My favorite definition of an alcoholic or drug addict is anyone who has gotten into trouble (legal, relational, or work related) while drinking or using drugs, then continues to use them. They did not learn from the previous experience. A rational person would realize that he or she has trouble handling the alcohol or drugs and stay away from them. Unfortunately, many people with these problems have to experience repeated failures because of the substance use, and thus. .h.i.t "rock bottom" before treatment is sought.

In treating substance abuse, it is important to recognize and treat any underlying cause of the problem, such as unrecognized depression, bipolar disorder, anxiety disorders, or ADD. New medications have been developed that have been found helpful in alleviating withdrawal symptoms and decreasing cravings for the substances. Psychotherapy and support groups are often helpful.

Drugs and alcohol are a nightmare for brain function.

Toxic Exposure Toxic exposure hurts the brain. Many substances have the potential to be brain toxic and most people have no clue. Many medications, much caffeine, nicotine, and environmental toxins, such as pesticides, paint fumes, hair-coloring chemicals, and nail polish, can hurt your brain. Understanding the sources of brain poisons can help you avoid them.

Many medications are brain toxic. From a psychiatric standpoint, I was taught to use a cla.s.s of antianxiety medications called benzodiazepines, such as Xanax, Ativan, and Valium, to treat patients with intense feelings of anxiety and panic. As soon as I started performing SPECT studies, I saw that these medications were often toxic to brain function. Scan after scan on these medications showed an overall diminished or dehydrated pattern of activity, just as there is with drug abuse. It didn"t take long for me to stop using these medications and look for other ways to heal anxiety and panic. In much the same way, painkillers often showed brain toxicity on scans: Vicodin, Darvon, Percodan, OxyContin, and others caused overall decreased brain activity. No wonder they help pain, they make people feel numb all over. Of course, this doesn"t mean that these medications are never indicated. Many people would rather die than live with chronic pain. It does mean, however, that we should look for alternatives to painkillers for chronic pain that also numb the brain.

Nicotine prematurely ages the brain. Nicotine, found in cigarettes, cigars, chewing tobacco, and nicotine patches, tablets, and gum, causes blood vessels to lessen blood flow to vital organs. We know smokers have more problems with impotence; it is bad to have low blood flow to s.e.xual organs. Nicotine constricts blood flow to the skin, making smokers look prematurely older than they are. Nicotine also constricts blood flow to the brain, eventually causing overall lowered activity and depriving the brain of the nutrients it needs.

High amounts of caffeine can also be trouble. Caffeine constricts blood flow to the brain and many other organs. A little caffeine a day is not a problem, but more than a cup or two can be trouble. Caffeine does three bad things to the brain. First, brain-imaging studies have shown that caffeine constricts blood flow to the brain. Since blood is critical in bringing nutrients to cells and taking away toxic waste products, anything that diminishes blood flow to an organ causes premature aging. Second, caffeine blocks a chemical called adenosine and fools us into believing we need less sleep. Less sleep also causes overall lower blood flow to the brain. In addition, caffeine is a diuretic. The brain is 80 percent water. Anything that dehydrates you has a negative impact on brain function. As little caffeine as possible is a good rule if you want to respect and nurture your brain.

Sleep Deprivation Sleep deprivation hurts the brain. People who get less than seven hours of sleep a night have lower activity in the temporal lobes of the brain, the part of the brain involved in learning and memory. Shift workers, those suffering from jet lag, teens who have their sleep schedules off-kilter from school schedules, and those suffering from sleep apnea are all at risk for poorer brain function. Those who are sleep deprived score poorer on memory and math tests, have lower grades in school, and are at much greater risks for driving accidents. Sleep deprivation is also a.s.sociated with depression and attention deficit disorders. Recently, sleep apnea (snoring loudly, holding breath when sleeping, and tiredness during the day) has been linked to Alzheimer"s disease. This is due to the direct effect of a lack of oxygen damaging the brain. Work to sleep at least seven to eight hours a night. Practice good sleep habits, such as avoiding much caffeine or nicotine; staying away from alcohol as a sleep aide, as it will wear off and cause you to wake up in the middle of the night; and avoiding exercise before bed; and learn relaxation techniques to calm your mind.

