1. Addiction A disease

2. Facts About Addiction & Treatment WHAT IS ADDICTION? A BRAIN DISEASE BUT WITH BIOLOGICAL, PSYCHOLOGICAL & SOCIAL COMPONENTS DOES TREATMENT WORK? YES, IT IS COST-EFFECTIVE IN THE LONG RUN

3. So what substances are people abusing?

4. Addiction is a Complex Disease …with biological, sociological and psychological components

5. Why Do People Take Drugs in The First Place? To Feel Good To have novel: feelings sensations experiences AND to share them To Feel Better To lessen: anxiety worries fears depression hopelessness

6. Drugs of Abuse Engage Motivation and Pleasure Pathways of the Brain Drugs of Abuse Engage Motivation and Pleasure Pathways of the Brain Why Do People Abuse Drugs? Why Do People Abuse Drugs?

7. Nature of Addiction - a continuum of use? However, addiction is more than mere drug use… Loss of control 

8. Continuum of Use No Use Stage 1 – Experimental Use – like it Stage 2 – More regular use/seeks mood swings – Want it Stage 3 – Daily preoccupation / harmfully involved – Need it Stage 4 – Dependency / harmfully dependent / uses it to feel normal – crave it

9. Addiction Involves Multiple Factors

10. How Drugs & Alcohol Work  They interact with nerve circuits, centers, and chemical messengers   Results  I Feel Good – Euphoria & Reward  I Feel “Better” – Reduce negative feelings  This Feels “Normal”  I’m craving it, tolerating its effects, withdrawing and feeling sick

11. SymptomsCharacteristics Loss of control Preoccupation with substance Cravings Chronic use despite negative consequences Unable to limit use effectively High tolerance All addiction are progressive and chronic

12. Di Chiara et al., Neuroscience, 1999.,Fiorino and Phillips, J. Neuroscience, 1997. Natural Rewards Elevate Dopamine Levels 0 50 100 150 200 060120180 Time (min) % of Basal DA Output NAc shell Empty Food Sex Box Feeding 100 150 200 DA Concentration (% Baseline) Sample Number 12345678 Female Present

13. Amphetamine Cocaine Time After Drug Morphine 0 100 150 200 250 0123 hr Time After Drug % of Basal Release Accumbens Caudate Nicotine Di Chiara and Imperato, PNAS, 1988 Effects of Drugs on Dopamine Release

14. Brain Reward Pathways

15. Activation of Reward

16. Circuits Involved In Drug Abuse and Addiction All of these brain regions must be considered in developing strategies to effectively treat addiction

17. Dopamine Spells REWARD Release Activate Recycle

19. Self-Control Addicts seek control, not abstinence If I can have just one, then I will be normal, just like my friends

20. Addiction is a Developmental Disease: It Starts Early 67% 1.5% 5.5% <12 12-17 18-25>25 26% First Marijuana Use, (Percent of Initiates )

21. When Reading Emotion… Adults Rely More on the Frontal Cortex While Teens Rely More on the Amygdala When Reading Emotion… Adults Rely More on the Frontal Cortex While Teens Rely More on the Amygdala Deborah Yurgelon-Todd 2000.

22. The Adolescent Brain Adolescents do not think with the same part of the brain as adults Limbic system – emotional responses (fear, anger mood, hormones, motivations, pain / pleasure sensations Prefrontal cortex development takes place during the teen years – until 25 yrs Reeved up emotions + low impulse control = Risk taking

23. Cognitive Deficits and D&A Memory problems – short-term loss Impaired abstraction Perseveration using failed problem- solving strategies Loss of impulse control These deficits are similar to those with brain damage

24. Why do some people become addicted to drugs while others do not?Vulnerability

25. Genetics is a Big Contributor to the Risk of Addiction… And… The Nature of this Contribution Is Extremely Complex

26. Addiction Risk Factors Genetics – one parent increases risk by 4x - Two parents increases risk by 8x Earlier Age of Onset Childhood Trauma (violent, sexual) Learning Disorders & ADD/ADHD Mental Illness Predating Use –Depression –Bipolar Disorder –Psychosis –ADHD Culture and values Availability of substances

27. What Other Biological Factors Contribute to Addiction--Comorbidity Prevalence of Drug Disorders Percent Prevalence of Nicotine Addiction General public Schizophrenia 0 20 40 60 80 Depression Percent General public Any Mood Disorder Any Anxiety Disorder Depression Mania Panic w/ Agoraphobia Panic w/out Agoraphobia Social Phobia Generalized Anxiety 0 5 10 15 20 25 30 35 40

28. Why do Mental Illnesses and Substance Abuse Co-occur? Self-medication –substance abuse begins as a means to alleviate symptoms of mental illness Causal effects –Substance abuse may increase vulnerability to mental illness Common or correlated causes –the risk factors that give rise to mental illness and substance abuse may be related or overlap

29. What Environmental Factors Contribute to Addiction? Stress Early physical or sexual abuse Witnessing violence Peers who use drugs Drug availability

30. A family Disease

31. Principles that support the triangle The CD should be able to control or stop their use on their own Family members are responsible for the behaviour of the CD Family members are supposed to protect the CD from unpleasant experiences

32. A Family Disease CD Increased tolerance to chemical(s) Unwillingness to discuss the issue Learns to medicate feelings Neglects responsibilities Tries to control use of chemicals Family Increased tolerance for unacceptable behaviour Unwillingness to discuss issues Learns to deny and stuffs feelings Takes responsibility Tries to control the CD

33. Family Disease Continued CD Compromises values Isolates from the family Focuses on the drug(s) Physical and emotional problems Spiritual crisis – loss of hope and options Family Compromises values Isolates socially Focuses on the CD Physical and emotional problems Spiritual crisis – loss of hope and options

34. Treating a Biobehavioral Disorder Must Go Beyond Just Fixing the Chemistry Pharmacological Treatments (Medications) We Need to Treat the Whole Person! In Social Context Behavioral Therapies Social Services Medical Services

35. Recovery “You don’t recover from an addiction by stopping using. You recover by creating a new life where it is easier to not use”