Cobbers on the Brain

Overview

If you are anything like me, you don’t see the point in gambling. You see that you are risking a lot with minimal chance of winning big. Around 6-9% of young adults experience problems related to gambling. Gambling becomes an addiction once a person starts to compulsively gamble, even when it takes a toll on your life. Compulsive gambling is a serious condition that can destroy lives.

Symptoms

A person might be a compulsive gambler if they are preoccupied with how to get more gambling money, needing to gamble with increasing amounts to get the same thrill, try to cut back and are unsuccessful, or they gamble to escape problems in their life. Unlike most casual gamblers who stop when losing or set a loss limit, people with a compulsive gambling problem are compelled to keep playing to recover their money; a pattern that becomes increasingly destructive over time (Mayo Foundation et al., 2016).

Biological similarities between substance abuse and compulsive gambling

Pathological gamblers generally have lower levels of norepinephrine than normal gamblers. Furthermore, norepinephrine is secreted under stress, arousal, or thrill, so pathological gamblers gamble to make up for their under dosage. It was also found during MRI and fMRIs that, “Monetary reward in a gambling-like experiment produces brain activation very similar to that observed in a cocaine addict receiving an infusion of cocaine (Jazaeri et al., 2012).

Comparing substance abuse and compulsive gambling

Compulsive gambling is described as “persistent and recurrent maladaptive gambling behavior,” similar to the description for substance dependence and abuse (Jazaeri et al., 2012). One of the key components to categorize substance abuse is withdrawal. One of the criteria for compulsive gambling is a need to gamble with increasing amounts of money to achieve the desired excitement. This is an example of “tolerance” in gambling. Furthermore, substance abuse includes a persistent desire or unsuccessful efforts to cut down or control substance use. Similar in compulsive gambling, a person may desire to cut down on the amount they gamble, but may find themselves unsuccessful (Jazaeri et al., 2012).

Treatments

There are a few ways to treat compulsive gambling including, therapy, medications, and self-help groups. Therapy can include behavioral or cognitive therapy. Behavior therapy uses systematic exposure to the behavior you want to unlearn and teaches you skills to reduce your urge to gamble. Cognitive behavioral therapy focuses on identifying unhealthy, irrational and negative beliefs and replacing them with healthy, positive ones. For medications, antidepressants and mood stabilizers may help problems that often go along with compulsive gambling such as depression, OCD or ADHD. Narcotic antagonists, which are useful in treating substance abuse, may help treat compulsive gambling (Mayo Foundation et al., 2016).

Conclusion

Although I may not understand the desire some people may have to gamble, it is clear that this is a serious disorder that some people cannot control. It is important to recognize if someone you know might be a compulsive gambler so you can reach out to them and help. If you currently are like me and do not gamble, you should probably keep it that way.

Works cited

Jazaeri, S. A., & Habil, M. H. (2012). Reviewing two types of addiction − pathological gambling and substance use. Indian Journal of Psychological Medicine, 34(1), 5–11. https://doi.org/10.4103/0253-7176.96147

Mayo Foundation for Medical Education and Research. (2016, October 22). Compulsive gambling. Mayo Clinic. Retrieved from https://www.mayoclinic.org/diseases-conditions/compulsive-gambling/symptoms-causes/syc-20355178.

Figure 1; provided by me

Our current culture seems to be very adamant about legalizing the recreational use of marijuana. As someone who works in the healthcare field and often sees people who are suffering from marijuana induced psychosis, I often find myself wondering if that is wise. Lets put our personal opinions aside and look at the effects that marijuana has on the brain. As a caveat I would like to mention that the effects which I speak about will almost entirely be negative. To be fair however, here are some of the speculated benefits of marijuana; it is used to treat chronic pain, used in different aspects of cancer treatment, and it is used to help treat symptoms of epilepsy (MediLexicon International).

Currently, legalization on a state level would allow 21 year old’s to have, purchase, and use marijuana recreationally. But that is not to say individuals who are younger than 21 will not use. 23% of adolescents in grades 8-12 report using marijuana in the past month as is, what happens when marijuana becomes even more available (Jacobus, J., & Tapert, S. F)? If 23% of high schoolers used marijuana when it was illegal in almost every state (the article I am referencing is from 2015),  what will the percentages be when states legalize it for those over 21? Will the punishments for violating the age requirement be similar to alcohol, punishments that seem to be no more than a slap on the wrist? If that is the case then we need to look at the affects that marijuana has on the adolescent brain. There are certainly side effects of marijuana in adults as well, here are some of them; increased risk of psychosis (including schizophrenia), increased likelihood to experience suicidal thoughts and depression, increased rates of testicular cancer, and increased risk of respiratory diseases (MediLexicon International). However, for the sake of this blog I am going to focus primarily on adolescent marijuana use.

