Transcript Addiction as a Disease

Addiction as a Disease
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Arlin J.Silberman D.O.,FAOAAM
Certified in Addiction Medicine
Certified in Addiction Psychiatry
Fellow of the American Osteopathic
Academy of Addiction Medicine
Abuse vs Dependence
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There is a difference between intentional
drug abuse and pathological drug
dependence.
The latter is what is referred to as
addiction.
Chemical Abuse
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Maladaptive pattern of drug use leading to
impairment or distress,presenting as one
or more of the following over a 12 month
period-failure to fulfill obligations,use that
is physically hazardous,drug related legal
problems,and continued use despite
social/interpersonal problems.
Chemical Dependence
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3 or more of the
following:tolerance,withdrawal,drug used
more than intended,inability to control
use,effort to obtain drug,important
activities replaced by drug use,use despite
negative consequences.
Present Understandings
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Drug abuse causes short-term and longterm changes in brain function.
Medial forebrain bundle(mesolimbic
dopamine system)
History
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References made in the civilizations of
ancient Egypt and Greece,called ‘drink
madness’.
In colonial America, Anthony Benezet
noted drunkenness to self accelerate.
In 1784 Dr.Benjamin Rush wrote a
pamphlet describing an ‘odious
disease’and a ‘disease induced by a vice.’
History cont.
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Rev.Lyman Beecher’s sermons in 1825
describes ‘intemperance is a disease as
well as a crime.’
Dr.Samuel Woodward recommended
special asylums for the treatment of
inebriates.(1830’s)
First Treatment Facility
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In 1864 the New York State Inebriate
Asylum founded by Dr.Joseph Turner.
Disease Concept
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Dr.William Sweetser described
intemperance causing a ‘morbid alteration’
in nearly all the major structures and
functions of the human body.(1829)
Concept of Alcoholism
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Biological predisposition
Drug toxicity
Morbid craving
Tolerance
Disease progression
Loss of volitional control over quantity
Opiate Addiction
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In the 1870’s dope fiends where
caricaturized as Chinese immigrants when
the majority were white middle-aged
women using patent medicines laced with
opium.
Criminalization
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Dr.CW.Earle led the first anti-drug
campaign.”It is becoming altogether too
customary in these days to speak of vice
as disease”
In the 1880’s the term ‘drug vice’ used.
Disease Concept
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American Association for the Cure of
Inebriety formed in 1870.
Founding principles-disease
concept,curable,constitutional
susceptibility which maybe inherited or
acquired.
Moral Treatment
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Franklin Reformatory for Inebriates in
Phila. recognized ‘drunkenness as a
habit,sin,and crime.’(1874)
Alternative views of alcohol and
drug use
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Source of the problem was in the person
in terms of vice and sin.
Source of the problem was the product.
Aggressive promotion of the product.
Disease Concept Abates
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By the end of the 1800’s the disease
concept faded away.
Disease Concept Returns
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E.M.Jellinek presents disease model in
1960.
American Psychiatric Assoc. uses the term
disease to describe alcoholism in 1965.
American Medical Assoc. follows in 1966.
Present Understandings
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Drug abuse causes both short-term and
long –term changes in brain function.
This makes it nearly impossible for users
to stop on their own.
The biology of the brain changes may
never return to preuse state.
Our Understandings
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‘Dependence’brain areas are parts of the
brain that govern unconscious thought.
Medial forebrain bundle,also known as
mesolimbic dopamine system.
Neurotransmitters involved in
dependence.
Our understandings
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Functional dysregulation-they aren’t
working right.
One or more neurotransmitter chemicals
involved.
Neurotransmitters
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Dopamine(affected by cocaine,
amphetamines or alcohol).
Serotonin(alcohol or LSD)
Endorphins(alcohol or opiods)
Neurotransmitters
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GABA(alcohol or benzodiazepines)
Glutamate(alcohol)
Acetylcholine(alcohol or nicotine)
Genetic Factors
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Abnormal genes lead to abnormal
proteins.
This results in abnormal transmittersynthesizing enzymes,abnormal
transmitter breakdown enzymes,or
abnormal receptors.
Genetic Factors
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The above factors lead to neurotransmitter
dysregulation.
This is why scientists believe that
dependence is a chronic medical brain
disease.
Needs Long Term Treatment
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As chronic relapsing disease like heart
disease,diabetes and
schizophrenia,disease management,not
one shot treatment,is the most promising
approach. Alan Leshner PhD.,Director
NIDA.(1997)
Treatment Modalities
Behavioral approaches change brain
chemistry.
Medications to treat withdrawal and
cravings.
Medications Approved for Alcohol
Treatment
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Antabuse(disulfiram)
Naltrexone
Acamprosate
Critics of the Disease Model
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Stanton Peele-disease concept has
spread to include eating,child
abuse,gambling,shopping,premenstrual
tension,compulsive love affairs,and almost
every form of self destructive behavior.
Critics
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Herbert Fingarette states alcohol industry
itself contributes to the public perception
of alcoholism as a disease.(Heavy
Drinking:The Myth of Alcoholism as a
Disease.1988 Univ.of Calif.at Berkeley
Press)
Bibliography
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William L.White(1998).Slaying the
Dragon:The History of Addiction Treatment
and Recovery in America.
Bloomington,Ill.Chestnut Health Systems
Diagnostic and Statistical Manual of
Mental Disorders (DSM-IV)1994.
www.addictiontoday.co.uk