Biological Homeostasis and Adaptation are not Diseases

by Clark Miller

February 20, 2019

In these remarkable times – of public health crises created by healthcare, of addictive, abused opioids funded by public resources and fueling economies of abuse, of a public health “harm reduction” strategy endorsed by the FDA and Big Medicine flipping within months to a recognized pediatric substance dependence epidemic – we should perhaps not be surprised to find that colorful, exciting images of the human brain, in the age of Xbox and PlayStation, would be constructed as “research” establishing etiology (cause) of fictional disease states, the fictional brain disease critical to protecting status and control of resources by industries driving “treatment” approaches over past decades for public health epidemics that have continually worsened.

Or be surprised to know that it’s all a useful fabrication, and that the transient changes in brain imageable activity patterns in fact represent the most basic of adaptive, protective physiological mechanisms designed by evolution to maintain health in the organism – biological adaptation and homeostasis.

It turns out that brains change all the time, including in response to experiences in environments like adverse childhood experiences (ACE). Those changes are visible in brain scans and are known, predicted, by decades of research in areas of developmental neurobiology, social ecology, and psychology on how those experiences shift developing brains toward, for example, hyperarousal or “high alert” as an adaptive response – guaranteed by millions of years of evolution – to strengthen the ability of the organism to detect and react quickly and protectively to signs of danger in its environment.

(from PsyPost December 8, 2018)

Some key points:

The changes and capacity for those changes are adaptations and are adaptive, protective.

Kids with the changes – apparently visible on brain scans – are helped by treatment. Not medical treatment for a medical condition, instead effective, evidence-based psychotherapies, parent-skills training, and psychosocial supports to regain sense of safety, connection, competence, predictability, other factors.

In the fields of child psychology and mental health, the large longstanding areas of research related to ACE and its prevention and treatment – no one has or is framing those known, predictable, adaptive changes in brain neurophysiology (detectable in brain imaging, like essentially all repeated patterns of experience are) as a “disease” or brain condition, or “chronic disease of the brain”. No one talks about medical treatments for those changes that translate into disruptive and self-defeating mood states, disruptive behaviors, and problems with emotional and behavioral regulation.

Because the helpful interventions for those problems are not medical, instead, are behavioral health interventions required and indicated for psychological restructuring and gains in self-regulation versus impulsivity, moderation of inner distress, well-established psychotherapies and psychosocial supports including relationship (in this case parent-child) and family interventions.

 Use of visually appealing, vibrantly-colored brain images, – captivating in the age of digital media, PlayStation, and Xbox – has been central in branding and selling the long-invalidated fabrication of compulsive substance use as a medical condition of some sort. 

Protecting the brand of addiction as a medical condition and its payoffs required that the story change from a genetic cause – never supported by evidence – to current messaging of diseased brains “hijacked” by drugs. But the facts and research have never changed: the behavior of compulsive substance use concocted as a medical condition is falsified by all relevant lines of evidence.

Multiple lines of evidence – all lines of relevant evidence – are consistently, wholly inconsistent with the proposal that these images represent a disease state, or any state that predicts, explains, or causes compulsive substance use.

Some Examples

 – There is no evidence for a general effect of use-induced neurobiological changes driving return to problem substance use
          – Heyman GM. Addiction and Choice: Theory and New Data. Frontiers in Psychiatry. 2013;4:31

 – PET scans of dopamine release are the same for recreational and dependent cocaine users, an inconsistency – do recreational drug users have the brain disease? Do individuals using alcohol in moderation ?

 – Many methamphetamine-dependent users stop and stay stopped, with or without treatment, while experiencing protracted withdrawal with low mood

 – Many meth-dependent users don’t experience protracted withdrawal or anhedonia, and do relapse.

 – Brain scans of problem methamphetamine users change back to normal over time after use has stopped, but as noted by Steven Slate at The Clean Slate, there have been no medical treatments of any type to address a disease state over those periods.

-  In neurobiology, barring pre-existing abnormality, a brain is a brain is a brain – basic neurobiological processes are the same, including in the way mood-altering substances have their effects e.g. alcohol affects everyone about the same as do other substances.

How to possibly explain, then, for example, that of all brains exposed to moderate to long-term use of opioids, only 8% to 12 % of brains develop the disease state? It’s not like a contagious, airborne disease – the exposure is direct and bathes the brain’s neurobiology no matter who or where you are.

The disease model has no explanation for this discrepancy, genetic or other.

