Friday, 27 February 2015

Addiction : adverse childhood experience, Homeopathy, and neuroplasticity

Addiction : adverse childhood experience,
Homeopathy, and neuroplasticity

What is addiction?
Addiction can be defined as any behaviour that is associated with craving and temporary relief, and with long-term negative consequences, that a person is not able to give up despite their best intentions. Addiction is normally associated with drug abuse, but the definition can extend much wider than that. One can be addicted to shopping, food, sex, gambling, work etc.
Although some addictions are definitely more damaging than others, neurologically there is only one addiction process no matter what the behaviour or substance a person is addicted to. All addictions engage the same neural pathways, the same brain chemistry, and the same reward system.

Why is it that the addict will continue to persist in their addiction at the expense of their careers, family, finances, psychological integrity, physical health, and even their life? How can a substance or harmful behaviour have such a binding hold on a person?

A common belief is that addiction is a choice that people make – a choice that they make freely, and a bad choice. Therefore it is appropriate to punish drug addicts with extreme legal sanctions.

The modern medical approach to addiction is that it is a brain disease caused by genetics that then impairs brain function. This has some truth. However if it is just a bad choice then why call it a brain disease, and if it is a brain disease caused by genetics then why punish people? This does not make any sense.

Even if you are born with genes that supposedly pre-dispose you to addiction, it is the environment which dictates whether or not you will succumb or not – whether these genes become switched on or remain off (epigenetics).

What the ‘choice’ and ‘genetics’ viewpoints have in common is that they both take society off the hook. If we accept these definitions then we don’t have to look at the deeper reasons for addiction. These deeper reasons for addiction actually have very little to do with personal choice or genetics, and are much more associated with early adverse childhood experiences, stressed and overwhelmed parents, and a fragmented and unhappy society.

Yet another view of addiction is that the substances that are abused are in themselves addictive. But if that were true then everyone who had a drink would be in danger of becoming an alcoholic. The fact is that the majority of people can try even very strong drugs like crystal meth or heroine and not become addicted to these substances. The question should be why do some people become addicts where others do not?

Adverse Childhood Experiences:
There is now heaps of research studies showing conclusive links between adverse childhood experiences (ACE’s) and addictive behaviour. The major piece of research involved over 17,000 people and indicated an overwhelming correlation between adverse childhood experiences and addiction later in life. The higher one’s ACE score (i.e. one has suffered more adverse childhood experiences) the more likely it is for one to develop addictive behaviour later in life. In fact for each ACE a person’s likelihood of addiction increases by about 200%.

The graph above shows how the likelihood of being an alcoholic as an adult exponentially increases with having suffered adverse childhood experiences. ACE’s are things like emotional or physical abuse/neglect, sexual abuse, witnessing family violence, absent parent/no parents…
Not everyone who is traumatised becomes an addict but early trauma is proven to radically increase likelihood of addiction.

Gabor Mate, a Canadian doctor who works in Vancouver’s impoverished drug area, says that out of the thousands of female drug users he has seen, every single one of them had been sexually abused as a child. That is quite a revealing statistic. The fact is that almost all addicts are really just damaged children trying to self-medicate.
Any addictive behaviour is actually an attempt to self-medicate. Drug addicts will say, ‘the first time I took heroine it was like being wrapped up in a warm soft hug’, ‘when I took cocaine it made me feel normal for the first time in my life’. Addicts say that a drug takes away their pain, soothes, gives a sense of control, makes them feel able to function, de-stresses them… etc.

So maybe the real question should not be ‘why the addiction?’, but ‘Why the pain?’

Building a brain:
So we know for sure that there is a strong link between what happens (or doesn’t happen) in early childhood and addiction. But why is this?
The key thing to really understand here is that the human brain actually develops though interaction with the environment. This is no longer theory – we know it for certain.   According to the research, the key factor that determines the development of the infant brain is the relationship and connection with those around esp. the primary care giver(s) – usually the mother. People connection=neural connection.
In other words the neural pathways of the brain are set early on by the mutual responsiveness of parent-child relationships. The more present and responsive the care-giver is to the infant, the more neural connections are made in that infant’s brain. The type of attention will determine the type of connections that grow.
In an infant’s life there are periods when every second millions of connections are being made. The human brain is the only one that continues to grow outside the uterus at the same rate as it does inside the womb. We are actually born premature compared to other animals (i.e. compared to a horse that can run on the first day). This means that most that most of our brain development happens after we are born. The human brain is 80% mature within 3 years of life.

