Downers and Dual Recovery How do depressant drugs affect mental health?
How Drugs Affect the Brain · 2020. 11. 23. · Nora D. Volkow, M.D. Director @ NIDAnews. National...
Transcript of How Drugs Affect the Brain · 2020. 11. 23. · Nora D. Volkow, M.D. Director @ NIDAnews. National...
Nora D. Volkow, M.D.Director
@NIDAnews
National Institute on Drug AbuseNational Institutes of Health
How Drugs Affect
the Brain
Brain Circuits Involved in the Addiction Cycle
Koob and Volkow, Lancet Psychiatry 2016.
Addiction Involves Multiple Factors
Addiction
DRUG
Brain Mechanisms
Biology/GenesJo
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Car
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Environment
`
Thos
e w
ho h
ave
used
(%)
Age at first use (years)10 20 30
TOBACCO
10 20 30
ALCOHOL
10 20 30 40
CANNABIS100
90
80
70
60
50
40
30
20
10
0
Adolescence is the period of greater vulnerability for drug use and addiction
Degenhardt, JAMA Psychiatry 2016.
Role Of Genetics On Brain Development
•Highest heritability in evolutionarily novel regions (temporal poles, inferior parietal lobes, and superior and dorsolateral frontal cortices)
•Heritability increased through late childhood and adolescence.
Schmitt et al., Proc Natl Acad Sci U S A. 2014 111(18): 6774–6779.
Social and Emotional Deprivation Increases Risk For SUD and Mental Illnesses
Decreases in brain connectivity with social neglect in childhood
Decreases in connectivity were proportional to time in orphanage
Govindan et al., Cereb Cortex 2010 Mar;20(3): 561-569.
Early (<18y) Long-Term Cannabis Use Decreases Connectivity
Reduced connectivity (measured with MRI) in cannabis users (n=59) compared to controls (N=33).
Zalesky et al Brain 2012.
Early Drug Use Can Modify Brain Development
Lower Hippocampal Synaptic Density In Cannabis Use Disorder
[11C]UCB-J BPND in Cannabis Use Disorder (CUD) and Healthy Controls (HC)
D’Souza, CD et al., Molecular Psychiatry, online September 24 2020.
Imaging of TSPO (Neuroinflammation Marker)in Long-term Cannabis Users[18F]FEPPA Distribution Volume in
Cannabis Users
Da Silva T et al., JAMA Psychiatry 2019;76(12):1306-1313.
TYROSINE
DA
DOPA
DA
DA
DA
DA
D A
DA
Acutely, Drugs Increase Dopamine but Repeated Use Decreases it
TYROSINE
DA
DOPA
DA
DA
DA
D A D A D A
D AD AD A
DA
COCAINE
TYROSINE
DA
DOPA
DA
DA
DA
DA
D A
DA
Control Cocaine Misuse
PLEASURE
Repeated Drug Use Modifies Brain Chemistry & Function
Dopamine Receptor Over-Expression in Alcohol-Preferring Rats
Over-expression of D2 receptors in rats markedly reduces alcohol intake
0102030405060
% C
hang
eD
2R
Time (days)4 6 8 10
p < 0.0005
p < 0.0005p < 0.005
p < 0.10D2R
Vec
tor
0-100
-80
-60
-40
-20
0
Time (days)4 6 8 10
p < 0.001
p < 0.001
p < 0.01
0
DA D2 Levels
Thanos et al., Alcohol Clin Exp Res. 2004.
Thanos, PK et al., J Neurochem, 2001.
**
S.003 .01 .03 .10
10
20
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40
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Cocaine (mg/kg/inj)
DominantSubordinate
Morgan, D. et al. Nature Neuroscience, 5: 169-174, 2002.
Social Rank & Vulnerability to Drug Use
3 months
Dominant
Group Housed
IndividualHoused
Subordinate3 months
Individual Housed
GroupHoused
Early Aggressive BehaviorPoor Social SkillsLack of Parental SupervisionSubstance UseDrug AvailabilityPoverty
RISK
Self ControlParental Monitoring & SupportPositive RelationshipsAcademic CompetenceAnti-Drug Use Policies
Strong Neighborhood
PROTECTION
IndividualFamilyPeer
SchoolCommunity
Protective Effects of a Supportive Parenting Intervention (SAAF n=59) on Poverty’s Effects on Brain Development (Control n=57)
Strong African American Families (SAAF)
Brody GH et al. JAMA Pediatr. 2017;171(1):46-52.
Brody GH et al., J Child Psychology Psychiatry. 2019 60(1):63-71.
Preventive Parenting Intervention (SAAF n=290) During Childhood and Young Black Adults' Unhealthful Behaviors (Control n=219)
Normal Control Methamphetamine(2x-1 month detox)
Methamphetamine(9 months detox)
Recovery of Brain Dopamine Transporters After Protracted Abstinence following Methamphetamine Misuse
Drug Use Can be Treated
Volkow et al., Mol Psychiatry 2015
1.5
DVR2.2
Intersection Between Opioid Crisis and COVID-19
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Overdoses Grew Dramatically During COVID Pandemic
ST
Total Study Population Change in Unadjusted Positivity Rate for Cocaine, Fentanyl, Heroin and Methamphetamine
31.96%
19.96%
10.06%12.52%
Total US Increase
Drug Use Increase During COVID
Millennium Health Signals Report™ COVID-19 Special Edition: Significant Changes in Drug Use During the Pandemic Volume 2.1 Published July 2020
Social Interaction Favored over Heroin Unless Social Interaction is Punished
Venniro et al., Nature Neuroscience 2018
Resident self-administration
chamber
Partner chamber
Social leverDrug lever
Slidingdoor
HEROIN