Most glaringly, the brains of all humans on the planet are exposed to the biochemical changes in the brain each time food is ingested and tweaks neurotransmitters, the pleasure-reward center, and other areas of brain neurophysiology in the same ways that other mood-altering substances with potential for “addiction” do. Yet, despite rising rates of compulsive, harmful food use especially in the U.S., less than a majority of all individuals develop the brain disease of addiction, and this varies widely across historical time periods, environments, demographic groups, and cultures. A brain is a brain, is a brain.

The brain self-adjustments

naturally resulting from regular substance use are in fact adaptive, protective responses evolved to maintain stability, “homeostasis”. As regular use of mood-altering substance exposes the brain to increased levels of activity of mood-altering neurotransmitters, the brain adaptively decreases its own production of those neurotransmitters. When substance use decreases or stops, the brain adjusts again, increasing natural production and over time restoring normal brain physiology.
During the period of regaining normal brain physiology – when neither abused mood-altering substances nor the brain’s integral capacity to moderate pain, fear, worry, other distress are operating to moderate distress – substance users are at risk of turning back to substances to escape distress.

Just as when someone rehabilitating long-unused muscles that have atrophied – changed physiologically due to disuse through injury, illness or other cause – and experiencing the associated pain, worry, and frustration of lack of functioning while regaining normal use is at risk of turning back to inactivity or external sources of compensation to avoid that distress, a potentially self-defeating response. Like becoming dependent on external aids (like driving instead of walking, prolonged use of motorized or assisted movement substituted for the work and discomfort of increasing physical activity) that become barriers to regaining functioning.

That process is not merely analogous to substance use effects, instead describes the same biological phenomenon: loss of physiological functioning due to disuse of that function followed by risk of self-defeating choices in response to the discomfort and distress of the work (physical and mental) of regaining normal functioning. Medical imaging of the atrophied muscles would picture marked differences compared to normal muscle tissue, just as the captivating brain images picture differences in brain tissue after prolonged substance use and adaptive brain response to that use.

Neither type of loss of physiological functioning through disuse – of natural brain neurotransmitters due to substance use or of muscle and coordination physiological competence through incapacitation – strikes us as a disease. Because neither is. And in neither case does the recovery process of distress and frustration in rehabilitation with risk of regression or “relapse” to dependence on external compensation represent a disease, let alone a chronic disease of the brain.

If individuals facing the work of rehabilitating from atrophied muscles were convinced by the medical and rehab industries of the absurd fiction that their condition was a chronic, relapsing medical disease, that would predict lower effort and investment in the hard work of rehab, lower motivation, likely much higher risk of remaining dependent on external supports or compensations that would otherwise be unnecessary – wheelchairs and other equipment forming a barrier to recovery, avoidance of normal activity. Similarly, it’s established that a key factor predicting return to problem substance use is belief in the fictional disease model.

And,

as detailed here, with links to primary research and other sources:

The nature, course, patterns of relapse known for substance use problems simply do not fit with what is predicted from the disease model and

Epidemiology is wholly inconsistent, invalidates, the diseased brain model

That is,

extensive evidence – it turns out all lines of relevant evidence  – invalidate the diseased brain fabrication constructed as necessary to rationalize continued diversion of public healthcare funds to ineffective, evidence-free medical interventions for the entirely non-medical condition of compulsive substance use – just as useful fabrications to  support addictive medicine for a non-medical issue generated the lethal opioid crisis.

The fabrications have required hijacking America’s brain down a rabbit hole, into the darkness, away from core knowledge and principles of basic biology, human development, psychology, and logic – away from established knowledge and research pointing to understanding of compulsive substance use as the behavioral symptom of inner distortions and distress, that understanding pointing to established effective treatments that have never been adequately supported or incorporated into the criminal scam constituting “addiction treatment”.

When the most basic protective biological regulatory processes are constructed as diseases, then we have a problem, a pathology process, but not in the organism – in institutions, culture, media, policy, and delivery of healthcare services.

From Biology 101

One of the most fundamental organizing and survival principles of life itself is homeostasis – the designed (by evolution) adaptive, protective integrative functional aspect of the organism that ensures return to a steady state, a baseline physiological/biochemical status that protects physiological processes necessary for health and survival.

Homeostasis is: increasingly complex and important up phylogeny, increasingly critical and advantageous with the warm-blooded animals, required for cells and especially for brains – where organismal control (= survival) of neurochemical, endocrine, biochemical and other basic processes are vulnerable to narrow changes in temperature, pH, biochemistry of the cellular and intercellular spaces.

That is, in the exquisitely complex and organized control center, the brain, the subcellular “switches”, “sensors” and biochemical control processes require a stable baseline state in order to function in predictable, life- and health-protecting ways. Just as the software code for a large computer’s operating system requires stability in order to function as needed.

