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See all Premium member Presentation Transcript Addiction is a Brain Disease: Blending Research and Practice: Addiction is a Brain Disease: Blending Research and Practice Lucinda L. Miner, Ph.D. Deputy Director, Office of Science Policy and Communications National Institute on Drug Abuse Advances in Science Have Revolutionized Our Fundamental Views of Drug Abuse and Addiction: Advances in Science Have Revolutionized Our Fundamental Views of Drug Abuse and AddictionSlide4: Your Brain on Drugs YELLOW shows places in brain where cocaine goes (Striatum) Front of brain Back of brainSlide5: There is a Unique Disconnect Between the Scientific Facts and the Public's Perception About Drug Abuse and AddictionSlide6: Drug Abuse Is A Preventable Behavior Partnership for a Drug Free America Drug Addiction Is A Treatable DiseaseSlide7: Initial Drug Use Is A Voluntary Behavior… A Person Chooses to Take a Drug for the First TimeWhy Do People Take Drugs In The First Place?: Why Do People Take Drugs In The First Place?People Take Drugs To:: People Take Drugs To:A Major Reason People Take a Drug is They Like Whatit Does to Their Brains: A Major Reason People Take a Drug is They Like What it Does to Their BrainsSlide14: storage synthesis precursor release reuptake degradationSlide15: Natural Rewards Elevate Dopamine LevelsSlide17: Prolonged Drug Use Changes The Brain In Fundamental and Long-Lasting WaysSlide18: Post-Chronic Amphetamine (10 days) Pre-Amphetamine/Control Striatal FDOPA Activity 4 weeks 6 months 1 year 2 years Superior InferiorSlide19: Normal Cocaine Abuser (10 Days) Cocaine Abuser (100 Days)Slide20: Dopamine Transporters in Methamphetamine Abusers Methamphetamine abusers have significant reductions in dopamine transporters. Normal Control Methamphetamine Abuser p < 0.0002 Dopamine Transporters (Bmax/Kd) 1.0 1.2 1.4 1.6 1.8 2.0 2.2 2.4 BNL - UCLA - SUNY NIDA - ONDCP - DOESlide21: Dopamine Transporters in Methamphetamine Abusers BNL/UCLA/SUNY NIDA, ONDCP, DOE Motor Task Loss of dopamine transporters in the meth abusers may result in slowing of motor reactions. Memory Task Loss of dopamine transporters in the meth abusers may result in memory impairment. Time Gait (seconds) Delayed Recall (words remembered) Dopamine Transporter Bmax/Kd Slide22: Implication: Compromised dopamine systems contribute to the consequences of drug addiction.Slide23: DAT Recovery with prolonged abstinence from methamphetamine Normal Control Methamphetamine Abuser (1 month detoxification) Methamphetamine Abuser (24 month abstinent) [C-11]d-threo-methylphenidate Source: Volkow, N.D. et al., Journal of Neuroscience, 21(23), pp. 9414-9418, December 1, 2001.Slide24: Many Things Are Happening During the Transition Between Voluntary Drug Use and Addiction…What is the switch for addiction?: What is the switch for addiction? What are the adaptive changes that occur in the brain that turn on addiction?Slide27: …and Cellular Adaptations It’s Likely That the Transition Involves Both Learning and Memory Events… Drug Use AddictionSlide28: Research Has Shown that the Brain Circuitry Involved in Addiction Has Similarities to that of Other Motivational Systems Slide29: Cocaine Food DA D2 Receptor Availability Meth Alcohol Dopamine D2 Receptors in Addiction Experimental groups Control groupsSlide30: Implication: Elucidation of the mechanism of drug addiction will help to understand other addictive behaviorsMemories Appear to Be A Critical Part of Addiction: Memories Appear to Be A Critical Part of AddictionSlide33: The Memory of Drugs Nature Video Cocaine Video Front of Brain Back of Brain Amygdala not lit up Amygdala activated Slide34: Drugs Usurp Brain Circuits and Motivational Priorities Slide35: Cocaine Film Cocaine Craving: Population (Cocaine Users, Controls) x Film (cocaine, erotic) Garavan et al A .J. Psych 2000 IFG Ant Cing Cingulate Signal Intensity (AU) Controls Cocaine UsersSlide36: Cocaine Craving: Population (Cocaine Users, Controls) x Film (cocaine, erotic) Garavan et al A .J. Psych 2000 IFG Ant Cing Cingulate Signal Intensity (AU) Controls Cocaine UsersSlide37: This Results in “Motivational Toxicity” and Compulsive Drug Use (Addiction)Slide38: Addiction is a Brain Disease Expressed As Compulsive Behavior Both Developing and Recovering From It Depend on Behavior and Social ContextSlide39: Social Dominance in Monkeys: Dopamine Receptors and Cocaine Self-Administration:Dopamine Receptor Density Morgan et al, Nature Neuroscience 2002Slide40: Effect of Social Dominance on Cocaine Self -Administration * * .003 .01 .03 .1 0.0 0.5 1.0 1.5 2.0 TOTAL INTAKE (mg/kg/session) Cocaine (mg/kg/injection) Subordinate Dominant Mean intake/session (mg/kg) Slide41: DRUGS BRAIN MECHANISMS BEHAVIOR ENVIRONMENT HISTORICAL ENVIRONMENTAL - previous history - expectation - learning - social interactions - stress - conditioned stimuli - genetics - circadian rhythms - disease states - gender PHYSIOLOGICAL Drug Addiction: A Complex Behavioral and Neurobiological Disorder Addiction is the Quintessential Biobehavioral Disorder: Addiction is the Quintessential Biobehavioral DisorderSlide43: That’s Why Addicts Can’t Just Quit That’s Why Treatment Is Essential!Treating A Brain DiseaseMust Go Beyond JustFixing The Chemistry: Treating A Brain Disease Must Go Beyond Just Fixing The ChemistrySlide45: Drug Use Addiction Treatment Normal Challenge:A Major Task for Drug Treatment is Changing Brains Back!: A Major Task for Drug Treatment is Changing Brains Back!Slide47: We Need to Treat the Whole Person!The Most Effective Treatment Strategies Will Attend to All Aspects of Addiction:: The Most Effective Treatment Strategies Will Attend to All Aspects of Addiction: Biology Behavior Social ContextSlide49: We Need to Keep Our Eye on the Real Target Abstinence Functionality in Family, Work and Community In Treating Addiction…Slide50: Drug Abuse Treatment Core Components and Comprehensive Services Medical Mental Health Vocational Educational Legal AIDS / HIV Risks Financial Housing & Transportation Child Care Family Etheridge, Hubbard, Anderson, Craddock, & Flynn, 1997 (PAB)Slide51: We Are Using Science to Develop Even Better Treatment Slide52: Cabergoline Disulfiram (Antabuse) Reserpine Selegiline Cocaine Methamphetamine Bupropion Lofexidine OpiatesNIDA-Funded Behavioral Therapy Research: NIDA-Funded Behavioral Therapy Research Stage I Reducing HIV Risk Behaviors in IV Drug Users Treatment for Substance Abuse in Schizophrenia Prescriptive Therapy for Drug Abuse with Depression Concurrent Treatment of PTSD and Cocaine Dependence Therapy Development for Smoking Cessation Duration and Pacing Effects on Smoking Reduction Enhancing Readiness to Change is Schizophrenics Career/Training in Drug Abuse Research Dual Diagnosis Adherence Strategies Adapting Behavioral Marital Therapy to Treat Drug Abuse The Therapy Relationship and Anxiolytic Dependence Adherence Therapy for Opioid Abusing Pain Patients Treatment of Nicotine Dependent Smokers Smoking Cessation Intervention for Youth Expectancy-based Coping Skills Therapy Treating Nicotine Addiction in Pregnancy Treating the Partners of Drug Using Pregnant Women Behavioral Therapy For Depression In Drug Dependence HIV Testing Among Adolescents with Substance Abuse A Field-Based Treatment Model for Hispanic Cocaine Users Addressing Nicotine Addiction in Drug Abuse Patients Abstinence-Linked Money Management Developing Family Therapy for BPD Drug Abusing Youths Developing a Culturally Rooted Adolescent Family Therapy Brief Behavioral Therapy to Enhance Treatment Engagement Family Consulation For Change-Resistant Smokers A Reinforcement-Based Therapeutic Workplace Treatment Outcome for Runaway Adolescents Medication of HIV-Positive Drug Abusers Novel Lapse-Responsive Approach to Smoking Cessation Resistant Adolescent Substance Abusers in Treatment Relapse Prevention Group for Bipolar Substance Abusers Stage II Smoking Cessation For Pregnant Substance-Dependent Woman Treatment of Drug Dependence and Psychiatric Illness Psychotherapy of Substance Use Disorders Treating Chinese Smokers with Interactive Expert Systems Improving Efficacy of Drug Abuse Treatment Psychotherapy Development for Cocaine and Opioid Abuse Treatments for Complex Patients in New Settings Motivating Marijuana Cessation Opiate Dependence: Combined Naltrexone/Behavior Therapy Promoting Entry to Treatment: A Service Enhancement Behavioral Therapy for Gay Male Methamphetamine Abusers Reducing High Risk Behavior in HIV-Positive Drug Abusers Aftercare for Cocaine Patients: Effectiveness and Costs Motivational Interviewing for Teen Smokers in the ER Brief Intervention for Drug Use in Pregnant Women Relational Parenting Therapy for Opioid Abusing Mothers Expectancy-based Coping Skills Therapy Cocaine Dependence: Medication and Behavioral Treatments Enhanced Referral and Social Support in Detoxified Women A Clinical Trial of Acupuncture for Cocaine Dependence Reducing HIV Risk in Drug Abusing Youth Prevention of Smoking Relapse in Women Reinforcing Effects of Benzodiazepines in Anxiety Acceptance and Polysubstance Abusing Methadone Clients Coping with Depression in Smoking Cessation Stages of Change and Cocaine Treatment Cognitive Enhancements for Treatment of Probationers Maintaining Non-Smoking Outpatient Aversion Therapy For Cocaine Abuse Cocaine TX for the Homeless Women: Community Support (CRA) Psychosocial Treatment Dose: A Prospective Study Evaluating Voucher Based Contingencies in a Drug Court Increasing Treatment Adherence Through Social Engagement Cognitive Behavioral Treatment of HIV+ Drug Abusers Assessment of Early Retention Strategies Vouchers Vs. Prizes: Contingency Management Motivational Interviews