Can heroin harm your brain?

Doctor's letter : Addictions

Alcohol addiction

EXPLANATION Most people are reluctant to talk about their illnesses - especially when they are addictions or addictions. This also applies to excessive alcohol consumption, the most common form of addiction. "Alcohol and other drugs such as nicotine or cannabis act through neurochemical reactions on our reward system in the brain," says Peter Neu, chief physician at the Clinic for Psychiatry and Psychotherapy at the Jewish Hospital Berlin. An increase in the release of dopamine at this point in the brain caused by intoxicants encourages the development of addiction.

How quickly you become addicted depends, among other things, on the substance in question - alcohol addiction, for example, is often insidious. "On average, it takes a good three to 15 years for those affected to become aware of their dependency," says Neu. And during this time, alcohol can cause a lot of damage: every year around 42,000 Germans die in connection with it - both from the substance itself, such as from poisoning or long-term organic damage, and from indirect effects such as drunk driving.

SYMPTOMSHow alcohol affects the individual depends primarily on the amount consumed and the individual physical and mental condition. The highest blood alcohol levels can be measured around 45 to 90 minutes after drinking. "If you acutely drink too much, it leads to equilibrium disorders and it is harder to concentrate or remember certain things," says psychiatrist Neu. The impulse threshold sinks, which means that one is more likely to be carried away to wrong actions and react more violently to one's environment. With regular consumption there is also a certain habituation effect. Then the body reacts less sensitively to alcohol, but all the more extreme when it suddenly stops, for example in a withdrawal. "This can go as far as delirium, in which the patients are disoriented towards themselves and their surroundings, tremble and hallucinate."

CAUSES It is true that when a dependency develops it is relevant how one resolves one's conflicts, what one is used to from oneself and others, or how the environment around one is designed. However, as with many other diseases, experts today assume that alcohol addiction has several causes that work at the same time: "These are primarily behavior, environmental factors or hereditary predispositions," says Neu. However, this does not mean that if one parent has drunk, the children will automatically follow this example. "Because the notorious addictive gene does not exist scientifically."

DIAGNOSIS “In order to make the diagnosis, certain criteria have to be met.” To do this, the doctor checks whether the patient has already developed a tolerance for the effect or whether he has lost control of the amount of drink. Does the victim drink as if under duress? Do you notice withdrawal symptoms? Does the patient continue to drink even after they have noticed how negatively this is affecting their social life?

In addition to these points, the doctor clarifies whether there are other mental illnesses that can induce drinking, such as depression or a stress disorder after previous traumatic experiences.

THERAPY Regardless of how much someone can tolerate, excessive alcohol consumption is harmful to the body. Because alcohol acts as a cell poison that attacks cells and organs such as the liver or the nervous system above a certain amount. Any subsequent physical damage that has already occurred must therefore be treated, but above all doctors fight alcohol abuse itself as its cause.

Therapy usually takes place in three steps: "First, the patients are put on withdrawal under medical supervision," says Neu. "That is very demanding for them, because the body has got used to the alcohol." The reward center, the brain metabolism and the entire body have to adapt to this sudden stop. Strong physical defense reactions can occur here (see symptoms). Acute withdrawal takes around three weeks. "In the second step, the patients are involved in psychotherapy and behavioral therapy," says psychiatrist Neu. Self-help groups such as Alcoholics Anonymous are also involved in this phase. In the third phase, patients should be assured of further treatment after the acute clinic so that the transition to an addiction-free life can be achieved.

How high the chances of a permanent cure are in alcoholics is difficult to predict, because each case is individual. Studies show that after inpatient therapy, every second addict gets rid of alcohol permanently. However, relapses are not uncommon with alcohol addiction. "Old addictions can be reactivated at any time, so it is best for patients to refrain from alcohol completely after successful therapy," says Neu. Support from the social environment or regular meetings in self-help groups can help to remain abstinent over the long term.

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Heroin addiction

EXPLANATION The history of natural opiates goes back to ancient Egypt two to three millennia ago before our era. "Heroin is one of the opiates that are also used as anesthetic in medicine," says addiction expert Peter Neu. Heroin use, for example, triggers a suddenly shooting sense of wellbeing and alleviates pain.

But illegal drug use can have fatal consequences because it can be addictive and damage the body. "Heroin acts on the reward center in the brain and is stronger and faster than other drugs such as alcohol," says Neu.

SYMPTOMS Once a heroin addict has administered his dose, he usually appears lethargic and sedated - in other words, very different from someone who is on stimulating or stimulating drugs, for example. In contrast to alcohol, heroin is not a substance that is directly harmful to organs. "Rather, it is the complications of addiction and consumption that heroin addicts perish," says psychiatrist Neu. Thromboses, abscesses or infections with hepatitis or HI viruses through the use of dirty needles are not uncommon. “Many of those affected become neglected because of their addiction or they no longer eat.” Heroin also affects the rhythm of breathing, which is why there is a risk of suffocation if an overdose occurs. There is also a risk of unconsciousness, circulatory failure and a slow heartbeat.

CAUSES An addiction disorder can have biological, familial, and social causes. In general, drugs stimulate the reward center, which is located in the mesolimbic system (see graphic). Actually, it is used for the preservation of the species and for reproduction, since it ensures feelings of happiness in "evolutionarily desired" behaviors - for example when eating, drinking or having sex. If the reward center is stimulated, it releases various messenger substances that have different effects on the body. "Heroin inhibits pain receptors and leads the addiction center to believe that it has positive effects," says Neu. As a result, those affected would often withdraw into a constructed, illusory world if they could not cope well in the real world. However, addiction can also be genetically determined in part - at least for heroin, experts see a connection.

DIAGNOSISThe World Health Organization has set four criteria to define addiction in general: regularity, compulsiveness, withdrawal symptoms and tolerance development. With the latter point, those affected continuously increase their drug use in order to get the same effect. "We check whether these criteria apply to the patients and reconstruct the amounts of drugs the patient usually consumes," says chief physician Neu. In addition, almost all intoxicants can be detected via a urine test.

THERAPYThe personal insight into being an addict is the key to successful treatment - because this is mainly based on the principle of voluntariness. "We treat the addicts in three steps: withdrawal, therapy and reintegration," says addiction expert Neu.

The addicts are separated from the drugs in a clinic in different ways - "cold" or "warm". With a "cold withdrawal", the patient is radically isolated from the addictive substances. Withdrawal symptoms such as depression, anxiety, headaches and body aches, itching, nausea, vomiting and diarrhea make the first few nights a torture for them.

In the case of “warm withdrawal”, the addictive substances are gradually discontinued or replaced with alternative substances such as methadone. But even here the withdrawal symptoms are inevitable. "Acute heroin withdrawal usually takes three to six days and demands a lot from the patient, but it is not really physically dangerous for them," says Neu.

The real work to get off the drugs for good doesn't begin until the poison has left the body. In the individual and group therapies, those affected learn to develop a personal disease concept and are motivated to change their lives. “Because with addicts, personal contact is particularly decisive for whether or not someone can be helped after withdrawal,” says psychiatrist Neu.

Drug addicts have the best chances of staying “clean” in a functioning social environment made up of family and work. Without this network, the outlook is bleak. Only one in five will manage to exit in the long term, says Neu.

The editors of the magazine "Tagesspiegel Kliniken Berlin 2016" compared the Berlin clinics that treat this disease. For this purpose, the treatment numbers, the hospital recommendations of the outpatient doctors and the patient satisfaction were compiled in clear tables in order to make it easier for the patient to choose a clinic. The magazine costs 12.80 euros and is available in the Tagesspiegel shop.

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