Funding for this module was provided by a Science Education Drug Abuse Partnership Award (SEDAPA) from the National Institute on Drug Abuse, a component of the National Institutes of Health, Department of Health and

Human Services. #1 R25 DA 020472-01A1

To educate students about the neuroscience of addiction & its relevance for working with clients with addictive disorders

O ve r a l l G o a l

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Curriculum Learning Objectives

• Developaworkingdefinitionof addiction• Describetheprevalence&public healthimpactofaddiction• Identifyriskfactorsthatincreasethe vulnerabilitytoaddiction• Understandthebrainrewardpathway &itscentralroleintheneurobiology ofaddiction• Recognizeresearch-basedprinciples ofaddictionprevention&treatment

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Mod

ule

1Exploring

Our Beliefs about Addiction

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Module 1 Learning Objectives 1. Toexaminesomepre-conceivedideasaboutwhat definesaddictionaswellasattitudesandbeliefs aboutthepeoplewhobecomeaddictedandtheir behavior.

2. Todevelopapractical“working”definitionofaddiction basedonthewayscientistsandresearchersdefineit.

3. Tolearnsomeofthekey developmentalriskfactorsthat increasethevulnerabilitytoaddiction.

4. Tounderstandtheprevalence,costs,and publichealthimpactofaddiction.

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What Do You Believe About Addiction?

1.Whydopeoplebecomeaddicted?

2.Canaddictionbeprevented?(Why or why not)

3.Iftreatmentworks,whydosomanypeoplegointo treatmentmultipletimes?

4.Peoplewithaddictionsare ? (List three characteristics of people with an addiction.)

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Why Do People Use Alcohol & Drugs

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ClassroomExercises

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“Addiction is a choice… they could stop if they really tried.”

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How is Addiction Defined

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How do YOU define Addiction?

1.Comeupwithabriefstatementofhowyouwould defineaddiction.2.Shareyourdefinitionwiththeclass.

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How Clinicians & Researchers Define Addiction

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Substance Use Disorders… a maladaptive pattern of use leading to clinically significant

impairment as manifested by …Substance Abuse: One or more of the following in a 12 month period• Recurrentuseleadingtofailuretofulfillobligationsatwork,school,orhome• Useinhazardoussituations• Socialorinterpersonalproblemsbecauseofuse• Recurrentsubstancerelatedlegalproblems

Substance Dependence (Addiction): Three or more of the following in a 12 month period • Needlargeramounttogetthesameeffect(tolerance)• Experiencewithdrawalsymptomsoruseofsubstancetoavoidwithdrawalsymptoms• Difficultycontrollinguse(substancetakeninlargeramountsoroverlongerperiodsthan intended)• Unsuccessfulineffortstocutdown• Importantsocial,occupational/school,orrecreationalactivitiesreducedorgivenup becauseofuse• Increasingamountoftimespentobtainingsubstances,usingorrecoveringfromuse• Continuedusedespitenegativephysical,mental,social,orlegalproblemsrelatedto substanceuse

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Working Definition of Addiction

Continued compulsive use despite negative consequences

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How Do People Become Addicted

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Casual, Experimental Use

Regular Use (negative consequences are rare)

Misuse (some negative consequences)

Abuse (frequent negative consequences)

Dependence or Addiction (Use Despite Negative Consequence)

Addiction

The Downward Spiral of Drug Addiction

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• Genetic predisposition• Poorcopingskills• Early,persistentantisocialbehavior• Mentalhealthdisorders• Earlyinitiationofsubstanceuse

• Favorableattitudestowardsuse• Perception of peers using • Substanceusingpeers• Ganginvolvement

• Substanceabusehistory• Major/frequentfamily conflictordisruptions

• Parentalsubstanceuseattitudes• Crime,violence,abuse/neglect

• Learningproblemsordisabilities• Lackofcommitment• Behaviorproblemsatschool

• Earlyacademicfailure• Lowlevelsofreadingability• Expulsion/suspension

• Availabilityofdrugs/alcohol• Highcrimerate• Normsfavorabletosubstanceuse

• Lowneighborhoodattachment• Extremeeconomicdeprivation

Individual Risk Factors

Family Risk Factors

School Risk Factors

Community Risk Factors

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• Activitieswithnon-usingpeers• Parentalmonitoringof friendsandactivities

