Bringing the Full Power of Science to Bear on
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Transcript of Bringing the Full Power of Science to Bear on
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Bringing the Full Power of Scienceto Bear on
Bringing the Full Power of Scienceto Bear on
NIDANIDANATIONAL INSTITUTE
ON DRUG ABUSE
NATIONAL INSTITUTE
ON DRUG ABUSE
Drug Abuse & Addiction Drug Abuse & Addiction
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NEUROTOXICITYAIDSCANCERMENTAL ILLNESS
NEUROTOXICITYAIDSCANCERMENTAL ILLNESS
NeurotoxicityAIDS, CancerMental illness
NeurotoxicityAIDS, CancerMental illness
Health careProductivityAccidents
Health careProductivityAccidents
HomelessnessCrimeViolence
HomelessnessCrimeViolence
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4 Out of 10 U.S. 4 Out of 10 U.S. AIDSAIDS Deaths Are Deaths Are Related to Drug AbuseRelated to Drug Abuse
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Estimated Economic Cost to Society from Substance Abuse and Addiction:
Illegal drugs: $181 billion/year
Alcohol: $185 billion/year
Tobacco: $158 billion/year
Total: $524 billion/year
Surgeon General’s Report, 2004; ONDCP, 2004; Harwood, 2000.
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What is Addiction? Addiction is A Brain Disease
• Characterized by compulsive behavior • The continued abuse of drugs despite
negative consequences • A chronic, potentially relapsing disorder
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Advances in science have revolutionized our fundamental views of drug abuse and addiction.
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used to be
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Your Brain on Drugs Today
1-2 Min 3-4 5-6
6-7 7-8 8-9
9-10 10-20 20-30
YELLOW shows places in brain where cocaine binds (striatum)
Front of Brain
Back of Brain
Fowler et al., Synapse, 1989.
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Healthy Heart
Diseased Heart
Decreased Heart Metabolism in Heart
Disease Patient
Diseased Brain/Cocaine Abuser
High
Low
Addiction is Like Other Diseases… It is preventable. It is treatable It changes biology. If untreated, it can last a lifetime.
Research supported by NIDA addresses all of these components of addiction
Healthy Brain
Decreased Brain Metabolism in Drug Abuser
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Addiction Involves Multiple FactorsAddiction Involves Multiple Factors
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that starts in adolescence and childhood
National Epidemiologic Survey on Alcohol and Related Conditions , 2003.National Epidemiologic Survey on Alcohol and Related Conditions , 2003.
AgeAgeAge at tobacco, alcohol and cannabis dependence per DSM IV
0.0%0.0%
0.2%0.2%
0.4%0.4%
0.6%0.6%
0.8%0.8%
1.0%1.0%
1.2%1.2%
1.4%1.4%
1.6%1.6%
1.8%1.8%
55 1010 1515 2121 2525 3030 3535 4040 4545 5050 5555 6060 6565
% in
eac
h a
ge g
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p w
ho
dev
elop
fi
rst-
tim
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epen
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firs
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CANNABISALCOHOL
TOBACCO
Addiction Is A Developmental Disease
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Why Do People Take Drugs in The First Place?
To feel goodTo have novel:
feelingssensations
experiencesAND
to share them
To feel betterTo lessen:anxietyworriesfearsdepressionhopelessness
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Drugs of Abuse Engage Systems in the Motivation and Pleasure Pathwaysof the Brain
Drugs of Abuse Engage Systems in the Motivation and Pleasure Pathwaysof the Brain
Why Do PeopleAbuse Drugs?
Why Do PeopleAbuse Drugs?
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addictionReward & well-being
motivation
Dopamine
movement
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Drugs are “Imposters” of Brain Messages
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Donald Bliss, MAPB, Medical Illustration
The Neuron: How the Brain’s Messaging System Works
Terminal branches of axon
Cell body(the cell’s life support center)
Dendrites
Axon
Myelin sheath
Neuronal Impulse
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dopamine transporters
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0
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0 60 120 180
Time (min)
% o
f B
asal
DA
Ou
tpu
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NAc shell
Empty
Box Feeding
Di Chiara et al., Neuroscience, 1999.
FOOD
MountsIntromissionsEjaculations
Fiorino and Phillips, J. Neuroscience, 1997.
Natural Rewards Elevate Dopamine Levels
100
150
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DA
Co
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ntr
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(%
Bas
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SampleNumber
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SEX
Female Present
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0100200300400500600700800900
10001100
0 1 2 3 4 5 hr
Time After Amphetamine
% o
f B
asal
Rel
ease
DADOPACHVA
Accumbens AMPHETAMINE
0
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0 1 2 3 4 5 hrTime After Cocaine
% o
f B
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AccumbensCOCAINE
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0 1 2 3 4 5hrTime After Morphine
% o
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Accumbens
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MORPHINE
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0 1 2 3 hrTime After Nicotine
% o
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asal
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AccumbensCaudate
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Di Chiara and Imperato, PNAS, 1988
Effects of Drugs on Dopamine Release
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Other neurotransmitter systems arealso affected:Other neurotransmitter systems arealso affected:
But Dopamine is only Part of the StoryBut Dopamine is only Part of the Story
• Serotonin: mood regulation, sleep
• Glutamate: learning and memory
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Prolonged Drug Use Changesthe Brain In Fundamentaland Long-Lasting Ways
Prolonged Drug Use Changesthe Brain In Fundamentaland Long-Lasting Ways
Science Has Generated MuchEvidence Showing That…
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We Have Evidence That These Changes Can Be Both
Structural and Functional
We Have Evidence That These Changes Can Be Both
Structural and Functional
AND…AND…
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Amph
NAC
Saline
Source: Robinson & Kolb, Journal of Neuroscience, Volume: 1997Source: Robinson & Kolb, Journal of Neuroscience, Volume: 1997
Structurally…Structurally…
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DA
D2
Rec
epto
r A
vaila
bili
ty
Control Addicted
CocaineCocaine
AlcoholAlcohol
DA
DA
DA DA DA
DA
Reward Circuits
DA DA DA DA
DA
Reward Circuits
DA
DA
DA
DA DA
DA
Drug Abuser
Non-Drug Abuser
HeroinHeroin
MethMeth
Dopamine D2 Receptors are Lower in Addiction
DA
Functionally…Functionally…
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Dopamine Transporters in Methamphetamine AbusersDopamine Transporters in Methamphetamine Abusers
Normal Control
Methamphetamine Abuser
Motor TaskLoss of dopamine transporters in the meth abusers may result in slowing of motor reactions.
Memory taskLoss of dopamine transporters in the meth abusers may result in memory impairment.
7 8 9 10 11 12 131.0
1.2
1.4
1.6
1.8
2.0
Time Gait(seconds)
468101214161.01.2
1.4
1.6
1.8
2.0
Delayed Recall(words remembered)
Do
pam
ine
Tra
nsp
ort
erB
max
/Kd
Volkow et al., Am. J. Psychiatry, 2001.
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Implication:
Brain changes resulting from prolonged use of drugs
may compromise mental and motor functions
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Circuits Involved In Drug Abuse and Addiction
All of these must be considered in developing strategies to effectively treat addiction
All of these must be considered in developing strategies to effectively treat addiction