JUST SAY NO!

Victor Bloom MD

Wednesday, June 30, I attended a special lecture, along with the faculty and students of the Wayne State University's Department of Psychiatry and Behavioral Neuroscience. There must have been two hundred people there, all connected with the psychiatry department--- faculty, researchers, residents, interns, students. It was in the Detroit Athletic Club and the microphone carried an important message to every corner of the room.

The speaker was introduced by the department head and Grosse Pointer, Tom Uhde, who elaborated in detail the eminent qualities of the speaker, Dr. Alan Leshner, Director of the National Institute On Drug Abuse. We were informed that Dr Leshner is the foremost addiction researcher in the world, commanding a budget of over six hundred million dollars, supporting collaborative research all over the world. The ongoing drug problem costs the economy untold billions.

Psychiatry is not simply Freud anymore. Ours is a department of psychiatry and BOLD>behavioral neuroscience.<BOLD That means exotic studies on how the brain works. Significantly, Freud predicted this. Freud was not always a psychoanalyst; his early training was basic neuroanatomy, in which he made some outstanding and basic contributions. Then he went into the practice of medicine and neurology, discovering that some seeming neurological cases of paralysis were not really 'organic' at all, but suffered from reminiscences. He found a way to cure them by hypnosis, and later by free-association, to uncover repressed and damaging memories. Still, Freud said at the time, psychoanalysis is what we can do now, but in the future, psychiatry will be able to cure sufferers by biologic means.

His prediction was accurate--- consider the impact on the mental health field of Thorazine, Miltown, Valium, Lithium and Prozac. These drugs have been over-used and poorly used, but in many cases, restored people to functioning and family. Psychoanalysts have had to consider the neurochemical diagnosis before undertaking a commitment of psychoanalysis with a patient. In the past, analysts have failed to help some people, such as patients with schizophrenia, manic-depression or obsessive-compulsive disorder, without supplementing the psychotherapy with the appropriate medicine (pharmacotherapy).

Research studies using the PET (positron emission tomography) scan show that there are chemical differences between the brains of schizophrenics and normals. It is not yet known whether observing these differences or understanding them will lead to a cure, but it is hopeful that researchers around the world are presently working diligently and using the Internet to be in quick touch with each other. There is a 'global village' of neuroscientists working on understanding the human brain and how neurochemical mechanisms become become pathological behavior and symptoms, as well as thoughts, symbols, feelings and actions.

Dr Leshner showed us slides of a PET scan showing the brains of a people who took marijuana, and those who did not. Six months later, the marijuana group continued to show the same changes, even though they stopped taking the drug. We don't know exactly what the changes mean, but they are there. The brain of non-drug users is clearly different.

The significance of this is the intimation that taking certain controlled substances may change the brain forever, by changing its neurochemical balance. The brain is not simply hardwired, it adapts to chemicals ingested and traversing the blood-brain barrier. Kids nowadays tend to think nothing of experimenting with 'pot'. It is deemed 'safe' by them. That is the drug-pusher's and drug-dealer's 'hype', that the stuff is harmless. It is not. I have had young patients who habitually smoked pot and did poorly in school and were overly laid-back and in a fog. Initiative was sapped and instead turned to ever more desperate attempts to get the stuff, even to risking going into the worst neighborhoods of the city to obtain it, exposing themselves to real danger and, of course, apprehension by the police. When the therapy succeeded in restoring rationality, the drug abuse ended, the grades went up and ambition returned.

The science of genetics reveals that some people have a greater tendency to addiction than others. Dr Leshner's studies showed that the very first taking of a drug is a matter of choice. What happens thereafter, considering neurochemical changes, is no longer a matter of choice. I may dispute this latter contention, as I believe that no choice is purely conscious and rational. The youngsters who try drugs are looking to feel better or be one of the gang, or simply be cool and rebel. Taking chances and risking trouble are top priority in the peer group.

Therefore, parents need to be very actively involved in preventing their offspring from taking the first controlled substance. They need to work toward being a larger influence on their child than his or her peer group. They need to be aware of the activities of their child's given sub-group or clique. They need to fill their offspring's time with music, art, science and sports. It is necessary nowadays, to be able to invade some aspects of their privacy, so that it will impossible for them to hide drugs and paraphernalia in the parents' home.

We are back to the essential words of Nancy Reagan: "Just say NO!" This rational exhortation was not effective then, but hopefully new scientific knowledge will add credence to that admonition.

Dr Bloom is Clinical Associate Professor of Psychiatry, Wayne State University School of Medicine. He is a member of the American Academy of Psychoanalysis and on the editorial board of the Wayne County Medical Society. He welcomes comments at his email address--- vbloom@comcast.net.