Childhood Abuse Has Long-lasting Effects on Brain Function

(© Derek Simon 2015)
(© Derek Simon 2015)

 

Why is it that one person becomes an addict and another does not?

This is a central question in addiction field and one that I’ve touched on in some of my posts (and will continue to explore in the future). Two recent papers may help to shed more light on this difficult and complicated question. Both studies have revealed changes that occur in the brain as a result of childhood trauma that may cause an individual to be more susceptible to risky behavior such as drug abuse.

Both papers are neuroimaging studies meaning they use living human subjects and look at brain activity in response to different scenarios. There are many ways to image a living brain but these studies both use functional magnetic resonance imaging (fMRI). Basically, fMRI measures blood flow into the brain. As neurons turn “on” (that is, when they conduct an electrical signal), they require energy. Neurons use glucose as their primary energy source, which is delivered to them through blood flow. Therefore, the more blood flowing to a region of the brain = the more energy required by neurons = more neurons “firing”.

 The analysis of fMRI data is very complicated and beyond the scope of my knowledge or this discussion. But in essence, when you think or read about something, certain areas of your brain process that information. Using fMRI, you can actually visualize regions of the brain that are turning “on” or “off” when a patient thinks about a particular situation! Watch these YouTube videos for additional explanations on fMRI.

 

fMRI Image (wikipedia.org)
fMRI Image (wikipedia.org)

In both of the studies featured in today’s post, subjects would read different scripts while in the fMRI scanner and the scientists would image the entire brain and identify the regions that were active during the test. Then data from multiple subjects can be compiled and a composite image that represents the averages all the subjects can be produced. The picture to the right is an example of this type of composite image. Finally, you can see which regions of the brain are active for most of the patients during the different experiments. Keep this information in mind as I go over the papers.

Elsey et al. Neuropsychopharm. 2015

The first paper performed fMRI scans on adolescents that had or had not experienced maltreatment or trauma during childhood (less than 18 years old). 67 subjects were recruited from a larger study looking at disadvantaged youth and 64 were eventually used in the study. The adolescents filled out a standard survey that allowed the scientists to learn which of the subjects had experienced maltreatment/trauma during childhood.

The experiment involved having the different subjects read a script about either a stressful moment, their favorite food, or something neutral or relaxing while their brains were being imaged in the fMRI scanner.

Amazingly, for the stressful scenario, a difference in brain activity was detected in multiple regions of the prefrontal cortex only in subjects that had experienced childhood maltreatment! What this means is those youths that were abused as kids responded to stress differently than youths that were not abused. Their brain function has literally been changed later in life as a result of the abuse they suffered as children.

 The prefrontal cortex is a part of the mesocorticolimbic system, a group of brain areas especially involved in addiction. The prefrontal cortex is also involved in decision making, impulsivity, and other functions. It’s not clear what this change in prefrontal cortex activity actually means but it is possible that the altered activity could make the youth more vulnerable to stress or more likely to engage in risky activities, such as drug abuse.

 Elton et al. Addiction Biol. 2014

The second study was also interested in subjects that had experienced maltreatment or trauma during childhood but it instead of adolescents, this study used subjects that are adult men dependent on cocaine. Similarly, the subjects were grouped into those that had been mistreated as kids and those that had not.

In a parallel design to the other study, the subjects read a script describing a situation while being scanned in the fMRI machine. The scripts in this study included stress, cocaine-associated, and neutral. Interestingly, an increase in activity in a specific region of the prefrontal cortex and an area of the brain involved in motor activity were detected in the subjects that had been abused during childhood. And even more important, these changes were correlated to enhanced drug craving. These results suggest that childhood trauma can affect drug craving for addicts, which may be relevant factor in triggering relapse. That is to say, addicts that have been abused as children may be more vulnerable to not only acquiring addiction but also relapse.

 It is important to keep in mind that, like the previous study, the real functional importance of these different changes in unknown. However, clearly there are real changes that occur in the brain as a result of abuse/maltreatment during childhood. Imaging data must be taken with a grain of salt because it is difficult to show real causality. Yet, both studies (and many others) suggest long-lasting changes in brain activity, especially in response to stress, as a result of childhood trauma/maltreatment.

