Sex, Drugs and Rejection-Sensitivity: How a Co-Existing Disorder Can Complicate Recovery from Addiction

rejection sensitivity 2

There is new research, just published in the journal Molecular Psychiatry and reported on Science Daily, that should be of interest to people who treat addictions, as well as people and families in recovery. It  offers insight into one of the ways that co-existing disorders, such as depression, may complicate recovery from addiction.

The new study was done in an effort to determine whether the brains of depressed people respond   differently to the experience of social rejection than the brains of non-depressed people.  It turns out that they do, and since rejection-sensitivity is thought to be a risk factor for addiction and relapse, the fact that some brains have unique responses to the pain of social rejection is something for people dealing with addiction and the treatment of addiction to think about.

People with high  rejection sensitivity  (RS)  “anxiously expect, readily perceive and react intensely to rejection”. (Leach and Kranzler, 2013.) They  frequently “react in ways that undermine their relationships, ultimately serving as “self-fulfilling prophecies” and they  tend to   have  lower self-esteem than people with low RS. Since they also exhibit higher levels of   drug use than low-RS individuals it is important for addiction researchers and treatment professionals to know more about the different conditions that can promote and exacerbate RS.

Investigators from  the University of Michigan Medical School  and the University of Illinois collaborated on this experiment, which  used brain-imaging technology and a simulated online dating scenario to see how activity in the mu-opioid receptor system in the brain was affected when depressed and non-depressed participants were exposed to social rejection.

The endogenous opioid system of the brain is intricately involved in controlling the human response to stress,  regulating pain, and responding to analgesic opiate drugs. Research has shown that when the  mu-opioid receptor system  is activated, people report sensory and affective relief of pain. On the other hand, mice who lack the mu-receptor gene show increased sensitivity to painful stimuli and altered emotional responses.

There were 27 depressed participants in the present study and 18 similar but non-depressed participants. Each participant viewed photos and profiles of hundreds of other adults and   identified the  profiles of people they were most drawn to  romantically.  In other words, the experimental setting was similar to an online dating scenario. After making the selections, all participants underwent brain scans using positron emission tomography.  During the scans, participants were told that the individuals they selected in the first part of the study  were not interested in them. The scans made during the moments of rejection showed both the amount and location of opioid release as measured by the  availability of mu-opioid receptors on brain cells.

The depressed individuals in the experiment exhibited reduced opioid release in brain regions regulating stress, mood and motivation. When  participants  were told that people liked them back, however, both depressed and non-depressed individuals reported feeling happy and accepted.  However, the positive feeling in depressed individuals disappeared rapidly after the period of social acceptance had ended, and  only the non-depressed people reported  feeling motivated to connect socially with other people. According to a summary of this research in Science Daily, this feeling of wanting to be with others was “accompanied by the release of opioids in a brain area called the nucleus accumbens — a structure involved in reward and positive emotions”. The dramatic responses of the depressed participants to rejection occurred even though the researchers informed all participants ahead of time that the “dating” profiles were not real, and neither was the “rejection” or “acceptance.”

opiod receptors in rejection sensitivity

(Note release of natural opioids in non-depressed participants during period of social rejection (light spots) vs. limited response in brains of depressed participants.)

 It is interesting to think about these results in connection with an earlier  review of research about  interpersonal stress and rejection sensitivity published in 2013 by by Leach and Kranzler. These investigators concluded  that “substance-dependent individuals with high trait rejection sensitivity and a critical interpersonal environment are particularly vulnerable to relapse to substance use”.  They attributed this vulnerability to the fact  that social pain, like physical pain, causes suffering and speculated that there are individual differences in the ability to tolerate this suffering, a supposition that the current study, while small, appears to bear out. 

The fact that some depressed people have such a marked inability to to cope, neurologically, with the experience of social rejection, and that interpersonal stress, including rejection-sensitivity, can be important relapse risk factors for people in recovery, reinforces the idea that comorbid conditions like depression should be treated concurrently with the addictions, since some people with substance use disorders are undoubtedly medicating their co-existing disorder as well as avoiding withdrawal.  NIDA points out that there are some medications that may benefit multiple problems, citing evidence that, for example,  bupropion (trade names: Wellbutrin, Zyban),which helps relieve depression in some patients also helps reduce craving and use of methamphetamine.  NIDA also identifies promising behavioral therapies, including  Cognitive-Behavioral Therapy (CBT)  which appears to be “the most effective psychotherapy for children and adolescents with anxiety and mood disorders,  and also shows strong efficacy for substance abusers” and Dialectical Behavior Therapy (DBT)  “designed specifically to reduce self-harm behaviors (such as self-mutilation and suicidal attempts, thoughts, or urges) and drug abuse. As NIDA cautions, in order to effectively address comorbid problems  in patients with substance use disorders  it is sometimes necessary to confront “lingering bias…in some  treatment centers against using any medications, including those necessary to treat serious mental disorders such as depression, ” and that it is important to choose treatment programs that “employ professionals qualified to prescribe, dispense, and monitor medications.”

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