The brain, with billions of years of R&D, is smarter than that code – it knows how to adjust if the baseline parameters get thrown off, to attempt to return itself to the stable baseline needed for adaptive control of everything from basic physiological processes to behaviors.

If there’s anything we’ve known always, with certainty, it’s that the brain would respond to the regular use of mood-altering substances with attempt to return to homeostasis. By, predictably, altering the brain’s natural, internal (“endogenous”) release/regulation of the neurotransmitters tweaked by drugs the brain is artificially exposed to from the outside (“exogenous”).

Too much exogenous dopamine – cut back on endogenous dopamine = regulation toward homeostasis, an adjustment back toward baseline.

Due to that rebalancing, more exogenous substance required for same euphoric, etc. effect = “tolerance” in the language of study of substance abuse.

Cessation of exogenous source (stop using) and the brain is left with a deficit because endogenous capacity was adjusted down, reduced = “withdrawal” with characteristic symptoms, almost always lasting days to a week or so, almost never longer.

 

Why? (this is important) Because of the survival (selective) value of homeostasis of the brain, the promotion of survival by returning the organ responsible for controlling all aspects of adaptive, protective functioning of the organism, as quickly as possible, back to baseline. That fast rebound designed and operationalized by a couple billion years of R&D (evolution).

How quickly?

 

 

From days to about three weeks, according to decades of accumulated and reviewed research by the APA, American Psychiatric Association.

The APA’s Diagnostic and Statistical Manual (DSM 5) and its predecessors have served over decades as significantly more than manuals for the identification, assessment and differential diagnosis of mental health disorders, including substance use disorders (SUD).

Decades of reviewed and incorporated research over decades of revisions and compilation have contributed to general sections and sections for each major disorder type (e.g. Major Depressive Disorder, Alcohol Use Disorder, Posttraumatic Stress Disorder) that provide information on onset, course, incidence and prevalence, associated morbidity, characteristics in addition to diagnostic symptoms, other features, and additional disorders to be considered in differential diagnosis.

The differential diagnosis of common mental health disorders not involving substance use (including depression, anxiety, psychosis, and mania in bipolar disorders) has always been challenging when substance use is present, substance intoxication and withdrawal capable of generating symptoms including sleep disturbance, anxiety, low mood, manic-like symptoms, psychotic features, other symptoms.

One of many myths, elements in the persistent and pervasive folklore of “addiction” is that substance use often results in persistent substance-induced symptoms or syndromes.

It doesn’t, based on the extensive research incorporated into the diagnostic guidelines and supportive information in the DSM. Persistent (long-lasting) symptoms due to substance use are rare, for example neurocognitive effects related to long histories of heavy alcohol use. By description in the DSM as established by research, substance-induced mental health conditions always arise during use (intoxication) or withdrawal and are generally short-lived, lasting days to weeks after cessation of use.

Folklore dies hard. For example, there is no persistent, substance-induced psychotic disorder in the DSM 5. Not a thing. And cannabis use does not cause schizophrenia, nor methamphetamine use psychotic disorders.

For purposes of differential diagnosis of pre-existing or independent mental health disorders, the recommendation in the DSM 5 is to allow 3 weeks past cessation of use of substances. Good clinical practice brings in more than that, of course, but not because histories of substance use typically or often result in lasting mental health symptoms that are substance-use-induced.

That is, after days to a couple of weeks, any substance-use-induced mental health symptoms are inconsequential enough to allow for diagnosis of non-substance-use mental health conditions without concern for error, for confounding effects. Without concern, apparently, for confounding effects of the “chronic brain disease” that was caused by substance use.

Folklore and fabricated disease states aside, is there a causal relationship between the experienced physiological features of withdrawal and return to a pattern of regular, problem substance use?

No.

Here’s how we know – see “The Research” section in this recent post: Clear Map of a Dark Wasteland: Bad Medicine, Lethal Crossroads, and Dead Ends in America’s Opioid Crisis.

In these remarkable times – of public health crises created by healthcare, of addictive, abused opioids funded by public resources and fueling economies of abuse, of a public health “harm reduction” strategy endorsed by the FDA and Big Medicine flipping within months to a recognized pediatric substance dependence epidemic – we should perhaps not be surprised to find that

The behavior of compulsive problem substance use driving worsening lethal epidemics isn’t explained by any features of a medical brain disease model

Instead by belief in that fabricated, long-invalidated model

Instead by visits for medical care and by medical advice