The conclusions we can draw from these studies is that childhood mistreatment, or trauma can have lasting changes on the brain. How these changes affect behavior is a much more difficult question to answer. Nevertheless, the changes that occur may be one of the factors that can contribute to susceptibility to addiction. These studies are supported by a previous post in which animal studies have shown that stress during early age leads to greater drug use as an adult.

And a broader point, these two neuroimaging studies help to put a different perspective on disadvantaged youth and importance of a stable home life, the lack of which can significantly affect you as an adult and may even contribute to susceptibility of become a drug addict.

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Stress and Addiction Part 3: Molecular Changes

Stress-BrainThis is part three on my series of posts looking at Stress and Addiction. To recap: we’ve seen that, in laboratory studies, stress increases susceptibility to drug addiction. Stress not only increases the self-administration of drugs in adult rats but stress during an early age can have a long-lasting effect on drug-taking behavior. Today, we’ll wrap up by looking at some molecular changes that might help to explain why this effect exists. I’ll conclude by addressing some questions that might have occurred during the course of this discussion.

Paper #1 Sorg 1991. Title

The first paper is examining the effects of stress and cocaine on dopamine. Dopamine is a very important neurotransmitter. All drugs of abuse cause increases in dopamine in an important region of the brain called the mesolimbic pathway. I will discuss this system in detail in the next post but for now don’t worry about the details. All you need to know is that drugs can increase dopamine.

Dopamine levels can be measured directly in the brain using the technique microdialysis (I discuss this technique in more detail in my post The Scientist’s Toolbox: Techniques in Addiction). In this first paper, the scientists use a type of stress called foot-shock stress. It is very similar to tail-pinch stress (see Part 1). The animals are placed on a grid that is connected to an electrical supply. The scientists administer a small amount of electric current to the grid, which gives the animals feet a little shock and stresses them out.

Figure 1.
Figure 1.

The microdialysis technique was used on rats that underwent foot shock stress in order to measure dopamine levels (in a region of the brain called the striatum) after the stress test. As you can see in the top graph of Figure 1, foot shock stress causes an immediate increase in the amount of dopamine released and this eventually returns to normal. The different symbols mean different stress intensity with the most intense stress represented as black squares. Interestingly, as you can see in the lower graph of Figure 1, a more intense foot shock (ie a more intense stress) causes more dopamine to be released.

Remember that I said that cocaine also causes dopamine release? So maybe stress makes cocaine feel better because it works together with cocaine to create a larger release in dopamine than cocaine would by itself. Next, the investigators decided to test this idea.

Sorg 1991. Figure 2
Figure 2.

In this experiment, mice were exposed to a weak foot-shock stress then given an injection of cocaine and the amount of dopamine released was measured. Figure 2 shows much more dopamine was released in the striatum in rats that received cocaine + stress (black squares) compared to cocaine + no stress (white squares) or just stress by itself (black circles). Perhaps the hypothesis that stress makes cocaine more pleasurable because its boosts dopamine released might be true?

Paper #2

Zhou 1996. Title

Recall from Part 1, that stress activates the HPA axis, which results in release of the stress hormone cortisol (corticosterone in rats and mice). But do drugs of abuse also activate the HPA axis? This next paper—done in lab that I work in—takes a look at this question.

Figure 1.
Figure 1.

Cocaine was given to rats under a number of different conditions. In the first experiment, cocaine effects on the HPA axis were examined in the short term (acute cocaine use). Rats were injected with either saline for two days, cocaine for 1 day, cocaine for 1 day and saline for 1 day, or cocaine for 2 days. After the injections, blood was drawn from the animals and the corticosterone in the serum was measured.

*Technical notes: 1) Serum is the liquid part of blood and it does not contain the red blood cells and clotting proteins. Serum is often used when measuring hormones in the blood. 2) Corticosterone can be measured multiple ways but this experiment used something called a radioimmunoassay (RIA). I’ll save the explanation of it for a future Scientist’s Toolbox post.

As you can see in Figure 1, immediately after the rats receive cocaine (either 1 day or 2 days) corticosterone increases. This means that cocaine has resulted in activation of the HPA axis. Interestingly, the animals received 1 day of cocaine and 1 day of saline did not show high corticosterone levels which means that the levels have returned to normal after the cocaine.

But what happens with repeated cocaine use (chronic cocaine use)? Addiction develops because of chronic use of the drug so are any changes occurring after many days of cocaine use?

