There is an old saying that goes something like this: “You never know what’s going on in someone else’s head.” Although this phrase is meant as a moral suggestion to not judge others because you don’t know their experiences, I believe it ties in brilliantly to our topics of research as of late and our prompt. While investigating the brain and the effect drugs can have on it (therapeutic or illicit) has been eye opening to the incredible sensitivity of our brain chemistry.
Our brain is made of more than 100 billion interconnected nerve cells. These cells have developed the ability to communicate with one another via synapses. These systems enable neurotransmitters to be released from a pre-synaptic neuron and signal the post-synaptic neuron. The remaining neurotransmitter is then re-uptaken by the pre-synaptic neuron to be used later. Needless to say, the balances of these neurotransmitter chemicals are imperative to a properly functioning brain.
There it is again, that buzz word of the semester: balance. Yes, the investigation of the brain’s chemistry and its interactions with drugs continued to give us an application for the Ayurveda concepts. Drugs have one purpose: to alter the balance in your body. When drugs are used safely and therapeutically, they strive to establish or re-establish the proper chemical balance of a specific molecule in your body. When drugs are abused or misused, they will alter these balances as well, but likely for the worse as they aren’t being dosed in a controlled manner to treat an existing issue.
Before I go on, I would like to clarify a key point: drug us is not bad. When people hear “drugs” they immediately picture illicit chemical compounds which can land someone in jail for even having it. Drugs are actually just chemical compounds which mimic internal molecules in order to illicit a physical response. Illicit drug use is commonly misrepresented as “drug use” but is actually a classification of drug misuse.
That being said, the rise of drug misuse in the United States is becoming a massive issue. Opioid abuse is still prevalent throughout our society, and the age of first exposure to drug misuse culture is dropping every year. Children are starting to use illicit drugs at a young age. For obvious reasons, this is not a good idea. One of the major issues of this situation may also be one of the major causes. Our brains are masters of compartmentalization. They have developed a spatial division of labor in the brain. We have studied these areas (called lobes) and learned how each function. One of these areas is called the frontal lobe. The frontal lobe is basically our elevated thinking center of the brain. This is the core of our problem solving, intellectual activities, and, more importantly, our judgement. Our frontal lobes don’t fully develop until well into adulthood, around our mid-30’s. This means that, until our mid-30’s, we will be more likely to make irrational and impulsive decisions. There’s nothing wrong with that, it’s the way our brain develops: trial and error. Unfortunately, unlike deciding to jump off a swing and learning that you can break your arm if you do that, if you decide impulsively to try illicit drugs, there can be much worse consequences.
There are plenty of drugs out there that do everything from knocking you out for surgery to helping clear your bowels. That being said, it is very clear why the specific drugs sold illegally are wanted. Unlike something like a laxative that has no real mental effects, every one of the “bad drugs” people use are active in altering balances of neurotransmitters. Although the mechanisms of action vary, they mostly target the same few neurotransmitters, usually dopamine. Dopamine is our “feel-good chemical.” It has evolved as a signal to the brain that it has made a good decision for survival. Natural events that produce dopamine are: eating, drinking water, having sex, and even nurturing. These make sense. They are all evolutionarily advantageous behaviors that the brain is positively reinforcing. However, this balance is the target for our evil drugs. Illicit drugs increase dopamine concentrations in our brains. This signals the brain that it has done a good thing. The brain associates the feeling of euphoria with the drug, creating a desire to do it again. Repeated use can bring up some serious issues, though.
Imagine you’re the owner of a logging company. Random, I know, but just go with it. You produce a steady flow of lumber to send off to your customers. Suddenly, a friend begins to drop off large loads of lumber for free at your site. You’re overflowing with stock, and don’t need to be producing as much labor. So, you fire some of your employees due to the lack of need for them. Out of the blue, after an extended period of time, your friend stops bringing you lumber. You’re now behind on production and unable to keep up with demand. This is what we call dependence. Dependence is when your brain has associated a compound as necessary for survival. In our analogy, the friend is the drug. It produces more of the neurotransmitter dopamine (lumber) and floods the brain with it. The brain in turn produces less dopamine in an effort to return these levels to normal. This is why drug abusers must continue to increase their dosage to maintain the same high. When a dependent user tries to stop misusing the drug(s), the brain goes into survival mode. Suddenly it’s not getting the signals that it’s doing the right thing. The brain perceives this lack of stimulation to the reward center as a sign that it is no longer surviving. This is why symptoms of withdrawal can be so brutal, the person’s brain literally thinks it is dying. Until the brain can re-establish the proper balance, the person will suffer from effects of low dopamine.
So why are these drugs even available? Why were they discovered? Well, doctors weren’t looking for a way to get people high, they were seeking to treat disease and stumbled upon these. The whole point of drugs is to treat imbalances of chemicals in the brain. But how bad can these imbalances actually be? Well mutations to nerve cells can lead to imbalances in neurotransmitter balances that can cause numerous brain diseases from Multiple Sclerosis to Tay-Sachs, there are a wide variety. These diseases can alter motor function, psychological and cognitive activities like MS. They can affect storage in the brain like Tay-Sachs. They can affect a person’s personality and/or mood like schizophrenia. They can cause detrimental development issues like autism or Down Syndrome. They could even be rare prion diseases like Creutzfeldt-Jakob’s disease. As impressive as the brain’s abilities are, it is still a fragile system. I’ve been able to see this first-hand.
My junior year of high school, my father suffered a massive stroke that, by all accounts, should have killed him. A cryptogenic ischemic stroke causing full blockage of his middle cerebral artery (MCA) deprived his entire right hemisphere of oxygenated blood. Fifteen minutes after onset, he was given a clot-busting drug, TPA. It had no effect, so he was flown to a different hospital which had an interventional radiologist. He underwent a procedure called an embolectomy in which a device was run through his femoral artery and retrieved the clot to end the stroke. Conscious the whole time and undermedicated, it was a daunting experience for him. After it was all said and done, his right hemisphere was deprived of oxygen for over 5 hours. None of the doctors who operated on him or saw him that night expected him to survive. 4.5 years later, he has made a miraculous recovery and still practices as a part time anesthesiologist today. His recovery has been a long and arduous task and is still ongoing. Damage to the brain can be long-lasting and stubborn.
I’ve been present for some scary brain injuries in sports. Heck, I’ve been part of some scary brain injuries in sports. I’ve had friends life-flighted off the football field, take ambulances home from games, and even received a number of concussions on the field and, surprisingly, in the pool. But what I have learned through all these experiences, including my dad’s stroke, is to respect the robustness of the brain. Our brains are certainly sensitive and precise instruments, but their ability to heal and recover is unbelievable. The brain may have imbalances and issues, but its natural impulse to restore chemical balances, along with our pharmaceutical aid, allow it to recover from even the most dire of circumstances.