By Lauren Brande | Published 7/3/17
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Welcome back to Let’s Talk Drugs, where we take a close look at drug research so we can all be armed with facts. Let’s Talk Drugs is presented by ProjectKnow.com (that’s project k-n-o-w dot com), a website dedicated to providing digestible explanations for the complex world of drug and alcohol abuse. If you or someone you care about is struggling with substance abuse, call to reach out to our dedicated treatment support specialists for help in starting the recovery journey.
My name is Lollie, and in this series I want to take on a topic that can seem intimidating: the brain. More specifically, how drugs affect the brain. I’m sure many of us have heard that drugs can damage the brain, but why is it so few of us have heard exactly how they cause damage? Well, it’s time for you to know. This series will explore all the crazy ways that drugs affect the brain, from the mysteries surrounding psychedelics to why opioids can kill you in an instant.
In order to fully understand drug effects, we need to have a basic understanding of how the brain works. For this first episode, I interviewed Dr. Scott Salomone, a resident in psychiatry with a passion for knowledge sharing. We’ll cover the basics of brain function and how drugs manipulate this system to produce their effects. Ready for the information your health class missed? Here we go…
You might remember the PSA: a woman, holding an egg and a frying pan. The egg is your brain, the pan is drugs. She slams the pan down onto the pan, it cracks open, yolk and eggy goop running all over the counter, dripping down onto the floor. “This is what happens to your brain,” she says. She holds up the goopy, dripping pan glittered with pieces of egg shell and says, “this is what your body goes through.” Dishes and glassware get shattered, for some reason a clock is smashed in there, all while she lists other things that drugs will inevitably destroy: your family, friends, money, job, and future. It closes with a simple, “any questions?” The implication is obvious: drug use will completely destroy your life. This message was not only memorable and potent, it was honestly pretty terrifying for kids all across America.
As a kid I worked through the elementary school DARE, or Drug Abuse Resistance Education, program. In fact, I got second place in my 5th grade anti-drug essay writing contest and lectured my parents on a daily basis about their cigarette smoking (and how it would undeniably lead to heroin use down the line). The way the DARE program, and ultimately the war on drugs, depicted drug use was both intimidating and wildly incorrect. Of course drug use can lead to addiction, but trying marijuana once isn’t the fast track to shooting heroin. In fact, for many addicts, addiction starts at the doctor’s office.
This image of a cracked egg leaking down a cast iron pan has stuck around because it is extremely memorable. Countless 90’s kids saw this smashed egg-brain coupled with the escalating war on drugs and found themselves believing a terrifying narrative that they would soon discover was not true.
In high school we begin to see our peers drinking and trying drugs, further glorified by movies and television shows. The terrifying picture painted by the DARE program begins to peel away and we start to see that drug use isn’t actually turning all kids into street-dwelling lowlifes. It even looks kind of fun, and we have no education beyond the simple “just say no” that gets drilled into our heads at an early age.
Why is alcohol dangerous? No idea.
Can marijuana cause permanent brain changes? Who knows.
Why shouldn’t we steal our parent’s painkillers? What’s the worst that could happen?
All you need to know is you should never ever do anything that seems fun because you WILL end up living on the street with no dreams and no food, only wanting drugs for the rest of your life.
The gap left in the wake of a failed war on drugs has yet to be filled by adequate and accurate drug education. The fact is that scare tactics have been proven not to work, but the counter narrative of drugs being entirely safe is also dangerous and just as inaccurate. The truth lies somewhere in the middle. Drugs are not safe to abuse, but people who are going to try drugs will do it whether or not they have accurate safety information. The best we can do is arm them with the facts about drugs- an approach known as harm reduction.
The human brain develops well into our 20’s, which is a big reason the anti-drug movement has mainly targeted adolescents. If you abuse a drug before your brain is fully developed you could risk causing long-term damage that can change the way your brain works forever. The same applies for adults, but damage incurred after the brain is developed is less likely to cause permanent functional changes.1
One of the most important things to understand about drugs is how they produce their effects. The human brain is a seriously miraculous thing. Every single thing we experience in the world, from sensory input, to memories, to the ability to plan out actions and control movement, is determined by this squishy little sack of cells. Okay well, “little” isn’t the best description. It may only weigh 3 pounds, but every brain has around 50 billion independent nerve cells with over 100 trillion connections.2, 3 That’s 100,000,000,000,000, a number that’s almost impossible to grasp.
Drugs manipulate the functions of these billions of cells, or neurons, to produce feelings and sensations that are well beyond what we can naturally encounter in our day-to-day lives. Sometimes they even make us see and feel things that that aren’t there at all. Some drugs’ effects come from their ability to reduce our brain cell communication, which is a major part of what makes these drugs so dangerous. Others increase activity in the brain, which can affect heart rate, blood pressure, or even body temperature. Understanding why certain drugs or certain drug combinations are dangerous is a vital part of being safe.