Those that use marijuana during their adolescent years show impaired attention and memory later in life even after quitting. Individuals who use marijuana during their adolescent years lose on average 6-8 IQ points by their mid-adult years (National Institute on Drug Abuse). Figure 2 below shows a nice overview of some of the negative aspects of adolescent marijuana use. Although some adults are prescribed marijuana to help with anxiety and depression, it has been shown that marijuana use in adolescence can actually worsen depression and anxiety. There is a common argument that “marijuana is not addictive, so unlike other things I can quit whenever I want.” Now to an extent this is kind of correct, but not entirely. Research varies but it has been found that 9-30 percent of indidiuvals who use marijuana develop something known as a substance use disorder (National Institute on Drug Abuse). A substance use disorder essentially means that the individual cannot stop using the substance in question even when it is causing them health and social problems. Okay, so how does this dependency reflect in children. The answer is in a bad way, those that use before age 18 are four to seven times more likely than adults to develop a marijuana use disorder. Those that try quitting after becoming dependent report the following symptoms; grouchiness, sleeplessness, decreased appetite, anxiety, and cravings. Although marijuana is not as addictive as something like alcohol or opiates, it certainly has addictive characteristics (National Institute on Drug Abuse).

Figure 2, shows a summary of the negative psychological affects on adolescent users

What evidence is there to support the bold statement that “marijuana is a gateway drug?” Well, its complicated and certainly in a way that makes it feel intentional. Many of the studies and research done on marijuana has political and ideological agendas that influence the research itself (Powell, A.). It is hard to find evidence that is not biased, therefore take this next statement with some pessimism. Almost all of the studies conducted on the “gateway drug theory” are done using animal models. It has been found that animals exposed to THC at younger ages have enhanced reactions to addictive substances later on in life. They are also more likely to show addictive behaviors to those addictive substances, this is shown by their increased behavior of self-administering drugs (National Institute on Drug Abuse).

It has been speculated, and partially verified that THC changes the brains reward system in a way that alters connections and reduces vital structures of the brain. These structures include regions associated with memory, learning, and impulse control (National Institute on Drug Abuse). Additional changes linked to THC use include; gray matter alterations, damaged white matter integrity, and abnormal neural functioning (Jacobus, J., & Tapert, S. F.). Some of these changes in brain structure/functioning are shown in the two figures below. Speaking on each of these altered brain structures would propel me well into the completely rambling section of blogging, so I will not.

Figure 3 ; shows abnormally high levels of a protein that is directly linked to stress

Figure 4; shows the hippocampus and amygdala before and after cannabis use, after use there is a clear size difference

Something important to note about cannabis use relates to dosage, the saying “all things in moderation,” is certainly applicable here. There is certainly a valid concern for individuals using cannabis before their brains are fully formed. However for adults, dosage is important because like all things dosage, and therefore quantity, can determine if something is recreational or detrimental to the user. All of the negatives and positives that I have listed are dependent on different quantities of marijuana use. For adults this varies wildly by person, perhaps controlled usage can do more good than bad. However, for adolescence there seems to be no real benefit, only negatives. The reality of our situation is that adolescent individuals will continue using marijuana even if it is not legalized. If we legalize the drug perhaps we can limit the lacing and contamination of the drug itself via a regulated provider. Many of the individuals I meet in the hospital used marijuana that was laced with something more potent. There are many in our society that believe that marijuana has no negatives to it, that it is simply harmless. If we legalize marijuana, there is a concern that this idea of a “harmless” plant will continue and even grow exponentially until marijuana is thought to be completely safe by society as a whole. The reality though is that nothing is cut and dry, we need to have honest conversations without falling into the trap of completely believing one side over the other. Our brains are on the line here, literally…

Jacobus, J., & Tapert, S. F. (2014). Effects of cannabis on the adolescent brain. Current pharmaceutical design. Retrieved October 11, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3930618/.  

MediLexicon International. (n.d.). What are the health benefits and risks of cannabis? Medical News Today. Retrieved October 11, 2021, from https://www.medicalnewstoday.com/articles/320984#What-are-the-medical-benefits-of-marijuana?  

National Institute on Drug Abuse. (2021, April 13). What are marijuana’s long-term effects on the brain? National Institute on Drug Abuse. Retrieved October 11, 2021, from https://www.drugabuse.gov/publications/research-reports/marijuana/what-are-marijuanas-long-term-effects-brain.  

Powell, A. (2020, February 24). Professor explores marijuana’s safe use and addiction. Harvard Gazette. Retrieved October 11, 2021, from https://news.harvard.edu/gazette/story/2020/02/professor-explores-marijuanas-safe-use-and-addiction/.  

What is addiction?