So the brain develops through this interaction with the environment in first three years of life. The circuits that get stimulated will grow and the ones that do not will atrophy or die.
As an extreme example, if a child is left in the dark the visual circuitry will not develop and that child will be blind – forever – because the visual circuitry needs to be stimulated by light in order to grow. Imagine In an infant whose mother is suffering from post-natal depression. The mother will lack a feeling of connection to her child, will be less available and less able to sooth the child, will be less responsive to that child, and may even neglect its basic needs (in severe cases). This will influence the infant’s developing brain and which circuits develop or atrophy. This hard-wiring of the brain occurs very early on in life and sets the patterns for behaviour, and stress handling ability later in life.

In double blind experiments on mothers with post-natal depression with a control group of non-depressed mothers they could tell by looking at the EEG of the infants whose mothers were depressed and whose was not depressed.

The neuro-chemicals of addiction:
The three main neuro-chemical circuits involved in addiction are endorphins, dopamine, and cortisol. Understanding how these three circuits are ‘built’ during infancy through interaction with the environment, in particular the primary care-giver, and how they operate, is the key to understanding addiction in all its forms.

Endorphins and love:
One main class of drugs are the opiates (from the opium poppy). These include morphine, codeine, and heroin. The opiate drugs are extremely powerful pain relievers. Opiates sooth both physical and emotional pain. Brain scans show that physical pain and emotional pain are felt in the same area of the brain. When someone is hooked up to an EEG and experiences physical pain or emotional pain, the same areas of their brains light up. How is it that these chemicals derived from a poppy even work in our brains? It is because our brains have receptors for opiates. Why do we have receptors for opiates? We actually have receptors for our own endogenous opiate-like substances called endorphins. One of the functions of endorphins is to relieve pain. Imagine how life would be if we had no mechanism in place with which to relieve pain?

Endorphins are also the neurochemical of pleasure. People who have very low endorphin levels may feel depressed and take no joy in life. Exercise releases endorphins which accounts for the high experienced by long-distance runners. Imagine life without the ability to feel pleasure?

Most importantly, endorphins are released during the loving interaction of people, especially between mother and child. In experiments with rats and monkeys, if endorphin receptors are blocked, the mother will not bond with or take any interest in her offspring, and the offspring will not thrive. In this way we can see that without endorphins life would not be possible.
In infants whose mothers are not present, loving, and connected, the endorphins will not be flowing and so this endorphin fed pleasure/pain/bonding brain circuitry does not properly develop. One can understand how this might leave the person more susceptible to addiction later in life, as they will become dependent on getting the endorphin substitute they need from an outside source.

Dopamine and reward:
Dopamine is another important neurotransmitter involved in the addiction process. Dopamine is the incentive or motivation hormone and flows when you are seeking food or a sexual partner. It is the brain chemical implicated in curiosity, interest, novelty, feelings of alertness and aliveness. If your dopamine receptors are knocked out you take no interest in anything - a zombie-like state. You won’t even feed yourself. The more dopamine in your system, the more alive, engaged, and motivated you will feel.
The more exciting something is perceived as being, the more dopamine is released. The addict’s dopamine response is very linked in to their addiction, meaning that even thinking about their addiction will trigger dopamine which then drives them on to seeking out their substance or behaviour even if another (wiser) part of themselves knows it is not a good idea. This is why addicts have extremely poor impulse control and find it very difficult to stop their addiction even though they may want to. If it were a matter of ‘just saying no’ then there would not be so many addicted people!
All the stimulant drugs (amphetamines, cocaine, coffee, tobacco) increase dopamine levels. A shot of cocaine increases dopamine by 300% meth-amphetamine by 1200%.
The other thing that increases dopamine levels is any risk taking activity; extreme sports, gambling, illicit or novel sex. The greater the risk, the greater the dopamine kick. The problem is that the addict’s dopamine circuits get wired to the addiction, whatever form it takes. So, for the shopaholic, their dopamine circuit gets wired to their shopping addiction. The addict will often say that their addiction is what makes them feel most alive, most engaged, most motivated. When the addict is not engaged in their addiction, their dopamine level is low and they feel withdrawn, dis-interested, anxious etc.  This begs the question, is it the drug/behaviour that people get addicted to, or is it their own dopamine?

Cortisol and stress:
Cortisol is a stress hormone. It helps to maintain fluid balance, blood pressure, blood sugar and a host of other things when we are experiencing undue stress. It is similar to adrenalin although has a longer lasting action. Adrenalin’s affect is more immediate and passes more quickly compared to cortisol. Cortisol levels rise dramatically in the face of stress as a useful and necessary response to deal with the immediate threat. Stress raises cortisol levels which enable us to more effectively deal with a challenging or dangerous situation by increasing our heart rate, blood oxygenation, glucose levels, and a host of other things.
Experiences during infancy are known to affect the organism’s ability to regulate cortisol levels. While stressful early experiences have been associated with deregulated cortisol levels, positive early experiences, i.e. high maternal caregiving quality, contribute to more optimal cortisol regulation  ( .  The infant’s stress regulation response is undeveloped and is mediated by the mother through soothing contact and attuned responsiveness.  So, a well-bonded infant with a responsive attuned mother will mean that the infant will develop healthy stress regulation circuitry. However, an absent, tuned out, stressed out, or depressed mother will mean that the infant will not develop healthy stress handing ability, and so will remain chronically stressed with raised cortisol levels.

