The Addicts Brain

The first part described how trauma and our biological stress responses are implicated in all addictions and the benefit of CST. In this second part we will look at the addicts brain and the relevance and importance of working with the brain in CST, as it is rewarding, life changing and totally underestimated in the inclusion of any kind of holistic treatment, be it for trauma, addiction, chronic pain, insomnia or concussion. There are so many bones, cranial nerves, glands, membranes, sutures and cranial foramina - openings that allow passage of cranial nerves, tissues and blood vessels to go through - to work with, with far reaching implications, when there is any kind of dysfunction in the cranium. It is important that all structures in the cranium are functioning properly, in order to maintain optimal function and general health. In my clinics I see clients with all kinds of addiction: from alcohol, work, drugs, shopping, gambling, sex, opioids, behavioural to food addiction, sometimes all combined in one, well almost.
All addictions use the same brain systems and chemicals, creating an altered physiological state, to escape emotional and mental pain, anger, anxiety, deep-seated fear, feeling powerless, less than, loneliness and disconnection. Addiction engages the brains reward (endorphins) system, the reinforcement-motivation (dopamine) system and the brains executive functions, where impulse control and self-regulation lies.
The three dominant brain systems involved in addiction are:

1. The Endorphins (Opioid) system - Attachment-reward system
2. The Dopamine system - Incentive-motivation system
3. Prefrontal cortex - Self-regulation

1. The Endorphins (Opioid) System - Attachment-reward system
Endorphins are our natural opiates and feel-good chemicals, produced inside the brains pituitary gland. They are our natural pain reliever for stress and discomfort and play a key role in how we react to both physical and emotional pain, as they calm the nervous system, slow down muscle contraction in the gut and diminishes saliva secretion in the mouth. Endorphins are released during rewarding activities like eating, exercise, work or sex. Endorphins are responsible for the pleasure-reward seeking behaviours that stimulates the addiction, as our brain rewards us when we engage in something that brings us pleasure, reduces pain, triggers the chemistry of love and connection and results in a feeling of general wellbeing.
Endorphins also play a critical role in the emotional bonding between parent and infant and forms the basis of our attachment system. Attachment is the biological impetus for physical and emotional closeness with firstly our parents and later on with other people. When we grow up in a functional household, receive attentive care, nurturing and loving responses, our brain gets flooded with endorphins. Young children who did not receive nurturing love and attentive presence to boost their internal chemical happy hormones are often also not able to self-regulate as well and rely on external dopamine hits. Secure attachment may be difficult when you have been hurt in your primary relationship. You may long to connect and to belong but any form of closeness or intimacy may pose too much of a threat to the nervous system and brain. They will try to escape their distress and are at greater risk for seeking chemical or behavioural satisfaction from external sources in life, as our early attachment style drives a lot of our behaviour and impulse control. Overall, the less effective our own internal chemical happiness is, the more driven we are to seek joy or relief through addictions or other compulsions that are perceived as rewarding and boosts our endorphins levels to receive that hit.
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2.The dopamine apparatus - Incentive – motivation system
The brains incentive-motivation system controls our motivation and pleasure by releasing dopamine when we initiate in pleasure seeking and life-sustaining activities like eating, sex, forming new partnerships, exploring and engaging in new activities. Incentive feelings like desire, wanting and craving are all central to increasing dopamine levels and key to the reinforcing patters of addictions. As dopamine levels are increased, it will motivate us to do it again as it makes us feel more energised, inspired, focussed and happier. Addiction elevates dopamine in the reward circuit. Speed, nicotine, caffeine, meth, cocaine, porn, eating all tap directly into this system by flooding the reward circuit with dopamine. When we have learned for instance, that eating a chocolate bar or candy makes us feel good and is pleasurable - the likelihood of doing it again is greater,especially when we lack other self-regulation practices. Dopamine release is triggered in a brain center called the nucleus accumbens, located on the underside of the front brain, and plays a major component in the incentive circuit. graphic Sarah Huges - thesagon.online

Food, sex, novelty seeking behaviour, intense exercise all trigger dopamine release in the NA. Research shows that the existence of relatively few developed or damaged dopamine receptors may be one of the biological bases of addictive behaviours, as we are driven to make up for any loss of dopamine activity. Consistent dopamine releases causes our brain to create new neural pathways leading to desensitisation. The nucleus accumbens also acts as a liaison with the limbic system, which is also known as the emotional brain.  ​

The limbic system consist oa of the Hippocampus (memory conversion) and Amygdala (emotion). The limbic system interprets thoughts, feelings and processes our emotions like love, joy, pleasure, pain, anger and fear. It determines whether we go towards something or away, it  makes it possible to feel love, compassion and to have healthy social interactions. When properly developed our emotional brain is a reliable guide to life. When impaired or confused -  it can trouble us and addictions is one of its main dysfunctions.