• Resilienttemperament• Positivesocialorientation

• Bonding/attachmentto positivefamilymembers• Healthyfamilybeliefs• Favorableparentalattitudes

• Clear standards regarding substanceuse&behavior• Recognitionforpositive behaviors,successes

• Successinschool• Parentalmonitoringofacademic performance/schoolbehavior

• Involvementingroupactivities• Positiverecognitionforgood behaviors,successes

• Healthycommunitysubstance use&behaviornorms• Positivecommunity activities/rolemodels

• Work• Anti-drugusepolicies,policies limitingavailabilityofalcohol

Individual Protective Factors

Family Protective Factors

School Protective Factors

Community Protective Factors

Prevalence, Public Health Impact, & Costs of Addiction

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In 2009, an estimated 9.0% of Americans (22 million individuals) aged 12 or older met the

criteria for substance abuse or dependence

(SAMHSA,2009)# 1 R25 DA 020472-01A1

Substance Use Across the Lifespan

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Perc

ent U

sing

in th

e Pa

st M

onth

Age

(SAMHSA,2010)

Past Month Illicit Drug Use among Persons Aged 12 & Older, 2009

4%

9%

17%

22% 21%

14%

7%

3% 1% 0

10

20

30

12-13 14-15 16-17 18-20 21-25 26-29 30-59 60-64 65+

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Past Month Illicit Drug Use by Age Category, 2009

10.0%

21.2%

6.3%

0

5

10

15

20

25

12-17 years 18-25 years 26 + years

(SAMHSA,2010)

Perc

ent U

sing

in th

e Pa

st M

onth

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Alcohol Use across the LifespanPe

rcen

t

Age(SAMHSA,2010)

3.5 13.0

26.3

49.7

70.2 66.4

58.7

50.3

39.1

1.6 7.0

17.0

34.7

46.5

38.8

25.4

12.5 9.8

0.2 1.4 4.5 11.3

15.4 10.8 7.1 3.8 2.2 0

20

40

60

80

12-13 14-15 16-17 18-20 21-25 26-29 30-59 60-64 65+

Alcohol-Current use Alcohol-Binge use Alcohol-Heavy use

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• 50%ofindividualswilldevelopsubstanceabuseordependenceatsome pointduringtheirlifetime• 47%ofadolescentsexperimentwithdrugsoralcoholbeforegraduating fromhighschool• Mostaddictedadultsbeganusingwhentheywereadolescents• Most“experimenters”donotbecomeaddicted,butthosewhohave developmentalvulnerabilitiesareatgreaterrisk

Research shows that approximately...

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Public Health Impact & Costs

Associated with Addiction

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Substance Abuse & Addiction Cost about $1 Trillion per Year

Lost Productivity

71%

Other 20%

Healthcare Costs 9%

For example: •  Criminal justice costs •  Child abuse/neglect •  Homelessness

For example: •  ED visits •  HIV/AIDS •  FASDs

For example: •  Poor job performance •  Increased employee turnover •  Illness/absenteeism •  Work-related accidents •  Victims of crime •  Incarceration

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Substance Abuse Impact on the Child & Family Assistance System

(SAMHSA,2009)

Combined data from 2002 to 2007 indicate that over 8.3 million children under 18 years of age (11.9%) lived with at least one parent

who was dependent on or abused substance.

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• 11%ofchildabuse/neglectcases• 75%ofout-of-homechildwelfareplacements

(http://sparkaction.org/content/impact-substance-abuse-foster-care;http://www.acf.hhs.gov/programs/opre/abuse_neglect/natl_incid/index.html,2010)

Substance abuse is shown to be a factor in at least

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Average length of time spent in out-of-home

care is longer for children of addicted parents

(27 months) compared to

non-addicted parents (10 months)

(http://sparkaction.org/content/impact-substance-abuse-foster-care;http://www.acf.hhs.gov/programs/opre/abuse_neglect/natl_incid/index.html,2010)

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Underage drinking costs society $68 billion per year for youth violence, traffic accidents, property crime,

academic underachievement, high-risk sex, & FASDs among teen mothers

(OJJDP,2007)# 1 R25 DA 020472-01A1

Substance Abuse Impact on the Criminal Justice System

Of the $38 billion spent on corrections in 1996, more than $30 billion was spent incarcerating individuals who had alcohol or drug problems, or committed alcohol or drug related crimes.

