressure, and narrowing of blood vessels.

 

Cocaine can kill in a variety of ways, most commonly heart attack, overheating (hyperthermia), and brain damage. After taking even a low dose of cocaine, you are 24 times more likely than normal to have a heart attack.

 

Amphetamine, methamphetamine, and MDMA (ecstasy) are also stimulants. They all increase levels of the neurotransmitter dopamine and the hormone norepinephrine, potentially causing heart attack, overheating, and/or brain damage. Because the “club drug” ecstasy is often used in hot, overcrowded conditions where people are dancing, overheating is the most common result of an ecstasy overdose.

 

When scientists look for “addiction genes,” what they are really looking for are biological differences that may make someone more or less vulnerable to addiction. It may be harder for people with certain genes to quit once they start. Or they may experience more severe withdrawal symptoms if they try to quit.

 

Factors that make it harder to become addicted also may be genetic. For example, someone may feel sick from a drug that makes other people feel good. But someone’s genetic makeup will never doom them to inevitably become an addict. Remember, environment makes up a large part of addiction risk.

 

Many Genes Influence Addiction

 

Scientists will never find just one single addiction gene. Like most other diseases, addiction vulnerability is a very complex trait. Many factors determine the likelihood that someone will become an addict, including both inherited and environmental factors.

 

Because addiction is a complex disease, finding addiction genes can be a tricky process. Multiple genes and environmental factors can add up to make an individual susceptible, or they may cancel each other out. Not every addict will carry the same gene, and not everyone who carries an addiction gene will exhibit the trait. However, multiple lines of research show that addiction is still, to some extent, influenced by genes.

 

When Addiction Runs in the Family

 

Because addiction has an inherited component, it often runs in families. That is, it can be passed down from parent to child by way of genes.

 

Researchers often study large families to learn which genes may be making them susceptible to addiction. They begin by comparing DNA sequences of family members who are affected by addiction with those who are not, and they look for pieces of DNA that are shared among affected individuals and less common in the unaffected.

 

Because people have complex and varied lives, researchers often look to animal models to learn more about the genetics of addiction.

 

Discovering Addiction Genes

 

Many genes with roles in addiction were identified with the help of animal models, especially mice. Because the reward pathway—and many of the genes that underlie it—functions in much the same way in mice as it does in people, mice are leading the way in identifying addiction genes.

 

When researchers discover a gene that plays a role in addiction in a model organism, such as mouse or fruit fly, they can then identify the counterpart gene in humans by looking for similar DNA sequences.

 

The following include examples of some of the genes suspected to play a role in addiction, many of which were identified first in animals:

– The A1 allele of the dopamine receptor gene DRD2 is more common in people addicted to alcohol or cocaine.

– Mice with increased expression of the Mpdz gene experience less severe withdrawal symptoms from sedative-hypnotic drugs such as barbiturates.

– Mice without the cannabinoid receptor gene Cnr1 are less responsive to morphine.

– Mice lacking the serotonin receptor gene Htr1b are more attracted to cocaine and alcohol.

– Mice bred to lack the β2 subunit of nicotinic cholinergic receptors have a reduced reward response to cocaine.

– Mice with low levels of neuropeptide Y drink more alcohol, whereas those with higher levels tend to abstain.

– Fruit flies mutated to be unable to synthesize tyramine remain sedate even after repeated doses of cocaine.

– Mice mutated with a defective Per2 gene drink three times more alcohol than normal.

– Non-smokers are more likely than smokers to carry a protective allele of the CYP2A6gene, which causes them to feel nausea and dizziness from smoking.

– Alcoholism is rare in people with two copies of the ALDH*2 gene variation.

– Mice lacking the Creb gene are less likely to develop morphine dependence.

 

From Genes to Treatment

 

One goal of genetic research is to help develop improved treatments. Each new addiction gene identified becomes a potential “drug target.” That is, researchers can focus on one gene product and develop a drug that modifies its activity. In so doing, signals or pathways in the brain may be modified or stabilized to restore proper brain function.

 

Understanding the role of genetic variation in addiction genes can also help inform treatments. The effectiveness of medications vary from person to person, depending on their genetic make-up. In the future, genetic tests could be used to determine which medications are likely to be most effective based on an individual’s genetic profile.

Dopamine Levels Increase

 

All addictive drugs affect brain pathways involving reward—that is, the dopamine system in the reward pathway. Within seconds to minutes of entering the body, drugs cause dramatic changes to synapses in the brain. By activating the brain’s reward circuitry, drugs deliver a jolt of intense pleasure.

 

Synapse Activity Decreases

Brain Connections Are Rewired

 

As the brain continues to adapt to the presence of the drug, regions outside of the reward pathway are also affected. Over time, brain regions responsible for judgment, decision-making, learning, and memory begin to physically change, making certain behaviors “hard-wired.” In some brain regions, connections between neurons are pruned back. In others, neurons form more connections.

 

Once these changes take place, drug-seeking behavior becomes driven by habit, almost reflex. The drug user becomes a drug addict.

 

After cocaine use, connections between neurons in the nucleus accumbens, part of the reward pathway, increase in number, size, and strength.

 

Changes Last Long After Use

 

Stopping drug use doesn’t immediately return the brain to normal. Some drugs have toxic effects that can kill neurons—and most of these cells will not be replaced. And while changes to connections between neurons in the brain may not be permanent, some last for months. Some research suggests the changes may even last for years.

