January 13, 2020
Honourable Tyler Shandro
423 Legislative Building
10800-97 Avenue NW
Dear Mr. Shandro:
Imagine a world where there were no serious addictions. Imagine how different Alberta would be if every down and out addict could be suddenly transformed into a taxpayer and a productive member of the community. Our standard of living is directly related to our productivity. Some people question whether addictions at their core are a medical problem or if they should be treated as something else. As you read on you will see that there is a medical basis to nearly all addictions and there is an addiction base to most health care problems. So understanding addictions is a very central to modernizing our failing healthcare system.
Of all the healthcare problems that one can have, addictions are by far the sadist. With most problems like cancers, heart problems, or accidental injuries, the affected person is usually surrounded by family and friends and given enormous support. Addicts often get a lot of loving support from family and friends at the start but often end up abandoned and avoided by their own parents, siblings, children, coworkers, neighbors, childhood buddies, and other friends from an earlier better time. This rejection has got to be so sad for not only the addict but also for all others who know and love the addict. Imagine being a parent who has to throw out a child or worse yet bury a child that was once their beautiful baby, loving toddler, good little kid, and eventually unmanageable problem. Yet there is probably not a person in Alberta who has not seen a good friend or family member ruin their lives due to addictions of some sort.
The big news in addictions today is the opioid crisis which claims the life of more than one person a day in Alberta and has for many years now. This shows us how bad addiction problems can get. However, the opioid crisis is more a criminal matter than it is a healthcare matter. Criminals who supply deadly carpentanol are guilty of manslaughter at a minimum and as their body counts continue to increase, so should their accountability. They know what they are selling! Even physicians who prescribe Oxycontin for minor pain without discussing the risks of addiction and other side effects are guilty of a lack of informed consent (Which is unprofessional conduct.) and again as the individual cases mount up , so should the accountability and the consequences.
Even if we could stop all the cases of the opioid crisis today, we would still have decades of work ahead of us before we could restore all today’s addicts back to being full time, happy, hard-core taxpayers. If you only manage to fix one problem during your time as minister of health, this is the one to fix. If you fix the addiction problem, you will fix nearly all healthcare problems. If you ever thought you would like to add the phrase, “Nobel Prize Laureate” to your CV, this could be your ticket. Read on.
Until now, we often thought of addictions as a human failing, a moral weakness, a lack of willpower. This may be partly true but not entirely true. The most successful treatments for addictions in the past are mostly a version of the Alcoholics Anonymous twelve step program which stresses complete abstinence, asking God for help to overcome the addiction, a solid support group of recovered addicts, attempting to restore old damaged relationships, and taking responsibility for their past actions. Also, they address psychological damage and baggage stemming from unpleasant early childhood experiences. While all of this has been very good work and I wouldn’t suggest abandoning any of it ; it is very labour intense and the success rate at around 10% is disappointing. But what if their was a giant piece of the puzzle missing. And, what if you were to find that missing piece sometime in the next five minutes. Read on.
Like a lot of things in life, when we don’t understand how they work, they seem very complicated and very overwhelming. Then, often when we do get them figured out we think, “Can it really be that simple?” Addictions may really be that simple. Recent findings demonstrated mostly through better brain scanning technology, have confirmed that all addictions have one thing in common and that is DOPAMINE! Dopamine is a neurotransmitter associated with reward and pleasure. It is released by nerve endings in the nucleus accumbens located in the underside of the brain below the frontal lobes. All chemicals associated with addictions, such as alcohol, nicotine, opioids, amphetamines, all either cause the release or prevent the reuptake of dopamine in the nucleus accumbens thereby providing a level of pleasure or at least normality for a while.
We have long known about chemical addictions like the ones described above but we have also long suspected that there could also be addictions to other behaviors such as gambling which have no apparent chemical means of stimulating the release of dopamine in the nucleus accumbens. However, more advanced brain scanning technology has confirmed that gambling does somehow cause the release of dopamine in the nucleus accumbens of the brain thereby becoming the first behavior to be classified as an addiction. Since then, other behaviors that have been confirmed by brain scans to somehow cause the release of dopamine in the nucleus accumbens in the brain and therefore satisfy the definition of addictions include video games, sex/pornography, shopping in some cases, and hyperpalatable foods (blend of sugar, fat and salt). Another substance confirmed by brain scans to be addicting and considered by some to be the worst addiction of all is SUGAR! (And, we give sugar to babies.)
One interesting observation that we have known for a long time and which the dopamine explanation of addictions explains very well is why we have cross addictions. By that we mean cases where we see multiple addictions and people who quit one addiction such as cocaine only to increase other addictive substances such as alcohol and nicotine. This explains why AA meetings are often held in very smoky rooms. It also explains why some people who quit smoking increase their intake of hyperpalatable foods and gain weight. It also explains why diabetics also often have other addictions.
So, the next logical question is, “How do we use this information to mount a more successful approach to controlling and stopping addictions?” Certainly we do not want to abandon any of the good work and good methods developed in the past but the one big piece that seems to have been overlooked until now is dopamine. Since the production and release of dopamine is common denominator of all addictions it seems logical to assert that assessment of the state of dopamine levels in the addict is a good starting point. Fortunately today we do have good technology capable of assessing this situation. It is probably worth noting at this time that in the last letter we noted that a highly significant amount of the body’s dopamine is actually produced in the gut by nerve endings and also by some of the bacteria normally found in a healthy microbiome. We noted that both dopamine and serotonin are produced in abundance in a healthy gut but that sugar and other refined carbohydrates strongly support other harmful bacteria that can crowd out the good bacteria.
To that end I submit that sugar and other refined carbohydrates are not only addicting but that sugar is the mother of all addictions. The reason that I bestow the title of , “Mother of all addictions,” is that not only does sugar fit the definition of an addiction, ie causes the release of dopamine in the nucleus accumbens, but also sugar and only sugar has the ability to shut down the body’s normal mechanism to produce most of the necessary dopamine in the gut. This deficiency of dopamine is the root cause of all the other addictions that we know and struggle to control. Out of this shortage of dopamine is born the need to cause the release of dopamine by the nucleus accumbens by any means possible be that alcohol, nicotine, opioids, or more sugar.
So, what is the practical value of this new and different incite into the most basic cause of addictions. For the individual trying to beat an addiction, the main message has to be that since a lack of dopamine is the root cause of the addiction problem that you must deal as much with the dopamine issue as with the addicting substance itself. Functional medicine practitioners might be helpful with this but anything that helps restore gut health and general health is a step in the right direction. The main focus should be on total health and wellness and a normalization of dopamine. Don’t just focus on the addicting substance. That is the result f the problem. Dopamine is the causes of the problem. Always treat the cause!
How about the poor parents who stand by and watch in horror as their beloved children fall further and further into the grip of addictions. What can they do? Again, all the usual AA type stuff is helpful but you must also realize that dopamine is the real root of the problem. To that end, basic nutrition might be a part of the solution. . We have seen how high carb – low fiber diets can mess with our microbiome and this in turn leads to dopamine and serotonin disruptions. Could a mother’s best defense against addictions be to nag her children to, “Eat your vegetables!” and back off on the sugar. This could be helpful but like all things in healthcare the best approach is to watch for the early clues and get started early. We learned earlier that in order to prevent diabetes you take metabolic syndrome seriously. In the case of addictions, since a lack of dopamine is often associated with a lack of serotonin and since a lack of serotonin is associated with depression; depression is probably the early sign that needs to be taken more seriously.
But what is the practical value of this information to a young health minister like you who is trying to balance the budget, transform drug addicts into taxpayers, and win the Nobel Prize? Granted this is a tall order but take it in small steps and work with groups that are already doing very good work on these problems. Most of their work is very good but they all seem to be missing the root cause of addictions which is dopamine.
Probably your best resource for the whole lack of dopamine due to poor gut health is the U of C professor that I mentioned in the previous letter. She probably has lots of wisdom about the best probiotics and prebiotics to correct this problem expeditiously. If that information is not fully worked out yet something like fecal transplants might be an option in the short term. If she does not have all the answers; she might at least point you in the right direction. That is how these things often go. Once you feel that you have a good enough plan to get started you will need some test groups. (Just another thought, the Big Pharma Guys might have some kind of a synthetic dopamine concoction that might be helpful at least in the early stages.)
Test groups should not be hard to find. Willing participants can be found throughout currently operating residential rehab clinics, AA groups, mental health facilities and even penitentiaries for that matter. This is not quite a double blind study but at least you have a test group and other addicts at the same facility who aren’t interested in the experiment can be used as the controls. At the end of the study you see how many addicts from each group have been transformed into taxpayers.
If the outcomes of your initial investigation are promising, then this information can be shared with the ubiquitous subclinical addicts found almost everywhere in society. This would involve the use of some simple self help communication tools which the department of health does not have yet but that is a topic for another day.
I hope that this information is helpful to you and hopefully good things will come from all of this. Even if a very successful treatment protocol is developed it still will take years to clear up the mess caused by the opioid crisis and other crimes and errors. No need to respond to this letter beyond a simple acknowledgement that you have received it.
Dr. Murray Hennings, DMD