The Science of Addiction

Homelessness Crime Violence Homelessness Crime Violence Neurotoxicity AIDS, Cancer Mental illness Neurotoxicity AIDS, Cancer Mental illness Health care Productivity Accidents Health care Productivity Accidents

4 Out of 10 U.S. AIDS Deaths Are Related to Drug Abuse

Estimated Economic Cost to Society Due to Substance Abuse and Addiction: Illegal drugs: $181 billion/year Alcohol: $185 billion/year Tobacco: $158 billion/year Total: $524 billion/year Surgeon General’s Report, 2004; ONDCP, 2004; Harwood, 2000.

What is Addiction? Addiction is A Brain Disease Characterized by: –Compulsive Behavior –Continued abuse of drugs despite negative consequences – Persistent changes in the brain ’ s structure and function

PATH TO ADDICTION Drug Use – the mind enjoys the effects of the drug Tolerance – the mind needs more to feel the same effect Dependence – need the drug in order to function properly Addiction – lost control over the habit

Advances in science have revolutionized our fundamental views of drug abuse and addiction.

Your Brain on Drugs in the 1980’s

Your Brain on Drugs Today YELLOW shows places in brain where cocaine binds (e.g., striatum) Fowler et al., Synapse, 1989.

Addiction is Like Other Diseases…  It is preventable  It is treatable  It changes biology  If untreated, it can last a lifetime Healthy Brain Diseased Heart Decreased Heart Metabolism in Heart Disease Patient Decreased Brain Metabolism in Drug Abuser Diseased Brain/ Cocaine Abuser Healthy Heart High Low Research supported by NIDA addresses all of these components of addiction.

Addiction Involves Multiple Factors Genetics Environment Brain Mechanics Addiction Involves Multiple Factors Genetics Environment Brain Mechanics

Addiction is a Developmental Disease: It Starts Early 67% 1.5% 5.5% < >25 26% First Marijuana Use, (Percent of Initiates )

National Epidemiologic Survey on Alcohol and Related Conditions, Age 0.0% 0.2% 0.4% 0.6% 0.8% 1.0% 1.2% 1.4% 1.6% 1.8% % in each age group who develop first-time dependence CANNABIS ALCOHOL TOBACCO Addiction Is A Developmental Disease that starts in adolescence and childhood Age at tobacco, alcohol, and cannabis dependence per DSM IV *The highest percentage of individuals who develop first-time dependence are between ages 15 – 21.

Why Do People Take Drugs in The First Place? To Feel Good To experience new: feelings sensations experiences AND to share them To Feel Better To lessen: anxiety worries fears depression hopelessness

Drugs affect the parts of your brain that control pleasure and motivation, which is why they become addictive. Why Do People Abuse Drugs? Why Do People Abuse Drugs?

Choices Magazine Article Prescription Pain Medications: What You Need to Know Pages 20-21

Drugs can be “Imposters” of Brain Messages (an essential fatty acid neurotransmitter) (Pot)

DrugImpact Heroin, LSD, Ecstasy“Imposters” - Act like a natural neurotransmitter and send confusing messages CocaineInterferes with the transporters so they get sent back to where they came from, which creates unnatural floods of neurotransmitters in synapses MethCauses large amounts of neurotransmitters to be released at once – dopamine transporters are lost

Amphetamine Cocaine Time After Drug Morphine hr Time After Drug % of Basal Release Accumbens Caudate Nicotine Di Chiara and Imperato, PNAS, 1988 Effects of Drugs on Dopamine Release

But Dopamine is only Part of the Story Scientific research has shown that other neurotransmitter systems are also affected: –Serotonin –Regulates mood, sleep, etc. –Glutamate –Regulates learning and memory, etc.

ControlAddicted Dopamine Receptors are Decreased by Addiction DA D2 Receptor Availability Cocaine Alcohol Heroin Meth

Implication? Brain changes resulting from prolonged use of drugs may compromise mental AND motor function.

Basic Science Tells Us that Adolescents’ Brains Are Still Developing… So drug use and abuse during adolescence can have life-long effects on your brain.

Why do some people become addicted to drugs while others do not?Vulnerability

Mental Health & Addiction Prevalence of Drug Addiction Percent Prevalence of Nicotine Addiction General public Schizophrenia Depression Percent General public Any Mood Disorder Any Anxiety Disorder Depression Bipolar Panic w/ Agoraphobia Panic w/out Agoraphobia Social Phobia Generalized Anxiety

Schizophrenia

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

Individualized - No single treatment is appropriate for all individuals. Readily available – Relatively convenient for patient Treating the WHOLE person (not just the drug use) Multiple courses of treatment may be required for success. An extended period of time – remaining in treatment is critical for effectiveness. Treatment Can Work! But it should be…

Relapse Rates Are Similar for Drug Addiction & Other Chronic Illnesses Type I Diabetes Drug Addiction Hypertension Asthma 40 to 60% 30 to 50% 50 to 70% Percent of Patients Who Relapse McLellan et al., JAMA, 2000.

Full recovery is a challenge but it IS possible …

Extended Abstinence is Predictive of Sustained Recovery It takes a year of abstinence before less than half relapse Dennis et al, Eval Rev, 2007 After 5 years – if you are sober, you probably will stay that way.