                                                 3. The Self-regulation circuits 
The prefrontal cortex (PFC) sits in the front of our front brain, acting like the CEO with highly specialised functions like complex planning, problem solving, decision making, impulse control, rational judgement, balancing short-term vs long term consequences and inhibiting harmful impulses.
Gabor Maté describes in his excellent book – In the Realm of Hungry Ghosts - studies that link addiction to a specific centre of the prefrontal cortex – the orbitofrontal cortex (OFC). The OFC has an abundant supply of opioid and dopamine receptors and is responsible for inhibiting inappropriate action and helping to postpone reward seeking behaviour, both not functioning well in addicts.

Of interest and linking why it is so important to work with trauma and the brain, is that neurological traces of early formative events are embedded in the OFC. The emotional traces of psychological and physical trauma/abandonment are encoded in nerve patterns in the OFC, including experiences you cannot consciously recall (implicit memories). The brain structures to conscious recall develop during the first years of life but aspects of the implicit memory system which stores emotional memories are present at birth, priming the OFC  unconsciously, as it interprets stimulus through the lens of its experiences. 
Maté further describes how through its connections with the limbic system, the OFC serves as its mission control room for our emotional lives. The OFC receives input from all our sensory area’s - vision, touch, taste, smell and sound and regulates how we process our emotions and how we react to them, based on past and present experiences. The OFC decides the emotional value of a stimuli and its personal meaning, our likes, dislikes, preference or aversion and decides in a micro second, what we focus on. The Prefrontal cortex is often impaired as a result of life experiences, leading to poor impulse control when it is highly activated during cravings disrupting self-regulation circuits.
 
CST and the Brain
In CST we feel, listen and work with all the structures in and around the brain – below the main ones implicated in addiction:

Pituitary gland (the master gland –producing endorphins) is located inside the sella turcica of the sphenoid bone. In CST we assess for any cranial base dysfunctions – between the occipital bone and sphenoid bone. There can be torsion, side-bending or lateral strains imposed upon this area with clinical significance. It is important that the sphenoid bone is able to move optimally, with no lesions within the cranium in order to maintain its subtle movement to optimise the release of hormones. 

• The Prefrontal cortex -  In CST we work with the prefrontal cortex and with the orbitofrontal cortex within– found near the eye socket/orbit – where important nerve systems are implicated in addiction. This involves working with the frontal bone, the intracranial membrane system, the sphenoid bone and surrounding areas. Intraoral mouth work-working with the hard palate of the mouth is also an important part of CST as it connects with the sphenoid bone and many important nerve structures leading into the eye socket. 
• Limbic System – working with the limbic system is a key component of CST. Calming the amygdala – the smoke alarm of the brain and the limbic system overall, may discharge traumatic emotional effects in a safe and contained way as it releases any stored emotional energies.
• Regulating and slowing down brain waves that contribute to anxiety, restlessness and creating new neural pathways – rewiring the old brain and making the unconscious, conscious. Life experiences around unconscious conditioning and patterns may begin to become more conscious and the potential for insight and clarity can come to the surface, as clients make deep realisations about their past life experiences and current situation. Often in Trauma and Addiction our implicit memories, lie below conscious levels and when we work with the brain, the craniosacral system and the entire body, they have a chance to come up to the surface and be released. People often experience a level of calm, insights, stillness and peace that they have not experienced in years.

 
All the above described brain structures are rich and important sources for CST, as the brain can start to initiate its own healing process by creating change in thought processes, wiring, emotions and behaviour. CST is no quick fix and attending other recovery programs is vital too. The pain that runs far back, runs deep. It takes time, dedication, recognition, effort and a real desire in wanting to change. One day at a time.
 
Part 3 – The Addicts physiology and bodily symptoms
References

• Class notes – Craniosacral Therapy Education – Switzerland – Kiental – Teacher: Friedrich Wolf
• Mate, Gabor – In the realm of the Hungry Ghosts - close encounters with addiction - 2008 (Highly recommend).
• The Guardian (online) – how dealing with past trauma may be key to breaking addiction – November 2018
• Johann Hari – You tube – Everything you know about addiction is wrong
• Thesagon.online