Living Well November/December 2017 by Missoulian

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November/December 2017 ~ living well

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living well ~ November/December 2017

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People in Missoula and western Montana want to feel good, look good and live well. Available at more than 150 newsstand locations throughout the area, Western Montana Living Well is well suited to more than 23,000 readers monthly who want health tips on fitness, nutrition, family, wellness, therapy and beauty.

The opinions, beliefs and viewpoints expressed by the various authors and forum participants in this publication do not necessarily reflect the opinions, beliefs and viewpoints of the Missoulian or Lee Enterprises. The author of each article published in this publication owns his or her own words. No part of the publication may be reprinted without permission. ÂŠ2017 Lee Enterprises, all rights reserved. Printed in the USA.

november/december 2017 VOL. 43

IN THIS ISSUE addiction digital addiction

over eating

Page 4

ALSO IN THIS ISSUE

Page 6

gambling

Page 12

Opioid emergency

Page 14

alcohol reshapes the brain Page 8 nicotine dependence Page 16

November/December 2017 ~ living well

DIGITAL ADDICTION by Jan Henderson, Pacific Northwest Adult & Teen Challenge

living well ~ November/December 2017

Is digital technology becoming the unspoken addiction of our society? I have asked myself this question as I find myself wanting to check my notifications at the stop light. I question myself as we all sit around the table on our cell phones or computers-being together- but not. We may all be in the same home but actually disconnected. I question it as I observe the teenagers in my life who will spend hours on their phones isolated in their rooms. I question myself as I feel the need to regularly and quickly check my emails or stop what I am doing to check my Facebook for notifications. I question it as I work with those who have lost their lives to addiction and I recognize the symptoms. Then a friend sent me the book, “Digital Cocaine, A Journey Toward iBalance” by Brian Huddleston. (Comically it is expensive to get in paperback but easily available digitally.) I was blown away by the correlation of large amounts of time on technology which produces the same thing in our brains that drugs or alcohol addiction does. He quotes on page 35 in his book: “According to cybersecurity and technology journalist Lorenzo Franceschi-Biccierai: As it turns out, receiving and answering notification results in a hit of dopamine, a chemical neurotransmitter associated with the motivation and reward response in the human brain. Dopamine is also released in high quantities when we consume drugs or have sex. Social media notifications can have the same addictive effect. “ (http://mashable.com/2012/11/03/facebookaddiction/#Dqur89aT9Pqf .) And on page 50 of Huddleson’s book, “A person who is able to derive pleasure from the simple things in life has an unobstructed highway in the brain where signals can flow freely along the dopamine pathway into the nucleus accumbens. When a person continuously floods the pleasure center with dopamine, a barrier forms and grows over time. Eventually, anhedonia sets in when the barrier grows so strong that normal amounts of dopamine can no longer get into the pleasure center. Now, only significant pleasures, such as drugs, dangerous sex, and risky thrill seeking can generate enough dopamine to deliver pleasure. “(Excerpt from Archibald Hart. iBooks. Page 37)

Since we also use technology in many positive ways in nearly every segment of our society, do not lose heart. I appreciate that Huddleson was full of ideas on how to manage time involvement with digital media so that chances for addiction are minimized. Taking time to detach helps to protect our brains. One of his recommendations was to detach every hour even for a short time, or to turn off the wifi at night so we are shutting off the dopamine dumps from our screens. Also, if we take off our notifications in our settings so that we are not being distracted by them and drawn to check what just came across our emails or social media also helps tremendously. We could even commit to have one day per week where the family chooses to turn off the wifi to have more relational time together. Does just the thought of any of this cause you to hyperventilate? If you tell your family that you are going to turn off the wifi for a few hours do you think that you will have mutiny and be hated? If so you may want to do some of your own research to see if you and your family are at risk of addiction as well. The beginning of any recovery from addiction starts with admitting you have a problem. We can all become intentional about being more relational with the ones we love. If that means turning off our notifications for social media and not checking our screens regularly just to give ourselves a break for a couple of weeks we may see how family time and interaction might be improved. Anxiety levels may decrease and any depression caused by digital stimulation may decrease as well. It may be messy for a time but it will be worth it all in the end. Go for a walk; read a paperback book. Play a board game together. Create some memories together. We will not remember what we looked at on our phones but we will remember the relational times together with loved ones. It will be worth it in the end just like breaking free from any other addition. Happy Trails of Recovery to You! Jan Henderson, Executive Director Pacific Northwest Adult & Teen Challenge Missoula Campus

