1 Prevention & Recovery Conference November 28, 29 & 30 Norman, Ok
4 What is Addiction? The American Society of Addiction Medicine (ASAM) released on August 15, 2011 their latest definition of addiction: Addiction is a chronic brain disorder and not simply a behavioral problem involving too much alcohol, drugs, gambling o sex. This is the first time that ASAM has taken an official position that addiction is not solely related to problematic substance abuse. Outward behaviors are actually manifestations of an underlying disease that involves various areas of the brain Addiction, at its core, is not just a social problem or a problem of morals. Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.
5 REWARD PASSWAY The reward pathway reinforces behavior by creating an affect on memory which using then can be trigger by eye sight, and smell The brain is divided into several distinct regions that are each responsible for performing functions. In the center of the brain sits the reward pathway, which is responsible for driving our feelings of motivation, reward and behavior. Neurons are the cells responsible for passing chemical and electrical signals along the pathway of the brain. They come in many shapes and sizes enabling them to conduct specialized functions such as storing memories or controlling our muscles.
6 The Midbrain is the SURVIVAL Brain Not conscious Acts immediately, no future planning or assessment of longterm consequences A life-or-death processing station for arriving sensory information
7 In addiction, the drug is equated with survival at the level of the unconscious (i.e. the drug IS survival)
18 The Two Part Brain The Cortex: Higher brain The Limbic System (lower brain): 85 % to 90 % of our behaviors are driven from the subconscious limbic region of the brain Our brains are made up of tiny chemicals called neurotransmitters. These tiny chemicals drive our emotions, feelings and behaviors The physical/chemical brain has a tremendous capacity to gain control of the mind. It can subject it and trap it. In other words it can take over the human will and influence how a person thinks, feels and acts. This state is known as addiction. This control over the human mind is called addiction
22 Structural Damages Stimulants like amphetamines can alter the structure of neurons. In this case, the dendrites of dopamine neurons in the nucleus accumbens a part of the reward pathway have more dendritic spines or connections in the amphetamine exposed animal compared to one treated only with saline.
27 Re-uptake Blocked
28 DOPAMINE (DA) GLUTAMATE (Glu) All drugs of abuse and potential compulsive behaviors INCREASE DA Reward salience this is important! I really want this! Rostral (toward the nose) projections: PFC < Nucleous Accumbens < Ventral Tegmental Area All drugs of abuse and potential compulsive behaviors EFFECT Glu Drug memories Drug seeking OK, I ll remember Fine, go and get it Caudal (toward the tail) projections: PFC > NA
31 Addiction Neurochemical Glutamate: The most abundant neurochemical in the brain Critical in memory formation & consolidation All drugs of abuse and many addicting behaviors effect Glutamate which preserves drug memories and creates drug cues And glutamate is the neurochemical of motivation (it initiates drug seeking)
32 Hijacked Brain SOBER PERSON ADDICT Frontal Cortex Does the Thinking Limbic System In Control Free Will Exists Responsibility Can stop No Free Will No Responsibility Can t Stop Punishment & Coercion DO work Punishment & Coercion DON T work
33 Executive Function Abstract thinking Motivation for goal-directed activity Planning and problem-solving Attention to tasks Inhibition of impulsive responses Weighing consequences of future actions Flexibility of responses (rule shifting) Reflective decision-making Gives us the capacity to use past experience and knowledge to make sense of our current behavior
34 DSM-IV Criteria for Substance Abuse RECURRENT SUBSTANCE USE leading to failure to fulfill major role obligations (work, school, home) RECURRENT SUBSTANCE USE in physically hazardous situations (impaired driving, operating machinery, in the work place) RECURRENT SUBSTANCE USE with related legal problems CONTINUED SUBSTANCE USE despite social/interpersonal conflict Person has never before met the criteria for Substance Dependence
35 DSM-IV Criteria for Substance Dependence (I M A TOWN DRUNK) INABILITY (to cut down) MORE DRUG USED (than intended) A LOT OF TIME (spent obtaining, using & recovering from using the drug) TOLERANCE OLD ACTIVITIES, FRIENDS & FAMILY MEMBERS (given up in favor of the drug) WITHDRAWAL NEGATIVE CONSEQUENCES (have no effect on the pattern of drug use)
The Addicted Drug abuse produces long-term changes in the reward circuitry of the brain. Knowledge of the cellular and molecular details of these adaptations could lead to new treatments for the compulsive
1. Is addiction a disease? What are the arguments for and against this notion? People often disagree with the idea of calling addiction a disease in the same way we call conditions like diabetes a disease.
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