The Brain, Behavior, and Addiction. Objectives. Advances in science have revolutionized our fundamental views of drug abuse and addiction.

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1 The Brain, Behavior, and Addiction Flo Hilliard University of Wisconsin-Madison Division of Continuing Studies Objectives Progress of science in addiction studies Why it is a brain disease Changing our perspective Relapse prevention Advances in science have revolutionized our fundamental views of drug abuse and addiction. 1

2 Drug kit on sale at Macys (circa 1908) with vials of cocaine and heroin. Sears Roebuck also sold a drug kit. Courtesy of Fritz Hugh Ludlow Memorial Library. Your Brain on Drugs in the 1980 s Bringing the Full Power of Science to Bear on Drug Abuse & Addiction 2

3 Your Brain on Drugs Today YELLOW shows places in brain where cocaine binds (e.g., striatum) Fowler et al., Synapse, What Does Science Tell Us About Addiction? Disorder /dis or der/ (dis-or der) a derangement or abnormality of function; a morbid physical or mental state. Addiction is Like Other Diseases It is Preventable It is Treatable It Changes Biology 3

4 Addiction is Like Other Diseases Changing Biology of the Brain Decreased Brain Metabolism in Drug Abuser High Decreased Heart Metabolism in Heart Disease Patient Healthy Brain Diseased Brain/ Cocaine Abuser Low Healthy Heart Diseased Heart Research supported by NIDA addresses all of these components of addiction. ASAM Definition of Addiction August 15, 2011 Primary, chronic disease of brain reward, motivation, memory and related circuitry. Reflected in individual pathologically pursuing reward and/or relief by substance use. ASAM Definition of Addiction Characterized by: Inability to consistently abstain, Impairment in behavioral control, Craving, Diminished recognition of significant problems with one s behaviors and interpersonal relationships, Dysfunctional emotional response 4

5 ASAM Definition of Addiction Can involve cycles of relapse and remission Without treatment or engagement in recovery activities, is progressive and can result in disability or premature death Addiction A Brain Disorder Characterized by: 1. Non medical use; preoccupation with substance 2. Loss of control of use 3. Continued use despite negative consequences Addiction A chronic brain disorder More about neurology of the brain than Outward manifestations of behavior and poor choices. Not About The Drug It s About The Brain! 5

6 Developing Addiction A Continuum Science Changes the Dialogue: Continuum of Substance Use Disorders: Abuse of alcohol and other drugs are preventable behaviors Alcohol and drug addiction is a chronic but treatable disease Recovery from addiction is a reality Understanding the science of addiction and recovery is important: For the Recovering Person helps recovery journey helps people understand their cravings helps reduce stigma 6

7 The science of addiction is also important: For the Family -helps explain the unexplainable -reduces stigma, blame and anger Facilitates the recovery process for person and family members 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 A major reason people take a drug is they like what it does to their brains. 7

8 Vulnerability Why do some people become addicted to drugs while others do not? We know there s a genetic contribution to addiction But the nature of this contribution is extremely complex Individual Differences in Response to Drugs: DA Receptors influence drug liking High DA receptor high Low DA receptor low As a group, subjects with low receptor levels found MP pleasant while those with high levels found MP unpleasant Adapted from Volkow et al., Am. J. Psychiatry,

9 Individual Differences in Response to Drugs: DA Receptors influence drug liking High DA receptor high Low DA receptor low As a group, subjects with low receptor levels found MP pleasant while those with high levels found MP unpleasant Adapted from Volkow et al., Am. J. Psychiatry, A complex behavioral and neurobiological disorder HISTORICAL - previous history - expectation -learning ENVIRONMENTAL - social interactions -stress - conditioned stimuli DRUGS BRAIN MECHANISMS PHYSIOLOGICAL - genetics -circadian rhythms - disease states -gender BEHAVIOR ENVIRONMENT Source: National Institute on Drug Abuse The brain s exquisite complexity Approx 4-5 pounds 100 Billion interconnected nerve cells Many varieties of neurons Trillions of supportive cells Trillions more synaptic connections Miles of blood vessels 9

