addiction a disease. facts about addiction & treatment what is addiction? a brain disease but...
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Addiction
A disease
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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
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So what substances are people abusing?
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Addiction is a Complex Disease
…with biological, sociological and
psychological components
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Why Do People Take Drugs in The First Place?
To Feel GoodTo have novel:
feelingssensations
experiencesAND
to share them
To Feel BetterTo lessen:
anxietyworries
fearsdepression
hopelessness
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Drugs of Abuse Engage Motivation and
Pleasure Pathwaysof the Brain
Drugs of Abuse Engage Motivation and
Pleasure Pathwaysof the Brain
Why Do PeopleAbuse Drugs?
Why Do PeopleAbuse Drugs?
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Nature of Addiction - a continuum of use?
However, addiction is more than mere drug use…
Loss of control
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Continuum of UseNo 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
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Addiction Involves Multiple FactorsAddiction Involves Multiple Factors
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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
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Symptoms Characteristics
• Loss of control
• Preoccupation with substance
• Cravings
• Chronic use despite negative consequences
• Unable to limit use effectively
• High tolerance
• All addiction are progressive and chronic
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Di Chiara et al., Neuroscience, 1999.,Fiorino and Phillips, J. Neuroscience, 1997.
Natural Rewards Elevate Dopamine Levels
0
50
100
150
200
0 60 120 180
Time (min)
% o
f B
asal
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0100200300400500600700800900
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0 1 2 3 4 5 hr
% o
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asal
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ease
DADOPACHVA
Accumbens
Amphetamine
0
100
200
300
400
0 1 2 3 4 5 hr
% o
f B
asal
Rel
ease
DADOPACHVA
AccumbensCocaine
Time After Drug
Morphine
0
100
150
200
250
0 1 2 3 hr
Time After Drug
% o
f B
asal
Rel
ease Accumbens
Caudate
Nicotine
Di Chiara and Imperato, PNAS, 1988
Effects of Drugs on Dopamine Release
% o
f B
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ease
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Dose mg/kgmg/kg
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Brain Reward Pathways
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Activation of Reward
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Circuits Involved In Drug Abuse and Addiction
All of these brain regions must be considered in developing strategies to effectively treat addiction
All of these brain regions must be considered in developing strategies to effectively treat addiction
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Dopamine Spells REWARD
Release
Activate
Recycle
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Self-Control
• Addicts seek control, not abstinence
If I can have just one,
then I will be normal, just
like my friends
If I can have just one,
then I will be normal, just
like my friends
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Addiction is a Developmental Disease: It Starts Early
1
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Child Teen Young Adult Adult
67%
1.5%
5.5%
<12 12-17 18-25 >25
26%
Fir s
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ar i
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When Reading Emotion…Adults Rely More on the Frontal CortexWhile Teens Rely More on the Amygdala
When Reading Emotion…Adults Rely More on the Frontal CortexWhile Teens Rely More on the Amygdala
Deborah Yurgelon-Todd 2000. Deborah Yurgelon-Todd 2000.
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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
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Cognitive Deficits and D&A
• Memory problems – short-term loss
• Impaired abstraction
• Perseveration using failed problem-solving strategies
• Loss of impulse control
These deficits are similar to
those with brain damage
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Why do some people become addicted to drugs
while others do not?
VulnerabilityVulnerability
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Genetics is a Big Contributor to the Risk of Addiction…
And…
The Nature of this Contribution Is Extremely Complex
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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
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What Other Biological Factors Contribute to Addiction--Comorbidity
Prevalence of Drug Disorders
Per
cent
Prevalence of Nicotine Addiction
Gen
eral
public
Schizo
phrenia
0
20
40
60
80
Depre
ssion
Per
cent
Gener
al public
Any Mood D
isord
er
Any Anxiet
y Diso
rder
Depre
ssion
Man
ia
Panic
w/ Agor
aphobia
Panic
w/out
Agora
phobia Social P
hobia
Gener
alized
Anxiet
y0
5
10
15
20
25
30
35
40
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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
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What EnvironmentalFactors Contribute to Addiction?
• Stress
• Early physical or sexual abuse
• Witnessing violence
• Peers who use drugs
• Drug availability
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A family Disease
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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
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A Family Disease
CD
Increased tolerance to chemical(s)
Unwillingness to discuss the issue
Learns to medicate feelings
Neglects responsibilities
Tries to control use of chemicals
Family
Increased tolerance for unacceptable behaviour
Unwillingness to discuss issues
Learns to deny and stuffs feelings
Takes responsibility
Tries to control the CD
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Family Disease Continued
CD
Compromises values
Isolates from the family
Focuses on the drug(s)
Physical and emotional problems
Spiritual crisis – loss of hope and options
Family
Compromises values
Isolates socially
Focuses on the CD
Physical and emotional problems
Spiritual crisis – loss of hope and options
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Treating a Biobehavioral Disorder Must Go Beyond Just Fixing the Chemistry
Pharmacological Treatments
(Medications)
We Need to Treat theWe Need to Treat theWhole Person!Whole Person!
In Social ContextIn Social Context
Behavioral Therapies
Social ServicesMedical Services
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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”