There is a clear link between a person’s ability to handle stress and the likelihood of developing addictive behaviour. Addiction is about self-soothing.  Due to the stress regulation patterns set up in early infancy, adult addicts not have learned how to regulate their own stress response and so will experience more stress, and longer lasting stress from a lesser stimulus. One can then understand that they are more likely to fall into addictive patterns of self-soothing with drugs or other forms of addictive behaviour.

As an aside, chronically raised cortisol levels are related to a whole host of health problems including cardiovascular disease, diabetes, and osteoporosis.

These three circuits - for the opiate love chemistry, for the dopamine reward system, and for cortisol stress regulation, are all set up during early infancy mainly through mutual responsiveness between the infant and the mother. If there is any major or ongoing disturbance or trauma in the infant’s early environment, this will shape how these circuits function as the person goes through life, and therefore how prone this person will be to self-soothing addictive behaviour.
For the healthy development of the infant’s brain neural chemistry it requires that the care-giver is not stressed, is present, relaxed, consistently available and attuned to the infant.

This is not about blaming parents though. Most parents are loving, attentive, and want the best for their children. Most parents would never knowingly do things that will impact their child’s well-being. However, it is not just about things that shouldn’t happen happening, but about things that should happen not happening. D.W. Winnicott [the late British child psychiatrist] said that there are two things that can go wrong in childhood: things that happen that shouldn’t happen — that’s trauma — and things that should happen that don’t happen. Children are equally hurt by things that should happen and don’t as they are by things that shouldn’t happen but do. If the parents aren’t emotionally available, [for example], no one will define that as trauma, but it will be for the child. If a mother has post natal depression, that’s not defined as trauma but it is likely to lead to emotional neglect, consequently interfering with child brain development.

Of course it is impossible for a parent to be emotionally available and non-stressed all of the time. For one thing, we live in a highly stressed society. Often both parents have to work in jobs that they don’t like just in order to pay the bills. Or the young mother is herself traumatised, isolated, stressed, and has no support. Also, the nuclear family is not necessarily the ideal model for healthy non-stressed child rearing. So the African proverb states: ‘It takes a village to raise a child’. Now days most parents do not even have extended family living nearby to help with raising the children. The current way that we live so separate from each other is only a very recent phenomenon (probably due to economic growth). The fact is that humans have lived in small communities for tens of thousands of years, and it is only relatively recently that we have moved to the nuclear family model.

So, in this context, addiction is a disease of our culture, and not of the individual. It is our society that is sick, and this expresses itself in the individual in a myriad of ways, one way being addiction. What if it is what happens in peoples’ lives that makes them addicted? Then we have to look at our society, the way we treat each-other, the way we bring up our children, the mechanisation of childbirth, the split from nature and the wanton destruction of the environment for the sake of economic growth.

As an example consider the first nations aboriginal people. Aboriginal people used substances like peyote, alcohol, tobacco, psychotropic mushrooms without any problems with addiction. These substances were always used in the context of a sacred ceremony for the village. It was only much later after these cultures had been violently crushed, raped, dispossessed of their lands, their freedom, and their right to practice their religion that they developed addiction problems. The current accepted ‘truth’ is that aboriginal people have a genetic predisposition towards alcoholism and that’s why they became addicted. Yet if it were just down to the genes then they would have been alcoholics a long time ago because genes do not change in a population within a few decades.

The road to recovery
So, if the tendency towards addictive behaviour is hard-wired into the infant’s brain through painful early experiences, is there any hope of recovery for the adult addict? The answer is a resounding ‘yes’. Fortunately the brain is ‘plastic’, meaning that it has the ability to re-wire itself and make new neural pathways, and so the addict is able to change their behaviour. This can take a long time though and certainly does not happen over-night. The little story below gives an idea of how the brain builds new neural pathways:
As sheets of snow fell, two high school buddies and I had a daring idea.
Hanging in the barn was the rusty hood of a Volkswagen Beetle, and our thoughts went downhill from there, literally. Its rounded shape, narrow in the front and wide in the back, made the car hood the perfect giant sled. And the most dangerous slope we could think of was a straight shot down an old logging road that descended what we simply called “the mountain.” On the left side of this steep and rutted gravel road a hill rose dramatically, but to the right a bank fell sharply to a wooded valley.
Fresh, unpacked snow can make for slow sledding. So to get the trail started we got a running start at the crest and then all three of us recklessly leaped onto the curved hood. It bored down the road, but soon careened over the right edge toward the valley where we smashed into a tree. Bruised, aching, and laughing about it, we then devised a plan to correct the failed track. We dragged the hood to the place where we veered off the logging road, and then walked the hood the rest of the way down the hill. By doing so, we created a groove in the fresh, deep snow, so that the next time we rode down the hill we could avoid the original path that led to the uncomfortable crash. At the top of the hill again, less reckless and more intentional, we got another running start. The makeshift sled shot down the road, and when we reached the exit to where we had crashed we leaned to the left to stay on track. We flew past the danger point and gained such momentum that the hood propelled the three of us across a creek at the bottom of the hill. The new pathway that we took time to build had been the key to our success.

