Transcript addiction lesson

Addiction
A disease
Facts About Addiction &
Treatment
WHAT IS ADDICTION?
A BRAIN DISEASE
BUT WITH
BIOLOGICAL, PSYCHOLOGICAL &
SOCIAL COMPONENTS
DOES TREATMENT WORK?
YES, IT IS COST-EFFECTIVE
IN THE LONG RUN
So what substances are people
abusing?
Addiction is a Complex Disease
…with biological,
sociological and
psychological
components
Why Do People Take Drugs in The
First Place?
To Feel Better
To Feel Good
To have novel:
feelings
sensations
experiences
AND
to share them
To lessen:
anxiety
worries
fears
depression
hopelessness
Why Do People
Abuse Drugs?
Drugs of Abuse
Engage Motivation and
Pleasure Pathways
of the Brain
Nature of Addiction - a
continuum of use?
Loss of control 
However, addiction is more than mere drug use…
Continuum of Use
No Use
Stage 1 – Experimental Use – like it
Stage 2 – More regular use/seeks mood swings – Want it
Stage 3 – Daily preoccupation / harmfully involved – Need it
Stage 4 – Dependency / harmfully dependent / uses it to feel normal – crave it
Addiction Involves Multiple Factors
How Drugs & Alcohol Work
 They interact with nerve circuits, centers, and
chemical messengers

Results
 I Feel Good – Euphoria & Reward
 I Feel “Better” – Reduce negative feelings
 This Feels “Normal”
 I’m craving it, tolerating its effects,
withdrawing and feeling sick
Symptoms
• Loss of control
Characteristics
• Unable to limit use
effectively
• Preoccupation with
substance
• Cravings
• High tolerance
• Chronic use despite
negative
consequences
• All addiction are
progressive and
chronic
Natural Rewards Elevate
Dopamine Levels
DA Concentration (% Baseline)
Food
% of Basal DA Output
200
NAc shell
150
100
Empty
50
Box Feeding
Sex
200
150
100
Female Present
0
0
60
120
Time (min)
180
Sample 1
Number
2
Di Chiara et al., Neuroscience, 1999.,Fiorino and Phillips, J. Neuroscience, 1997.
3
4
5
6
7
8
Effects of Drugs on Dopamine Release
Accumbens
400
DA
DOPAC
HVA
% of Basal Release
1100
1000
900
800
700
600
500
400
300
200
100
0
Accumbens
DA
DOPAC
HVA
300
200
100
0
0
1
2
3
4
0
5 hr
Nicotine
250
% of Basal Release
Cocaine
200
Accumbens
Caudate
150
100
0
0
1
2
Time After Drug
Di Chiara and Imperato, PNAS, 1988
1
250 Accumbens
3 hr
% of Basal Release
% of Basal Release
Amphetamine
2
3
4
5 hr
Morphine
Dose
0.5 mg/kg
1.0 mg/kg
2.5 mg/kg
10 mg/kg
200
150
100
0
0
1
2
3
Time After Drug
4
5 hr
Brain Reward Pathways
Activation of Reward
Circuits Involved In Drug Abuse and Addiction
All of these brain regions must be considered in developing
strategies to effectively treat addiction
Dopamine Spells REWARD
Release
Recycle
Activate
Self-Control
• Addicts seek control, not abstinence
If I can have
just one, then
I will be
normal, just
like my friends
Addiction is a Developmental Disease:
It Starts Early
67%
100
26%
5.5%
10
1.5%
1
Child
<12
Teen
12-17
Young Adult
18-25
Adult
>25
When Reading Emotion…
Adults Rely More on the Frontal Cortex
While Teens Rely More on the Amygdala
Deborah Yurgelon-Todd 2000.
The Adolescent Brain
• Adolescents do not think with the same part of the brain
as adults
• Limbic system – emotional responses (fear, anger mood,
hormones, motivations, pain / pleasure sensations
• Prefrontal cortex development takes place during the
teen years – until 25 yrs
• Reeved up emotions + low impulse control = Risk taking
Cognitive Deficits and D&A
• Memory problems – short-term loss
• Impaired abstraction
• Perseveration using failed problemsolving strategies
• Loss of impulse control
These deficits are similar to
those with brain damage
Vulnerability
Why do some people
become addicted to drugs
while others do not?
Genetics is a Big Contributor to the
Risk of Addiction…
And…
The Nature of this Contribution
Is Extremely Complex
Addiction Risk Factors
• Genetics – one parent increases risk by 4x
- Two parents increases risk by 8x
• Earlier Age of Onset
• Childhood Trauma (violent, sexual)
• Learning Disorders & ADD/ADHD
• Mental Illness Predating Use
–
–
–
–
Depression
Bipolar Disorder
Psychosis
ADHD
• Culture and values
• Availability of substances
What Other Biological Factors
Contribute to Addiction--Comorbidity
Prevalence of
Nicotine Addiction
Prevalence of Drug Disorders
40
80
35
25
20
60
Percent
Percent
30
40
15
20
10
5
0
0
Why do Mental Illnesses and
Substance Abuse Co-occur?
• Self-medication
– substance abuse begins as a
means to alleviate symptoms
of mental illness
• Causal effects
– Substance abuse may
increase vulnerability to
mental illness
• Common or correlated
causes
– the risk factors that give rise
to mental illness and
substance abuse may be
related or overlap
What Environmental
Factors Contribute to Addiction?
•
•
•
•
•
Stress
Early physical or sexual abuse
Witnessing violence
Peers who use drugs
Drug availability
A family Disease
Principles that support the triangle
• The CD should be able to control or stop
their use on their own
• Family members are responsible for the
behaviour of the CD
• Family members are supposed to protect
the CD from unpleasant experiences
A Family Disease
CD
Family
Increased tolerance to
chemical(s)
Increased tolerance for
unacceptable behaviour
Unwillingness to discuss the issue
Unwillingness to discuss issues
Learns to medicate feelings
Learns to deny and stuffs feelings
Neglects responsibilities
Takes responsibility
Tries to control use of chemicals
Tries to control the CD
Family Disease Continued
CD
Family
Compromises values
Compromises values
Isolates from the family
Isolates socially
Focuses on the drug(s)
Focuses on the CD
Physical and emotional problems
Physical and emotional problems
Spiritual crisis – loss of hope and
options
Spiritual crisis – loss of hope and
options
Treating a Biobehavioral Disorder Must Go
Beyond Just Fixing the Chemistry
We Need to Treat the
Whole Person!
Pharmacological
Treatments
(Medications)
Medical Services
Behavioral Therapies
Social Services
In Social Context
Recovery
“You don’t recover from an addiction by
stopping using. You recover by creating a
new life where it is easier to not use”