Mechanisms of Addiction Charles Schutt, MA LADC with special thanks to Carol Ackley

What is the brain’s primary function? Survival Automatic Functions: Heart Rate Blood Pressure Body Temperature pH Balance Semi-Automatic Functions: Breathing Blinking Bathroom

The Brain Behaviors: Physical Discomfort: Emotional Discomfort: Eat Headache Drink Water Fatigue Sleep Muscle Cramps Have Sex Emotional Discomfort: Hangry Sad Weary Concentration?

Two Rules Pain is Bad Stress Headache Nausea Hunger Discomfort Sadness Anxiety Depression

Brain Energy 50% 50% 25% 75% 5% 95%

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Brain Energy 25% 75% 5% 95%

Survival You know better? Semi-Automatic: Behaviors: Breathing Eat You are trying? Blinking Drink Water Bathroom Sleep Have Sex You want this? What happens if you don’t surface in time?

Survival 5% 95% ?

Two Rules Pain is Bad Pleasure is Good Euphoria Satiety Well-being Contentment Happiness Motivation Satisfaction Comfort

Neurotransmission Dopamine Serotonin Norepinephrine Endogenous Opioids NOT pleasure reward, movement, motive Serotonin digestion, mood, sleep Norepinephrine fight, flight, or love Endogenous Opioids decrease pain and stress Glutamate learning, cognition, memory

Stages of Addiction Binge/Intoxication Withdrawal/Negative Affect Consumption Pleasant Effects Withdrawal/Negative Affect Negative Emotion Physical Discomfort Preoccupation/Anticipation Seeking Behavior Triggers and Cravings

Downregulation 1050% 350% 225% 200% 100% 50%

Acute Withdrawal Extended Amygdala Pain is Bad Pleasure is Good Corticotrophin Releasing Factor Norepinephrine Dynorphin Pain is Bad Withdrawal Pleasure is Good Absence of Pain is Good No withdrawal

Post-Acute Withdrawal Syndrome Honeymoon Adjustment/Resolution The WALL Acute Withdrawal Day 15 Day 45 Day 120 Day 180

Disease Eat DRUGS Drink Water Sleep Have Sex

Disease Requirements What We Know Identify Organ Identify Dysfunction Identify Symptoms What We Know Progressive Fatal Chronic

Medication Anxiolytic Heroin Methadone Buprenorphine

Habit Formation Behavioral Theory Classical Conditioning Operant Conditioning Reinforcement Positive US UR Negative Punishment Positive Negative CS CR US CS

Habit Formation Bob the Caveman Conditioning US UR US CS CR

Habit Formation Tantrum Tantrum Cognitive Behavioral Theory Tantrum Antecedent Want Candy Behavior Tantrum Get Candy Consequence Tantrum Ask Politely Punishment Ignore Tantrum Immediate Tantrum Consistent Severe Near Enforcer

Neuroplasticity Substance Use Stress No Use Use More Stress Less Stress Less Stress Meditation Breathing Exercise Use Stress

Two Rules Pain is Stress Stress is Trauma Trauma is Survival Cramps Grief/Loss Headache Employment Nausea ADHD Hunger Relationships Discomfort Shame/Guilt Sadness Fear Anxiety Peer Pressure Depression Deadlines

In Closing Addiction is a disease of survival “I should have been stronger” “Using drugs is a choice” “Just. Say. No.” Learned behavior can be replaced What is the desired consequence? What other behavior can I use? Stress management is key Stress and cravings are positively correlated Trauma triggers can lead to relapse

References Clapp, P., Ph.D, Bhave, S. V., Ph.D, & Hoffman, P. L., Ph.D. (2008). How adaptation of the brain to alcohol leads to dependence. Alcohol Res Health, 31(4), 310-339. Retrieved October 20, 2017, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2923844/ Goldstein, R. Z., & Volkow, N. D. (2011). Dysfunction of the prefrontal cortex in addiction: neuroimaging findings and clinical implications. Nature Reviews Neuroscience, 12(11), 652-669. doi:10.1038/nrn3119 Kalivas, P. W., Ph.D, & Volkow, N. D., M.D. (2005). The Neural Basis of Addiction: A Pathology of Motivation and Choice. American Journal of Psychiatry, (162), 1403-1413. Retrieved October 20, 2017, from http://web.as.uky.edu/biology/faculty/cooper/Bio380- Neurophysiology%20seminar/neural%20basis%20of%20addiction-Thompson.pdf Smith, F. (2017, September). The addicted brain. National Geographic, 232(3), 30-53. Substance Abuse and Mental Health Services Administration (US); Office of the Surgeon General (US). Facing Addiction in America: The Surgeon General's Report on Alcohol, Drugs, and Health [Internet]. Washington (DC): US Department of Health and Human Services; 2016 Nov. CHAPTER 2, THE NEUROBIOLOGY OF SUBSTANCE USE, MISUSE, AND ADDICTION. Available from: https://www.ncbi.nlm.nih.gov/books/NBK424849/