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Dear
Dr. Bill,
I am a recovering alcoholic in treatment. I am
Jewish and, to my knowledge, there is no history of
alcoholism in my family. My counselor at your institute
told me, after finding out that my mother and her mother
both are severely overweight, that there is a relationship
between a family history of obesity and my drug addiction.
When I told my mom about this, she was devastated. I
thought that I was a family aberration...an object of
shame. Should I be?
Anonymous
- Englewood
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Dear
Anonymous,
How sad it is that "shame" is still the
moralist tag placed on those suffering from an addictive
illness. It reminds me of the old story of the rabbi
who, upon learning of a congregant's addiction to alcohol,
commented, "Somebody in his family must have married
a goy!" Addiction, whatever the inciting chemical,
is AN EQUAL OPPORTUNITY BRAIN DISEASE. There is a rare
family, of any ethnic origin, that doesn't have an addicted
"Uncle Louie" hidden in the closet....in your
case the other family addicts may well be your mom and
grandma.
Robert
Mathias, of the National Institute of Drug Abuse recently
reported in NIDA NOTES (Oct.2001) on a study (Wang,
Valkow,et.al.: "Brain dopamine and obesity."
Lancet 357(9253):354-357, 2001) which suggested that
"Reduced brain activity of dopamine, a naturally
occurring substance that modulates feelings of pleasure,
may contribute to (pathological) obesity as well as
drug addiction." The study found that "the
brains of obese individuals have relatively few of the
nerve cell components, called D2 receptors, through
which dopamine acts to stimulate pleasurable feelings
from basic activities such as eating and sex. Individuals
with this deficiency may need to overeat to get feelings
of gratification from food." Because a deficit
of the same receptor has been implicated in addiction
to cocaine, heroin, and other drugs of abuse, the researchers
suggest that "it may be linked to a whole range
of compulsive behaviors."
The
study further states that, "Although many complex
factors may be involved in excessive behaviors such
as compulsive drug abuse, overeating, and gambling,
they are all similar in that THE BRAIN IS CHANGED, reward
circuits are disrupted, and the BEHAVIOR EVENTUALLY
BECOMES INVOLUNTARY. Finding low D2 receptors across
various drugs of abuse and now obesity suggests a common
brain mechanism....
"Compared
to controls, obese individuals had significantly fewer
dopamine D2 receptors located in the brain's reward
system where these receptors are concentrated.... neither
gender nor brain metabolism was related to these differences."
They found that the best direct relationship to receptor
availability was Body Mass Index (BMI)....the greater
an individual's BMI, the fewer available dopamine D2
receptors. Eating increases extracellular levels of
dopamine in the reward system, "producing feelings
of satisfaction and pleasure." Drugs that increase
dopamine levels in this area decrease appetite; drugs
that block dopamine receptors increase appetite and
lead to more weight gain. Wang concludes that "low
D2 receptor levels in obese individuals may contribute
to continued overeating to compensate for reduced stimulation
of their brain reward circuits."
Dr.
Volkow adds, "Thus, we do the things we perceive
as pleasurable...If you have a decrease in dopamine
receptors that transmit pleasurable feelings, you become
less responsive to the stimuli, such as food, sex (or
drugs) that normally activate them....When these activities
don't reward you enough, your brain signals you to do
something more that will stimulate the circuits enough
to create a sense of well-being." Thus, individuals
who have a low sensitivity to normal stimuli will eventually
develop compulsive behaviors to increase the activating
stimuli to the reward centers by overeating or abusive
use of alcohol and other drugs. Dr. Volkow concludes,
"If the only behavior that will activate reward
centers is taking drugs, then people are going to take
drugs." Thus, the goal of professional treatment
(and of AA) is to help addicted patients replace these
unacceptable behaviors with healthy alternatives that
have an equal power to activate the brain's reward centers.
Addiction is NOT a moral problem.
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