November/December 2017 ~ living well

OVER EATING is this addiction?

by Kay Jennings, BSN, MSHSA, MSN, APRN-PMH

living well ~ November/December 2017

In 1980, obesity was a minor problem compared to what we see today in adults and children. Back then, the US Department of Health put out guidelines to help stop the growing incidence of obesity. Those original guidelines recommended eating a variety of food, maintain ideal body weight, eat adequate fiber and starch, avoid foods too high in fat, saturated fats and cholesterol, avoid too much sugar and sodium, and if you drink alcohol, do so in moderation. In addition, we were encouraged to increase physical activity. America has gotten fatter More than 30 years later, obesity has become a major health problem. According to data from the National Health and Nutrition Examination Survey (NHANES), 2013–2014: • More than 1 in 3 adults were considered to be overweight • More than 2 in 3 adults were considered to be overweight or have obesity • More than 1 in 3 adults were considered to have obesity • About 1 in 13 adults were considered to have extreme obesity • About 1 in 6 children and adolescents ages 2 to 19 were considered to have obesity What has happened to our society that we have actually gotten fatter? Have we suddenly all become addicted to food? Is there such a thing as food addiction? Triggers of food addiction Most nutritional studies have been done on rats. According to “¬The Hungry Brain” by S. Guyenet, rats can be made to overeat simply by feeding them supermarket foods such as Fruit Loops, sweetened condensed milk, chocolate chip cookies, salami, cheese, bananas, marshmallows, milk chocolate and peanut butter. Within weeks the rats became obese despite exercise. If these foods can make rats obese, what will it do to humans? The exact same thing! So what controls our food choices and the amount that we do eat? The brain does. But, you might ask, how does it do this? Research reveals that people who meet the criteria for binge eating disorder are also likely to be obese. People do not become addicted to celery and leeks. Rather the foods that trigger addiction are those with high concentration of sugars: Refined processed foods such as breads, snack foods, pastas made with white flour, white rice, soda pop, etc. These foods release dopamine in the ventral striatum (the reward center of your brain). The more frequently we eat these foods, the more dopamine is released in the ventral striatum and

the more reinforced (addictive) our behavior becomes. Food manufacturers have figured out how to concentrate the most addictive foods into products that keep us coming back for more. In the last 20 years our eating habits have changed and we are now eating out more frequently, particularly at fast food establishments. 50% of our food budgets are spent on eating out. The foods you find in most fast food joints is a combination of addictive ingredients and additives. The food industry has learned ways to process and combine elements in a way that stimulate our reward center. How to Avoid Food Addiction? Outsmart your brain. First of all, clean out your pantry and get rid of the processed, refined foods such as cookies, chips, ice cream. Limit your foods to ones that you have to cook or peel or crack (nuts). This will make you only want to eat when you are actually hungry and not just on cue when you see an easy-to-eat food. Next, you have to manage your appetite by eating foods that are closer to their natural states, less calorie dense, higher in protein and fiber content. These foods have less of a taste reward so are not as addictive. Get enough sleep because research has found that restorative sleep has a large impact on eating behaviors. Exercise helps burn off those excess calories especially if you do a High Intensity Interval Training. Shop the perimeter of the stores and avoid the center aisles that contain all these processed, refined foods and the sugar. And finally, manage your stress. Stress often causes one to look for and eat comfort foods that increase dopamine release and feed the addictive cycle. So start doing things such as yoga, breathing, meditation, gratitude journals, prayer, or therapy if needed. Kay Jennings, BSN, MSHSA, MSN, APRN-PMH, has more than three years of postgraduate training in functional medicine and is the owner of New Health, a functional medicine practice based in Missoula. In addition to providing in-office care to her patients, she also offers telemedicine appointments for clients across the State of Montana. To learn more about Kay and her Functional Medicine practice, call 406-721-2537 or visit newhealthmontana.com.