Helping your partner get enough sleep is an effective form of foreplay. Helping with the children, work, house ch.o.r.es, or other things that interfere with sleep is likely to help your partner sleep better and be more available to you.

Untreated Mental Illnesses As in the case of Roseanne earlier in the chapter, being plagued with depression, anxiety, distractibility, impulsivity, mood swings, or obsessions is not very s.e.xy. Having an untreated psychiatric problem can ruin your chances for great love. Many people never seek help for their mental or emotional problems because they do not recognize them or think they can control them. All aspects of s.e.xuality may be affected by the distress of mental illness. In both men and women, people who were depressed had half the s.e.xual arousal than their normal counterparts did. Mental illness is very common, almost the norm. According to the U.S. Epidemiological Catchment Area Study, 49 percent of the U.S. population will experience a mental illness at some point in their lives, with anxiety, depression, attention deficit disorders, and substance abuse being the most common. If you suffer from emotional or behavior problems, get the help.

Poor Diets The increase in fast-food diets and poor nutrition is directly responsible for the rise in mental illness over the past fifty years. Studies have linked attention deficit disorder, depression, Alzheimer"s disease, and schizophrenia to junk food and the absence of essential fats, vitamins, and minerals in industrialized diets. These illnesses have a direct impact on s.e.xual and relationship health. Rates of depression have been shown to be higher in countries with low intakes of fish, for example. Lack of folic acid, omega-3 fatty acids, selenium, and the amino acid tryptophan are thought to play an important role in the illness. Deficiencies of essential fats and antioxidant vitamins are also thought to be a contributory factor in schizophrenia.

Helpful Brain Behaviors Protect Your Brain Protecting the brain from injury is the first step to optimizing its function. Your brain is the consistency of tofu and it is housed in a really hard skull. Wear a seat belt in a car and always wear a helmet when you ride a bicycle, motorcycle, or go s...o...b..arding.

Limit Brain Toxins As mentioned above, current research has shown that many chemicals are toxic to brain function. Alcohol, drugs of abuse, nicotine, much caffeine, and many medications decrease blood flow to the brain. When blood flow is decreased, the brain cannot work efficiently. Avoid these toxic substances.

Get Enough Sleep Sleep deprivation decreases brain activity and limits access to learning, memory, and concentration. A recent brain-imaging study showed that people who consistently slept less than seven hours had overall less brain activity. Getting enough sleep is essential to brain function.

Counteract Stress Scientists have only recently discovered how stress negatively affects brain function. Stress hormones have been shown in animals to be directly toxic to memory centers. Brain cells can die with prolonged stress. Managing stress effectively through meditation, relaxation, and exercise is essential to good brain function.

Eat Right to Think Right The fuel you feed the brain has a profound effect on how it functions. Lean protein, complex carbohydrates, and foods rich in omega-3 fatty acids (large cold-water fish, such as tuna and salmon, walnuts, Brazil nuts, olive oil, and canola oil) are essential to brain function. Research has shown that fish consumption is a.s.sociated with the prevention of cognitive decline as people age.

Daily multiple vitamins. With our poor diet, many Americans are overweight but nutrient poor. The American Medical a.s.sociation recommends we all take a 100 percent multiple vitamin everyday. Your brain needs it.

Daily high-quality fish oil. Omega-3 fatty acids are essential to brain health. Low levels of this nutrient have been a.s.sociated with depression, ADD, dementia, and even suicide. Fish oil has been found to be helpful for hearts, joints, skin, and brain. Take 1,000 to 2,000 milligrams a day.

