Drugs and Addiction
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Transcript of Drugs and Addiction
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Drugs and Addiction
Neuropsychiatry Lecture11.21.12
Jeannine Foley
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Which of the following treatments for opioid dependence is both an opioid receptor agonist and antagonist?
• A Clonidine• B Methadone• C Lofexidine• D. Naltrexone• E. Buprenorphine
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Which of the following treatments for opioid dependence is both an opioid receptor agonist and antagonist?
• A Clonidine• B Methadone• C Lofexidine• D. Naltrexone• E. Buprenorphine
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The CAGE Questionnaire surveys an individual's relationship between alcohol and
• A. concentration.• B gambling.• C. anxiety.• D eating• E. guilt.
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The CAGE Questionnaire surveys an individual's relationship between alcohol and
• A. concentration.• B gambling.• C. anxiety.• D eating• E. guilt.
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Chronic abuse of which of the following drugs can cause intracerebral vasculitis / or hemorrhage, or subarachnoid hemorrhage?
• A Heroin• B. Marijuana• C. d-Amphetamine• D. Phencyclidine• E. Lysergic acid diethylamide
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Chronic abuse of which of the following drugs can cause intracerebral vasculitis / or hemorrhage, or subarachnoid hemorrhage?
• A Heroin• B. Marijuana• C. d-Amphetamine• D. Phencyclidine• E. Lysergic acid diethylamide
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Dopamine has been shown to inhibit the release of:
• A follicle-stimulating hormone.• B. antidiuretic hormone• C. testosterone.• D. prolactin• E. thyroxin
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Dopamine has been shown to inhibit the release of:
• A follicle-stimulating hormone.• B. antidiuretic hormone• C. testosterone.• D. prolactin• E. thyroxin
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Abrupt drug withdrawal is most likely to be life-threatening for a person addicted to.
• A. heroin.• B. cocaine.• C. naloxone.• D. amobarbital.• E. phencyclidine (PCP).
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Abrupt drug withdrawal is most likely to be life-threatening for a person addicted to.
• A. heroin.• B. cocaine.• C. naloxone.• D. amobarbital.• E. phencyclidine (PCP).
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Severe opiate overdose is appropriately treated with:
• A. naloxone.• B. naltrexone.• C. pentazocine.• D. buprenorphine.• E. levo-alpha-acetylmethadol.
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Severe opiate overdose is appropriately treated with:
• A. naloxone.• B. naltrexone.• C. pentazocine.• D. buprenorphine.• E. levo-alpha-acetylmethadol.
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Elevation of which of the following laboratory tests is most useful in detecting chronic alcohol abuse?
• A. Alkaline phosphatase• B. White blood cell count• C Creatinine phosphokinase • D. Gamma-glutamyl transferase
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Elevation of which of the following laboratory tests is most useful in detecting chronic alcohol abuse?
• A. Alkaline phosphatase• B. White blood cell count• C Creatinine phosphokinase • D. Gamma-glutamyl transferase
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Select a function for the gamma-aminobutyric acid-A (GABA-A) receptor
• A. Depolarizes cells by opening channels that principally allow calcium to enter the cell
• B. Gates channels that allow sodium, but not calcium, to cross the cell membrane
• C. Gates chloride channels• D. Activates G proteins and modulates calcium
and potassium channels• E. Activates adenylyl cyclase and raises cyclic
adenosine monophosphate (cAMP)
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Select a function for the gamma-aminobutyric acid-A (GABA-A) receptor
• A. Depolarizes cells by opening channels that principally allow calcium to enter the cell
• B. Gates channels that allow sodium, but not calcium, to cross the cell membrane
• C. Gates chloride channels• D. Activates G proteins and modulates calcium
and potassium channels• E. Activates adenylyl cyclase and raises cyclic
adenosine monophosphate (cAMP)
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Select a function for the Dopamine (Dl) receptor
• A. Depolarizes cells by opening channels that principally allow calcium to enter the cell
• B. Gates channels that allow sodium, but not calcium, to cross the cell membrane
• C. Gates chloride channels• D. Activates G proteins and modulates calcium
and potassium channels• E. Activates adenylyl cyclase and raises cyclic
adenosine monophosphate (cAMP)
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Select a function for the Dopamine (Dl) receptor
• A. Depolarizes cells by opening channels that principally allow calcium to enter the cell
• B. Gates channels that allow sodium, but not calcium, to cross the cell membrane
• C. Gates chloride channels• D. Activates G proteins and modulates calcium
and potassium channels• E. Activates adenylyl cyclase and raises cyclic
adenosine monophosphate (cAMP)
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Which of the following substances contributes most to premature death anddisability in the United States?
• A Heroin• B. Cocaine• C. Alcohol• D Nicotine• E Amphetamine
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Which of the following substances contributes most to premature death anddisability in the United States?
• A Heroin• B. Cocaine• C. Alcohol• D Nicotine• E Amphetamine
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The cycle of addiction
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Human vs Mouse Brain Anatomy
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Addiction Circuitry
Kauer and Malenka, 2007
DopamineGlutamateGABAOrexin
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Modeling Addictive behavior
Image from NIAAA
• To model relapse behavior, train animals in apparatus with contingent or non-contingent cocaine exposure and withdraw them for a period of time.