November/December 2017 ~ living well

Alcohol reshapes the brain

By Melissa Healy, Los Angeles Times (TNS)

The idea of a “gateway drug” may sound like a throwback to the “Just say no” era. But new research offers fresh evidence that alcohol and nicotine — two psychoactive agents that are legal, ubiquitous and widely used during adolescence — ease the path that leads from casual cocaine use to outright addiction. About 21 percent of those who use cocaine on an occasional basis wind up taking the drug compulsively, experts estimate. That leads researchers who study drug addiction to ask: What sets those addicts apart from their peers? Perhaps alcohol and nicotine are the missing link. When rats were primed with either substance, they experienced durable chemical changes in their brains that could make them more susceptible to cocaine dependency, according to a study published Wednesday in Science Advances. Those changes were etched into the machinery that turns genes on and off in the reward centers of the brain, creating a “permissive environment” for addiction, the

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living well ~ November/December 2017

study authors wrote. Indeed, when rats were allowed to drink alcohol every day for nearly two weeks — a considerable length of time in the lifespan of a rat — and then given access to a dose of cocaine, they engaged in drug-seeking behavior with such determination that they were barely deterred by painful electric shocks. The experimental results help “cement the validity of the gateway hypothesis,” said Dr. Nora Volkow, director of the National Institute on Drug Abuse, which funded the study. The findings also suggest that researchers might be better off focusing on “gateway mechanisms” — the common molecular pathways through which some substances can influence future addiction — than on “gateway drugs,” she added. To be sure, even rats who had never tried alcohol took to cocaine when given the chance, pressing a lever to administer themselves doses. And as researchers made rats work harder for a dose of cocaine, both

teetotalers and alcohol-primed rats stepped up their efforts. Many rats continued to press the lever — even when doing so resulted in increasingly stronger electrical shocks. But alcohol made a big difference. In experiments led by psychiatrist Dr. Edmund Griffin, neurobiologist Dr. Eric R. Kandel and epidemiologist Denise Kandel, all of Columbia University, a group of rats were allowed access to alcohol for two hours a day over 11 days. Then they gained access to cocaine for various stretches over the next 32 days. As researchers required more work for the cocaine, the alcohol-treated rats pressed a lever an average of 563 times — much more than the average 310 lever presses mustered by another group of rats with no alcohol history. Days after cocaine administration had ceased, the rats exposed to alcohol pressed the cocaine lever 58 times, on average — far more than the 18 lever presses averaged by the rats that were not primed with alcohol, according to the study. The two groups of animals also reacted differently to the painful shocks meant to deter them from using cocaine. Among rats who’d gotten no alcohol, the shocks prompted most to stop pressing the lever pretty quickly, with only 14 percent continuing to do so. However, among rats primed with alcohol, most were willing to endure several sets of shocks before giving up, and 29 percent continued to press the lever even when doing so brought on the strongest shocks researchers gave. It wasn’t just their drug-seeking behavior that was different; the researchers observed a wide range of chemical differences in their brains as well. Many of those changes were seen inside the nucleus accumbens, a key node in the brain’s reward-seeking network. And they took place in the epigenome, the chemical messaging system that turns genes on and off in response to changing needs or circumstances. Scientists had previously seen that when the specific brain changes wrought by alcohol were induced by other means, the result was a higher propensity to addiction. The results of earlier work by the same research group

