1. The Importance of Knowing Addiction as a Brain Disease
Carlton Erickson, Ph.D.
Director, Addiction Science Research and Education Center
University of Texas at Austin, USA
APIA-Singapore, 2004

2. What IS addiction? • heroin addiction • cocaine addiction
• alcohol addiction (“alcoholism”)
• marijuana addiction
• amphetamine addiction
• nicotine addiction

3. What IS addiction? • sex addiction?? • gambling addiction??
• food addiction??
• shopping addiction????
• internet addiction????
• cell phone addiction????

5. A World Problem
• The ability to solve a world problem is directly proportional to our ability to define it.
• Are we dealing with a problem or a disease?

6. A World Problem
• The ability to solve a world problem is directly proportional to our ability to define it.
• Are we dealing with a problem or a disease?
• (Guess what? It doesn’t have to be one or the other. It could be BOTH!)

7. How do we define addiction?
• some people think it’s based upon problems people have when they are addicted
- I have problems with my mother-in-law. Am I addicted to my mother-in-law?

8. How do we define addiction?
• some people think it’s based upon how much and how often the drug (activity) is carried out
- university students drink a great amount of alcohol, usually many days a week. Are they all addicted to alcohol?

9. How do we define addiction?
• some people think it’s based upon a person’s personality or lack of will power
- many addicts are high functioning, intelligent people with no other psychopathology
- does this make sense?

10. How do we define addiction?
• I contend that “addiction” is not a useful scientific term
- chocolate addiction, exercise
addiction, television addiction
• Is heroin addiction similar to exercise addiction? (Probably not..)
• Has this dichotomy caused a problem in getting support for treatment, research, & education?

11. In Fact, It’s Even Worse! • Stigma (against the disease)
• Prejudice (against the addict)
• Anger (toward the addict)
• Misunderstanding (about what to do)
SPAM leads to myths: widely-held inaccurate beliefs, as compared to research-generated facts)

12. Too Many Myths! • “treatment doesn’t work”
• “addicts are bad, crazy, stupid”
• “crack is worse than cocaine”
• “marijuana rots your brain”
• “there is an addictive personality”
• “sugar is addicting”

13. The Facts…… • DSM and ICD: two drug problems
• abuse: caused by rebellion, money, boredom, experimentation, thrill-seeking, desperation, self-medication
• dependence: caused by genetics, brain chemistry sensitivity, with input from the environment
• we have medical and social criteria….

14. How to reduce these…
• abuse - education, coercion, punishment, environmental change, maturation, pressure to stop, life events
• dependence - “treatment” to positively affect abnormal brain function to reduce need for drug

15. Where Drugs Work

17. Medial Forebrain Bundle
• ventral tegmental area (VTA)
• (lateral) hypothalamus (LH)
• nucleus accumbens (NAc)
• frontal cortex (FC) - key portions
- prefrontal cortex (pfc)
- orbitofrontal cortex (ofc)

18. Drugs Associated wth Neurotransmitters
Why do people have “drugs of choice”?
• Dopamine - amphets, cocaine, ETOH
• Serotonin - LSD, ETOH
• Endorphins - opioids, ETOH
• GABA - benzos, ETOH
• Glutamate -ETOH
• Acetylcholine - nicotine, ETOH
(Marijuana?)

19. A Brain Chemistry Disease!
• addicting drugs seem to “match” the transmitter system that is not normal
• a chronic, relapsing, medical disease
• there are mild, moderate, and severe forms
• detox is traditionally the first step in the total treatment process
• methadone and nicotine maintenance is evidence that some people require a chemical to overcome the non-normal transmitter system

20. Important Point!
Dependence is not a loss of “will power”, for two reasons:
• The main problem with dependence
lies in the subconscious MFB.
• Problems with the frontal cortex
produce a pathological impairment of
decision-making.
Thus, dependence is not primarily under conscious control!

21. What Shall We Do?
• remember that “addiction” is an imprecise term; use “dependence” to indicate disease
• use “abuse” or “misuse” for overuse
• remember that most people misunderstand “alcoholism”
• try to use proper terminology in all technical and clinical situations

22. Precedents for Change • Hansen’s Disease - leprosy
• blood sugar disease - diabetes
• Grave’s Disease - hyperthyroidism
• common cold - influenza
• Lou Gehrig’s Disease - ALS
• Goldflam Disease - myasthenia gravis

23. Today’s Options (It’s all about options….)
• traditional: 12 step programs (abstinence)
• talk: inpatient/outpatient/aftercare
• misunderstood: harm reduction, MM
• new: brief motivational counseling, CBT, MET, SO-involved therapy, vouchers
• medical tx: new medications to enhance abstinence - anticraving meds, methadone, vaccines, drugs to alleviate withdrawal
(MM= Moderation Management, CBT= cognitive behavioral therapy,
MET= motivational enhancement therapy, SO = significant other)

24. How does “talk therapy” work to help people stop using drugs?

25. Logic Says: Behavioral Therapies Probably Change Brain Chemistry!

26. We need more research!
• There is lots of disagreement and misinformation in this field.
• This is a result of not having all of the facts.
• Facts come from good scientific research.
• Facts reduce myths and stigma.

28. RESEARCH VALIDITY ESTIMATE (RVE)
(A Thoughtful Appraisal of
High-Quality Scientific Research)
High RVE
• many large, well-controlled studies
• replicable results
• much peer-reviewed, published literature
Low RVE
• few replicable studies
• highly speculative results
• little peer-reviewed, published literature
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29. Things to Remember
• New research is changing our understanding of dependence (“addiction”).
• Learning this new information requires a willingness to give up old ideas and learn new ones.
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