Addiction: It’s a Brain Disease Beyond a Reasonable Doubt: Addiction: It’s a Brain Disease Beyond a Reasonable Doubt


Slide2: Presentation Objectives Identify impact of substance abuse andamp; addiction Examine contribution of nature vs. nurture Explain how drugs 'work' Understand how prolonged drug use changes brain circuitry Understand how appropriate treatment can help people recover from drug abuse and addiction.


Slide3: NEUROTOXICITY AIDS CANCER MENTAL ILLNESS Neurotoxicity AIDS, Cancer Mental illness Health care Productivity Accidents Homelessness Crime Violence


Estimated Economic Cost to Society from Substance Abuse and Addiction:: Estimated Economic Cost to Society from Substance Abuse and Addiction: Illegal drugs: $181 billion/year Alcohol: $185 billion/year Tobacco: $158 billion/year Total: $524 billion/year Surgeon General’s Report, 2004; ONDCP, 2004; Harwood, 2000.


Contributors to the Economic Costs of Substance Abuse and Addiction: Contributors to the Economic Costs of Substance Abuse and Addiction Health care expenditures Alcohol and drug abuse services Medical consequences Productivity (lost earnings) Premature death Impaired job performance Institutionalized population Incarceration Criminal victimization Other impacts on society Crime Social welfare administration Vehicular accidents Adapted from Harwood et al., Addiction, 1999.


Between 50% and 80% of Adult Male Arrestees Tested Positive for Illicit Drug Use in 2000: Between 50% and 80% of Adult Male Arrestees Tested Positive for Illicit Drug Use in 2000 Drug Use Correlates with Crime 2000 Arrestee Drug Abuse Monitoring: Annual Report, April 2003.


The Perpetrator is Involved in Drug Use in…: More than 50% of violent crimes 60-80% of child abuse and neglect cases 50-70% of theft and property crimes 75% of drug dealing Belenko and Peugh, 1998; National Institute of Justice, 1999. The Perpetrator is Involved in Drug Use in…


However… advances in science have revolutionized our fundamental views of drug abuse and addiction, showing us that: ► abuse is a preventable behavior ► addiction is a treatable disease : However… advances in science have revolutionized our fundamental views of drug abuse and addiction, showing us that: ► abuse is a preventable behavior ► addiction is a treatable disease


Slide9: used to be


Slide10: Your Brain on Drugs Today YELLOW shows places in brain where cocaine goes (striatum) Front of Brain Back of Brain Fowler et al., Synapse, 1989.


Common Myths About Drug Abuse…: Common Myths About Drug Abuse… Drug abuse equates to drug addiction Alcohol is not a drug Addiction is a moral weakness You have to hit rock bottom to recover You have to want treatment for it to be successful Drug abuse is more common among minorities


What is Addiction?: What is Addiction? A brain disease expressed as a compulsive behavior The continued abuse of drugs despite negative consequences A chronic, potentially relapsing disorder


Why Do People Take Drugs in The First Place?: Why Do People Take Drugs in The First Place? To feel good To have novel: feelings sensations experiences AND to share them To feel better To lessen: anxiety worries fears depression hopelessness


Slide14: Why do some people become addicted while others do not? Vulnerability


Slide15: We Know There’s a Big Genetic Contribution to Drug Abuse and Addiction… ….Overlapping with Environmental Influences that Help Make Addiction a Complex Disease.


Slide16: Biology/genes Environment Biology/ Environment Interactions


Slide17: high low High DA receptor Low DA receptor DA Receptors and the Response to Methylphenidate (MP) As a group, subjects with low receptor levels found MP pleasant while those with high levels found MP unpleasant Adapted from Volkow et al., Am. J. Psychiatry, 1999. Dopamine receptor level


Slide18: Drug Abuse Drug/Alcohol Related Traffic Accidents Delinquency Academic Failure and Dropping Out of School Juvenile Depression Sexually Transmitted Diseases (Including HIV/AIDS) Running Away From Home Unwanted Pregnancies Suicidal Behavior Community Peer Cluster Family Individual


How Do Drugs “Work”?: How Do Drugs 'Work'?


Slide20: Initially, a person takes a drug hoping to change his or her mood, perception, or emotional state Translation – …hoping to change their brains.