Addiction is the compulsive seeking of an addictive substance or act despite horrible consequences. In addiction there is a loss of control, the individual can no longer determine their actions. The addiction I will be focusing on is drug addiction. Drugs have the ability to change the brain in a way that drives uncontrollable behaviors to seek out drugs and continue their consumption.

Since 2000, there have been over 700,000 deaths due to drug overdose in the US. 11.7% of Americans aged 12+ have used illegal drugs within the past 30 days. 165 million Americans aged 12+ currently abuse drugs, including alcohol, tobacco, and illegal drugs. Over 70,000 drug overdose deaths occur in the US annually. The number of overdose deaths increases at an annual rate of 4.0%. Figure 1, shows how many overdose deaths have occurred pere year since 1999.

9.5 million adults over the age of 18 have both a substance abuse disorder and a mental illness. There are more frightening statistics like these that could take up the rest of this post, but I think I have made my point. Drugs are scary and they cause disaster. 1

Drugs and your brain

The circuit of the brain that receives the most attention in addiction is called the Mesolimbic Dopamine Pathway (ML-DA). In figure 2, you can see where in the brain this pathway is by the purple area between the two structures. This path is also known as the reward system. The start of the path is in the ventral tegmental area (VTA) a group of neurons located in the midbrain. 65% of these neurons are dopaminergic, meaning they produce the neurotransmitter dopamine. Dopamine is our feel-good neurotransmitter, it doesn’t cause pleasure itself, but it induces other things to produce those feelings. When the VTA is activated by a stimulus it sends dopamine to the nucleus accumbens (NAc).

What kind of stimulus can activate the VTA?

There are three main stimuli that stimulate the VTA: a reward, anticipation of a reward, and a stressor. The type of stimuli will determine the kind of signal VTA neurons send and thus how much dopamine is produced. If the stimulus is a drug of abuse, the signal will send a lot of dopamine to the NAc.

The NAc is a region in the basal forebrain, and it is best known for its role in reward, cognition, reinforcement, and motivational salience. When this structure is stimulated by the dopamine from the VTA, it encodes a value to the stimulus. Researchers believe that the NAc is involved in stimulating actions to pursue rewards and inhibiting actions not helpful in obtaining a reward. The transitions between the two types of firing patterns form the VTA are thought to change concentrations of DA at the terminal and ultimately help encode the salience of stimuli, promote seeking of reward, and tune reward predication error for cue-associated behaviors.

There are some general assumptions provided for what dopamine does in this system. Dopamine is released in response to positive rewarding stimuli, but also in aversive stimuli & stress AND in the anticipation of a potential reward. This response to DA, is one of the reasons for the affective neuroethological perspective that views the ML-DA system in terms of its ability to activate an instinctual emotional appetitive state (seeking) evolved to induce organisms to search for all varieties of life-supporting stimuli and to avoid harms. This view is that the reward system not only aims to seek out rewards but also to avoid non-rewarding stimuli. Therefore, this could relate to the withdrawal factor of addiction. Symptoms of withdrawal are uncomfortable; thus, the reward system could stimulate the addict to seek out a reward (drugs). The memory of the NAc is that this drug has value, and this mechanism could potentially encode a value for a drug that is the same as food and water (actual life-sustaining substances).

Addiction is not a choice

After reading this information on how drugs change brain chemistry, you should understand that addiction is not a choice. Drugs create a hold on an individual that they cannot shake. Their brain has turned on them to need this drug for survival. Therefore, drug addiction is not easy to overcome. Drug addicts require our empathy for the disease state they are in. It takes tremendous strength to quit drugs of abuse, you can’t just stop taking drugs. Drugs are scary and they cause disaster.

References:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3898681/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3125054/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1920543/

I think it’s one thing to be health condition but, it’s another to be able to get the help that you need. I grew up in an area that used to see mental illness as evil spirits, bad karma, family misfortunes. This not only caused stigmatization and discrimination against mental health patients but it also prevented the patients of the disease to be able to get the adequate help that they need.

In other words, Schizophrenic patients are prone to human rights violations in society and even in mental health facilities (WHO,2019).

Mental illnesses that attack the central nervous system such as Schizophrenia are mostly genetic and/or can be triggered by environmental stressors such as drug abuse, domestic abuse, other neurological illness, etc.

Schizophrenia is a psychosis largely characterized by cognitive, emotional, physical distortions. The actual cause of it is not fully known but hypotheses have been made of the possible reason behind the gradual deterioration and based on the symptoms. There are cognitive, positive, and negative symptoms. Positive include delusions, negative include lack of emotional expression, and cognitive symptoms include the inability to make decisions (PsychCentral, 2021).

