Addiction: A Treatable Brain Disease Amir H. Rezvani, Ph. D Addiction: A Treatable Brain Disease Amir H. Rezvani, Ph.D. Professor of Psychiatry and Behavioral Sciences, Duke University Azadi@duke.edu March 1, 2019

No one is born an addict, but anyone with a brain can become one.

She said no, pass me a beer!

Cost and Scope of Addiction

**************************** Why Do People Take Drugs in the First Place?

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Testimony “I can remember my first drink, I was only elven. I hated the taste., but I felt the glow and it worked. I would get sick as a dog and then swear on a stack of Bibles I would not do it again, but I kept going back. I got drunk because ………

* …..because I had a hole in my gut so big, and alcohol and then other drugs would fill the hole. They became the solution.”

Wanting-liking Theory

What do YOU think? Addiction begins with a voluntary behavior, thus addicts should be able to quit by force of will!

Amazing Story of Phineas Gage

Hijacked Brain

Disease: Any deviation from or interruption of the normal structure or function of any part, organ or system (or combination thereof) of the body that is manifested by a characteristic set of symptoms and signs and whose etiology, pathology, and prognosis may be known or unknown. Dorland’s Medical Dictionary, 26th edition

Disease Model Organ Defect Symptoms

Organ (pancreas) Defect (cell death) Symptoms (high blood sugar) Diabetes Organ (pancreas) Defect (cell death) Symptoms (high blood sugar)

Alcoholism It is a primary, chronic disease with genetic, psychosocial and environmental factors influencing its development and manifestation. It is often progressive and fatal. It is characterized by continuous or periodic impaired control over drinking, preoccupation with alcohol despite adverse consequences and distortion in thinking, most notably denial.

drug user environment Social status Age Potency Risk-taking “High” Psychiatric state Genetics Potency “High” Cost Side Effects drug user Addiction environment SES=Socioeconomic Status Peers Parents Attitudes Opportunity

More Hugs = Less Drugs: Pair-bonding in Prairie Voles

Social Bonding Social Bonding Decreases the Rewarding Properties of Amphetamine Through a Dopamine D1 Receptor-Mediated Mechanism. The journal of Neuroscience 31:7960; 2011

Therapeutic Communities Therapeutic Communities (TC) Triangle Residential Options for Substance Abusers (TROSA) (Durham, NC)

Did we learn anything from our addicted soldiers returning from Vietnam war?

Treatment Early prevention Multiple path to recovery Drug alone is not enough At least 90 days rehab Holistic treatment is the best Certain treatments work for certain drugs Leverage can be good Patient’s input very important Relapse is part of the recovery process

Blocks & Barriers in Treatment Denial (85% in denial) Stigma Anonymity Terminology confusions Physicians’ lack of proper training.

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More Hugs = Less Drugs

Thank you for your attention and have a lovely weekend! ******************************