Kill the ANTs That Invade Your Brain The quality of your thoughts also impacts brain function. Happy, hopeful, positive thoughts are a.s.sociated with improved brain function, while negativity (I call these bad thoughts ANTs, automatic negative thoughts) turns off certain cerebral centers. Positive thinking is not just good for you, it helps make your brain work better. List five things you are grateful for today.

Work Your Brain Your brain is like a muscle. The more you use it, the more you can use it. Every time you learn something new, your brain makes a new connection. Learning enhances blood flow and activity in the brain. If you go for long periods without learning something new, you start to lose some of the connections in the brain and you begin to struggle more with memory and learning. Strive to learn something new every day, even if it is just for a short period of time.

Exercise for Your Brain People who physically exercise on a regular basis have better memories with age, they have better blood flow to the brain, and many cerebral processes are enhanced. The best kind of exercise improves the pump force of your heart (cardiovascular exercise).

It has been known for many years that s.e.x was good exercise, but until now n.o.body had made a scientific study of the caloric content of different s.e.xual activities. An anonymous source on the Internet listed, tongue in cheek, the following results.

REMOVING HER CLOTHES.

With her consent 12 calories Without her consent 2,187 calories OPENING HER BRA.

With both hands 8 calories With one hand 12 calories With your teeth 485 calories PUTTING ON A CONDOM.

With an erection 6 calories Without an erection 3,315 calories POSITIONS.

Missionary 12 calories 69 lying down 78 calories 69 standing up 812 calories Wheelbarrow 216 calories Doggy style 326 calories Italian chandelier 2,912 calories o.r.g.a.s.mS.

Real 112 calories Fake 1,315 calories POSTo.r.g.a.s.m.

Lying in bed hugging 18 calories Getting up immediately 36 calories Explaining why you got out of bed immediately 816 calories GETTING A SECOND ERECTION IF YOU ARE ...

2029 years 36 calories 3039 years 80 calories 4049 years 124 calories 5059 years 1,972 calories 6069 years 7,916 calories 70 and over Results are still pending DRESSING AFTERWARD.

Calmly 32 calories In a hurry 98 calories With her father knocking at the door 5,218 calories With your wife knocking at the door 13,521 calories Results may vary!

Develop a "concert state" for your brain Optimal performance is best achieved when a "concert state" exists in the brain. By "concert state" I mean "a relaxed body with a sharp, clear mind," much as you would experience at an exhilarating symphony. Achieving this state requires the ability to relax and focus. Ten minutes of slow, deep breathing is usually enough to develop this state.

Coordinate Your Brain Recently, it was learned that the cerebellum, a structure at the back, bottom part of the brain, is involved not only with physical coordination but also with processing speed and thought coordination, or how quickly you can integrate new thoughts. Doing coordination exercises helps the brain overall work smarter and faster. One exercise shown in scientific studies to help is juggling. People who learned how to juggle three b.a.l.l.s for a minute straight enhanced brain function.

Make Love for Your Brain As discussed in Lesson Two, making love on a regular basis improved mood, memory, and overall health. One study showed that it decreased the risk of heart attack and stroke by 50 percent. Hold the medicine, give me love.

Do Not Let E-mail Control Your Life A recent study showed that constantly checking e-mails and phone messages actually lowered IQ by ten points, more than double the loss in IQ of cannabis users. E-mail can be addictive, as one is always waiting for the next good e-mail to hit, like waiting for the next blackjack in the card game twenty-one. The antic.i.p.ation of something good keeps us checking something routine. It also distracts us from staying focused on the person or task at hand. Limit your time on e-mail.

Treat Brain Problems Early If you have learning, mood, behavior, or memory problems, get an evaluation. The brain is an organ just like your heart or kidneys. When there are signs of trouble, work on getting it fixed.

Use these strategies to have the best brain possible. A better brain improves everything else in your life, including your s.e.x life.

Lesson #12: Caring for your brain increases your chances for great s.e.x.

