Comments for AddictionDoctor.Org

Comment on What If… by AddictionDoctor

AddictionDoctor — Sat, 18 May 2013 11:28:46 +0000

Cal,
1. No, I don’t think so. This issue isn’t the MER, but rather the state of the person. If the person has enough dopamine tone to hear the healing message of recovery they may not need medication at that point in their lives at all. There’s no doubt that 12-step programs work for those that work them, but I have grave doubts about the traditional explanations of those who don’t work them. I don’t believe that they are people who aren’t ready, or people who really don’t want it. Instead, I believe they are people who are so situated biologically as to not get a dopamine bump from a the end of isolation. Instead of seeing a glowing room full of loving people, they see a bunch of smiling old people making fun of them. The only reason I have for giving any one medication is to get them into or keep them in recovery from addiction. If they can get there without medication, I’m great with that.

2. As I said above, it isn’t the MER, it’s the state of the person. Let’s say Bob has addiction and his MER is cocaine. Genetically he’s fine, however he was brought up in a situation in which he learned that he’s a waste of space. His existence ruined his family’s lives and destroyed their goals. He heard that he’s the worst kid on the planet and his behavior seems to suggest that that’s true. The reason for his low dopamine tone is the low dopamine receptor density caused by isolation and feeling less than. If he could get into a situation where that is reversed, he’d have a bump of dopamine. He’d enjoy the experience and he’d become attached to it. No take Jane, who was born with a dopamine reuptake pump that works overtime. It sucks up her dopamine faster than it should so that she has lowered dopamine tone because the actual level of dopamine at the synapse is low. Let’s imagine she’s got perfectly maxed out density of dopamine receptors. If we reverse isolation and less than in her we don’t get a bump, but if we give her Wellbutrin, we do. Then when she has enough dopamine she can perceive something in 12-steps that she couldn’t before.

I’m sure it’s much more complicated than that, and there’s a lot we don’t know, but that’s just an illustration of the possible reasons why someone might get better without medicines and someone might need medicines.
Hope that helps,
h

Comment on What If… by Cal

Cal — Sat, 18 May 2013 00:09:04 +0000

Dr. Wetsman,

After reading your comments to Jason, i am a bit confused. Maybe i am misunderstanding what you wrote.

1. Do all people with addiction need medication?

2. If not, why? Isn’t addiction the same for all? So why would one person with an MER of say…alcohol…need meds but another does not? Thanks for your time!

Comment on What If… by AddictionDoctor

AddictionDoctor — Wed, 15 May 2013 03:55:49 +0000

Jason,
The effect is indirect. Dopamine tone is made up of the dopamine released, the receptors that “see” it and the time they are on the receptors. As the receptors rise with the release from isolation or shame, the dopamine tone goes up even if dopamine release doesn’t. Because dopamine release isn’t involved in this effect, there should be no effect from either suboxone or naltrexone as long as dopamine release is normal. If it isn’t, then we’d have to wonder if the person would enjoy the meeting if they had their mu receptor blocked or just not augmented. We always hope that people will get in recovery and off of their medications if they can. Not all can, but a great many can greatly decrease dose if not get off entirely.
thanks
h

Comment on Goodhart’s Law and Prohibition by Mike Lindenberg

Mike Lindenberg — Wed, 15 May 2013 03:55:45 +0000

While a bravo idea, I’m afraid it’s wishful thinking. Too many people aroound the world ARE flat out miserable in some sort of way, and for whatever reason gravitate towards substances that relieve their misery. And then you have those that just enjoy getting loaded, whether socially or by themselves.
No, the drug war is a travesty, culminating in gangs, black market, cartels, untaxed profits and unregulated drugs. Triillions of dollars have already been spent and now there is this perpetual circle of you scratch my back and
I’ll scratch yours within the punitive judicial system. It will never stop! Too many jobs at stake! Too many prison cells to fill! Too many non-violent offenders having their life ruined instead of rehabilitated.

Comment on What If… by Jason

Jason — Tue, 14 May 2013 10:11:43 +0000

So, you believe that there’s a dopamine response from attending meetings?

What effect, if any, would naltrexone have on that experience?

Comment on What If… by AddictionDoctor

AddictionDoctor — Tue, 14 May 2013 01:03:31 +0000

Jason,
Yes it is poor hedonic tone. AA can help as it reverses the isolation and feeling “less than” that lower dopamine receptor density. So someone who has low hedonic tone from that cause may very well have an immediate positive response to an AA meeting. If their dopamine tone is too low from other causes, they may perceive that that same meeting isn’t as helpful.
thanks,
h

Comment on What If… by Jason

Jason — Mon, 13 May 2013 23:41:20 +0000

Gotcha. Is this the same thing as poor hedonic tone?

How does something like AA (or something else) treat this deficiency?

Thanks again.

Comment on What If… by AddictionDoctor

AddictionDoctor — Mon, 13 May 2013 21:09:41 +0000

Jason,
I think there are some people who have a deficit of midbrain dopamine tone because of insufficient activity at the mu opioid receptor. The endorphin releases dopamine in normal people for normal rewards. People with such a deficiency would not experience normal rewards as rewarding. They would instead, only get a “normal” reward when they tried something bigger, like a drink or some oxycontin. If we were to block this person’s mu receptor with naltrexone, they would have the original problem exacerbated and be looking to pick up something that worked. I’m not saying that everyone who is alcohol or opioid dependent needs supplementation at that site, but until we know who does and who doesn’t it’s risking lives needlessly to say that no one can have it.
thanks,
h

Comment on What If… by Jason

Jason — Mon, 13 May 2013 20:20:20 +0000

Thanks. I’m on the same page as you. You’re getting into territory that is more difficult to communicate clearly to others.

How would you explain the patient’s problem?

Thanks!

Comment on Goodhart’s Law and Prohibition by AddictionDoctor

AddictionDoctor — Mon, 13 May 2013 11:32:56 +0000

Thanks Eben,
h