Professional Documents
Culture Documents
Drug Abuse
& Addiction
AddictionMedical
DRUGS
Neurotoxicity
AIDS, Cancer
Mental illness
Social Economic
Homelessness
Crime
Violence
Health care
Productivity
Accidents
$524 billion/year
What is Addiction?
Addiction is A Brain Disease
Characterized by:
Compulsive Behavior
Continued abuse of drugs despite negative consequences
Persistent changes in the brains structure and function
YELLOW
shows places in
brain where
cocaine binds
(e.g., striatum)
It is preventable
It is treatable
It changes biology
If untreated, it can last a lifetime
Healthy Brain
Diseased Brain/
Cocaine Abuser
Low
Healthy
Heart
Diseased Heart
TOBACCO
1.6%
1.6%
1.4%
1.4%
CANNABIS
ALCOHOL
1.2%
1.2%
1.0%
1.0%
0.8%
0.8%
0.6%
0.6%
0.4%
0.4%
0.2%
0.2%
0.0%
0.0%
55
10
10 15
15
21
21 25
25 30
30 35
35 40
40 45
45 50
50 55
55 60
60 65
65
Age
To Feel Better
To have novel:
feelings
sensations
experiences
AND
to share them
To lessen:
anxiety
worries
fears
depression
hopelessness
Why Do People
Abuse Drugs?
Drugs of Abuse
Engage Motivation and
Pleasure Pathways
of the Brain
Movement
Motivation
Dopamine
Addiction
Cell body
(the cells life
support
center)
Terminal
branches of
axon
Neuronal Impulse
Myelin
sheath
dopamine
transporters
Food
% of Basal DA Output
200
NAc shell
150
100
50
Empty
Box Feeding
0
0
60
120
Time (min)
180
Sex
200
150
100
Sample 1
Number
Female Present
DA
DOPAC
HVA
100
250 Accumbens
150
DA
DOPAC
HVA
100
5 hr
Accumbens
Caudate
3 hr
Cocaine
200
Nicotine
200
Accumbens
300
250
% of Basal Release
400
% of Basal Release
1100
1000
900
800
700
600
500
400
300
200
100
0
% of Basal Release
% of Basal Release
Amphetamine
5 hr
Morphine
Dose
0.5 mg/kg
1.0 mg/kg
2.5 mg/kg
10 mg/kg
200
150
100
5 hr
Glutamate
AND
We Have Evidence That
These Changes Can Be Both
Structural and Functional
Structurally
Neuronal Dendrites in the
Nucleus Accumbens
Saline
Amph
Robinson & Kolb, Journal of Neuroscience, Volume: 1997
Functionally
Dopamine D2 Receptors are Decreased by Addiction
Cocaine
DA D2 Receptor Availability
Meth
Alcohol
Heroin
Control
Addicted
Normal Control
Dopamine Transporter
Bmax/Kd
Motor Task
Loss of dopamine
transporters in
methamphetamine
abusers may result in
slowing of motor
reactions.
9 10 11 12 13
Time Gait
(seconds)
2.0
1.8
1.6
1.4
1.2
1.0
16 14 12 10
Memory Task
Loss of dopamine
transporters in
methamphetamine
abusers may result
in memory impairment.
Delayed Recall
(words remembered)
Methamphetamine Abuser
Implication?
Treatment Research
(New Targets & New Strategies)
HIV/AIDS Research
67%
26%
5.5%
1.5%
<12
12-17
18-25
>25
Deborah
Deborah Yurgelon-Todd
Yurgelon-Todd 2000.
2000.
Do We Need Fundamentally
Different Strategies At
Different Stages of Adolescence?
Vulnerability
Why do some people
become addicted to drugs
while others do not?
high
Low DA receptor
low
As a group, subjects with low receptor levels found MP pleasant while those
with high levels found MP unpleasant
Adapted from Volkow et al., Am. J. Psychiatry, 1999.
And
The Nature of this Contribution
Is Extremely Complex
Prevalence of
Nicotine Addiction
35
80
25
Percent
Percent
30
20
15
10
60
40
20
5
ph
re
ni
a
An
zo
ed
i
z
c
i
l
So
ra
e
en
G
y
et
i
x
Sc
hi
lp
P
al
bi
o
h
G
en
er
a
r
er
il c ord
de s i o n ni a bi a
r
a o
ub D i s
iso res M ph
p
D
a
p
l
or t
ra ood iety
De
e
g
u
A
x
en M
/ o bi a
/
n
G ny
w
w c ho
yA
A
ic
n
ni rap
n
a
a
A
P go
P
ub
lic
ep
D
si o
s
re
COMORBIDITY
Causal effects
Substance abuse may increase
vulnerability to mental illness
What Environmental
Factors Contribute to Addiction?