show that prolonged nicotine use can do the same thing. “We certainly suspected” that both alcohol and nicotine were implicated in addiction to illegal drugs, Volkow said; population studies have clearly suggested as much. “But the finding of this common gateway pathway between nicotine and alcohol opens up new avenues in prevention research,” she said. Teen smoking has dropped to its lowest level since tracking began 41 years ago, with 7 percent of kids in 8th, 10th and 12th grades saying they’ve smoked in the last month. But the proportion of high school students who say they’ve drunk alcohol in the last month is about 33 percent, with 18 percent acknowledging a session of binge drinking in that period. Volkow added that the study raises the question “whether marijuana, which is also considered a gateway drug, shares these properties.” University of Pennsylvania neuroscientist John Dani, who researches addiction but was not involved in the new study, called the findings intriguing on many levels. By changing the order in which humans usually try cocaine and alcohol, the authors showed there may be something uniquely “priming” about using alcohol first, Dani said. That message is particularly important for adolescents, who should understand that drinking and smoking early in life may cause lasting brain changes that make addiction more likely down the line. The fact that the experiments were conducted on rats, not people, does not diminish the significance of their results, Dani added. “A rat is not necessarily a good model for the behavior of a human, but their neurons do things very similar to our neurons,” he said. “We have those same enzymes and same epigenetic processes in our neurons, and that’s where this has real value. At this molecular level, they’re very similar to us.”

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GAMBLING:

the new addiction! By Dr Quinton R. Hehn LCPC

Hardly, gambling and gambling problems have been around throughout recorded history in every culture of the world! Every culture has experienced some problems with gambling at rates of 2-3% generally. The big question is how anyone can get addicted to a behavior; doesn’t it require some sort of drug for an addiction? We have learned that alcohol, opiates, amphetamines, and barbiturates are all drugs that can cause addiction. Over the years I have met a number of people who beat their 12

living well ~ November/December 2017

addictions to alcohol, heroin, meth, etc. Each indicated that beating that addiction was the hardest thing they did in their life – up until they tried to stop gambling. The drugs mentioned work because they mimic drugs in our own bodies; that’s how they exert influence over us. The drugs in our bodies are the real thing and not some weak substitute and these are the key players at work in gambling addiction. Most all of us have tried gambling at some point

in our lives - probably starting with a carnival, crane machine in a store, or trying to win arcade tickets. As adults we have also put a few coins or dollars into Keno or Poker machines. We generally lost, but had a little fun and excitement in the process. This is simple first level gambling and the players enjoy the experience, often to the chagrin of the ‘real’ gamblers. This innocent fun triggers the endorphins in our brain which give us pleasure, as well as dopamine with excites us and makes us want more. People often try their luck again, especially if they are lonely, bored, tired, or sad. In the process, sooner or later they will experience a ‘win’, maybe only a few dollars, but as they keep playing over time, they will experience more and more wins which makes them more excited to try again. They also find that when they sit and gamble, their problems fade away and nothing seems to worry them in that moment. This is the second stage of the gambling problem, as a person begins to gamble more frequently, they experience the ‘escape’ from their problems and the excitement of possibly winning. It is no accident that the 80% payout rate just happens to be the most profitable. A 90% rate would addict more people but earn less profit. A 70% rate would save payouts but not addict as many people. The third stage is a time of more gambling and begins when a person realizes that they are gambling so much that they have gotten behind on their bills; they are losing money they need. Yet, rather than quit gambling, they keep retuning to the habit over and over, hoping for the big win that will make their lives okay again. Often they will turn to writing bad checks, selling or pawning property, borrowing money from friends and family, and stealing money or property to support them “just until they win enough to pay it all back.” The last stage is the ‘defeated’ stage. When people in this stage acquire money, they use it all to gamble. They do not gamble to enjoy the experience and I am often told that, while winning is the stated goal, the real goal is to sit and gamble until all of their money is gone. Winning any money just means they have to sit and gamble longer. This self-defeating stage is the cause of the high rate of suicide for compulsive gamblers. While winning money is the stated goal of gamblers, it is not really possible in the long run. The gambling machines pay out 80%, thus for every $10 put into the machine the gambler can expect, on average, to win $8. Well, that was fun! But now the money is in the machine in the form of credits, 32 credits. The gambler can collect the $8 or, like most people, can try to win back the two dollars by playing the credits. In the course of playing the entire $10, the gambler can expect to win almost $40 total, and leave with nothing to show for it.

