By Patricia L. Gerbarg, M.D. and Richard P. Brown, M.D.
Humans are incredibly adaptable, brilliant learners. Advances in neuroscience show that we have a brain that is capable of changing itself [1]. While this confers enormous survival advantages, it also burdens us with unintended consequences: We can be reprogrammed to take pleasure from and crave almost anything. This is no secret to Madison Avenue. Advertisers sow discontent, a kind of an itch that can be scratched only by designer handbags, sweet foods laced with chocolate, or hot videogames — all of which stimulate our pleasure centers, opening the door for addictions. How do addicting substances, such as alcohol or nicotine, and addicting behaviors, such as gambling, shopping, porn, or voyeurism, compel us to keep coming back for more?
Addicting substances and behaviors stimulate the release of neurotransmitters and neurohormones that act on networks of nerves that produce subjective experiences of pleasure. Prominent among these are the neurotransmitter dopamine and the prosocial hormones (called so because they foster love, empathy, bonding, and caretaking) oxytocin and vasopressin. Intense pleasurable stimulation can lead to the release of hoards of dopamine molecules that grab our pleasure neurons by their dopamine receptors and VA VA VOOM!
But that’s not the entire story. If it were, we’d all become hooked on whatever put a smile on our faces. So, why do some people develop addictions while others don’t? Are there clues that indicate how vulnerable an individual might be to addiction and its consequences? Once established, addictions are tough to overcome, so it makes sense to learn about preventive measures as well as complementary treatments to improve the odds of quitting.
There are numerous risk factors for getting hooked. Some people are more prone to addiction than others due to genetic variants called polymorphisms (literally, many forms) and differences in brain wiring. For example, specific polymorphisms in genes responsible for the synthesis of dopamine and its receptors result in impaired dopamine transmission and manifest as less responsive to pleasurable stimuli. Drugs of abuse reduce dopamine release and the number of dopamine receptors, further compromising the pleasure-processing circuitry and increasing vulnerability to addiction. Regarding the wiring of neural networks, functional MRI (fMRI) scans show that the brain of a chocoholic responds differently to the sight of chocolate than that of someone who can take it or leave it [2]. Over-reactivity to stress and addiction-related cues predispose to addictions. Anxiety, depression, boredom, loneliness, emptiness, disconnection, social awkwardness, and frustration can also set the stage for addictions that either soothe or distract us from our negative feelings.
Addictive behaviors can produce very unpleasant withdrawal. The need to avoid withdrawal symptoms perpetuates the addiction and the addiction, in turn, perpetuates the withdrawal symptoms. Treatments that mitigate withdrawal are essential in overcoming many addictions. Medications can be useful: for example, baclofen, a GABA-B receptor activator, for alcohol dependence. Preliminary evidence suggests that N-acetylcysteine (NAC), an amino acid, may reduce impulsivity, cravings and grooming compulsions such as nail-biting. Wannabe quitters may need psychotherapy, cognitive behavioral therapy (CBT), neurofeedback, lifestyle changes to reduce stress, exercise, mind-body practices, and/or healthy ways to self-soothe, fill the void, and feel loved, worthwhile, or safe.
Fortunately natural, low-cost techniques can activate our innate recharging, healing, and self-soothing systems: the parasympathetic nervous system (PNS); the cuddle hormone, oxytocin; the calming neurotransmitter, gamma-aminobutyric acid (GABA); and feel-good endorphins. When we feel threatened, the sympathetic nervous system (SNS) revs up, preparing for fight or flight, increasing heart rate and respiratory rate and heightening tension and alertness. Once danger has passed, the SNS should stand down while the PNS turns on to slow the heart and respiratory rates, relax the mind and body, repair damaged tissues, reduce inflammation, and induce feelings of safety. Unfortunately, in this high-stress world, our SNS is overactive, while its counterpoint, our PNS, is underactive. How can we amp down the SNS and crank up the PNS?
It is a fact that the PNS can be turned on by warm fuzzies: stroking, petting, hugging, holding a teddy bear, walking in the woods, yoga, qigong, meditation, or loving thoughts and feelings. Giving and receiving caretaking and helping others also mobilize the PNS [3]. In addition, warm fuzzies increase the release of oxytocin, the neurohormone that facilitates bonding. Moreover, activating the PNS increases activity of GABA, the inhibitory neurotransmitter, and improves the ability of regulatory centers (prefrontal cortex and insular cortex) to control the over-reactivity generated in the emotion processing centers (amygdala and hippocampus). Many addiction treatment programs include community service because helping others fosters a sense of meaningful connection, self worth, and the ability to experience the healthy addictive pleasures of giving.
