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Addiction is Like Other Diseases

It is preventable
It is treatable
It changes biology
If untreated, it can last a lifetime

Decreased Brain Metabolism


in Drug Abuser

Decreased Heart Metabolism


in Heart Disease Patient
High

Healthy Brain

Diseased Brain/
Cocaine Abuser

Low

Healthy
Heart

Diseased Heart

Addiction Involves Multiple Factors

To Feel Good

To Feel Better

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

Movement
Motivation

Addiction

Reward & well-being

The Neuron: How the Brains


Messaging System Works
Dendrites
Axon

Cell body
(the cells life
support
center)

Terminal
branches of
axon

Neuronal Impulse
Myelin
sheath

Donald Bliss, MAPB, Medical Illustration

dopamine
transporters

Natural Rewards Elevate


Dopamine Levels

% of Basal DA Output

200

DA Concentration (% Baseline)

Food
NAc shell

150

100

50

Empty
Box Feeding

0
0

60

Time (min)

120

180

Sex
200

150

100

Sample 1
Number

Female Present

Di Chiara et al., Neuroscience, 1999.,Fiorino and Phillips, J. Neuroscience, 1997.

Effects of Drugs on Dopamine Release


Accumbens

DA
DOPAC
HVA

100

Time After Drug


Di Chiara and Imperato, PNAS, 1988

250 Accumbens

150

DA
DOPAC
HVA

100

5 hr

Accumbens
Caudate

3 hr

Cocaine

200

Nicotine

200

Accumbens

300

250

% of Basal Release

400

% of Basal Release

1100
1000
900
800
700
600
500
400
300
200
100
0

% of Basal Release

% of Basal Release

Amphetamine

5 hr

Morphine
Dose
0.5 mg/kg
1.0 mg/kg
2.5 mg/kg
10 mg/kg

200
150
100

Time After Drug

5 hr

Science Has Generated Much


Evidence Showing That

Prolonged Drug Use Changes


the Brain In Fundamental
and Long-Lasting Ways

AND
We Have Evidence That
These Changes Can Be Both
Structural and Functional

Structurally
Neuronal Dendrites in the
Nucleus Accumbens

Saline

Amph
Robinson & Kolb, Journal of Neuroscience, Volume: 1997

Functionally
Dopamine D2 Receptors are Decreased by Addiction

DA D2 Receptor Availability

Cocaine

Meth

Alcohol

Heroin

Control

Addicted

Normal Control

Dopamine Transporter
Bmax/Kd

Dopamine Transporters in Methamphetamine Abusers


2.0
1.8
1.6
1.4
1.2
1.0 7

Motor Task
Loss of dopamine
transporters in
methamphetamine
abusers may result in
slowing of motor
reactions.

9 10 11 12 13

Time Gait
(seconds)

2.0
1.8
1.6
1.4
1.2
1.0
16 14 12 10

Memory Task
Loss of dopamine
transporters in
methamphetamine
abusers may result
in memory impairment.

Delayed Recall
(words remembered)

Methamphetamine Abuser

Volkow et al., Am. J. Psychiatry, 2001.

Circuits Involved In Drug Abuse and Addiction

Addiction is a Developmental Disease:


It Starts Early
First Marijuana Use, (Percent of Initiates)

67%

26%

5.5%

1.5%

<12

12-17

18-25

>25

Basic Science Tells Us that


Adolescents Brains
Are Still Developing

Copyright 2004 by the National Academy of Sciences

Gogtay, Giedd, et al. Proc. Natl. Acad. Sci., 2004

When Reading Emotion

Adults Rely More on the Frontal Cortex


While Teens Rely More on the Amygdala

Deborah Yurgelon-Todd 2000.

Collins et al, Neuropharmacology, 2004, Levin et al, Psychopharmacology, 2003

Do We Need Fundamentally
Different Strategies At
Different Stages of Adolescence?

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

What Other Biological Factors


Contribute to Addiction--Comorbidity
40

Prevalence of
Nicotine Addiction

Prevalence of Drug Disorders

35

80

25

Percent

Percent

30

20
15
10

60
40
20

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COMORBIDITY

Prevention Works:
Knowledge of Risk and Protective
Factors Has Led to the
Development of Effective
Prevention Strategies

Monitoring the Future Study, 2007.

Why Cant Addicts Just Quit?


Non-Addicted Brain

Addicted Brain
Control

Control

Saliency

Drive

NO
GO

Memory

Saliency

Drive GO

Memory

Because Addiction Changes Brain Circuits


Adapted from Volkow et al., Neuropharmacology, 2004.

This is why addicts cant just quit.

and
This is why treatment is essential.

We Need to Treat the


Whole Person!
Pharmacological
Treatments
(Medications)

Medical Services

Behavioral Therapies

Social Services

In Social Context

We Are Using Science to


Develop Even Better Treatments

Genetics

Mechanisms

Treatments

McLellan et al., JAMA, 2000.

Full recovery is a challenge


but it is possible

After 5 years if you are sober,


you probably will stay that way.

It takes a year
of abstinence
before less than
half relapse

Dennis et al, Eval Rev, 2007

In Treating Addiction
Abst

We Need to Keep Our Eye on


the Real Targets!
in e n

ce

n
i
y
t
i
l
a
n
o
i
t
c
n
k
r
Fu
o
W
,
y
l
i
m
a
ity
F
n
u
m
m
o
C
d
an

Drug Use Has Played a Prominent


Role in the HIV/AIDS Epidemic
In Several Ways
Disease Transmission
- IV Drug UseNeedle sharing
- Drug Intoxication: Impaired judgment,
disinhibition, leading to risky sexual
behaviors
Disease Progression
Neurological Complications