The Amen Clinic Brain

System Questionnaire

Please rate yourself on each of the symptoms listed below using the following scale. If possible, for the most complete picture, have another person who knows you well (such as a spouse, lover, or parent) rate you also.

PREFRONTAL CORTEX ISSUES (PFC).

1. Fails to give close attention to details or makes careless mistakes 2. Has trouble sustaining attention or trouble listening 3. Is poorly organized 4. Is easily distracted 5. Finds difficulty expressing empathy for others 6. Blurts out answers before questions have been completed, interrupts frequently 7. Is impulsive (saying or doing things without thinking first) ANTERIOR CINGULATE GYRUS (ACG).

8. Excessive or senseless worrying 9. Upset when things do not go your way 10. Upset when things are out of place 11. Tendency to be oppositional or argumentative 12. Tendency toward compulsive behaviors 13. Intense dislike for change 14. Needing to have things done a certain way or you become very upset DEEP LIMBIC SYSTEM (DLS).

15. Frequent feelings of sadness or moodiness 16. Negativity or irritability 17. Low energy 18. Decreased interest in things that are usually fun or pleasurable 19. Feelings of hopelessness, helplessness, worthlessness, or guilt 20. Crying spells 21. Chronic low self-esteem BASAL GANGLIA (BG).

22. Frequent feelings of nervousness, anxiety, or panic 23. Symptoms of heightened muscle tension (headaches, sore muscles, hand tremor) 24. Tendency to predict the worst 25. Conflict avoidance 26. Excessive fear of being judged or scrutinized by others 27. Excessive motivation 28. Lack of confidence in abilities TEMPORAL LOBES (TLs) 29. Short fuse or periods of extreme irritability 30. Frequent misinterpretation of comments as negative when they are not 31. Frequent periods of deja vu (feelings of being somewhere you have never been) 32. Sensitivity or mild paranoia 33. History of a head injury or family history of violence or explosiveness 34. Dark thoughts, may involve suicidal or homicidal thoughts 35. Periods of forgetfulness or memory problems ANSWER KEY.

Prefrontal cortex (PFC) symptoms, 17: ____ Anterior cingulate gyrus (ACG) symptoms, 814: ____ Deep limbic system (DLS) symptoms, 1521: ____ Basal ganglia (BG) symptoms, 2228: ____ Temporal lobe (TL) symptoms, 2935: ____ In each system, the following number of questions with the answer of 3 or 4 indicates that problems may be present in that area.

5 questions = Highly probable 3 questions = Probable 2 questions = May be possible See Lesson Two for a description of the brain systems, problems, and treatments.

Why SPECT?

What Brain-SPECT Imaging Can Tell Clinicians

and Patients That Cannot Be Obtained Elsewhere

If we agree that mental disorders and difficult behaviors may be related to functional problems in the brain, then a logical next step is clearly to consider physically evaluating the brain itself when faced with people who struggle with complex problems or who are unresponsive to our best diagnostic and treatment efforts. Why are psychiatrists the only physicians who rarely look at the organ they treat? It is time to change. Amen Clinics, Inc. (ACI) has provided leadership and understanding on the clinical use of brain imaging in psychiatry. Since 1991, ACI has built the world"s largest database of brain scans related to emotional, learning, and behavioral problems. The study we do is called brain-SPECT imaging. SPECT stands for Single Photon Emission Computed Tomography. It is a nuclear medicine procedure widely used in medicine to study heart, liver, thyroid, bone, and brain problems. Brain-SPECT imaging is a proven, reliable measure of cerebral blood flow. Because brain activity is directly related to blood flow, SPECT effectively shows us the patterns of activity in the brain.1 SPECT allows physicians to look deep inside the brain to observe three things: areas of the brain that work well, areas of the brain that work too hard, and areas of the brain that do not work hard enough. ACI has performed more than 35,000 scans on patients from age 10 months to 101 years, and has also scanned many normal, "healthy brain" individuals as well.

