Drug Abuse Can Play Mind Games in Recovery

Dr. Richard A. Friedman, a professor of psychiatry at Weill Cornell Medical College, wrote about the long-lasting behavioral effects of drug abuse on the brain in The New York Times' Science section recently.

In his article, ”Lasting Pleasures, Robbed by Drug Abuse” Dr. Friedman tells the story of how, as a psychiatrist, he has struggled with understanding the drug addict, through one of his patients.

The doctor’s patient, in recovery for cocaine, has begun to crave the drug compulsively. Dr. Friedman concedes that his patients have told him all drugs of abuse feel good — at least initially. But for most people, the euphoria doesn’t last. The patient who Dr. Friedman writes about in this article says he craves the drug even though it doesn’t get him high anymore.

“Long after someone has apparently kicked the habit, long after withdrawal symptoms subside; the individual is vulnerable to these deeply encoded unconscious associations that can set off a craving, seemingly out of the blue.

I could not rewire my patient’s brain. But at least I could try to help him reconfigure his environment by avoiding cues that might provoke cocaine craving. I had him make an inventory of all the people and places he associated with his drug use — and then had him steer clear of as many as he could. Lucky for him that he never used drugs at home,” Dr. Friedman explained.

So, what triggered this craving? The patient had run into an old friend with whom he had used drugs earlier. Although the man did not consciously associate the friend and the drugs, his brain had not forgotten, and the meeting touched off the urge to use again.

Dr. Friedman observed that recreational drugs like cocaine don’t just usurp the brain’s reward circuit; they have powerful effects on learning and memory. For his patient, like others in recovery for drugs like cocaine and methamphetamine, their responses to everyday occurrences are lackluster.

And what Dr. Friedman and his colleagues have learned over the years treating addicts is that the loss of dopamine transporters may not be reversible and that a drug-induced pleasure doesn’t last.