Addiction: Its a Brain Disease Beyond a Reasonable Doubt

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Addiction Its a Brain Disease Beyond a
Reasonable Doubt
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• Presentation Objectives
• Identify impact of substance abuse 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.

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Addiction
Medical
Medical
Neurotoxicity AIDS, Cancer Mental illness
NEUROTOXICITY AIDS CANCERMENTAL ILLNESS
DRUGS
Economic
Social
Health care Productivity Accidents
Homelessness Crime Violence
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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 Generals Report, 2004 ONDCP, 2004
Harwood, 2000.
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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.
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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.
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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.
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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
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used to be
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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.
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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

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What is Addiction?

• A brain disease expressed as a compulsive
  behavior
• The continued abuse of drugs despite negative
  consequences
• A chronic, potentially relapsing disorder

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Why Do People Take Drugs in The First Place?
To feel better To lessen anxiety worries fears de
pression hopelessness
To feel good To have novel feelings sensations ex
periences AND to share them
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Vulnerability
Why do some people become addicted while others
do not?
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We Know Theres a Big Genetic Contribution to
Drug Abuse and Addiction .Overlapping with
Environmental Influences that Help Make Addiction
a Complex Disease.
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Biology/genes
Biology/ Environment Interactions
Environment
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DA Receptors and the Response to Methylphenidate
(MP)
High DA receptor
high
Dopamine receptor level
low
Low DA receptor
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.
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Drug Abuse
Drug/Alcohol Related Traffic Accidents
Delinquency
CommunityPeer ClusterFamilyIndividual
Sexually Transmitted Diseases (Including
HIV/AIDS)
Academic Failure and DroppingOut of School
Juvenile Depression
Suicidal Behavior
Running Away From Home
Unwanted Pregnancies
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How Do Drugs Work?
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Initially, a person takes a drug hoping to
change his or her mood, perception, or emotional
state
Translation
hoping to change their brains.
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We know that despite their many differences,
most abused substances enhance the dopamine and
serotonin pathways
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GABA and Glutamate Role in Motivation
Dopamine
GABA
Glutamate
Adapted from Kalivas and Nakamura, Curr. Opin.
Neurobiol., 1999.
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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

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vesicle
Precursor
neurotransmitters
Synthesis
receptor
Storage
Degradation
Reuptake
Release
Synaptic Cleft
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dopamine transporters
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Natural Rewards Elevate Dopamine Levels
SEX
FOOD
200
200
NAc shell
150
150
DA Concentration ( Baseline)
100
100
of Basal DA Output
Empty
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Box
Feeding
0
0
60
120
180
Female Present
Time (min)
Sample Number
Di Chiara et al., Neuroscience, 1999.
Fiorino and Phillips, J. Neuroscience, 1997.
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Effects of Drugs on Dopamine Release
Di Chiara and Imperato, PNAS, 1988
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Science has generated much evidence showing that
prolonged drug use changes the brain in
fundamental and long-lasting ways
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Dopamine D2 Receptors are Lower in Addiction
Cocaine
DA
DA
DA
DA
DA
DA
DA
DA
DA
DA
DA
DA
Meth
Reward Circuits
Non-Drug Abuser
DA D2 Receptor Availability
DA
DA
Alcohol
DA
DA
DA
DA
Heroin
Reward Circuits
Drug Abuser
Control
Addicted
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Dopamine Transporters in Methamphetamine Abusers
Motor Task Loss of dopamine transporters in the
meth abusers may result in slowing of motor
reactions.
Normal Control
Memory task Loss of dopamine transporters in the
meth abusers may result in memory impairment.
Volkow et al., Am. J. Psychiatry, 2001. .
Methamphetamine Abuser
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Implication
Brain changes resulting from prolonged use of
drugs may compromise mental and motor
functions
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CRAVING INDUCTION IN A PET SETTING
Childress et al., Am. J. Psychiatry, 1999
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Memories Appear to Be A Critical Part of
Addiction
Its about people, places and things
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Cocaine Craving Population (Cocaine Users,
Controls) x Film (cocaine, erotic)
Cingulate
Ant. Cing.
Signal Intensity (AU)
Cocaine Film
IFG
Controls Cocaine Users
Garavan et al., Am. J. Psychiatry, 2000.
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Drugs Are Usurping Brain
Circuits
and Motivational
Priorities
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Treatment and the Cycle of Addiction
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Addiction is the Quintessential Biobehavioral
Disorder
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Drug Addiction A Complex Behavioral and
Neurobiological Disorder
Historical
Drugs
Physiological
- Prior experience- Expectation- Learning
- Genetics- Circadian rhythms- Disease states-
Gender
Environmental
- Social interactions- Stress- Conditioned
stimuli
Brain Mechanisms
Behavior
Environment
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Addiction Changes Brain Circuits
Source Adapted from Volkow et al.,
Neuropharmacology, 2004.
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This is why addicts cant just quit
This is why treatment is essential
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Treating a Biobehavioral Disorder Must Go Beyond
JustFixing the Chemistry

• Pharmacological (medications)
• Behavioral Therapies
• Medical and Social Services

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Treatment Can Work
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But, drug addiction is a chronic illness with
relapse rates similar to those of hypertension,
diabetes, and asthma
McLellan et al., JAMA, 2000.
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Relapse Rates Are Similar for Drug Addiction
Other Chronic Illnesses
McLellan et al., JAMA, 2000.
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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

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There is a right way and a wrong way to Measure
the Outcome of Treating Chronic Illnesses like
Addiction
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Full recovery is a challenge but it is possible
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C-11d-threo-methylphenidate
DAT Recovery with prolonged abstinence
from methamphetamine
Normal Control
high
Methamphetamine Abuser (1 month detoxification)
low
Methamphetamine Abuser (14 month abstinent)
Volkow et al., J. Neuroscience, 2001.
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In Treating Addiction
We Need to Keep Our Eye on the Real Target
Abstinence
Functionality in Family, Work and Community
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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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• We want to thank TASC, Inc., of Illinois for
  their contribution to this presentation.