To break an addiction it is not enough to just stop or suppress the addictive behaviour, but one needs to replace it with something new (and healthy!). One needs to intentionally create a new brain patterning by changing one’s thinking and behaviour to more healthy life-affirming pursuits.

Healing the original pain - How homeopathy can help people with addiction:
Consciously rewiring the brain by changing one’s behaviour will help with addiction, but the addict will need to dig deeper if they are truly to overcome their addictive nature. Because the susceptibility towards addiction begins with traumatic brain-wiring experiences that occur early in childhood, it is through healing of these past experiences that the foundation for addictive behaviour is dissolved.
Homeopathic treatment can help a great deal with this, as it gives self-insight into the nature and origins of one’s addictive patterning and has the power to heal at a very deep level.
Healing is not about just fixing the symptoms, or, in the case of addiction, rewiring the brain. Healing is about treating the whole person; understanding the dis-ease within the context of the person's life history, taking into account all aspects of their nature, inherited predisposition and susceptibility. This approach fits perfectly within the remit of homeopathy in which every aspect of the individual is considered - physical, psycho/emotional, spiritual.
The homeopathic approach always views addiction (or any illness) as an expression of dis-harmony within the whole person. It recognizes that all symptoms are part of the whole and nothing stands in isolation; the person's neural wiring is not a separate entity in its own right. This of course is an absurd idea, but it does  tend to be the view that conventional medicine takes regarding disease. This is why there is a different specialist for every part of your body, and they often don't talk to each other!

The addict can be viewed as being ‘stuck’ at a particular stage in their life when the painful experiences occurred. Basically, something happened to them (usually at a very young age), and they have never recovered. This is why post-traumatic stress disorder (PTSD) and addiction are so intertwined. The neural pathways (and therefore behaviour patterns) are set in response to these early experiences, and so the person becomes stuck at this place in time, behaving and responding in the present time as if these painful experiences were still occurring. This phenomenon is known as implicit memory.
True health is not only about being free from physical pain and suffering. In true health we are also free from our past pain and conditioning so that we can respond appropriately to the present circumstances whatever they may be. The key word here is ‘appropriately’. As an example, a baby who experiences maternal abandonment will, as an adult, tend to re-experience or interpret abandonment even when this is not actually happening. They will be so keyed into this brain groove that they will interpret and perceive abandonment in situations where they are not actually being abandoned. Also, if this person experiences (or perceives) abandonment as an adult (and we all do at some point in our lives) they will re-experience very intensely all the associated feelings they experienced as an abandoned infant – terror, anxiety, worthlessness…
In this way we can see how dis-ease is an inappropriate response – a stuck ingrained pattern that has its roots in our early conditioning.
True health does not mean that we are pain free, but that the pain is in proportion to the current situation. For example your partner criticizes you for not doing the washing up properly, and you experience crushing rejection, humiliation, and rage... This is an out of proportion reaction and we need to realize that this reaction must be being fed from an earlier stuck and unresolved experience of rejection and humiliation.
Homeopathic treatment can help to heal the pain and undo this past conditioning so that we are unencumbered by our early negative programing, and so able to respond in a more wholesome way, leading to healthier relationships, peace of mind, and a far greater sense of well-being. This is the way to really heal addiction; to remove the susceptibility towards it, so that it has nothing to attach to.

In the homeopathic pharmacopeia we have over 3000 remedies of which many can be used to heal this early emotional patterning. Each homeopathic remedy has its own unique highly developed ‘picture’. The homeopath’s task is to find the remedy whose picture most closely resembles the case history of the patient. When the correct remedy is given, it triggers a healing response in the person, often revealing and resolving deep emotional issues, as well as physical ailments and predispositions towards disease.

The first step for the addict though is the realization that they have a problem and then the willingness to address it. It should now be clear that ‘just saying no’ is not enough, that detoxing by itself is not enough. Remember that addiction is about self-medicating for pain, distress, depression… It is these deeper issues that need to be addressed in order to fully heal.