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FACT: Addiction is a chronic, often relapsing brain disease that causes compulsive
drug seeking and use, despite harmful consequences to the addicted individual and
to those around him or her. Although the initial decision to take drugs is voluntary for
most people, the brain changes that occur over time challenge an addicted person’s self-control and hamper his
or her ability to resist intense impulses to take drugs.
The American Society of Addiction Medicine states:
“Addiction is not about drugs, it’s about brains. It is not the substances a person uses that make them
an addict; it is not even the quantity or frequency of use. Addiction is about what happens in a
person’s brain when they are exposed to rewarding substances or rewarding behaviors, and it is more
about reward circuitry in the brain than it is about the external chemicals or behavior that “turn on”
that reward circuitry.
Many people do not understand why or how other people become addicted to drugs. It is often mistakenly
assumed that drug abusers lack moral principles or willpower and that they could stop using drugs simply by
choosing to change their behavior. Whereas choice is involved, there are brain change barriers that must be
overcome in order to return to a sober life. Like Cancer and Diabetes, Addiction cannot be cured, but it can be
managed. First and foremost however, we must have a clear understanding of this complicated disease.
SOME BASICS
There is a natural chemical that our brain produces called Dopamine. Dopamine is a neurotransmitter that helps
control the brain's reward and pleasure centers. Dopamine also helps regulate movement and emotional
responses, and it enables us not only to see rewards, but to take action to move toward them. This chemical is
what stimulates our pleasure center and also lets our brain interprets what measures it needs to take for
survival. Dopamine is released naturally after we see or experience things we like; say a steak dinner, a kiss,
hearing a funny joke, etc. Dopamine makes live enjoyable. Without it we become unbearably depressed.
THE GAME RULES
Think Pac-Man for a minute: The game brain hurls out little Pac-Dots called Dopamine. In order for Dopamine to
do its job of making us feel good, it must be eaten by a Pac-Man receptor. A few balls of Dopamine get tossed
out with a pleasurable activity and a few receptors grab it up to allow us to feel the joy.
x xx
Understanding Addiction via Pac-Man By Susan Bartz Herrick, MFA, Ed.D., Mom
2
Let’s say candy bar might toss out 1 ball of Dopamine. Drugs like Heroin, Cocaine, Oxycodone, even Alcohol,
release up to 100 times the normal amount of Dopamine - or 100 balls. This dumping causes euphoria which is a
definite feel good! It’s easy to see why swallowing one little pill that causes euphoria may induce one want to
swallow another one. – 100 more dopamine dots instead of just one.
After doing this continually however, we see that there are obviously going to be too many balls out on the field
for the normal amount of Pac-Men to consume as they simply cannot eat up the unusually high amount of
Dopamine balls that are being supplied. But our brains, being creative little organs, seek any and every means
for survival and therefore they simply grow other Pac-Men to help it accommodate the overload and the game
speeds up. 100 dopamine balls – 100 Pac-Men.
TOLERANCE
This means 200 times the normal amount of Dopamine Dots is being released and the process continues: Not
enough Pac-Men to eat the dots so the brain grows another, and another and another.
This is called drug tolerance. With continued use, tolerance grows due to the extra Pac-men that need to be fed,
and fed on a consistent basis This is why drug addicts can take drugs in a high enough dosage that it would kill a
normal person. For them it is the amount that they need to feed all those critters and keep feeling normal. Too
much of these drugs however can close down the heart, lungs, kidneys, etc and this is when overdose death
occurs.
CHEMICAL DEPENDENCE
Soon the need for pain relief and/or feeling euphoria is up to 6 or 7 pills a day. At this point the brain brain is led
to believe that it now HAS to have this chemical to survive, just as it knows that it needs food and sex to live and
to reproduce. However the chemical foundation of the brain has now been permanently changed as these Pac-
Men simple do not return from whence they came if there is not enough food. They arrived hungry and are
here to stay and will make the brain feel starved if they are not fed.
So, now we have 100 Pac-Men running around wanting to
be fed when the dopamine balls run low. They are not
happy little campers when they are hungry so they start
chasing along with the original Pac-Man to gobble up the
dopamine dots as they can. This action then places a
demand for more drug dots. But now instead of needing to
only take 1 or 2 pills a day, suddenly people find that they
need 3 or 4 to get relief or to experience a ‘feel-good.’