• Induce relapse via stress, drug administration, or cue
Drug/Alc
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Psychomotor Sensitization
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Addictive drugs enhance DA neurotransmission
1. Increased extracellular DA in the striatum2. Increased SA when DA Rs are partially
antagonized, with cessation at more complete blockade
3. Inhibition of SA when DA synthesis is blocked4. Cessation of SA when DA neurons have axons
ablated
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Nutt D, King LA, Saulsbury W, Blakemore C (March 2007)
The most addictive drugs tend to be the most harmful
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Ethanol
• ½ Americans over 12 consume alcohol• ¼ Americans binge drink• 3 drinks increases DA by 138% in men and
69% in women• 5-20mM induces reinforcing DA concentration• Causes GABA disinhibition• Directly activates VTA DA neurons
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Ethanol increases DA to a different extent in different species of rats
Bustamante et al., 2009
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Nicotine
• 1/3 of the population over 13 uses it• Most common cause of drug-induced
premature death and disability• Enhances excitatory output to DA neurons• Acts on presynaptic Rs on DA terminals• 240nM/cigarette max brain concentration– Decreases to 25nM overnight
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Chronic stress blocks the nicotine induced increase in striatal dopamine
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Opioids
-Increase burst firing of VTA DA neurons-Disinhibition by inactivation of GABA neurons
DopamineGABA
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Morphine increases DA in the NAc
Ogawa et al., 2007 PNAS
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Cocaine and Amphetamines
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Cocaine injections cause rapid dopamine release in the NAc and VTA
Bradberry and Roth, 1989 Neurosci Letters
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Cocaine-Induced Glutamate Signaling in the NAc
McFarland et al., 2003 Cornish and Kalivas, 2000
Glutamate in NAc
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Increasing GABA Concentrations Attenuate Cocaine Seeking Behavior
McFarland and Kalivas, 2001
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Plasticity is attenuated in the NAc After Extinction
Moussawi et al., 2009
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Modulation of synaptic function and plasticity in the VTA
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Synaptic strength measured by the AMPAR/NMDAR ratio
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Orexin enhances NMDAR EPSCs in VTA neurons
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Modulation of synaptic function and plasticity in the NAc
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Mesolimbic system on drugs
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Glia surround synapses and release glutamate
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Glutamate homeostasis hypothesis of addiction
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Effects of Cocaine on Spine Morphology
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Addiction: pathological synaptic plasticity
• Reward behavior circuits become habitually active and have decreased response to environmental stimuli and top down processing
• Behavior starts as drug seeking and is easily influenced by external stimuli. Changes in D2R levels in NAc alter behavioral circuits which become habitual then compulsive
• People with abnormal D2R concentrations may be more vulnerable to addiction
• Differential effects of drugs
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PFC activity is reduced in subjects which abuse cocaine
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Decreased D2 receptors in the ventral striatum have been found in alcoholics and addictive users of other drugs as well as in obese individuals
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PET scanning in monkey basal ganglia
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Treatment
• psychotherapy • methadone for heroin addicts • nausea-inducing Antabuse for alcoholics• TMS- stimulate PFC->VTA->DA in NAc to accoutn
for decreased DA in addicts• Vaccines like TA-CD (for cocaine) prevent the
addictive substance from ever reaching the user's brain
• Pharmacotherapy
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GABA therapies• GABAa receptor antagonists that bind at or near the active site, such as
picrotoxin and bicuculline, have been found to reduce self-administration of ethanol and cocaine. – Nowak et al. reported that microinjections of picrotoxin or of bicuculline into
the VTA resulted in decreases in ethanol consumption, but that microinjections in regions outside the VTA failed to decrease ethanol intake
• Compared to rats that were in the lowest 15th percentile of ethanol self administration (LES), the rats that were in the highest 15th percentile (HES) had significantly higher GABAA receptor mRNA levels in the dorsal raphe, medial raphe, cerebellum, and hippocampus (Tyndale and Tomkins). – (Thus, elevated GABAA receptor mRNA associated with an increased density of
GABAa receptors, may predispose to the development of an addictive process.)
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GABA therapies
•Gabapentin (~1200mg/day) decreased alcohol craving and increased sleep quality in double blind placebo controlled human studies•Topiramate increases GABAa activation and decreases AMPA/Kainate activatin which decreases DA release in the Nac•GABAb receptor agonist baclofen has been found to attenuate self-administration of cocaine, heroin, ethanol, nicotine, and d-amphetamine.
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Ion Channel Targeting Drugs
• L-type Calcium channel blockers– DHP decreases drug related behavior in rodents
but human studies are lacking• SK-Type calcium activated potassium channels– Chronic EtOH exposure in rodents decreases SK
currents– Decreased alcohol and cocaine creaving and intake
in human addicts with bipolar and some evidence for decreased alcohol intake in schizophrenics
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AMPAR/NMDAR ratio is increased after withdrawal from chronic cocaine
Kourrich et al., 2007
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Increase in AMPAR/NMDAR ratio is Reversed by Cocaine Challenge
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Cocaine-Induced AMPAR Plasticity in the NAc is Mediated by NMDARs
Schumann and Yaka, 2009