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

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

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

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

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

7. Video

8. Brain Energy
25%
75% 5%
95%

9. 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?

10. Survival 5%
95% ?

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

12. 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

13. 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

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

15. 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

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

17. Disease
Eat
DRUGS
Drink Water
Sleep
Have Sex

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

19. Medication
Anxiolytic
Heroin
Methadone
Buprenorphine

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

21. Habit Formation
Bob the Caveman
Conditioning US UR US CS CR

22. 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

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

24. 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

25. 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

26. 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), Retrieved October 20, 2017, from
Goldstein, R. Z., & Volkow, N. D. (2011). Dysfunction of the prefrontal cortex in addiction: neuroimaging findings and clinical implications. Nature Reviews Neuroscience, 12(11), doi: /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), Retrieved October 20, , from Neurophysiology%20seminar/neural%20basis%20of%20addiction-Thompson.pdf
Smith, F. (2017, September). The addicted brain. National Geographic, 232(3),
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: