What is Addiction?

When differentiating between "physical" addiction and "psychological" addiction in newborns of addicted mom's, it is a slippery slope of distinction. It is known that physical addiction comes about through an array of neuroadaptive changes and the laying down and strengthening of new memory connections in various circuits in the brain. We do not yet know all the relevant mechanisms, but the evidence suggests that it is the long-lasting brain changes from prolonged drug use that are responsible for the distortions of cognitve and emotional functioning that characterize addictive behaviors, possibly including the cravings of psychological addiction.

Scientists are characterizing physical addiction as a circumstance occuring when a person's body becomes dependent on a particular substance and that this person builds tolerance to that substance, so that the person needs a larger dose than previous to achieve the same effect. Psychological addiction is characterized by the scientific community as the cravings or desire involved in needing the chemical. One form of addiction is neurochemical, while the other is a perceptual experience of needing the substance.

It is hypothesized by the medical community that the baby's brain has not had a long enough period of exposure to become actually addicted or physically dependent on the drug beyond the withdrawl period. This distinction does not mean that the baby has not experienced a neuroadaptive response in utero and possible permanent nervous system damage as a response to the drug. It simply means that we can not confidently state that a baby is neurochemically "addicted" as we define addiction in the adult population.

On the other hand, babies definitely experience withdrawl from drugs as is described as Neonatal Abstinence Syndrome. It is speculated that based upon what we know about "learning", the baby has learned how it feels to be influenced by the drug and perceives the absence of it.

I hope this helps to define and clarify the concept of neonatal addiction. This blog continues to welcome both questions and also additional information that may serve to clarify or expand concepts discussed here....Kim

Neonatal Abstinence Syndrome

A large number of drugs pass from the mothers' blood stream through the placenta to the fetus. Drugs of abuse have a low molecular weight and lipid solubility making it easier to cross the placenta. When drugs or other substances of abuse are taken by the mother equilibrium is established between the materanal and fetal circulations. This in utero equilibrium provides a constant supply to the baby and with the mothers' excretory and metabolic mechanisms the drug is cleared from the baby's circulation. During this time, the fetus undergoes a biochemical adaptation to the abnormal in utero environment and as a result the addiction of the mother now becomes the psychological addiction of the fetus. The substance exposed baby is NOT actually addicted, instead it is the psychological cravings that lead to substance seeking behaviors.

The baby's dependence on the substance continues after birth and with the cutting of the cord the baby's drug supply is abruptly removed. The baby however continues to metabolize and excrete the substance and when low tissue levels have been reached withdrawl signs occur. Since the drug is no longer available the baby's central nervous system becomes overstimulated causing the symptoms of withdrawl.

There are two theories on neonatal withdrawl

1. Disuse hypersensitivity theory where the nervous system responds to the depressant drug
by increasing the sensitivity of the target receptors in the brain. The removal of the drug
causes the target receptors to become overwhelmed by input that was previously blocked
by the drug.

2. Neural hyperactivity theory occurs when normal minor activity pathways become more
active when the depressant drug blocks the usual neural pathway. When the depressant
drug is removed, both pathways are active resulting in neural hyperactivity.

Withdrawl symptoms occur from a few hours up to 2 weeks of age. The timing of the withdrawl onset depends on the time of the last drug exposure and the metabolism and excretion of the drug and its metabolites.

The behaviors we see in infants are:

• high pitched cry
• inability to sleep
• frantic sucking of fists
• yawning
• sneezing
• nasal stuffiness
• poor feeding behaviors
• regurgitation, vomiting and losse stools
• hyperactive moro reflex
• hypertonicity
• tremors

What can we do?

• swaddling (deep pressure touch)
• soft pack baby carrier
• smooth slow rocking
• pacifier
• decrease feeding intervals
• reduce environmental stimuli
• lambskin bedding

Although no actual studies have been found to date identifying long term changes to the receptor sites within the nervous system, many therapists report long term sensory processing challenges and arousal issues in this population. What have you observed?

Labyrinth Journeys

Welcome to the Blogspot of Labyrinth Journeys. This page is an opportunity for therapists to share their experiences and ideas to support the evolution of therapeutic intervention for children with special needs.