Figure 2.
Figure 2.

Interestingly, in Figure 2, corticosterone is high after 3 days of cocaine but after 14 days of cocaine corticosterone levels are much lower! What’s going on here? What these data suggest is that 14 days of cocaine use has caused a change in the HPA axis activity. The cocaine has activated the HPA axis so frequently the axis has compensated for this over activation. The activity of the HPA axis response has been blunted because of the repeated cocaine use.

This one small example of how drugs can cause long lasting molecular adaptations and changes in the brain. Perhaps this is why stress helps to make someone more vulnerable to addiction, because changes occur both at the level of dopamine release (paper #1) and in HPA axis activity (paper #2). Both drugs and stress have similar molecular effects that may work together! I’d like to very briefly discuss one more paper that combines both of these concepts.

Paper #3

Boyson 2014. Title

This paper is complicated but I’m just going to present a small amount of the data. The key points you need to know is that the scientists are using social stress (see Part 1) in this paper for two key experiments 1) self-administration to measure cocaine taking behavior and 2) microdialysis to measure dopamine release. However, they also inject a chemical compound directly into the rat’s brain that blocks HPA axis activity. This chemical acts at the starting point in the HPA axis: the activity of CRF is blocked (the chemical name is abbreviated as CP). Let’s see what happens in this experiment!

*Technical notes: 1) the drug actually prevents the action of CRF interacting with its receptor. Chemicals that do this are called antagonists. Therefore, the scientists are injecting a CRF Receptor antagonist into the rat brains. 2) as a control, an inactive solution is also injected into some animals. This is called artificial cerebral spinal fluid (aCSF). For the drug studies, the correct comparision is CP vs aCSF.

Figure 1.
Figure 1.

Like we saw in other papers, stress increases self-administration (Figure 1, black circles) compared to no stress (white triangles). However, when you give the CP at a high dose (light grey circles) compared to a low dose (dark grey circles) it reduces the self-administration! This means that blocking HPA axis activity reduces the effects of the stress on the cocaine self-administration. Cool!

Figure 2.
Figure 2.

Next, they did a very similar experiment but only this time measure the interaction between stress, cocaine, and the CRF antagonist on dopamine release. The results are presented in Figure 2. Animals that were stressed and than given a dose of cocaine but not the CP (stress + cocaine + aCSF, black circles) released a large amount of dopamine compared to animals that were only given the cocaine injection (white triangles), which is consistent with findings from Paper #1. Amazingly animals that were stressed and then given cocaine + the anti-HPA axis drug CP showed reduced amounts of dopamine released at bot a low dose of CP (dark grey circles) and high dose (light grey circles). These experiments show that the effect of stress on cocaine taking behavior might be because the stress activates the HPA axis which causes more dopamine to be released.

*Technical note: I described this experiments very briefly but they are extremely technically challenging and probably required months of hard work just to make the two little graphs!

Summary

Finally, if we summarize the papers from Part 1, 2 and 3 we can come up with a little mechanism to help explain the different results from the different papers. Based on the data, stress can contribute to the vulnerability of becoming an addict because it activates the HPA axis and increase the dopamine released, which may cause the drug to feel better to a person and make them want to take more of it. There may be a synergy between stress and drugs that changes brain function so that addictive drugs feel more addictive.

You probably noticed I used the word “may” many times and this is because our proposed mechanism requires a lot more testing. In fact, we barely even scratched the surface with this discussion! There are literally hundreds more papers looking at many other details just on stress and addiction. Hopefully this post and the previous two can give you a little appreciation for the difficultly in learning anything about how addiction really works and what specific changes occur in the brain from drug use! Science is a challenging and time-consuming pursuit but also totally worth it!

To wrap up our discussion on stress and addiction, I’ll address some questions/criticisms that you might have with the research papers in this and previous two posts.

Q & A

Some questions about the research you might have and my answers:

Q: Only the psychostimulants cocaine and amphetamine were looked at in these papers. Does stress have the same effects on other drugs of abuse?

A: Yes. The effect of stress is the same with nearly all drugs of abuse tested including the opioid morphine and heroin, alcohol, and nicotine. The neural machinery that is responsible for enhancing the addictive powers of drugs is common to all drugs of abuse.

