Addiction

A disease

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

So what substances are people abusing?

Addiction is a Complex Disease

…with biological, sociological and

psychological components

Why Do People Take Drugs in The First Place?

To Feel GoodTo have novel:

feelingssensations

experiencesAND

to share them

To Feel BetterTo lessen:

anxietyworries

fearsdepression

hopelessness

Drugs of Abuse Engage Motivation and

Pleasure Pathwaysof the Brain

Drugs of Abuse Engage Motivation and

Pleasure Pathwaysof the Brain

Why Do PeopleAbuse Drugs?

Why Do PeopleAbuse Drugs?

Nature of Addiction - a continuum of use?

However, addiction is more than mere drug use…

Loss of control

Continuum of UseNo 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

Addiction Involves Multiple FactorsAddiction Involves Multiple Factors

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

Symptoms Characteristics

• 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

Di Chiara et al., Neuroscience, 1999.,Fiorino and Phillips, J. Neuroscience, 1997.

Natural Rewards Elevate Dopamine Levels

0

50

100

150

200

0 60 120 180

Time (min)

% o

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Amphetamine

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300

400

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% o

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AccumbensCocaine

Time After Drug

Morphine

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100

150

200

250

0 1 2 3 hr

Time After Drug

% o

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Nicotine

Di Chiara and Imperato, PNAS, 1988

Effects of Drugs on Dopamine Release

% o

f B

asal

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ease

0

100

150

200

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Dose mg/kgmg/kg

mg/kgmg/kg

Brain Reward Pathways

Activation of Reward

Circuits Involved In Drug Abuse and Addiction

All of these brain regions must be considered in developing strategies to effectively treat addiction

All of these brain regions must be considered in developing strategies to effectively treat addiction

Dopamine Spells REWARD

Release

Activate

Recycle

Self-Control

• Addicts seek control, not abstinence

If I can have just one,

then I will be normal, just

like my friends

If I can have just one,

then I will be normal, just

like my friends

Addiction is a Developmental Disease: It Starts Early

1

10

100

Child Teen Young Adult Adult

67%

1.5%

5.5%

<12 12-17 18-25 >25

26%

Fir s

t M

ar i

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When Reading Emotion…Adults Rely More on the Frontal CortexWhile Teens Rely More on the Amygdala

When Reading Emotion…Adults Rely More on the Frontal CortexWhile Teens Rely More on the Amygdala

Deborah Yurgelon-Todd 2000. Deborah Yurgelon-Todd 2000.

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

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

Why do some people become addicted to drugs

while others do not?

VulnerabilityVulnerability

Genetics is a Big Contributor to the Risk of Addiction…

And…

The Nature of this Contribution Is Extremely Complex

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

What Other Biological Factors Contribute to Addiction--Comorbidity

Prevalence of Drug Disorders

Per

cent

Prevalence of Nicotine Addiction

Gen

eral

public

Schizo

phrenia

0

20

40

60

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ssion

Per

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Gener

al public

Any Mood D

isord

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Any Anxiet

y Diso

rder

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ssion

Man

ia

Panic

w/ Agor

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Panic

w/out

Agora

phobia Social P

hobia

Gener

alized

Anxiet

y0

5

10

15

20

25

30

35

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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

What EnvironmentalFactors Contribute to Addiction?

• Stress

• Early physical or sexual abuse

• Witnessing violence

• Peers who use drugs

• Drug availability

A family Disease

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

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

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

Treating a Biobehavioral Disorder Must Go Beyond Just Fixing the Chemistry

Pharmacological Treatments

(Medications)

We Need to Treat theWe Need to Treat theWhole Person!Whole Person!

In Social ContextIn Social Context

Behavioral Therapies

Social ServicesMedical Services

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”