for Incarcerated Teens Contingency Management for Marijuana Dependence Group Motivational Intervention in Drug Abuse Treatment Scheduled Smoking with Transdermal Nicotine Increasing Contingency Management Success Using Shaping Reduced Smoking to Prompt Smoking Cessation Behavioral Treatment of Marijuana Dependence A Therapeutic Workplace to Prevent HIV Transmission Network Therapy Development, Stage II with Buprenorphine Reducing HIV Risk in Methadone-Maintained Patients Motivation and Patch Treatment for HIV-Positive Smokers Brief Motivational HIV Risk Reduction Among IDUs Immunizing Against Tobacco use in Pediatric Health Care Comparing Complementary Behavior Therapies Randomized Clinical Trial of Juvenile Drug Court and MST Behavioral Therapies for Drug Dependent Pregnant Women A Smoking Intervention for Juvenile Offenders Treatment for Dually-Dependent Methadone Patients Stage III Psychotherapy Development for Cocaine and Opioid Abuse Transporting Family Therapy to Adolescent Day Treatment Moving Motivational Interviewing Into Practice Contingency Management for Real-Life Drug Treatment Evaluating Manual-guided Training in Clinical Settings Training Clinicians to Perform Validated Therapies: TSF Slide56: So how come no one’s using much of this stuff?Slide57: We Must Work to Ensure That They Are Actually Used in Practice Advances in Science Have Given Us A Broad Range of Promising Options For Treating Addiction BUT…If a Tree Falls in the Forest, and No One Is Around… : If a Tree Falls in the Forest, and No One Is Around… Does It Really Make a Sound?Slide59: If Research is Done and Only Published in Peer Reviewed JournalsSlide60: that Remain on the Shelves….Slide61: Does It Have An Impact on the Lives of Individuals?Obstacles to Applying Research: Obstacles to Applying Research Plastic wrap on manuals often too tight to open. Off the shelf interventions often not readily accepted. May not work in real-life settings w/o modifications. Research often does not look at practical questions that determine effectiveness (e.g., ease of training, attitudes, cost).“…although carefully controlled efficacy studies of new treatment components are necessary to show that the component can work, they are not sufficient to show that the component will work under broader, less controlled, and more complicated real-world conditions.”-McLellan, JSAT, 22(4), 2002: “…although carefully controlled efficacy studies of new treatment components are necessary to show that the component can work, they are not sufficient to show that the component will work under broader, less controlled, and more complicated real-world conditions.” -McLellan, JSAT, 22(4), 2002Slide64: What Are We Doing About All of This?Slide65: National Drug Abuse Treatment Clinical Trials Network Philadelphia Portland Los Angeles Charleston Miami Cincinnati Denver CTN Sites Seattle Raleigh/ Durham Long Island Boston San Francisco (CA/AZ Node) New York City Detroit Albuquerque Baltimore/Richmond New Haven CTN Current Protocols: CTN Current Protocols Buprenorphine/Naloxone Detoxification In-Patient/Out-Patient Motivational Enhancement Therapy (MET)/Motivational Interviewing (MI) Motivational Incentive Therapy Drug-Free Clinic/Methadone Clinic Protocols Ready to Enroll: Protocols Ready to Enroll Baseline Study Bup/Nx Tapering Doses Smoking Cessation Treatment in Substance Rehabilitation Programs Bup/Nx for Adolescents Telephone Enhancement of Long-term Engagement (TELE) Infections and Substance AbuseProtocols Under Development: Protocols Under Development HIV/STD prevention skills for men/women Treating women with trauma and SUDs Brief Strategic Family Therapy for adolescents Job seekers training MET for pregnant women Performance monitoring and feedback to counselors HIV intervention in drug treatment settings Enhancing Linkages to Ensure Research is Used: Enhancing Linkages to Ensure Research is UsedSlide70: Improving Application of CTN Findings via Linkage with ATTCs Philadelphia Portland Los Angeles Charleston Miami Cincinnati Denver CTN Sites Seattle Raleigh/ Durham ATTC Puerto Rico ATTC Long Island Boston San Francisco (CA/AZ Node) New York City Detroit Albuquerque Baltimore/Richmond New Haven Slide71: Our Strategy Involves BLENDING Bringing Science-Based Technologies Into Ongoing Community Practice Science Can Replace Ideology As the Foundation For Drug Abuse and Addiction Prevention, Treatment and Policy Strategies: Science Can Replace Ideology As the Foundation For Drug Abuse and Addiction Prevention, Treatment and Policy StrategiesSlide75: For More Information NIDA Public Information Office: 301-443-1124 Or www.nida.nih.gov www.drugabuse.gov National Clearinghouse on Alcohol and Drug Information (NCADI): 1-800-729-6686 www.drugabuse.gov You do not have the permission to view this presentation. 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