All posts by pjdhanoa

A Common Pathway For Addiction – Scott Bienenfeld, M.D.


A Final Common Pathway of Addiction:
Recently, at a clinical conference on addiction, I overheard an intern ask a straightforward question about why a person recovering from a severe cocaine addiction should not consume alcohol, a drug they never really had a problem with. As it turns out, this is a common question asked by both clients as well as their spouses, families and friends (who often want to be able to drink socially with them). Seasoned clinicians, long-standing AA members and others who have successfully managed their addictions all seem to understand that a person battling a substance use disorder will be at a serious risk of relapse or “cross-addiction” if they start drinking or using another drug. The question as to why this is the case is of great interest medically and, as it turns out, has major implications not only for promoting abstinence among those with addictive disorders, but also for one day developing medical treatments that can directly target brain areas that are directly involved in both addiction and recovery.
Over the past twenty years, advances in brain imaging and neuroscience have greatly enhanced our understanding of several aspects of addiction. For a really good and technical overview read the article: (Nestler EJ. Is There a Common Molecular Pathway For Addiction? Nature Neuroscience. 8(11):1445-9, Nov 2005). One of the most interesting findings has been that when drugs of abuse are absorbed by the brain, certain important areas become activated in a predictable manner. This is only true for drugs that can be abused and/or cause addiction, and not true for drugs or other substances that cannot. The areas that “light up” on fMRI scans during ingestion of drugs of abuse are located deep in the brain in an area called the ‘mid-brain’ (see fig. 1) which is considered to be responsible for feelings of reward, pleasure, euphoria, compulsion, salience, and perseveration. Although different drugs of abuse cause a variety of feelings when ingested (e.g., cocaine, alcohol, marijuana and heroin have very different effects emotionally and physiologically), they all have a very similar effect on these sensitive yet powerful mid-brain areas. These areas activate very quickly and, frequently unbeknownst to the person. In fact, it has been clearly demonstrated that these important brain areas become activated even before the addicted individual actually ingests an addictive substance! So, when an alcoholic walks into a bar, or sees a beer commercial on television, it is quite likely that her mid-brain is firing and activating – a situation that probably accounts for what is known as “cue-induced relapse”.
There are three major reasons why this is important. First, if highly sensitive mid-brain areas can be activated by thoughts, sights, smells, etc…it is a very good reason why those with addiction need to avoid people, places and things associated with drug use. Second, as it turns out, the mid-brain communicates directly with the frontal part of the brain, the area responsible for decision making, weighing risk vs. reward, and managing impulsivity. In those suffering from addiction, the frontal brain areas (which by comparison activate slowly), seem to be overwhelmed by the impaired mid-brain areas which continuously fire and dominate the person’s actions and behaviors. Finally, since all drugs of abuse have a common effect upon sensitive mid-brain areas that are associated with feelings of reward, pleasure, euphoria, compulsion, salience, and perseveration, then it stands to reason that a person who suffers from an addiction to one substance should avoid ALL substances that could cause addiction!

Figure 1.Brain
VTA (Ventral Tegmental Area), part of the mid-brain and Nucleus Accumbens, part of the limbic system connect and communicate with the Frontal Cortex.

Scott Bienenfeld, M.D. 

Chef Rob Recipes: Thursday 3-7-13


Thursday, March 7


We pounded chicken breasts to about ½-inch thickness, which will insure a juicier final dish.  Coat the chicken breasts in flour (keep one hand dry, one hand wet), shaking off excess.  Brown chicken breasts in olive oil (with a little butter if you wish).  Remove breasts from pan.  Wipe pan mostly clean and add chicken stock (better) or water (adequate), plus lemon juice to pan.  Cook, stirring occasionally, until flavors have combined and mixture has reduced by about 1/3 to 1/2.  Add butter and capers, and stir to combine.  Turn off heat, taste and reseason with salt, pepper, butter, capers, lemon juice.  Put chicken back in to pan to warm and/or coat with sauce.  Finish with chopped parsley, if desired.


We used  approximate measurements for sauce. (Obviously tailor to your tastes and you may need to double, depending on how many people you are serving and how much sauce you want): Chicken stock or water = 1/2 cup; lemon juice = 1/3 cup; butter = 3 tablespoons, capers = 1 tablespoon.


Cut low-moisture mozzarella (important: not fresh mozzarella!) into desired size.  (We used Organic Valley low-moisture mozzarella cheese).  Dip into flour, then egg, then panko (or regular breadcrumbs).  Put pieces onto plate or baking sheet and freeze for 30 minutes.  Remove sticks from freezer and pan-fry in olive oil.  Amount of oil = a little less than half the height of the mozzarella sticks.  Cooking two sides is all that is necessary.  Drain on paper towels, try to eat immediately.  If possible, serve with marinara sauce (see below).