The procedure guidelines of the Society of Nuclear Medicine lists the evaluation of suspected brain trauma, evaluation of patients with suspected dementia, presurgical location of seizures, and the detection and evaluation of cerebral vascular disease as common indications for brain SPECT.2 The guidelines also say that many additional indications appear promising. At ACI, because of our experience, we have added the indications of evaluating violence, substance abuse, the subtypes of ADD, anxiety, and depression, and complex or resistant psychiatric problems for brain SPECT.

An important question for today"s mental health clinicians is "When and why would I order a SPECT study for my patients or get one for myself or a loved one?" My purpose in this section is to answer this question and to point out some of the benefits and caveats for using this powerful tool. A SPECT scan can provide distinct benefits to clinicians, and to the patient and his/her family. (There are also some things that should not be expected from a SPECT scan, listed later.) Benefits for Physicians and Clinicians A SPECT scan can show: Areas of the brain implicated in specific problems, such as the prefrontal cortex with executive function and the medial temporal lobes with long-term memory storage.

Unexpected findings that may be contributing to the presenting problem(s), such as toxicity, potential areas of seizure activity, or past brain trauma.

Potential seizure activity, in many cases more accurately seen by SPECT than standard EEG, especially in the areas of the medial temporal lobe. There are more than forty-one studies with more than 1,300 patients on SPECT and epilepsy (see www.amenclinic.com for references).

Targeted areas for treatment, such as overactive basal ganglia or anterior cingulate gyrus (seen on anxiety and OCD spectrum disorders) or an underactive temporal lobe (seen in seizure disorders and trauma).

Specific effects of medication on the brain to help guide us in adjusting dosages or augmenting treatment. Often patients report that SSRIs are helpful but also cause decreased motivation or memory problems, seen as decreased prefrontal or temporal lobe activity on SPECT.

Changes in brain function with treatment, improved or worsened. You can review many "before and after" scans at www.amenclinic.com.

The image occurs at the time of injection and outside the imaging camera, which gives SPECT several significant advantages. Most notably, we are able to sedate people after they have been injected so that they can lie still for the scan, often difficult for hyperactive or autistic children or demented adults (motion artifact ruins the scan in all of these imaging techniques).

A SPECT scan can provide explanations for refractory symptoms and help clinicians ask better and more targeted questions (e.g., about toxic exposure, brain injuries, anoxia, inflammation, or infections that patients may have denied or forgotten).

A SPECT scan can help us to avoid prescribing treatments that make the problem worse, such as unnecessarily stimulating an already overactive brain or calming an underactive one.

A SPECT scan can help to evaluate risk for dementia-the brain starts to change long before people show symptoms. There is usually a loss of 30 percent of hippocampal tissue before symptoms occur. Using autopsy data in fifty-four patients, Bonte reported that brain SPECT had a positive predictive value for Alzheimer"s disease of 92 percent.3 A SPECT scan can also help to differentiate between types of dementia. Early in the disease, Alzheimer"s disease, frontal temporal lobe dementia, Lewy body dementia, and multiinfarct dementia each have their own patterns. There are more than eighty-three studies with more than 4,500 patients on this subject (see www.amenclinic.com for references).

A SPECT scan helps clinicians understand the rationale for using certain medications (such as anticonvulsants to stabilize temporal lobe function or to calm focal areas of marked hyperactivity, or stimulants to enhance decreased prefrontal perfusion, or SSRIs to calm basal ganglia and anterior cingulate hyperactivity).

A SPECT scan can identify specific areas of the brain affected by trauma, better target treatment, and help deal with insurance, legal, and rehabilitation issues. There are more than thirty-eight studies with more than 1,300 patients on brain trauma (see www.amenclinic.com for references).