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WHY ‘JUST SAY NO’ DOES NOT WORK
Just saying NO to Drugs is a well-intentioned phrase but biologically impossible at this point. When Pac-Men are
denied food they simply don’t lie down and get absorbed back into the grey matter. Instead they go into panic
mode and start savaging for dopamine dots. They think they are dying which in turn translates to the conscious
mind as it thinks it is dying. It is a violent physical sensation of deprivation that puts the body into a panic state.
Just as an individual would try to claw their way out a burlap bag that was about to be tossed into the ocean, so
a brain addicted to drugs will try to do anything to get what substance it needs to survive. This is where deviant
behavior, criminal actions and immoral choices begin. ‘Survival at all Cost’ is the brains mandate and the mind
seeks out the substance that will end the torment.
JUSTIFICATION
Most addicts want to stop but feel they cannot as the fear of drowning in their own head it too frightening. On
and off for months or years they try to give it up but the cravings, those pesky hungry Pac-Men are relentless.
At this point also, one part of the brain has greatly reduced
making its own dopamine as it now relies directly on the
drug. The other part of the brain now thinks that without it
drugs it will die. The brain does not care where the
dopamine comes from – it just knows it MUST have the
substance or it will die. In a very short period of time the
normal brain that has its one Pac-Man running around
eating dopamine dots an addict may have scores of Pac-
Men running around searching for food.
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To keep the game alive, people cycle through justification stages keeping their addiction in place.
It would be nice if the stages just came step by step and faded into acceptance. They don’t however. They go
back and forth day to day – sometimes hour to hour before one gets a crack at acceptance. Family members go
through the same stages with the addict as they try to save the lives on their loved one. It’s is a heartbreaking
rollercoaster ride for everyone until professional help is sought or forced upon them - which is usually the case.
INTERVENTION
Acceptance: “This is my problem and I must do something about it. If not I will die as the demon always
wins in the end. “Hitting Bottom” is the final stage. If you love someone with a drug accept you will
allow them to get to this point ASAP. It’s called “Tough Love.” Don’t enable them to keep using. Don’t
get hooked into their game. You didn’t cause their Addiction. You can’t control their addiction and you
can’t change their addiction.
Intervention is a professionally directed, education process resulting in a face to face meeting of family
members, friends and/or employer with the person in trouble with alcohol or drugs. Intervention helps the
person make the connection between their use of alcohol and drugs and the problems in their life. The goal of
intervention is to present the alcohol or drug user with a structured opportunity to accept help and to make
changes before things get even worse.
Consulting an addiction professional, such as an alcohol and addictions counselor, social worker, psychologist,
psychiatrist, or interventionist, can help you organize an effective intervention. A substance use or addiction
professional will take into account the particular circumstances surrounding the alcohol or drug use, suggest the
best approach, and provide guidance for what type of treatment and follow-up plan is likely to work best. So off
to Detox they go. You breathe easy again – they go through hell.
Denial: “I don’t have a problem. I can quit at any
time.”” Now you may argue that they don’t see it!!
You are right - and that is a good example of what
denial looks like. It is not the addict ignoring the
problem – they simply do not see it.
Bargaining: ‘I may be addicted to drugs but I can still
drink.’ ‘ I’ll substitute another drug but only keep it at
a small dose.’
Anger: “This is unfair!” Acting out accompanies this
stage – not nice to be around.
Depression: “I give up.”” I might as well die, or keep
using, as I can’t beat it.” Easy to OD here…
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WITHDRAWAL
7 to 10 days of extreme sickness (WD). The brain sends out distress signals just like it would if one quit eating.
