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 Addiction
Slide4: Your Brain on Drugs YELLOW shows places in brain where cocaine goes (Striatum) Front of brain Back of brain
Slide5: There is a Unique Disconnect Between the Scientific Facts and the Public's Perception About Drug Abuse and Addiction
Slide6: Drug Abuse Is A Preventable Behavior Partnership for a Drug Free America Drug Addiction Is A Treatable Disease
Slide7: Initial Drug Use Is A
Voluntary Behavior…
A Person Chooses to
Take a Drug for the First Time
Why 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 What it Does to Their Brains: A Major Reason People Take a Drug is They Like What it Does to Their Brains
Slide14: storage synthesis precursor release reuptake degradation
Slide15: Natural Rewards Elevate Dopamine Levels
Slide17: Prolonged Drug Use Changes The Brain In Fundamental and Long-Lasting Ways
Slide18: Post-Chronic Amphetamine (10 days) Pre-Amphetamine/Control Striatal FDOPA Activity 4 weeks 6 months 1 year 2 years Superior Inferior
Slide19: 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 - DOE
Slide21: 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 Addiction
Slide28: 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
groups
Slide30: Implication:
Elucidation of the mechanism
of drug addiction will help to
understand other addictive behaviors
Memories Appear to Be A Critical Part of Addiction: Memories Appear to Be A Critical Part of Addiction
Slide33: 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 Users
Slide36: 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 Users
Slide37: 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 Context
Slide39: Social Dominance in Monkeys: Dopamine Receptors and Cocaine Self-Administration:Dopamine Receptor Density Morgan et al, Nature Neuroscience 2002
Slide40: 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 Disorder
Slide43: That’s Why Addicts Can’t Just Quit That’s Why Treatment Is Essential!
Treating A Brain Disease Must Go Beyond Just Fixing The Chemistry: Treating A Brain Disease Must Go Beyond Just Fixing The Chemistry
Slide45: 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 Context
Slide49: 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 Opiates
NIDA-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 Journals
Slide60: 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), 2002
Slide64: 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 Abuse
Protocols 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 Used
Slide70: 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 Strategies
Slide75: 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