A SPECT scan can often identify factors contributing to relapse in recovering substance abusers, eating disordered, or s.e.xual addicts. For example, the patient may have suffered an injury to the prefrontal cortex or temporal lobes or have overactivity in the anterior cingulate gyrus, basal ganglia, limbic system, or prefrontal cortex, each of which could indicate comorbid disorders requiring treatment.

A SPECT scan can often identify a specific cause or reason that contributes to recovering alcoholics, drug addicts, eating disordered, or s.e.xual addicts relapse behavior in their recovery from an addictive process. For example, the patient may have suffered an injury in the prefrontal cortex or temporal lobes or have overactivity in anterior cingulate gyrus, basal ganglia, limbic system, or prefrontal cortex, each of which could contribute to the relapsing behaviors.

A SPECT scan is also useful to determine if further adjustment of medication is needed. Scans of patients on medication will reveal areas of the brain still overactive or underactive.

Benefits of SPECT-Brain Imaging for Patients

and Their Families

A SPECT scan helps develop a deeper understanding of the problem, resulting in reduced shame, guilt, stigma, and self-loathing. This can promote self-forgiveness, often the first step in healing. Patients can see that their problems are, at least in part, medical and physical.

A SPECT scan allows patients to see a physical representation of their problems that is accurate and reliable, and helps to increase compliance-pictures are powerful. It can influence a patient"s willingness and ability to accept and adhere to the treatment program. They can better understand that not taking medication for anxiety, depression, rage, ADD, etc. is similar to not wearing the "correct" prescription gla.s.ses.

A SPECT scan helps families understand when things, such as permanent brain damage from an injury, will not get better, so that they can better accept the condition and provide accordingly.

A SPECT scan shows substance abusers the damage they have done to their own brain, thus helping to decrease denial, provide motivation for treatment, and support perseverance in sobriety.

A SPECT scan shows patients how treatments have impacted (improved or worsened) brain function.

A SPECT scan helps motivate abusive spouses to follow medication protocols by showing that there is a physical abnormality contributing to their problems.

A SPECT scan is useful for cancer patients suffering with a "chemotherapy toxic brain." It gives them insight into their cognitive struggles and also helps their doctors see the neurophysiologic and emotional effects of having cancer and its treatment.

A SPECT scan can help take modern psychopharmacology from mystery and unknown consequences to reality and more predictable outcomes.

A SPECT scan allows patients to understand why specific treatments are indicated, which medications are likely to be most helpful, and what other interventions may be indicated.

What a SPECT Scan Cannot Provide Despite the many benefits that might be derived from a SPECT scan, there are clearly some things that it cannot provide. For example, a SPECT scan cannot: give a diagnosis in the absence of clinical information give the date of a head injury, infection, or toxic exposure a.s.sess or evaluate IQ a.s.sess or evaluate the guilt, innocence, motivation, or sanity of a criminal defendant guarantee a perfect diagnosis, or a cure.

How SPECT Differs from MRI A SPECT scan is similar to an MRI study in that both can show three-dimensional images and "slices" of the brain. However, whereas MRI shows the physical anatomy of the brain, SPECT shows brain functional activity. That is, SPECT yields images showing where the brain is functioning well, where it is working too hard, and where it is not working hard enough. A newer version of MRI, functional MRI or "fMRI," is also capable of showing brain activity and is used extensively in scientific research on brain function. fMRI shows instantaneous neural activity so you can see, for example, how the brain responds to a specific stimulus event. With SPECT we see brain activity averaged over a few minutes so it is better at showing the brain doing everyday activities such as concentrating, meditating, reading, etc. PET, another nuclear-imaging technique, is very similar to SPECT but is a slower and more costly imaging technique.

Ensuring High-Quality SPECT Images Although a SPECT scan is simple from the patient"s perspective, it takes considerable skill and experience to dependably generate accurate brain-SPECT images suitable for psychiatric applications. Equally important is the need for total consistency in imaging techniques among patients so that results are quantifiable, repeatable, and consistent.