There’s more good news. Changing the pattern of our breathing is probably the fastest way to jump start the PNS and thereby increase oxytocin and GABA [4]. For most people, breathing gently at three to six breaths per minute with equal inhalation and exhalation induces a calm, alert state within 10 minutes [5]. This pattern has been called coherent breathing or resonant breathing because it induces the optimal balance between the SNS and PNS — a calm, alert, focused state of mind and synchronization of brain waves with respiration and heartbeat. Furthermore, breathing at this rate maximizes the amount of oxygen the lungs extract with each breath, leading to enhanced sports performance. Gadgeteers offer a plethora of electronic devices that help correct imbalances in stress response systems and brain wave patterns. These best picks range from inexpensive to pricey:
• iPhone apps — Breathpacer (www.Breathpacer.com) and Saagara (www.Saagara.com)
• Respire-1 CD paces coherent breathing to five breaths per minute (www.coherence.com)
• Computer games — HeartMath (www. HeartMath.com) and Journey to the Wild Divine (www.wilddivine.com/servlet/-strse-72/The-Passage-OEM/Detail)
• Resperate devices can slow breathing to three breaths per minute (www.resperate.com)
• Cranial electrotherapy stimulators by Alpha-Stim (www.Alpha-stim.com) and FisherWallace (www.FisherWallace.com).
Many yoga and meditative practices include breath awareness and changing the pattern of the breath as a means to quiet the fluctuations of the mind, balance emotions, and improve stress resiliency [5,6]. Brain scans show that yoga and meditation can increase the size of critical brain areas and increase GABA activity [4,7]. Pilot studies are also indicating that mind-body practices can alter the expression of genes. One such study found that over time mind-body practices that elicited a relaxation response changed the expression of more than 1,000 genes, leading to altered metabolism, reduced production of destructive free radicals, and improved response to oxidative stress [8]. The iconic immutable DNA blueprint is giving away to evidence that many genes can be turned on (up-regulated) or turned off (down-regulated) by environmental events. Genomic research brings hope even to those with unfavorable polymorphisms. Changes in gene expression may be proven to underly many of the benefits that flow from mind-body practices, including resistance to addictions.
By understanding how innate and environmental factors contribute to addictive behaviors, we discover that caring relationship and self-healing activities, like yoga breathing, engender warm fuzzies that balance our PNS/SNS, reduce stressful over-reactivity, enhance positive emotions, bonding, and feelings of safety, and might even alter the activity of genes involved in addictions. Multi-modal treatment plans that integrate standard and complementary approaches offer greater hope for prevention and recovery for individuals who are vulnerable to addictive behaviors. Reprogramming the brain involves shifting from craving things that are bad for your mind and body to enjoying feel-good things that enhance health and well-being.
References
1. Norman Doidge. (2007). The Brain that Changes Itself. New York, Viking Press. http://www.normandoidge.com/normandoidge/ABOUT_THE_BOOK.html
2. Rolls ET, McCabe C. Enhanced affective brain representations of chocolate in cravers vs. non-cravers. Eur J Neurosci. 2007 Aug;26(4):1067-76. http://www.ncbi.nlm.nih.gov/pubmed?term=chocolate%20AND%20craving%20AND%20MRi
3. Porges SW, Carter CS. (2011). Neurobiology and evolution: Mechanisms, mediators, and adaptive consequences of caregiving. In SL Brown, RM Brown, and LA Penner, eds. Self Interest and Beyond: Toward a New Understanding of Human Caregiving. New York: Oxford University Press, 53-71. http://www.oup.com/us/catalog/general/?queryField=keyword&query=Self+Interest+and+Beyond&view=usa&viewVeritySearchResults=¬¬true&ss=relevancy
4. Streeter CC, Gerbarg PL, Saper MD, Ciraulo DA, and Brown RP. Effects of yoga on the autonomic nervous system, gamma-aminobutyric-acid, and allostasis in epilepsy, depression, and Post-traumatic Stress Disorder. Medical Hypotheses. 2012. May;78(5):571-9. http://www.ncbi.nlm.nih.gov/pubmed/22365651
5.Brown RP, Gerbarg PL, Muskin PR. How to Use Herbs, Nutrients and Yoga in Mental Health Care. 2009. New York, Norton. http://books.wwnorton.com/books/detail.aspx?ID=23122
6. Brown PP and Gerbarg PL. The Healing Power of the Breath. Simple Techniques to Reduce Stress and Anxiety, Enhance Concentration, and Balance Your Emotions. 2012. Boston, MA, Shambhala Publications, Inc. http://www.shambhala.com/html/catalog/items/isbn/978-1-59030-902-5.cfm¬¬
7. Lazar SW, Kerr CE, Wasserman RH, Gray JR, Greve DN, Treadway MT, McGarvey M, Quinn BT, Dusek JA, Benson H, Rauch SL, Moore CI, Fischl B. Meditation experience is associated with increased cortical thickness. Neuroreport. 2005 Nov 28;16(17):1893-7. http://www.ncbi.nlm.nih.gov/pubmed?term=Lazar%20AND%20meditation%20AND%202005
8. Dusek JA, Out HH, Wohlhueter AL, Bhasam M, Zerbini LF, Joseph MG, Benson H, Libermann TA.. Genomic counter-stress changes induced by the relaxation response. PloS One. 2008 Jul 2;3(7):e2576. http://www.ncbi.nlm.nih.gov/pubmed?term=Dusek%20AND%202008%20AND%20genomic%20AND%20relaxation
Reprogram With Healthy Habits and Warm Fuzzies: Trumping Addictions and Compulsions –
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