The symptoms of drug withdrawal, and the length of that withdrawal, vary depending on the drug of abuse and
the length of the addiction. These are a few withdrawal symptoms and timelines for major targets of abuse:
After a while the brain begins to realize that it is not going to die the addict starts to feel better physically. But
that is by no means the end of the problem. Think of those Pac-Men again for a minute - wouldn't it be nice if
when addicts quit the cravings disappeared and everything went back to normal? Unfortunately, that is not the
case and the addict’s brain is forever altered. Those Pac-Men NEVER go away, meaning they will always have all
those extras. Herein lays the problem…
DANGERS EARLY SOBRIETY
People think that since the addict has not taking drugs and feels a little better that all should be well towards an
easy recovery. Unfortunately this is far from true. In early recovery anything that releases Dopamine needs to be
reduced or eliminated if possible. Yes, food releases dopamine and of course they have to eat. But what they eat
can be the road in or out of hell.
Case in Point: The recovering addict eats candy bar. The normal amount (one ball) of Dopamine is released. But
all of those extra Pac-Men wake up to receive it and starts to scream "IT'S NOT ENOUGH!!" Which of course it is
not, as they now have 300 Pac-Men ravaging about expecting to be fed.
As stated before, the extra Pac-Men don’t go away. They do become less sensitive however and lay down in a
semi dormant state. But it takes a long time to get to that point and for that reason early recovery is so difficult.
The smallest triggers can set off a cataclysmic reaction. Many in early recovery overeat and start craving right
after a good meal. The dopamine dump for the cupcake quickly turns into a craving for drug of choice wake up
the dormant Pac-men. Some foods and drinks more than others.
HEROIN AND PRESCRIPTION PAINKILLERS: FLU-LIKE SYMPTOMS LASTING 24-
48 HOURS
BENZODIAZEPINES: ANXIETY AND/OR SEIZURES LASTING WEEKS OR (IN
SOME CASES) MONTHS
COCAINE: DEPRESSION AND RESTLESSNESS LASTING 7-10 DAYS
ALCOHOL: TREMORS AND/OR SEIZURES LASTING THREE DAYS TO SEVERAL
WEEKS
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MISSING LINKS OF UNDERSTANDING - DIET AND THE GUT
It’s not just the drug that sets the Pac-Men off. It can be normal every day foods, drinks, and sensory images.
That is why it is a good idea to avoid sweets or products like NyQuil, because they contain sugar and alcohol,
which "teases' those Pac-Men unnecessarily. AVOID SUGAR IN ALL FORMS. Stick to foods that have a low Glycemic
index to keep your blood sugar stable. Link Low Glycemic Foods.
Eat breakfast. Lots and lots of protein. Eat protein with every meal or snack, and eat at regular intervals. Why?
All of these things will stabilize blood sugar, so that moods and energy are at an even keel. Eat enough to feel
satisfied, and regularly enough so to feel stable, and thus curb cravings away. The will Keep the Pac-Men
dormant.
At the Integrative Addiction Conference 2016, experts on the subjects of addiction and nutrition address the
link between gut flora, neurotransmitters, and addiction. They reported that there are over three million
bacterial cells inhabiting our bodies. These bacteria can alter our ability to absorb certain vitamins and other
vital nutrients, such as Vitamin B6, which is supposed to promote the health of nerve and muscle cells.
Bacteria and other microbes have also been proven to affect brain chemistry and neurotransmitter production
and reception. Studies in rats and mice have shown that those without the beneficial bacteria in their guts have
impaired production of Brain-derived Neurotrophic Factor or BDNF. This protein is known to be involved in
anxiety response in humans, and low levels have been implicated in various psychiatric diseases including
depression and chronic anxiety. If both dopamine and serotonin levels are low, people will have no motivation
and no pleasure or contentment, resulting in depression and cravings.
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POSSIBLE CONTRIBUTOR TO ADDICTION
A large proportion of these neurochemicals is produced in the gut and affect appetite. The enteric nervous
system (Gut) uses more than 30 neurotransmitters, just like the brain, and in fact 95 percent of the body's
serotonin is found in the bowels. Now who would have thought!! It is only recently that research has been made
into the possibility that the microbes in the gut produce the substances. As the production of these
neurotransmitters and the anatomy of their receptors becomes affected or damaged by the presence of harmful
microbes and the lack of beneficial bacteria in the gut, the symptoms associated with their deficiency or
imbalance increase. Sufferers rely on ever-increasing quantities of mood-altering substances to balance the
shortfall. But the pleasure granted by these devices and substances becomes more and more fleeting, so more
and more has to be taken for the same “high”. Thus, addiction is born.