Brain Chemicals Associated with Addiction
Lollie: I’m sitting here with Scott Salomone, M.D., and he studying psychiatry, he’s a resident in psychiatry. We’re going to talk to him today about how drugs work in the brain. So, Scott, how exactly do drugs work in the brain?
Scott: Well, I think to start we need to take it down to the basics of how the brain works. So the brain is a collection of billions of cells, like you previously heard, and the main cell that really does the main actions of the brain is the neuron, and these neurons have to communicate with each other. Each neuron has chemicals that it can use to communicate with other neurons around it, and they’re all connected by groupings of these neurons in a chain. They use chemicals to send a signal from one to the next.
Lollie: Does one neuron only ever connect to one other neuron?
Scott: No, they can connect to thousands of other neurons, actually. So each neuron has hundreds of arms coming off of it.
Lollie: Okay really quick I just want to go over the terminology we’re using. When you hear the term “neuro” it means “brain.” So when you hear neurosurgeon, think “brain surgeon”; when you hear neuron that’s a brain cell, a particular type of nerve cell (there are many types but we’re only going to cover neurons in this); when you hear neurologist, it’s a doctor that studies the brain… So “neuro”– whenever you hear that, it has something to do with the nervous system and the brain. We’re also going to be talking about neurotransmitters, which are brain transmitters if you think it that way. These brain chemicals are neurotransmitters, so think of it as a chemical that transmits messages. You have neuro, brain, transmitter, sending a message. So neurotransmitters are brain chemicals that neurons use to communicate to all the other neurons that they connect with.
What Are Neurotransmitters and How Do They Work?
Lollie: We know what the neurotransmitters are now, we understand that the brain is made up of neurons, but how do neurons actually communicate with one another?
Scott: So where 2 neurons connect together there’s a small gap between them, and that gap is called a synapse, and that’s kind of where the connection and communication happens. So 1 neuron (brain cell) gives its chemical (neurotransmitter) into that gap, it releases it into that gap (synapse), and then the other cell receiving that message kind of takes that neurotransmitter and conveys that message through itself. The way it does that is through receptors. Each neurotransmitter, or brain chemical, has activity with only 1 type of main receptor.
Lollie: So kind of like a lock and key?
Lollie: So it’s releasing these chemicals that only fit into this one type of receptor. Can a neuron have multiple types of neurotransmitters?
Scott: Yes, absolutely.
Lollie: With drugs, how do drugs of abuse influence this type of action that is being used to communicate. So we have a presynaptic cell (the first cell) that releases the neurotransmitter (chemicals) out into this gap, and then the second cell is like, “Oh! I got the receptors for that, okay! Come on in!” and then it sends a signal because it detects these chemicals in the gap. What do drugs do to this network?
Scott: Yeah, so there are 3 main ways that the drug can interact with this communication happening between your cells. The first main way is that it can imitate those brain chemicals that you already have naturally in your body. A drug’s structure can imitate the shape of the key and plug itself into the locks that the receiving cell has. So it can act like your body’s own native neurotransmitters.
Lollie: So you don’t need the neurotransmitter for this activation?
Lollie: Basically you’re activating it when it would not otherwise be activated?
Scott: Correct. It acts like a native chemical that you already have, but when that chemical is not there it kind of acts in its place to activate the same types of activities.
Lollie: Okay, so when you take a drug like you smoke it, or you snort it, or ingest it in some way, it gets to your bloodstream, eventually it crosses the blood-brain barrier, gets into your brain and affects these synapses.
Scott: Absolutely, and the second type of interaction that drugs can cause is to increase your own native neurotransmitter release. So when the drug connects to receptors in your brain on the different neurons there, it can cause those neurons to release their own chemicals at higher levels than they normally would. That extra activation of a certain type of neurotransmitter causes an increased response down the certain pathways, and each neurotransmitter will activate a different type of pathway.
Lollie: Oh, okay, and so these pathways can activate any type of neurotransmitter, because there are neurotransmitters that increase activity in the brain, but there are also neurotransmitters that decrease activity in the brain.
Lollie: This same method of increasing neurotransmitter release could increase activity, but it could also slow down activity, right?
Scott: Correct, in other parts of the brain.
Scott: Yeah, absolutely.
Lollie: And what’s our third one?
Scott: The third way is that it can block the neurons from re-absorbing their chemicals. So how this works is whenever a neuron releases chemicals into that synapse, that gap between the two neurons, the cells then re-take some of those chemicals back and some of those chemicals that are left in that gap get broken down. But the main way that those chemicals are saved is that they’re taken back up into the neuron.