10 The Brain Responsible for initiating and controlling: every movement thought sensation emotion That makes up the human experience! Communication of the brain Neuron = nerve cell The Neuron: How the Brain s Messaging System Works Dendrites Cell body (the cell s life support center) Neuronal Impulse Axon Terminal branches of axon Myelin sheath Donald Bliss, MAPB, Medical Illustration 10

11 Source: National Institute on Drug Abuse Teaching Packet How do alcohol and other drugs work in the brain? Despite many differences, virtually all substances with the potential for addiction affect dopamine levels in the pleasure/reward pathway of the brain. 11

12 Source: National Institute on Drug Abuse Teaching Packet Movement Motivation Dopamine Addiction Reward & well-being Initially, a person takes a drug hoping to change their mood, perception, or emotional state TRANSLATION... Hoping to change their Brain. 12

13 The system becomes captured by the addicting drug Re-sets behavioral priorities in the primitive brain Drives behavior toward the drug Circuits Involved in Drug Abuse and Addiction All of these brain regions must be considered in developing strategies to effectively treat addiction 36 Natural Rewards Elevate Dopamine Levels % of Basal DA Output Food 200 NAc shell Empty 50 Box Feeding Time (min) DA Concentration (% Baseline) Sex Female Present Sample Number Di Chiara et al., Neuroscience, 1999.,Fiorino and Phillips, J. Neuroscience,

14 Why Can t Addicts Just Quit? Non-Addicted Brain Addicted Brain Control Control Saliency Drive NO GO Saliency Drive GO Memory Memory Because Addiction Changes Brain Circuits Adapted from Volkow et al., Neuropharmacology, Markers that addiction is a disease? can be reliably produced and easily recognized in animals. patterns of intake resemble humans - drug for drug. Follows behavioral symptoms of other chronic diseases resistance, denial, anger, relapse, etc. 14

15 What about relapse? Why Can t They Stay Quit? Form of Classical Conditioning Sets off physiological chain reaction in the body coming from the brain. What About Relapse? Complex triggers and anchors (internal and/or external) Set off physiological chain reaction in the body coming from the brain. Examples of external triggers: cash Fridays using buddies What About Relapse? Examples of internal triggers: loneliness celebration emotional pain 15

16 Relapse Rates Are Similar for Addiction and Other Chronic Illnesses Percent of Patients Who Relapse to 60% 30 to 50% 50 to 70% 50 to 70% Drug Type I Hypertension Asthma Dependence Diabetes Source: McLellan, A.T. et al., JAMA, Vol 284(13), October 4, Recovery Can and Does Happen Research has shown that: Brain has remarkable ability to adapt, heal and change. Key is length of time and experiences after drug leaves system. Partial Recovery of Brain Dopamine Transporters in Methamphetamine (METH) Abuser After Protracted Abstinence 3 0 Normal Control METH Abuser (1 month detox) METH Abuser (14 months detox) ml/gm Source: Volkow, ND et al., Journal of Neuroscience 21, ,

17 Sources: Volkow, et al., Synapse, 11: , 1992 & Volkow, et al., Synapse, 14: , 1993 Helping the Brain Heal: Recovery Management Pharmacological Behaviorally Contextually Conclusion Like other chronic diseases. Changes brain structurally and functionally. Has bio-psychosocial elements. If relapse occurs, like other chronic conditions, recovery can continue. Recovery can be from many pathways. 17

18 There are millions of Americans in long-term recovery. Faces & Voices of Recovery Summit Additional Resources National Institute on Drug Abuse (NIDA) Alcoholism (NIAAA) National Institute on Alcohol Abuse and Substance Abuse and Mental Health Services Administration (SAMHSA) and Center for Substance Abuse Treatment (CSAT) HBO s Addiction 18

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