(ONDCP,2002;http://www.suite101.com/content/the-economics-of-alcoholism-and-drug-abuse-a85770#ixzz11Wv4mwGz)# 1 R25 DA 020472-01A1

Costs associated with driving while intoxicated were estimated at $230 billion

in 2001 due to highway collisions(Califano,2007;Weisman,2006)# 1 R25 DA 020472-01A1

(12,371 agencies; 2009 estimated population 239,839,971)(http://www.fbi.gov/ucr/cius2009/data/table_38.html#overview)# 1 R25 DA 020472-01A1

46.8% of all arrests for drug abuse violations were persons under the age of 25

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Substance Abuse Impact on Worker Productivity

In 2005, the reported annual cost to employers for alcohol-related injuries to employees &

their dependents was $28.6 billion

(Zaloshnja,etal.,2006)# 1 R25 DA 020472-01A1

Substance Abuse Impact on the Health Care System

More than 116 million hospital emergency department visits in 2007

• Averagepervisitcostestimatedat$1038• Roughly1.9millionweredrugmisuse/abuserelated, withoverhalf(52%)involvingillicitdrugsaloneorin combinationwithpharmaceuticalsand/oralcohol

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Fetal Alcohol Spectrum Disorders could cost up to $4 million in health care and related specialized services over the course of the child’s lifetime.

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An estimated 1 million people in the United States are living with HIV/AIDS

(http://www.drugabuse.gov/Infofacts/DrugAbuse.html)

• Roughly1/3ofthosecasesarelinked directlyorindirectlytoinjectiondruguse• Approximately4of10AIDSdeathsare drugabuserelated• About400,000peopleareco-infected withHIV&HepatitisC

# 1 R25 DA 020472-01A1 (Califano,2007)

Co-occurring substance abuse & medical conditions

• LungandCardiovasculardisease• Stroke• Cancer• Mentaldisorders• Celldamageinthebrainorperipheralnervoussystem

(http://www.drugabuse.gov/Infofacts/infofactsindex.html)# 1 R25 DA 020472-01A1

Co-Occurring Substance Abuse & Mental Health Disorders

• Substanceabuse&addiction increasestheriskofmentalhealth problemsorpsychiatricdisorders (e.g.,conductdisorder,ADHD, depression)• Mentalhealthproblemsorpsychiatric illnessesincreasetheriskofsubstance abuse• 60-80%ofadolescentswhoenterdrug treatmentprogramshaveco-occurring psychiatricdisorders

# 1 R25 DA 020472-01A1 (http://www.drugabuse.gov/PDF/RRComorbidity.pdf)

National College Survey Data

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(CoreInstitute,2006)

National Profile of Substance Use among College Students (2006)

Tobacco 39.5% Marijuana 30.1% Other drugs 27.2% Alcohol 84.1% •  Heavy or frequent drinkers

(defined as 5 or more drinks in one sitting, 3 times or more/week)

24.0%

•  Average number of drinks/week 5.42 drinks

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Consequences of Alcohol & Other Drug Use

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Does our campus social environment promote substance use?

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Module 1Take Home

Points

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Working definition of addiction: continued compulsive use despite

negative consequences# 1 R25 DA 020472-01A1

The majority of high school students experiment with substances without

developing a substance use disorder.

However…# 1 R25 DA 020472-01A1

… a major concern is about doing STUPID things while under the influence.

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… no one knows ALL of their that can shift experimentation

to addiction.

RISK FACTORS

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Even those with few risk or protective factors can become addicted by repeatedly

using alcohol or drugs.# 1 R25 DA 020472-01A1

(Washton,2001)# 1 R25 DA 020472-01A1

Alcohol & drug problems are prevalent & intricately intertwined with other mental

health problems & medical conditions.

...impacts us all.

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