Nora D. Volkow, M.D. Director National Institute on Drug Abuse Nora D. Volkow, M.D. Director National Institute on Drug Abuse Research Advances in What Do They Mean for Recovery?

Biology/Genes Environment DRUG Addiction Brain Mechanisms 1.ADDICTION INVOLVES MULTIPLE FACTORS

2. ADDICTION IS A DEVELOPMENTAL DISEASE starts in adolescence and childhood 2. ADDICTION IS A DEVELOPMENTAL DISEASE starts in adolescence and childhood NIAAA National Epidemiologic Survey on Alcohol and Related Conditions, 2003 % in each age group who develop first- time cannabis use disorder 0.0% 0.2% 0.4% 0.6% 0.8% 1.0% 1.2% 1.4% 1.6% Age Age at cannabis use disorder as per DSM IV

Brain areas where volumes are smaller in adolescents than young adults Source: Sowell, E.R. et al., Nature Neuroscience, 2(10), pp , 1999 Recent Studies Have Shown that Maturation of the Brain’s Gray Matter Moves from Back to Front Recent Studies Have Shown that Maturation of the Brain’s Gray Matter Moves from Back to Front

Healthy Heart Diseased Heart Decreased Heart Metabolism in Heart Disease Patient 3. ADDICTION IS A DISEASE OF THE BRAIN as other diseases it affects the tissue function Control Cocaine Abuser Decreased Brain Metabolism in Drug Abuse Patient Sources: From the laboratories of Drs. N. Volkow and H. Schelbert High Low

Partial Recovery of Brain Dopamine Transporters in Methamphetamine (METH) Abuser After Protracted Abstinence Normal Control METH Abuser (1 month detox) METH Abuser (24 months detox) 0 3 ml/gm Source: Volkow, ND et al., Journal of Neuroscience 21, , ADDICTION CAN BE TREATED

Relapse Rates Are Similar for Drug Dependence And Other Chronic Illnesses Relapse Rates Are Similar for Drug Dependence And Other Chronic Illnesses Drug Dependence Drug Dependence Type I Diabetes Type I Diabetes Hypertension Asthma 40 to 60% 30 to 50% 50 to 70% Source: McLellan, A.T. et al., JAMA, Vol 284(13), October 4, Percent of Patients Who Relapse Addiction Treatment Does Work

Evaluation of A Hypothetical Treatment PreDuring Post Symptom Severity HYPERTENSION PreDuring Post Stage of Treatment Symptom Severity ADDICTION Just Like Hypertension, Addiction Is A Chronic Disease That Requires Continued Care Source: McLellan, AT, Addiction 97, , 2002.

Posterior Hippocampi of London Taxi Drivers Were Significantly Larger Than Those of Controls Posterior Hippocampi of London Taxi Drivers Were Significantly Larger Than Those of Controls Source: Maguire, E.A. et al., PNAS, 97(8), pp , Positive Correlation Between Gray Matter Volume and Time As A Taxi Driver Control Cocaine Abuser

In 2003, An Estimated 21.6 Million Americans Were Dependent On or Abused Any Illicit Drugs or Alcohol But…Only 3.3 Million (15%) Of These Individuals Had Received Some Type of Treatment In the Past Year In 2003, An Estimated 21.6 Million Americans Were Dependent On or Abused Any Illicit Drugs or Alcohol But…Only 3.3 Million (15%) Of These Individuals Had Received Some Type of Treatment In the Past Year Bench Bedside Community

NIDA Criminal Justice Drug Abuse Treatment Studies (CJ-DATS) Research Centers Coordinating Center National Drug Abuse Treatment Clinical Trials Network (CTN) National Drug Abuse Treatment Clinical Trials Network (CTN) CTN Sites

Where Do We Need to Go From Here? Where Do We Need to Go From Here? We Need to… Advance the SCIENCE Erase the STIGMA and to… Erase the STIGMA and to…