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Objectives

Objectives. Participants will: Recognize the difference between Substance abuse and Dependency Learn basic principles of the neurobiology of addiction Recognize the relationship between perceptions of harmfulness of substances and their use Recognize warning signs of addiction in colleagues.

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Objectives

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  1. Objectives Participants will: • Recognize the difference between Substance abuse and Dependency • Learn basic principles of the neurobiology of addiction • Recognize the relationship between perceptions of harmfulness of substances and their use • Recognize warning signs of addiction in colleagues

  2. Addiction Concepts: Dr Andrew P Mallon

  3. Acknowledgements • The better quality anatomical slides are from the NIDA Teaching Packet of Slides available for educational use at the NIDA web site (www.nida.gov) • The speaker is offering a summary of emerging concepts which he finds useful in his understanding the interplay between addictions and psychiatric disorders • The audience is strongly encouraged to review the original works cited in this presentation

  4. Short version • Drugs and alcohol are freely available • Our culture as a whole encourages experimentation • The less afraid people are about using a substance, the more likely they are to try it • People start an addiction career by choosing to use drugs or alcohol (voluntary component) • Persistent use of substance changes the structure and function of the brain in areas that control the ability to change behavior • Including substance use, which takes a life of its own (loss of control) • Some people are more likely to develop these brain changes • Chronic stress, drug abuse and several psychiatric syndromes may change normal neurogenesis • Although physicians are affected by addiction as frequently as other mortals, they can recover twice as often

  5. What is addiction • Abuse (one or more of the following): • A maladaptive pattern of substance use resulting in a failure to fulfill major role obligations at work, school, home • Use in situations in which it is physically hazardous • Recurrent substance related problems • Continued use despite persistent problems caused or made worse by the use of drugs

  6. Tolerance Need to use increasing quantities of the substance to achieve desired effect. o The effects of the substance are less prominent with repeated use Withdrawalsymptoms: When use of the substance ceases withdrawal symptoms characteristic to the drug occur The same substance or a substitute is used to prevent withdrawal The substance is used for longer than intended There are recurrent wishes to limit or reduce its use A lot of time is spent in activities designed to obtain the substance Important social activities are interrupted as a result of the use of the substance Use continues despite serious physical or emotional consequences Dependency (Addiction) Three or More:

  7. ECA Community Study Lifetime Prevalence, mental health and addictive disorders Ref: Burke et al: Age of Onset of selected mental Disorders in five community populations-Arch Gen. Psychiat 511-518 • Alcoholism (dependency & abuse) - 13.7% • Phobias - 12.6% • Drug Abuse/Dependence - 6.1% • Major Depression - 5.1% • Antisocial Personality - 2.5% • Obsessive Compulsive Disorder - 2.5% • Panic Disorder - 1.5% • Schizophrenia - 1.0% • Mania - 0.4%

  8. High Comorbidity • 22.5% lifetime diagnosis of non-SA disorder • 29% of those with mental illness had a drug/alcohol problem • 16.4% had lifetime Dx of substance use DO • 55% of those with drug abuse/dependency had mental illness Dx • 37% with alcohol abuse/dependency had mental illness Dx

  9. Why Do People Take Drugs In The First Place?

  10. I FEEL GOOD (sensation seeking)I FEEL BETTER (self medication)

  11. Drugs have to be available No drug exposure, no abuse

  12. Animal Models • Animals of many species seek intoxicants in the wild • In the laboratory, animals exposed to drugs quickly learn to develop drug-seeking behaviors • Drugs that are addictive to humans are also voluntarily self-administered by lab animals • Ref: Gardner E. Addiction and Animal Models of Self Administration. Am J Addictions 9:285-313 2000

  13. Drug-Seeking in Monkeys “the animals took the researcher's hand, dragged him to the cupboard where the morphine, syringes, and needles were stored, and voluntarily assumed the proper position to receive injections” Ref: Spraag SDS - Morphine Addiction in Chimpanzees Comp Psychol Monographs 1940; 15(7):1-32

  14. PERCEIVED RISK • Use of drugs increases as people believe that drugs are harmless

  15. Use of MJ compared to perceived harmfulness availability Perceived harm use WOD ’75 ’81 ’85 ’91 ’99 NIDA: Monitoring the Future Study (1999)

  16. Marihuana in the 1920’s

  17. Marihuana in the 1990’s

  18. Coca des Incas

  19. Cocaine was sold over-the counter

  20. Delicious! Refreshing! Invigorating! The New and Popular Soda Fountain Drink, containing properties of the wonderful coca plant and the famous cola nuts. For sale by Willis Venable and Nunnally & Rawson.“

  21. As American as Apple Pie

  22. Alcohol use within the past 2 weeks • 15% 8th graders • 24% 10th graders • 34% 12th graders NIDA: Monitoring the Future Study (1999)

  23. 9% adolescent girls Up to 20% adolescent boys Meet Adult Criteria for Alcohol Use Disorder CSAT TIP 32: Treatment of Adolescents with Substance Use Disorders Online: http://text.nlm.nih.gov/ftrs/tocview

  24. Pop Music Culture has Glorified Alcohol and Drug Use for Several generations Lyrics of popular songs, for example: The many “Dust” songs of the 30’s “Scotch and Soda” “Cocaine” (Eric Clapton) “A Little High With a Little Help from my Friends” (Beatles) “No Limit Soldier”(Puffy Coombs) And lots more….. Encourage young users to expose themselves to drugs as a normal part of growing up

  25. increased non injection use 1.6% 8th graders double the rate since 1991 Heroin NIDA: Monitoring the Future Study (1999)

  26. Heroin Use in Past 12 months NIDA: Monitoring the Future Study (1999)

  27. Perceived risk of sniffing heroin NIDA: Monitoring the Future Study (1999)

  28. Disapproval of Sniffing Heroin NIDA: Monitoring the Future Study (1999)

  29. Smoke Cigarettes Daily • 20% high school seniors NIDA: Monitoring the Future Study (1999)

  30. Vulnerability Why do some people become addicted while others do not?

  31. Complex genetic factors play a role In animals and people

  32. Relevance of Animal Models • Drugs that are voluntarily self administered by animals are the same as the ones that humans abuse • Almost without exception, self administered drugs increase brain reward functions in the mesolimbic reward system Useful reading: Gardner E - What we have learned about addiction from animal models of drug self-administration Am J Addict 2000;9:285-313

  33. Lewis Ratsnot to be confused with the Martin Rat(of the Rat Pack) • High vulnerability for self-administration of alcohol and cocaine • Learn alcohol/cocaine self administration more readily • Work harder for IV cocaine or opioid self-administration • Cue-condition for cocaine or opiates more rapidly • Resemble type II alcoholics Ref: Lepore M Studies on the neurobiological interrelationship between vulnerability to depression and vulnerability to drug abuse in animal models. Behav Pharmacol 1995;6(suppl1):82-84

  34. Lewis Rats • Dopamine surges in response to a variety of addictive drugs (opiates, THC, nicotine, cocaine) are much more pronounced in Lewis rats Ref: Lepore M Studies on the neurobiological interrelationship between vulnerability to depression and vulnerability to drug abuse in animal models. Behav Pharmacol 1995;6(suppl1):82-84

  35. DA Receptor Levels and Response to MPH In People • low receptor levels MPH pleasant high receptor levels MPH unpleasant • Ref: Volkow, ND, Wang, G-J, Fowler, JS, Logan, J, Gatley, SJ, Gifford, A, Hitzemann, R, Ding, Y-S, Pappas, N. Brain dopamine D2 receptor levels predict reinforcing responses to psychostimulants in humans. Am J Psychiatry, September 1999. 2.5 unpleasant response 0 pleasant response

  36. Relative Appetitiveness • Cocaine>morphine>benzodiazepines • Cocaine is so desirable, that if given continuous access, animals will spend essentially all of their waking hours self-administering the drug • The parallel to the extreme appetitiveness of crack cocaine at the human level is striking • Ref: Johanson CE Self administration of psychomotor stimulant drugs: the effects of unlimited access Pharmacol Biochem Behav. 1976;4:45-51

  37. A Major Reason People Take a Drug is They Like Whatit Does to Their Brains

  38. cannabis

  39. Dopamine binding to receptors and uptake pumps in the nucleus accumbens

  40. Cocaine binding to uptake pumps; inhibition of dopamine uptake

  41. Increased cAMP produced in post-synaptic cell

  42. All addictive substances are associated with increased Dopamine activity in the Nucleus Accumbens

  43. Effects of Drugs on Nucleus Accumbens Dopamine Levels Amphetamine Cocaine DA DA 0 5h 0 5h Nicotine Morphine 3h 5h Timothy P. Condon, Ph.D. Addiction as a Brain Disease: New Implications for Research and Practice Connecticut Statewide Addiction Medicine/Psychiatry Grand Rounds September 20, 2001 Source: Di Chiara and Imperato

  44. Natural Rewards Elevate Dopamine Levels Timothy P. Condon, Ph.D. Addiction as a Brain Disease: New Implications for Research and Practice Connecticut Statewide Addiction Medicine/Psychiatry Grand Rounds September 20, 2001 Nac DA Nac DA Feeding Empty Box Intromissions 0 60m 120m 180m SEX FOOD Ref: Fiorino and Phillips Ref: Di Chiara et al.

  45. when you make a mistake a lawyer can always find a colleague who knew you were going to screw up

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