Neurobiology of Addiction

Why do certain substances have the power to make us feel good? Using drugs repeatedly over time changes the brain structure and function in fundamental and long-lasting ways that can persist long after the individual stops using. These changes in structure and function occur due to neuroadaptive changes and new memory connections in various circuits of the brain. Addiction is the hijacking of the autonomic nervous system-the primary learning system, the pleasure reward cycle. These changes are due to neurotransmitters. Neurotransmitters, substances that ferry messages from one part of the brain to another, underlie every thought, every emotion, every memory, and all of our learning. When someone is exposed to alcohol or drugs that produce feelings of euphoria, this autonomic learning takes over.

It is now believed that the neurotransmitter dopamine is the master molecule of addiction. Addictive substances enhance the action of dopamine, which fools the brain into thinking that drugs are as beneficial as nectar to the bee, thus hijacking the reward system that dates back millions of years. Each time a neurotransmitter like dopamine floods a synapse, the circuits that trigger thoughts and motivate actions are also etched into the brain. Drugs stimulate dopamine production-assaulting receptor sites, making them respond defensively, causing a dopamine deficit. So, while addicts initially take drugs to feel high, they end up taking drugs just to feel normal as a result of this dopamine deficit.

Development of Addiction

As with any other chronic disease, anyone can develop the disease of addiction. The signs and symptoms are not readily apparent in the early stages. There is a genetic element that predisposes an individual to this disease, but this genetic loading does not guarantee the development of addiction. This disease is predictable, but it cannot be predicted; anyone who is exposed to mind altering substances is at risk for this disease.

Signs and Symptoms

PHYSICAL

* Shakiness

* Tremors

* Slurred speech

* Watery eyes

* Constricted/ dilated pupils

* Diaphoresis

* Unsteady gait

* Runny nose

* N/V/D

* Weight loss/gain * change in personal grooming

BEHAVIORAL

* Mood alterations/swings

* Inappropriate laughter

* Hyperactivity/sedation

* Depression

* Impaired concentration

* Blackouts

* Hiding track marks w/ clothing

* Accidents/emergencies

* ^ relationship problems

* ^ c/o physical pain

* Insomnia

OCCUPATIONAL

* Diligent/extra shifts-This is a quality any nurse manager would love in an employee. You may think the nurse would use more sick time, but work is where the drug supply is.

* Frequent requests for work schedule/ assignment alterations-^ drug access

* Difficulty completing assignments in timely manner

* Sloppy documentation and/or unacceptable performance

Appearance on unit on days off

* Frequent trips to bathroom

* Brief unexplained absences from unit

* Medication errors * Isolation from co-workers

* Mood changes after mealtime

* Frequent reports of poor pain relief by patients

* Obsession with: Narcotic cabinet or Pyxis, volunteering to medicate co-workers patients, patient's pain control

* Diversion:

1. Large amounts of wasted narcotics-attributable to one specific nurse

2. Many narcotic sign-outs by a particular nurse

3. Significant increases in stock replacements

4. Discrepancies between narcotic record and patient record

5. Discrepancies between patient reported pain relief and patient record

6. Alterations of verbal or telephone orders for controlled substances

7. Frequent incorrect narcotic counts

8. Evidence of vial tampering

9. Using Pyxis code of another nurse