Chop onion and cook in olive oil, stirring occasionally so onion doesn’t brown.  If desired, chop one or two cloves of garlic and add about five minutes into onion cooking time.  Cook for another three or four minutes.  Add tomatoes (we used a 24-ounce jar of Bionaturae organic strained tomatoes, but diced or stewed tomatoes work as well) and simmer until sauce thickens about 15 to 20 minutes.  If using herbs, add dried when you add sauce; add fresh at end of cooking process.  Let sauce cool for about 10 minutes, stirring occasionally.  Taste and reseason with salt, pepper and herbs, if using.

Chef Rob Recipe: Thursday 3-14-13


Thursday, March 14:
Which vegetables to use is completely personal preference.
Yield: 4 servings

1 to 1.5 lbs. Shrimp (wild and domestic, if possible; shells on is preferable)
1 can Coconut milk (we used Native Forest brand)
1 to 2 tspn. Green or red curry paste (we used Maesri brand)
1 Carrot, ¼-inch rounds (optional)
1 Red, yellow or orange pepper, ¼-inch strips (optional)
1 Zucchini or yellow squash, ¼-inch half-moons (optional)
1 Baby bok choy, stems chopped in ½-inch pieces (optional)
1 Onion, cut into strips (optional)
2 Tbs. Brown sugar or honey
1 Tbs. Fish sauce (we used Ka-Me brand)

1. Pour about 1 Tablespoon neutral-flavored oil (i.e. canola, vegetable) in a sauté pan, swirl in pan and heat. Add curry paste to pan and cook, stirring occasionally, for 30 seconds, or until you smell strong aroma. Add coconut milk and the vegetables you are using and cook over medium heat until vegetables begin to soften.
2. While the vegetables are cooking, peel shrimp. When the vegetables start to soften, add the peeled shrimp and simmer uncovered until the shrimp are about 70 percent cooked. Turn off heat and let shrimp finish cooking in the hot sauce.
3. Add fish sauce and brown sugar or honey; stir to combine. Taste and correct seasoning.

Shrimp are a great go-to when cooking quickly is the goal. For example, one of my favorite—and easiest—shrimp dishes entails browning some sliced garlic in butter or olive oil, adding shrimp to the pan, turning off the heat when the shrimp are 70 percent cooked, and then adding chopped parsley, fresh lemon juice, unrefined sea salt and fresh ground pepper. This takes less than 10 minutes.

Another straightforward shrimp dish is coconut shrimp.

First, combine some shredded coconut and bread crumbs (panko, Japanese bread crumbs, work well) in a shallow bowl. (The ratio depends on how much you like coconut!) Mix an egg in another bowl. Peel the shrimp. Dip the shrimp in the egg and then coat with the coconut-bread crumb mixture. Set on a plate big enough for all of your shrimp.

After coating is complete, heat olive oil and/or butter and/or coconut oil in a pan (enough to coat the pan). Add shrimp, be patient and let first side brown. Turn and let second side brown. Remove to paper towel-lined plate, sprinkle with unrefined sea salt and fresh lime juice. That’s it.

For complementary flavor I make an orange dipping sauce using orange fruit spread that I thin out with some water and lemon juice. (It’s too thick for dipping without the added liquid.) Another possibility is honey; it’s sweetness works nicely with the coconut and shrimp flavors.

If possible, buy wild shrimp, which far exceed farmed shrimp in flavor and nutrition. In addition, the growing conditions on most fish farms are less than ideal

Recovery Ride Spin Class 3-18-13


Still Feeling This Ride!

1) Mona Lisas and Mad Hatters – Elton John
2) Viva La Vida – Cold Play
3) Airline to Heaven – Billy Bragg and Wilco
4) Jungle Love – Steve Miller
5) Train in Vain – The Clash
6) A Message To You Rudy – The Specials
7) The Spicy McHaggis Jig – Dropkick Murphys
8) Misty Mountain Hop – Led Zepplin
9) Breed – Nirvana
10) Blue Monday – New Order
11) Givin’ Up – The Darkness
12) Walls Come Tumbling Down – The Style Council
13) Confetti – The Lemonheads
14) She’s a Rainbow – The Rolling Stones

Recovery Ride Spin Class 3-25-13


Great Ride!

1) Big Me – Foo Fighters

2) Cruel To Be Kind – Wilco

3) 88  Lines About 44 women – The Nails

4) Wasted – Camper Van Beetohvan

5) Paranoid Android – Radiohead

6) Oh la la – Faces

7) Wonderwall – Oasis

8) Take The  Skinheads Bowling – Camper Van Beetohvan

9) Jesus Built My Hotrod  – Minstry

10) Dyslexic Heart – Paul Westerberg

11) Knock Me Down – The Red Hot Chili Peppers

12) Tonight,Tonight – Smashing Pumpkins

13) The Hurdy Gurdy Man – The Butthole Surfers

14) Kiss Off – The Violent Femmes

15) Makes No Sense At All – Husker Du

16) Viva La Vida – Coldplay