Understanding the problem informs the solution. *Adopt a diet that limits gut damage and prevents the release
of harmful bacteria into the blood stream. Nutritional supplements and probiotics can restore the beneficial gut
flora to healthy levels. **There are also supplements that can increase the production and supply of the
neurotransmitters. A holistic and integrated approach to a solution will be more effective than treating only the
neurochemical imbalance without addressing the cause, which lies in the gut and the gut flora.
MAINTAINING SOBRIETY
Even though they are still there, eventually fewer Pac-Men will scavenge about and things will return to as close
to ‘normal’ as addicts will ever be able to get. So basically, addicts have Pac-Men for life lying dormant. If 6
months to a year of clean time passes, they pretty much leave the brain alone. Cocaine addicts have two years
8
of hungry Pac-Men. Sorry – just how the drug works. The longest time belonging to those whose DOC (drug of
choice) is opiated based, such as Vicodin, Oxycontin and Heroin. This is why such extreme caution has to be use
in early recovery and also why so many addicts relapse. It take so long to feel normal again that most give up
and return to the drug induced normality that they are used to - just to feel happy, not high.
How many times have you heard an addict say that they were clean for a while and thought they could just use
recreationally now and control it? Of course they can't control it, once they take that first pill (or whatever)
again, the HUGE amount of Dopamine is released and ALL of those dormant Pac-Men are wakened and the
tolerance is just as high as it always was. They don't have to build it back up and pick right back up at the
amounts that we are accustomed to.
Or, how many times have you seen someone who never had a drinking problem get clean from pills and then
become an alcoholic? They think that if they are not taking their DOC (drug of choice) they will be ok. But
remember, our brain doesn't know if we are feeding it Vicodin, 'H' or whiskey. All it knows or cares about it is
the end result that the substance produces. PAC- MEN chomping after Dopamine balls.
HEALING THE BRAIN
Addiction Addressed! Check. Withdrawal Over! Check. Not using any other substance! Check. Feeling great!
Not check. Feeling miserable instead: can't sleep, depressed, anxious, etc, etc.... Now, why is this, it's not fair,
right? They did what we were supposed to and yet they feel so ABNORMAL and it seems to last forever.
Well, the reason for this is simple. When they were growing all those extra Pac-Men. and training their brains to
rely on unnatural chemicals, they were actually physically altered the chemical makeup in the brain. So now they
are left with a bunch of synopsis (sic), and receptors that are in essence "misfiring". The brain was used to most
of the Dopamine coming in buckets instead of little pellets. The brain has to learn to make all its own feel good
chemicals again. And they are not just dopamine. There are other neurotransmitters involved including
epinephrine and norepinephrine, GABA, serotonin and dopamine, are closely tied to addiction behavior.
High levels of Serotonin keep away anxiety
and compulsions.
Norepinephrine is for energy and alertness
neurotransmitters and
Even hormones get wacked out with drug and
alcohol abuse.
9
There is hope however. Along with some cutting edge pharmaceutics to cut cravings, many clinics are starting to
use nutrition and nutraceuticals to do a rapid recovery of these neurotransmitters with great results. I know this
may sound counterintuitive, but medication is an essential part of alcohol/drug addiction treatment.
MEDICATIONS FOR ALCOHOL WITHDRAWAL AND MAINTENANCE
The medications most commonly used for alcohol withdrawal are benzodiazepines, sedatives that calm anxiety
and nervous system excitability by slowing down nerve impulses. Short-term side effects may include
drowsiness, dizziness, and dry mouth. They are administered by Doctors and one should not try to mix and
match drugs at home to save money. Believe or not, there are free detox clinics around.
Of course it’s not medications alone that will help. Treatment works well when medications and behavioral
treatments, such as counseling or a support group like Alcoholics Anonymous or Narcotics Anonymous are
combined. The right drug can help you overcome the desire for alcohol and help body and mind cope with the
physical effects of withdrawal, which could otherwise be life-threatening. The support group keeps you reaching
for them and not your DOC.