 

Long-lasting brain changes can make it challenging for addicts to stay drug-free. They often experience intense cravings, leading to relapse.

 

Addiction Is Not Strictly Mental

 

Today, teenagers are developing addictions at a higher rate than ever before, and higher levels of stress are believed to be blamed for an epidemic of drug and alcohol dependence within the adolescent community. By understanding how stress contributes to addiction in teens, you learn how to reduce the damaging effects of stress on your teen’s physical and mental health.

 

Indeed, addiction is often viewed as being solely a mental health condition. Yet the underlying causes of a person’s inability to stop using drugs or alcohol often has physiological roots that help to explain the nature of the disease.

 

Types Of Stress In The Teen Years

 

The media often portrays the teen years through rose-tinted lenses. While it is true that this time in a kid’s life marks a period of relative freedom before they take on the responsibilities of adulthood, it is too easy to forget that teenagers also encounter large amounts of stress in their daily lives. At school, students face constant pressure to reach high academic standards, and adolescents may experience elevated cortisol levels as they prepare to give a presentation in class or take a critical test.

 

Teens today also live in an increasingly public environment where all it takes is one embarrassing video to ruin their reputation. Alternatively, a teenager may feel stressed if they do not fit into what they believe is the normal standards of behavior. Peer pressure, the influence of technology and expectations from the adults in their life all cause teens to experience a stress response that may seemingly never stop.

 

Adolescents also experience stress as they try to navigate their way through their first adult responsibilities. You may be stressed out about how to handle a situation at their part-time job, or may be dealing with anxiety about how to deal with a relationship that ends. Unfortunately, teens must also sometimes cope with situations that feel beyond their control, like abuse or an adjustment to their parents’ divorce.

 

How Stress Affects The Body

 

In 1936, Hans Selye, a biochemist, found that a person’s body goes through a series of processes when it is exposed to stress that he named general adaptation syndrome. During these processes, the body releases cortisol and other hormones that are designed to provide a fight-or-flight response. As the levels of cortisol rise, the person may experience symptoms such as an increased heart rate and a desire to take action. While this response is often short-lived, the body can continue to release adrenaline and cortisol for longer than it should if a person is exposed to prolonged stress.

 

While the fight-or-flight response works well in situations where a person must react to extreme danger, problems arise if a person is not able to return to a state of calm. Over time, elevated levels of cortisol can lead to changes in a person’s psychological functioning that increases the risk of mental health disorders, such as depression and anxiety.

 

The Difference Between Short-Term And Chronic Stress

 

In most cases, your stress response goes away once the perceived threat is over. This is a healthy situation, but it can go awry if the stressor persists. Once stress becomes chronic, a teenager’s body is flooded with stress hormones that affect how they think and feel throughout the day. Eventually, an elevated stress response can cause teens to try to self-medicate with drugs or alcohol to calm their mind–this is often where addiction begins.

 

The Influence Of Cortisol On Mental Health

 

In addition to raising one’s heart rate, cortisol stimulates emotional responses such as fear, irritability and a desire to flee a situation. If cortisol levels stay elevated, then a person’s body begins to release additional hormones to try to mitigate the effects of the hormone. At first, a person may merely feel exhausted or frustrated, but they can also experience a sense of helplessness and anxiety when they are unable to control their body’s stress response.

 

Warning Signs Of High Stress Levels

 

Stress levels can often build up before a person is even fully aware of what is happening to their body. For this reason, one must be aware of signs that may indicate a struggle to handle stress. Watch for these signs of elevated cortisol levels in anyone you know so that you can reach out with help:

 

– Difficulty concentrating

– Increased agitation

– A refusal to participate in certain activities

– Complaints of heart palpitations or nausea

– Problems sleeping

– Frequent headaches

– Nighttime teeth grinding or jaw clenching

– A lowered level of immune activation

– Nervous habits, such as skin picking

 

For a teen who may have never experienced severe stress before, the influence of cortisol on their body may cause them to feel as though there is something wrong with them. Sadly, this can lead to further issues, such as a loss of self-esteem, that place a teenager at greater risk for drug abuse.

 

Adolescents who have always been exposed to stress due to childhood trauma or a difficult background may simply believe that these symptoms are a normal part of their life, and they may choose to use drugs in an effort to alleviate the worst of the effects.

 

Ways To Reduce The Negative Impacts Of Stress

 

Too much stress wreaks havoc on everyone’s mental and physical health, yet teens are at greater risk for falling into negative behavior patterns due to a lack of coping skills. Fortunately, the following strategies can often be implemented to help relieve stress.

 

1. Meditation is one way that teens can take their mind off of a stressful situation and learn how to lower their body’s stress response.
2. Teenagers also find it helpful to engage in physical exercise that helps the body burn off high levels of cortisol.
3. Seeking therapy for childhood trauma can help address stress. The process helps resolve the lingering emotions left over after the emotional or physical pain of abuse or tragedy has ended.

 

When it comes to battling addiction, the old theory that willpower is everything simply does not always hold true. Now that more is known about the effects of cortisol on the body, lowering stress in a person’s life can have tremendous benefits. From dealing with childhood trauma in counseling, to participating in a basketball game, today’s youth have many options available to address the stress in their life so that they benefit from a healthier mind and body.