by Daniel G. Amen M.D.
The Real Reason Not To Use Drugs

One day in the early spring of 1991 I attended a lecture at the hospital where I worked on brain SPECT imaging, a type of scan that looks at how the brain functions. It was so fascinating! Up to that point psychiatrists had no practical way to look at how the brain works, so most of our diagnoses were made based on patient symptoms and, quite frankly, a lot of educated guessing. SPECT scans showed the underlying physiology of our patients' problems so we could better tailor our treatment approaches to individual patient needs. With the use of the scans we had more success in treating difficult people. It also helped our patients have a better understanding of their problems, which in turn led them to have greater hope and be more willing to follow through with getting help.

The use of SPECT scans with people who had drug and alcohol problems was particularly helpful. Here are five things I have learned about substance abuse from brain SPECT imaging.

1. Alcohol and other drug abuse damages the brain.

From the first scan ordered on a patient with substance abuse problems, I saw very significant brain changes. A healthy scan shows full, even, symmetrical activity. Drug and alcohol abuse tended to cause overall decreased activity in the brain. These brains looked more aged, more shriveled, and more toxic than the brains of people who did not use drugs.

Heroin and heroin like drugs, called opiates, caused severe decreased activity, as did much alcohol. Methamphetamines and cocaine tended to cause what looked like multiple holes or mini-strokes in the brain. Marijuana caused decreased activity in the frontal and temporal lobe areas (areas involved with memory and motivation). All substance abuser brains did not look the same. Some people who have used drugs for a short time had horrible looking brains, while others, who used drugs for longer periods of time, had brains that did not look that bad. There must be genetic factors involved as well.

2. Alcohol and drug abuse disrupts development.

Younger brains are particularly vulnerable to the damaging effects of substance abuse. The brain continues to develop well into the late 20s, especially in the prefrontal cortex (in the front of the brain) responsible for decision-making. This is why a 25 year old usually has better decision-making ability than a 16 year old, and why 25 year olds pay less for auto insurance (better driving judgment). If a teenager or young adult starts using drugs or alcohol they disrupt the brain's natural development. So, if a person starts abusing substances at 16, they often stop maturing. If he or she is still using drugs at 20, likely, even though their chronological age is 20, they may be more emotionally still 16. We often see that young people with substances abuse issues have significant problems with judgment and maturity from brain damage.

3. Alcohol and drug abuse is often a form of self medication (hot brains and cold brains).

One of the most powerful lessons we have learned from imaging is that many people who abuse substances are really trying to change their own brain chemistry.

Firstly, a word about what SPECT studies actually s how us. We basically look for three things: areas of the brain that work well, areas of the brain that work too hard, and areas of the brain that do not work hard enough – good activity, too much or too little.

People with overactive brains, such as those with bipolar or manic-depressive disorder, anxiety disorders, certain forms of depression and obsessive compulsive disorder, tend to abuse substances that calm the brain down, such as marijuana, alcohol, or opiates. People with under-active brains, such as those who have attention deficit disorder, tend to abuse stimulating drugs such as methamphetamine or cocaine. The drugs or alcohol make them feel better, so they continue to use, even though it has many other problems. It is essential to treat the underlying problems in order for them to heal from the substance abuse. Brain injuries are involved in substance abuse in far greater numbers than most people realize.

4. Brain injuries are involved in substance abuse in far greater numbers than most people realize.

Another important lesson learned from imaging is that people who abuse substances have a very high incidence of brain trauma and virtually no on knows it, because most professionals do not look at the brain function in these patients. Brain injuries, especially those to the front part of the brain, decrease judgment and insight, and puts people at greater risk for problems, especially for abusing stimulant drugs. Unfortunately, many people forget that they have had significant brain injuries and do not report them or the professional discounts the injuries not serious enough (without ever looking at the brain).

Our studies have taught us that you can damage the brain, even when you never lose consciousness. The brain is very complicated: you have over 100 billion brain cells housed in a really hard skull. By looking at the brain with SPECT we have seen that even mild trauma can damage the brain. A head injury puts people at greater risk for substance abuse (poorer judgment and impulsivity), while substance abuse itself increases the risk of brain injuries (driving drunk or causing fights when paranoid on cocaine).