These medications are approved for treating alcohol dependence long-term to keep the Pac-men asleep and
therefore maintain sobriety after withdrawal:
Naltrexone Naloxone Subutex Campral Baclofen Neurontin
NUTRACEUTICALS FOR MAINTENANCE
BUT WAIT!!! Another important area in recovery and relapse prevention is the use of nutrition. The addition of
appropriate amino acids that serve as the building blocks for neurotransmitters can be a life saver as the brain
instantly recognizes them as calming agents. As stated before, neurotransmitters, including epinephrine and
norepinephrine, GABA, serotonin and dopamine, are closely tied to addiction behavior. With the use of various
amino acids, brain chemistry can be changed to help normalize and restore deficiencies in the
neurotransmitters that spur cravings that can lead to addiction and relapse. A much safer approach.
People recovering from alcohol or drug addiction are frequently deficient in essential minerals. This is due to
poor dietary habits during the addiction, as well as decreased organ function that leads to subpar nutrient
uptake. Common deficiencies include zinc, chromium, magnesium, calcium, iron, potassium and selenium.
Supplementing with zinc improves liver, brain and immunity function, while chromium will help stabilize blood
sugar levels. Calcium and magnesium help reduce irritability during recovery while restoring bone health and
muscular and nerve function. Iron will help reduce the headaches, fatigue and depression, while potassium will
help reduce muscle cramps and fatigue. Both potassium and selenium improve your blood pressure and heart
function.
Methadone Suboxone Levo alpha acetyl methadol Antabuse Acamprosate Topamax
10
Supplemental
Ingredient
Restored Brain
Chemical
Addictive
Substance Abuse
Amino Acid
Deficiency
Symptoms
Expected Behavior Change
D-Phenylalanine or
DL-Phenylalanine
Enkephalins
Endorphins
Heroin, Alcohol,
Marijuana,
Sweets, Starches,
Chocolate,
Tobacco
Most Reward
Deficiency Syndrome
(RDS) conditions
sensitive to physical
or emotional pain.
Crave comfort and
pleasure. Desire
certain food or drugs.
Reward stimulation. Anti-
craving. Mild anti-depression.
Mild improved energy and
focus. D-Phenylalanine
promotes pain relief, increases
pleasure.
L-Phenylalanine or
L-Tyrosine
Norepinephrine
Dopamine
Caffeine, Speed,
Cocaine,
Marijuana,
Aspartame,
Chocolate,
Alcohol, Tobacco,
Sweets, Starches
Most Reward
Deficiency Syndrome
(RDS) conditions.
Depression, low
energy. Lack of focus
and concentration.
Attention-deficit
disorder.
Reward stimulation. Anti-
craving. Anti-depression.
Increased energy. Improved
mental focus.
L-Tryptophan or 5
hydroxytryptophan
(5HTP)
Serotonin Sweets, Alcohol,
Starch, Ecstasy,
Marijuana,
Chocolate,
Tobacco
Low self-esteem.
Obsessive/compulsive
behaviors. Irritability
or rage. Sleep
problems. Afternoon
or evening cravings.
Negativity. Heat
intolerance.
Fibromyalgia, SAD
(winter blues).
Anti-craving. Anti-depression.
Anti-insomnia. Improved
appetite control. Improvement
in all mood and other
serotonin deficiency
symptoms.
GABA (Gamma-
amino butyric
acid)
GABA Valium, Alcohol,
Marijuana,
Tobacco, Sweets,
Starches
Feeling of being
stressed-out.
Nervous. Tense
muscles. Trouble
relaxing.
Promotes calmness. Promotes
relaxation.
L-Glutamine GABA (mild
enhancement)
Fuel source for
entire brain
Sweets, Starches,
Alcohol
Stress. Mood swings.
Hypoglycemia.
Anti-craving, anti-stress.
Levels blood sugar and mood.
GABA (mild enhancement).
Fuel source for entire brain.
Note: To assist in amino-acid nutritional therapy, the use of a multi-vitamin/mineral formula is recommended. Many vitamins and minerals serve
as co-factors in neurotransmitter synthesis. They also serve to restore general balance, vitality and well-being to the Reward Deficiency Syndrome
(RSD) patient who typically is in a state of poor nutritional health (see paragraph above chart for explanation of RSD).