Lollie: Okay, so the one that’s releasing is like, “Oh that was too much. Okay, let me take some back.”
Scott: Yeah, “Let me have some back so I can use it again later.”
Scott: You know, “Now that you got the signal that you needed I’m gonna keep some to make sure that I have the ability to send that message to you again.”
Lollie: But drugs stop that, so they’re like, “Nope! You’re not taking it back, you’re gonna send it across no matter what. We’re gonna flood them.”
Scott: Exactly, and so now all of those chemicals are left out in the open and that means that the signal can be sent to more cells.
Lollie: Okay, so these 3 main methods of action: lock and key, lock the floodgate open, and prevention of re-uptake (re-absorbtion). They explain how most drugs of abuse work, then, right?
Scott: Yeah, in a general sense that is how these drugs have an effect on the brain. But then, to understand more complexly how they function and how they differ, we look at which neurotransmitters they’re actually affecting. There are over 100 neurotransmitters identified, but there are certain ones that drugs tend to affect more commonly. The ones that increase signal in your brain most commonly are: dopamine, serotonin, and glutamate, as well as norepinephrine.2
Lollie: Okay, I’ve heard dopamine and serotonin a lot in reference to drugs of abuse.
Lollie: Those are the reward pathway, right? (We’ll talk about that in a little bit.)
Scott: Yeah. And then there’s other neurotransmitters that decrease signals throughout the brain, and those are: GABA and endorphins.2
Lollie: Okay, so even though they’re causing more release of neurotransmitters, drugs can actually decrease activity of the brain?
Lollie: These inhibitory signals that basically tell the next neuron, “Here’s a chemical to tell you to slow down.”
Don’t get too caught up on the names of these neurotransmitters, as we’ll be covering them in more detail later. The main thing we want you to take away from this is that natural brain chemicals called neurotransmitters are the key to brain function. These chemicals are the messaging system for neurons, and they can either cause an increase in brain activity or a decrease in brain activity, depending on the neurotransmitter being released.
Drugs hijack this system of brain communication, which is how they produce their effects.
- Some drugs pretend to be a neurotransmitter to influence signaling.
- Some drugs cause neurons to release unnaturally large amounts of neurotransmitters.
- Some drugs stop the releasing neuron from cleaning up extra neurotransmitter left in the gap between cells.
These three main methods of action ultimately result in changes in brain cell signals, which explains most of the effects that drugs have, from euphoric giddiness to stopped breathing and heartrate and, ultimately, death.
Lollie: So, drugs of abuse affect the entire brain, or do they only affect a certain part of the brain?
Scott: Yeah, so drugs can affect many different regions of the brain, but one of the biggest regions that they interact with is called the reward system. This is a system that is designed to reinforce activities that are good for your survival. So whenever you do something that is something that will help you survive it produces this pleasure feeling, or positive response that makes you feel really good and it almost rewards you for doing something that’s good for your survival.
Lollie: Hence the name.
Scott: Right, exactly. And drugs can hijack this system and create this feeling of reward for your survival.
Basically, when you eat a delicious sandwich, you feel good. When you drink a cool glass of water on a hot summer day, you feel good. When you have sex… you get the idea. Drugs take this hard-wired survival system and hijack the signals, producing the reinforcing pleasure without being necessary for survival.
When you abuse a drug, the reward system is inappropriately activated, tricking your brain into thinking that you should repeat the behavior in order to survive. Most of these thoughts are not explicit, conscious thoughts, but your brain believes them nonetheless. This is where addiction begins.
Did you learn something new? Connect with us on Twitter at #LetsTalkDrugs! We want to hear your feedback so we can expand the conversation around drug use and abuse. In our next episode we’ll look at how specific drugs affect the brain, from what makes psychedelic drugs so weird to why opioids are killing thousands of people every year.
Tune in next Monday, and in the meantime, be sure to subscribe and share so your friends will know the facts. We’re available on
SoundCloud, iTunes, Google Play, Youtube, and most podcast listening apps, so there’s always a way to stay informed. Until next time, I’m Lollie and this has been Let’s Talk Drugs. ?
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- Winters, K. C. & Arria, A. (2011). Adolescent brain development and drugs. The Prevention Researcher, 18(2). 21-24.
- Abadinsky, H. (2011). Drug use and abuse: A comprehensive introduction, 8th ed. Belmont, CA: Wadsworth.
- Kock, C., & Kuhl, P. (2013, June 14, 2013) Decoding ‘the Most Complex Object in the Universe’/Interviewer: I. Flatow. Science Friday, National Public Radio.
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