Q: Only the initial stages of drug taking were looked at in these papers. That is to say, the role of stress was only discussed in the initiation of addiction. How does this translate into progression to full blown addiction?

A: The effect of stress is consistent regardless of where you are on the addiction continuum: stress enhances the reinforcing properties of drugs of abuse. That is to say, stress makes the pleasurable feeling from drugs more pleasurable. However, in humans, you will never get as clear of an effect (that means, easily testable) as you will in laboratory animals. Humans experience many different types of stress throughout a single day and the specific effect of stress on drug taking depends on the type/length/frequency of the stress and other environmental factors. Nevertheless, in controlled clinical studies, changes in HPA axis function as a result of drug use have been widely reported. A feed-forward mechanism exists in which stress promotes drug taking and then drug effects the stress response so that the next stressor has a greater effect on drug taking, etc.

Q: Can stress trigger relapse?

A: Yes, this is one of the most well studied effects of stress on drug taking: stress can trigger drug cravings in abstinent individuals. In the laboratory, an animal can be taught to lose its self-administration behavior by switching the drug to a neutral substance like saline. Therefore, when the animal nose pokes it does not get drug and eventually it doesn’t nose poke at all. This is called extinction. Amazingly, if you stress an animal with foot-shocks or some other phase and then test it’s self-administration behavior the animal will go back to lever pressing again!

Thanks again for reading! If you stuck through all three of Stress and Addiction posts please comment or email me. I would love to know!

Next time: Doping on Dopamine.

Stress and Addiction Part 2: Early Life Stress and the Susceptibility to Addiction

Stress-Brain

This is part 2 of a series that deals with Stress and Addiction. It one part of a multi-part series of posts in which I attempt to provide a detailed analysis of all facets of one the most important questions in the addiction field: Why does one person become and an addict and another does not?

In Part 1 I showed how some forms of stress used in the laboratory, tail-pinch and social-stress, were able to increase the amount of psychostimulants self-administered by rats. Let’s expand this discussion to consider stress that may have parallels in human society.

Note: It is important to keep in mind that l am not making the claiming that stress exposure is the cause of addiction. I am merely providing evidence that your environment, specifically stress exposure, can increase your susceptibility to becoming an addict.

Can stress during childhood effect your susceptibility to becoming a drug addict?

It’s an intriguing question with many societal implications, given the disparities in the environments that children from different socio-economic backgrounds experience in the United States (I recommend reading Jonathan Kozol if you’re interested in learning about these disparities). But I’m not a sociologist, economist, public policy expert, etc. so I’m not capable of giving you my professional opinion on all the facets of this complicated issue but I can discuss the science behind the effects of early-life stress on drug-taking behavior.

Paper #1

Title. Kosten et al. Brain Res. 2000

This first paper looks at rats and the effects of stress during very early life on self-administration of cocaine as an adult but first, a little primer on the rodent life cycle. Rats and mice are mammals and like all mammals, give birth to live young. Litter size can be anywhere from 4-8 depending on the strain of animal. Animals born in the same litter are called littermates (note: this term doesn’t really have a human equivalent since humans typically only give birth to a single child at a time. Though we do have the terms twins, triplets, etc.).

Newborn animals (including humans) are called neonates. The mother rodent will then nurture her pups but feeding them breast milk through her nipples. All mammals are raised in this manner (even whales). This generally occurs for about three weeks in mice. In the lab, pups are then separated from the mother by the scientist, so they can become acclimated to an adult diet (i.e. not breast milk) but naturally, young mice will stop drinking breast milk once they are old enough The process of switching from breast milk to solid foods is a called weaning. Rodents are still considered in the adolescent stage for another three weeks after weaning. They go through puberty—the biological process in which mammals reach sexual maturity—at about 6-7 weeks of age and are then considered adults. *Note: these approximate times are for mice. Rat stages fall a little later.

The first study stresses rats during the neonatal phase by handling the newborn pups and separating them from their mother for 1 hour a day for days 2-9 after the date of birth. The authors call this neonatal isolation stress. The rats are then allowed to reach adulthood. At day 100 (3 months after the end of neonatal isolation stress) the stressed rats and rats from the same litter that were not handled (control group) underwent catheter implantation surgeries and then were tested for acquisition of cocaine self-administration for several didn’t doses.

Figure 1.
Figure 1.