If one gambles with $100 they get to lose the initial $100 as well as over $400 in additional ‘winnings’. While it is true that an individual can win a pot of hundreds, the law of averages says that over time these wins will all be cancelled out by the losses, many times over. In the long run, it is impossible to win. It would not be too surprising if a coin were tossed 10 times and one got 7 (70%) heads; quite believable. However, if a coin produced 700 (70%) heads in 1000 tosses, no one would find that possible! Further, not only does the 80% payout rate addict people and maximize profit, but the machine software is getting more and more sophisticated. Some machines are programmed to give the ‘player’ an extra card, or Keno number - a software generated card or number, if not a winner, is cast aside and another losing card or number replaces it. This card or number is ‘close’ to one that would be needed to earn credits. For example, a Keno player who marked 10, 20, 30, 40, and 50 would be given a number one away from one or more of these numbers because the research has shown that a ‘near hit’ triggers excitement in the gamblers brain almost to the degree that an actual ‘hit’ does. The machine players are the ‘escape’ gamblers, seeking the escape of their seat in front of the machine and in time entering a gambling trance, losing track of time and losses. Those who play live poker, bet the horses, sports bet, etc. are ‘excitement’ gamblers. They believe they have some ability to win and do develop some skills in these areas. However, the excitement they feel from winning extends to being excited just trying to win, then to just thinking about betting. Soon they become addicted to the experience and, as with all addictions, need to gamble more and more and with greater and greater amounts of money. There are a number of tests one can easily obtain at no cost to determine if someone has a gambling problem: South Oak Gambling Screen (SOGS), Gamblers Anonymous’ 20 Questions, etc. The Lie-Bet test is about the easiest: 1) “Have you ever lied about your betting - how much bet, how much lost, how much won?” and 2) “Have you ever bet more money than you planned?” Help is available! In Missoula there are currently two Gamblers Anonymous meetings each week: Mondays at 6:30pm at the Community Hospital Rehab wing, and Fridays at 9:00am at the Miller Creek Fire Station. There are also meetings held weekly in cooperation with the Montana Council for Problem Gambling, in the offices of Dr. Quinton R. Hehn LCPC, and Courage to Change.

November/December 2017 ~ living well

Opioid Emergency How Did We Get Here?

by Tamara Nauts, Executive Director, Recovery Center, Missoula

living well ~ November/December 2017

More than 600,000 deaths have occurred to date from opioid overdoses, with 180,000 predicted by 2020. Of the 20.5 million US residents 12 years or older with substance abuse disorders in 2015, 2 million were addicted to pain relievers. The recent declaration the opioid epidemic as a National Emergency by the President authorizes public health powers, mobilizes resources, and facilitates strategies to curb this rapidly escalating public health crisis. How did we get to the point of a National Emergency with scores of preventable deaths due to opioid use and overdose? Non-cancerous chronic pain became the 5th vital sign in the late 1990’s after which a more liberal prescribing practice emerged of opioids for pain management. Concurrently, our nation was plagued by a Methamphetamine epidemic like none other seen before. As predicted by drug use patterns monitored since the 1960’s, opioid and sedative hypnotic misuse always follow stimulant epidemics. This is proven true with what we face currently in our nation. Previous stimulant epidemics occurred in the 1960’s with the use of crank; then again in the 80’’s – 90’s with a sharp rise in the use of cocaine. Both of these periods of accelerated stimulant use was immediately followed by an upsurge in heroin use. Who is vulnerable to opioid use disorders? People experiencing with athletic injuries developed heroin addiction in adulthood; statistics show that 37% of persons using heroin had exposure to prescription opioids in adolescence. Of all persons prescribed opiates, 7% are vulnerable and likely to develop a substance use disorder. This in large part is due to a unique response whereby the individual experiences euphoria and a sense of well-being coupled with experiencing diminished life stressors feeds the urge to continue use. Continuing the cycle of use are the uncomfortable withdrawal symptoms accompanying opioid use when the supply is interrupted. Methamphetamine or other stimulants are most often used to diminish withdrawal symptoms which then progresses the addiction cycle to include other substance addictions. The cycle continues in a downward bio-psycho-social spiral whereby using substances is necessary to maintain a sense of normal. Increasing consequences of use appear and include decreasing health status such as the acquisition of Hep C, HIV, endocarditis, or other serious infections. Legal consequences which include incarcerations, felony convictions, DUI’s and misdemeanor charges. Finally decreased social functioning which includes loss of