Slide21: We know that despite their many differences, most abused substances enhance the dopamine and serotonin pathways


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Slide23: GABA and Glutamate Role in Motivation Adapted from Kalivas and Nakamura, Curr. Opin. Neurobiol., 1999. Dopamine Glutamate GABA


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Alcohol vs. Other Drugs: Alcohol vs. Other Drugs We know that alcohol impairs the brain and results in addiction with repeated use in the same way as other drugs


Slide26: Storage Synthesis Precursor Release Reuptake Degradation Synaptic Cleft = vesicle = neurotransmitters = receptor


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Slide28: dopamine transporters


Slide29: 0 50 100 150 200 0 60 120 180 Time (min) % of Basal DA Output NAc shell Empty Box Feeding Di Chiara et al., Neuroscience, 1999. FOOD Fiorino and Phillips, J. Neuroscience, 1997. Natural Rewards Elevate Dopamine Levels 100 150 200 DA Concentration (% Baseline) Sample Number SEX Female Present


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Slide31: Di Chiara and Imperato, PNAS, 1988 Effects of Drugs on Dopamine Release


Slide32: prolonged drug use changes the brain in fundamental and long-lasting ways Science has generated much evidence showing that…


Slide33: DA D2 Receptor Availability Control Addicted Cocaine Alcohol DA DA DA DA DA DA Reward Circuits DA DA DA DA DA Reward Circuits DA DA DA DA DA DA Drug Abuser Non-Drug Abuser Heroin Meth Dopamine D2 Receptors are Lower in Addiction DA


Slide34: Dopamine Transporters in Methamphetamine Abusers Normal Control Methamphetamine Abuser 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. Volkow et al., Am. J. Psychiatry, 2001. .


Slide35: Implication: Brain changes resulting from prolonged use of drugs may compromise mental and motor functions


Slide36: CRAVING INDUCTION IN A PET SETTING Childress et al., Am. J. Psychiatry, 1999


Memories Appear to Be A Critical Part of Addiction: Memories Appear to Be A Critical Part of Addiction 'Its about people, places and things…'


Slide38: Cocaine Film Cocaine Craving: Population (Cocaine Users, Controls) x Film (cocaine, erotic) Garavan et al., Am. J. Psychiatry, 2000. IFG Ant. Cing. Cingulate Signal Intensity (AU) Controls Cocaine Users


Slide39: Drugs Are Usurping Brain Circuits and Motivational Priorities


Treatment and the Cycle of Addiction: Treatment and the Cycle of Addiction


Addiction is the Quintessential Biobehavioral Disorder: Addiction is the Quintessential Biobehavioral Disorder


Slide42: Drugs Brain Mechanisms Behavior Environment Historical Environmental - Prior experience - Expectation - Learning - Social interactions - Stress - Conditioned stimuli - Genetics - Circadian rhythms - Disease states - Gender Physiological Drug Addiction: A Complex Behavioral and Neurobiological Disorder


Slide43: Source: Adapted from Volkow et al., Neuropharmacology, 2004. Addiction Changes Brain Circuits


Slide44: This is why treatment is essential This is why addicts can’t just quit


Treating a Biobehavioral Disorder Must Go Beyond JustFixing the Chemistry: Treating a Biobehavioral Disorder Must Go Beyond Just Fixing the Chemistry Pharmacological (medications) Behavioral Therapies Medical and Social Services


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Treatment Can Work: Treatment Can Work


But, drug addiction is a chronic illness with relapse rates similar to those of hypertension, diabetes, and asthma: But, drug addiction is a chronic illness with relapse rates similar to those of hypertension, diabetes, and asthma McLellan et al., JAMA, 2000.


Slide49: Relapse Rates Are Similar for Drug Addiction andamp; Other Chronic Illnesses McLellan et al., JAMA, 2000.


Addiction is Similar to Other Chronic Illnesses Because:: Addiction is Similar to Other Chronic Illnesses Because: Recovery from it--protracted abstinence and restored functioning--is often a long-term process requiring repeated treatments Relapses to drug abuse can occur during or after successful treatment episodes Participation in self-help support programs during and following treatment can be helpful in sustaining long-term recovery Therefore…


Slide51: There is a right way and a wrong way to Measure the Outcome of Treating Chronic Illnesses like Addiction


Slide52: Full recovery is a challenge but it is possible …


Slide53: DAT Recovery with prolonged abstinence from methamphetamine [C-11]d-threo-methylphenidate Volkow et al., J. Neuroscience, 2001. low high Normal Control Methamphetamine Abuser (1 month detoxification) Methamphetamine Abuser (24 month abstinent)


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Slide55: We Need to Keep Our Eye on the Real Target Abstinence Functionality in Family, Work and Community In Treating Addiction…


Slide56: Since it was established in 1974, NIDA has supported research on drug abuse treatment for individuals who are involved with the criminal justice system.


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Slide58: We want to thank TASC, Inc., of Illinois for their contribution to this presentation.