Interestingly, as shown in Figure 1, the rats that underwent the neonatal isolation stress self-administered more cocaine at lower doses (0.125mg/nose poke) and 0.25mg/nose poke). However, this effect was not seen at a higher dose (0.5mg/nose poke). These experiments suggest that early life stress can have an effect on adult rats and increases the pleasure they get from the drug and makes them more likely to self-administer cocaine at a dose they otherwise might not be interested in. The self-administration data are summarized in Figure 2.

Figure 2.
Figure 2.

What’s really fascinating is how a relatively brief period of stress (1hr a day for 7 days) can have such a drastic effect on the rats’ behavior 100 days later! This study suggests that stress during early life can have permanent (or at least, very long lasting) effects on brain function.

Paper #2

Title. Baarendse PJJ et al. 2011The second study takes a similar approach but looks at different developmental time period. This study isolates rats (meaning rats are placed in individual cages rather than with their littermates) during adolescence, days 24-42 after birth (the experimental group, ISO). The control animals were socially housed during this time (SOC). This time frame falls after weaning but before puberty. On day 43, ISO animals were than housed together and a few weeks later, at 12weeks of age (well into adulthood) ISO and SOC rats were tested for self-administration of cocaine.

Figure 1.
Figure 1.

Similar to the other study, the authors found that isolated rats acquired cocaine self-administration at a low dose of cocaine (0.0625mg/nose poke), which means that animals that underwent the social isolation stress self-administered more cocaine at a low dose when compared to the socially housed control animals. This is seen in the left half of the graphs in Figure 1 (the left panel shows nose pokes while the right panels shows the total amount of drug self-administered). However, at a higher dose of cocaine (0.25mg/nose poke), the right half of the graphs in Figure 1, there was no difference in self-administration between the two groups.

Figure 2.
Figure 2.

Importantly, the isolation stress also had an impact on motivation to take the drug. In the next experiment, rats were tested on a progressive ratio self-administration where they have to nose poke multiple times in order to get a single dose of drug. The number of pokes required increases everyday until the rat is no longer willing to try to get the drug. This limit where the animal gives up is called the break point and it is a measure of how hard the animal is willing to work to get the drug (ie how motivated is the animal for the drug).

As you can see in Figure 2, rats that underwent the social isolation stress during adolescence had higher break points, which indicates they were willing to nose poke more times in order to get the drug (more motivated).

In summary: these experiments also showed that stress that occurs early in the rats life (during adolescence) can have a long lasting impact on the rat brain. The stress made the rats more likely—more susceptible—to acquire self-administration behavior. That is to say, early life stress caused the drug to appear to be more pleasurable to those animals (they wanted to self-administer more of the drug) than for the control, socially housed animals.

In conclusion, these papers have shown that, in rats, stress during early life can have significant effects on an animal’s susceptibility to becoming an addict. Many other papers have identified similar findings. As I alluded to at the beginning of the post, this knowledge has disturbing implications for humans raised in drastically different environments.

However, let’s briefly discuss some caveats to these studies. You are probably wondering, “well, that’s good and well for rats, but has this effect been proven in humans?” First, one of the reasons we run these types of experiments in mice and rats because it is much easier to control for all the other variables that would make interpreting the experiment extremely difficult. Fortunately, we can’t take a bunch of kids, stress them out during their childhood, and then see how much drugs they take at as an adult! But there are other types of analyses and experiments that could be run using data gathered from the “real” world.

Are there studies in humans that confirm the animal studies, that early life stress can increase the susceptibility to addiction?

The answer is yes! Lots of them! I don’t have time to review them all but thankfully many other scientists have. Check out these two review papers for a summary of some these studies. If you are interested in stress and addiction studies in humans, please let me know! I would be happy to devote a post or two to this topic.

Title. Sinha. 2001

Title. Enoch M. 2011

Finally, I would just like to end on a broader point, these studies once again confirm how brain development during early life can have far-reaching effects on adult hood (many other fields look at the general top of early life brain development). Indeed, the conditions under which we are raised are an important contributor to how we turn out as adults. But let’s not forget the role of genetics (this will be saved for a future discussion)!

Next post I’ll wrap up the Stress and Addiction discussion by looking at some of the molecular details of how and why stress increases susceptibility to addiction.

 Thanks for reading!