relationships, poor work performance, isolation, and dishonesty with non-using associates. Once this cycle begins, it is near impossible to stop the cycle without support. Treatment becomes necessary to interrupt the cycle of addiction and provide support in establishing recovery. There are several recovery medications, or medication assisted treatment (MAT), available for opioid recovery as well as recovery from an alcohol use disorder. With opioid recovery specifically, buprenorphine, methadone, and naltrexone is used to assist in the brain healing process. With the use of these combined with treatment, the likelihood of sustained recovery increases to 85%. However, the use of MAT is not a widely accepted approach by some. There is belief that exchanging one ‘drug’ for another is not really recovery, most notably within the 12-step communities. It is important to understand that substance use disorders are a disease of the brain. What the brain synapses were able to do on their own is damaged by the use of substances. Without support the brain is not able to perform specific functions which promote feelings of ‘normal’. If this doesn’t occur, the drive to use remains. MAT helps support brain functioning and healing, which in turn produces the ability to function productively in daily living. This is similar to the need for diabetic medications to normalize insulin in the body. MAT differs in that it does not necessarily last a lifetime, but is beneficial until such a time that the brain can function effectively on its’ own. With support people are able to return to stable, productive, healthy lives. Barriers exist however within our service delivery systems and include financial barriers to paying for treatment, long wait lists, limited long term continuing care, limited transitional living homes, stigmatization of addiction and/or MAT, and less than optimal screening within our healthcare systems. Despite setbacks, we are making progress toward treatment and recovery for those who are in need. Medicaid expansion has served to widen the availability of payment for services. Increasing providers who can prescribe MAT is happening in our communities, and treatment opportunities are slowly increasing to support those pursuing recovery. Tammera Nauts is the Executive Director of Recovery Center Missoula, a program of Western Montana Mental Health Center. RCM provides inpatient and outpatient treatment services for substance use disorders and cooccurring mental health disorders.

November/December 2017 ~ living well

NICOTINE DEPENDENCE researchers identify genetic influence

Information provided by RTI International

living well ~ November/December 2017

A DNA variant-located in the DNMT3B gene and commonly found in people of European and African descent-increases the likelihood of developing nicotine dependence, smoking heavily, and developing lung cancer, according to a new study led by RTI International. Nearly 1 billion people smoke and 6 million premature deaths occur worldwide each year from cigarette smoking, according to the World Health Organization. Smoking is the leading cause of preventable death and one person dies approximately every 6 seconds from smoking-related causes, according to the WHO. The new study, published in Molecular Psychiatry, is the largest genome-wide association study of nicotine dependence. Researchers studied more than 38,600 former and current smokers from the United States, Iceland, Finland, and the Netherlands. “This new finding widens the scope of how genetic factors are known to influence nicotine dependence,” Dana Hancock, Ph.D., genetic epidemiologist at RTI and co-author of the study. “The variant that we identified is common, occurring in 44 percent of Europeans or European Americans and 77 percent of African Americans, and it exerts important effects

on gene regulation in human brain, specifically in the cerebellum, which has long been overlooked in the study of addiction.” The genetic variant was linked to an increased risk of nicotine dependence by testing nearly 18 million variants across the genome for association with nicotine dependence. The variant was also tested in independent studies and found to associate with heavier smoking and with increased risk of lung cancer. Researchers representing more than 20 organizations and institutions contributed to this study. The study was supported in part by the National Institute on Drug Abuse. RTI International is an independent, nonprofit research institute dedicated to improving the human condition. Clients rely on us to answer questions that demand an objective and multidisciplinary approach-one that integrates expertise across the social and laboratory sciences, engineering, and international development. We believe in the promise of science, and we are inspired every day to deliver on that promise for the good of people, communities, and businesses around the world. For more information, visit www.rti.org

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living well ~ November/December 2017

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