Stress
Early physical or sexual abuse
Witnessing violence
Peers who use drugs
Drug availability
Individually
Housed
Group
Housed
Becomes Dominant
No longer stressed
Becomes Subordinate
Stress remains
50
40
30
* *
20
10
0
S.003
.01
.03
.1
Cocaine (mg/kg/injection)
Morgan, D. et al., Nature Neuroscience, 2002.
Prevention Works:
Knowledge of Risk and Protective
Factors Has Led to the
Development of Effective
Prevention Strategies
Monitoring
Monitoring the
the Future
Future Study,
Study, 2007.
2007.
Treatment Research
(New Targets & New Strategies)
HIV/AIDS Research
Addicted Brain
Control
Control
Saliency
Drive
NO
GO
Memory
Saliency
Drive GO
Memory
and
This is why treatment is essential.
Medical Services
Behavioral Therapies
Social Services
In Social Context
Genetics
Mechanisms
Treatments
Basic Research
Medication
Agonist Therapy
Methadone
Buprenorphine
CB1 Antagonists
Inhibitors of
metabolizing enzymes
CRF Antagonists
Drug
Addiction
Type I
Diabetes
Hypertension
50 to
to 70%
70%
50
50 to
to 70%
70%
50
90
80
70
60
50
40
30
20
10
0
30 to
to 50%
50%
30
100
40 to
to 60%
60%
40
Asthma
Relapses can occur during or after treatment, and signal a need for
treatment adjustment or reinstatement.
Therefore
Extended Abstinence
is Predictive of Sustained Recovery
After 5 years if you are sober,
you probably will stay that way.
It takes a year
of abstinence
before less than
half relapse
[C-11]d-threo-methylphenidate
DAT Recovery
with prolonged
abstinence from
methamphetamine
Normal Control
high
Methamphetamine Abuser
(1 month abstinent)
Methamphetamine Abuser
(14 months abstinent)
Volkow et al., J. Neuroscience, 2001.
low
Treatment Reduces
Drug Use and Recidivism
Delaware Work Release Therapeutic Community (CREST) + Aftercare
3 Years After Release (N=448)
tr
ea
tm
C
R
en
ES
t
T
D
C
ro
R
ES
po
ut
T
s
C
om
C
pl
R
et
ES
er
+ T
s
Af C
te om
rc p
ar le
e ter
s
N
o
N
o
tr
ea
tm
C
R
en
ES
t
T
D
C
ro
R
ES
po
ut
T
s
C
om
C
pl
R
et
ES
er
+ T
s
Af C
te om
rc p
ar le
e ter
s
Percentage of Participants
p < 0.05,
compared to no treatment group
In Treating Addiction
We Need to Keep Our Eye on
the Real Targets!
Abst
in
en ce
in
y
t
i
l
a
n
o
i
t
c
n
Fu ily, Work
Fam mmunity
o
C
d
n
a
Treatment Research
(New Targets & New Strategies)
HIV/AIDS Research
% of Cases
50
40
Injection drug use
30
Heterosexual contact
20
10
0
1985
1985
1987
1987
1989
1989
1991
1991
1993
1993
1995
1995
1997
1997
Year
Year of
of Diagnosis
Diagnosis
Centers
Centers for
for Disease
Disease Control
Control and
and Prevention
Prevention (CDC)
(CDC)
1999
1999
2001
2001
2003
2003
HIV Prevalence
(n=448
(n=448 2004)
2004)
20
20
15
Respondent-Driven Sampling
13%
13%
CI
CI 12-15%
12-15%
12%
12%
CI
CI 9-16%
9-16%
15
10
10
Current
Non-Injectors
Current Injectors
Injectors Non-Injectors
Source:
Source: Des
Des Jarlais
Jarlais et
et al
al AIDS,
AIDS, 21:
21: 231-235,
231-235, 2007.
2007.
15%
15%
CI
CI 11-19%
11-19%
17%
17%
CI
CI 12-21%
12-21%
Current
Non-Injectors
Current Injectors
Injectors Non-Injectors
60
60
% of Cases
50
50
40
40
30
30
20
20
Asian/Pacific Islander
10
10
American Indian/
Alaska Native
00
1985
1985
1987
1987
1989
1989
1991
1991
1993
1993
1995
1995
1997
1997
Year
Year of
of Diagnosis
Diagnosis
Centers
Centers for
for Disease
Disease Control
Control and
and Prevention
Prevention (CDC)
(CDC)
1999
1999
2001
2001
2003
2003
2005
2005
NIDA International
Program Components
Post-Doctoral Research Fellowship
Technical
Consultation
International
Research
Collaboration
Scientific
Exchange
Information Dissemination
Where Do We Need
to Go From Here?
We Need to
www.drugabuse.gov
NIDA
NATIONAL INSTITUTE
ON DRUG ABUSE