This chart was originally published in the following article.
Blum K, Ross J, Reuben C, Gastelu D, Miller DK. "Nutritional Gene Therapy: Natural Healing in
Recovery. Counselor Magazine, January/February, 200
11
EXERCISE
1. Exercise relieves and reduces stress. Exercise has been shown to alleviate both physical and
psychological stress. Tension builds in our bodies when we’re at work, during everyday interactions, and
even when we’re watching television. This tension can come from having poor posture at work or having
a bad interaction with a co-worker. Moving your body alleviates this tension, and allows you to get rid of
any negative emotions you have been keeping in. Focused exercise uses both physical and emotional
energy, that might otherwise find unhealthy ways of escaping.
2. Exercise naturally and positively alters your brain chemistry. When you exercise, your body releases
those endorphins balls which create a natural high. These are the same endorphins your body released
while you abused substances. However, abuse of drugs and alcohol causes an imbalance that interferes
with a person’s ability to feel pleasure, happiness, and satisfaction. Dedicated physical activity during
treatment and recovery will help you reintroduce natural levels of endorphins in your system. This not
only helps you feel better, but reteaches your body that it is capable of regulating your own brain
chemistry and mood in healthy, natural ways.
3. “Exercise is meditation in motion.” The Mayo Clinic has described exercise as “meditation in
motion,” meaning by concentrating on the physical we can experience the psychological and emotional
benefits of meditation. Through movement, we can refocus our thoughts on our own well-being and
forget, at least briefly, all that is going on in our lives. You may leave your work-out with a clearer mind,
feeling more rejuvenated and optimistic. Finding this clarity within chaos can make recovery much more
manageable.
4. Exercise improves your outlook. Those who exercise regularly report increased feelings of self-
confidence and optimism and reduced feelings of depression and anxiety. This is in part has to do with
the body regulating and calibrating itself during exercise, but it also has to do with feelings of
accomplishment, pride, and self-worth as you see your body transform and your goals reached. As you
reach certain benchmarks you feel more accomplished, and reinforces the goal of continued sobriety as
attainable.
In addition, regular exercise fosters improved sleep, greater energy, and enhanced feelings of well-being, all
which make life much more manageable and enjoyable and recovery that much more possible and sustainable.
Many who abuse drugs or alcohol neglect important components of
daily health, wreaking havoc on both emotional and physical well-
being. It is important to repair the psychological and physical damage
of chemical dependency as well as the damaged mind-body
connection. Exercise in chemical dependency treatment serves many
purposes, but there are some primary benefits one can get from
exercise during substance abuse treatment and recovery.
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MEDIATION
Researchers from Yale recently found that a 4-week mindfulness training program was more effective as a
treatment for addiction for smoking than the American Lung Association's ‘gold standard’ treatment. Over a
period of 4 weeks, on average, people saw a 90% reduction in the number of cigarettes they smoked-from
18/day to 2/day and 35% of smokers quit completely! In a four-month follow-up over 30% maintained their
abstinence.1
Neuroscientists found that after just five 20 minute sessions of a mindfulness meditation technique, people had
increased blood flow to an area of the brain vital to self-control, the anterior cingulate cortex. After 11 hours of
practice, they found actual physical changes in the brain around this area.2
Although rigorous research on the use of meditation for addiction relief is still in its infancy, the results show
great promise for binge eating disorder, cigarette addiction and alcohol relapse prevention. It has even reduced
marijuana and crack consumption in trained prison inmates.
CONCLUSION
The sad truth is that only 2 out of 10 addicts recover and stay clean. And it again is not because they are weak
people, but rather because it is such an enormous battle mentally and physically. I mean, how long can you go
through living everyday just not caring about anything? That feeling will eventually pass, but it does take time
and most can't get through that. BUT, if one stays strong, has a support system and is patient, one day they
discover that they can smile again and while it may only last a few seconds, it is a real feeling and they can being
to hope.
There is life after drugs, and I won't lie, it is NEVER the same as it was before the addiction takes over but it can
be rewarding and meaningful. Have faith. Work the steps. Take care of yourself – One Day at a Time.