Considering that a large probability of proneness to schizophrenia is linked to genetic and early development, it is important to understand the role of the Wnt signaling pathway in this cascade

The Wnt signaling pathway

It is involved in cell maintenance and renewal. Basically, Wnt ligands bind their receptor complex which causes the recruitment of APC to the membrane, facilitating the dissociation of the destruction complex. This results in decreased phosphorylation of β-catenin. When the destruction complex is dissociated, β-catenin is then able to get into the nucleus and influence the targeted genes.

In a study on the “Convergent functional genomics of schizphrenia“, the targeted genes, in this case, researched in different groups included African Americans and European Americans, and were graded and ranked out of 5points as seen in the illustration below

The top genes targeted include DISC 1 (protects synaptic plasticity), and decreased expression of MBP ( involved in protein formation for myelin formation). Both these genes for example allow responsiveness to stimuli and learning which is seen to be hindered in schizophrenic patients.

The question at this point is how can we better deal with it, in terms of prevention, treatment and awareness. Given that it can be heredited, to what extent to we start treating it? Do we wait for symptoms to show once the disease has progressed? Can technology and gene therapy be the future for mitigating schizophrenia gene vulnerability? And how can Schizophrenic patients get affordable help regardless of their economic standpoints?

These are the big questions to think about in my opinion in order to progress more in the treatment of schizophrenia for long-term.

References:

1. John M. Grohol, Psy.D. “Schizophrenia Symptoms: Negative, Positive, and More.” Psych Central, Psych Central, 4 Feb. 2021, https://psychcentral.com/schizophrenia/schizophrenia-symptoms?utm_account=&utm_medium=cpc&utm_semcampaign=&utm_adgroup=&utm_match=b&utm_query=&utm_term=&utm_content=540967374863&utm_source=google&marinid=s&gclid=CjwKCAjwhuCKBhADEiwA1HegOXz527pV8bxnc59QXv7zMOppnMTflRYTKeTiTg13jh_FpCC06OhxQRoCS3UQAvD_BwE.
2. “Schizophrenia.” World Health Organization, World Health Organization, https://www.who.int/news-room/fact-sheets/detail/schizophrenia.
3. Ayalew, M, et al. “Convergent Functional Genomics of Schizophrenia: From Comprehensive Understanding to Genetic Risk Prediction.” Nature News, Nature Publishing Group, 15 May 2012, https://www.nature.com/articles/mp201237.

Mental illness is a rising phenomenon in our society, and it is something that as a society we have failed to appropriately address. People with mental illnesses are often shunned or downright discriminated against for something that no one can control. Hopefully this post will shed some light on the concept of mental illness and what can be done to help rather than hinder the efforts to help people with mental illnesses.

What is a Mentally Ill Person? And Can They Control It?

Mental illness is often considered an attention seeking tool or lumped in with general psychosis, but neither could be farther from the truth. Mentally ill people have a chemical or genetic dysfunction that is causing either direct damage or indirect changes to the way the brain functions. For example, schizophrenia is based on a pathway called the Wnt pathway, when any one part of that pathway goes wrong the chances of developing schizophrenia skyrocket. Schizophrenia can also be caused by a number of genetic issues, but the moral of the story is that mental illnesses like schizophrenia are caused by major impacts to the brain and are under no control of individuals. More on schizophrenia and Wnt signaling

What Are Symptoms of Mental Illnesses?

The most important thing to know about mental illness symptoms is that no two people present their symptoms in the same way. Sometimes the symptoms are not visible to outside view, which further complicates the matter. Using schizophrenia as an example, there are symptoms that are described as both positive and negative. Positive symptoms are symptoms specific to schizophrenia, which is primarily described by hallucinations and delusions that feel completely real to the person. On the other hand, negative symptoms could be cause by a variety of things: these symptoms include lack of emotion, lack of joy, speech issues, and lack of initiative. Figure 1 below visualizes the important distinction between these symptoms. Not only are these symptoms challenging to see and diagnose, they also are very individual based on the type of hallucinations and type of negative symptoms experienced. More on schizophrenia symptoms

What Are We Doing, and What Can We Do?

Mental illnesses are challenging to treat due to their direct impact on the brain and the stigma that comes with being mentally ill. There are a fair amount of medicines that focus on management of symptoms, such as anti psychotics and lithium, but in addition to symptoms and varying effectiveness these treatments don’t do much to actually manage schizophrenia in a patient. When the illness becomes too overwhelming or the behaviors become out of control, hospitalization may be necessary, but for the majority of other people impacted by mental illness they live in the same world as neurotypical people. The best way to “treat” schizophrenia and other mental illnesses is to interact with these people with empathy and grace. People may seem weird or even dangerous to you, but it’s entirely possible they just have a different brain chemistry than you. The more society begins to understand and welcome these people, the better off they will be and the better science can begin to understand these people. As the Platinum Rule says; treat others the way they want to be treated