The Brain, Behavior and Addiction National Family Dialogue January 27, 2010 Presenter: Flo Hilliard, MSH University of Wisconsin-Madison

Transcription

1 The Brain, Behavior and Addiction National Family Dialogue January 27, 2010 Presenter: Flo Hilliard, MSH University of Wisconsin-Madison

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3 Attitudes about addiction and recovery throughout history Disease? Behavioral problem? Self-inflicted vice? Moral/emotional weakness?

4 Attitude Without the Science Attitude of Culture: (without the science) Moral Issue Horrible Habit Alcohol was Devils Brew (inherently bad ) Weakness in personality

5 Your Brain on Drugs in the 1980 s

6 Bringing the Full Power of Science to Bear on Drug Abuse & Addiction

7 Your Brain on Drugs Today YELLOW shows places in brain where cocaine binds (e.g., striatum) Fowler et al., Synapse, 1989.

8 What is Addiction? Addiction is A Brain Disease

9 Addiction is Like Other Diseases It is preventable It is treatable It changes biology If untreated, it can last a lifetime Decreased Brain Metabolism in Drug Abuser High Decreased Heart Metabolism in Heart Disease Patient Healthy Brain Diseased Brain/ Cocaine Abuser Low Healthy Heart Diseased Heart Research supported by NIDA addresses all of these components of addiction.

10 Thinking About Addiction ENVIRONMENTAL PSYCHOLOGICAL GENETIC NEUROBIOLOGY ADDICTION

11 How Does This Help? Changes our beliefs and our language: Abuse of alcohol and other drugs are preventable behaviors Alcohol and drug addiction is a treatable disease Recovery from addiction is a reality

12 Understanding the science of addiction and recovery is important For the Recovering Person helps people on their recovery journeys helps people understand their cravings Facilitates the recovery process for person and family members

13 For the Family helps explain the unexplainable reduces stigma, blame and anger

14 Why Do People Take Drugs in The First Place? To Feel Good To have novel: feelings sensations experiences AND to share them To Feel Better To lessen: anxiety worries fears depression hopelessness

15 A major reason people take a drug is they like what it does to their brains.

16 Drugs can be Imposters of Brain Messages

17 Vulnerability Why do some people become addicted to drugs while others do not?

18 Individual Differences in Response to Drugs: DA Receptors influence drug liking High DA receptor 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.

19 The Brain Responsible for initiating and controlling: every movement thought sensation emotion That makes up the human experience!

20 Source: National Institute on Drug Abuse Teaching Packet

21 Communication of the brain Neuron = nerve cell Nerve cells have many different shapes, depending on the cluster of specialization in the brain.

22 The Neuron: How the Brain s Messaging System Works Dendrites Cell body (the cell s life support center) Neuronal Impulse Axon Terminal branches of axon Myelin sheath Donald Bliss, MAPB, Medical Illustration

23 Source: National Institute on Drug Abuse Teaching Packet

24 dopamine transporters

25 How do alcohol and other drugs work in the brain? Despite many differences, virtually all substances with the potential for addiction affect dopamine levels in the pleasure/reward pathway of the brain.

26 Natural Rewards Elevate Dopamine Levels % of Basal DA Output Food Empty Box Feeding Time (min) NAc shell DA Concentration (% Baseline) Sample Number Sex Female Present Di Chiara et al., Neuroscience, 1999.,Fiorino and Phillips, J. Neuroscience, 1997.

27 Effects of Drugs on Dopamine Release % of Basal Release % of Basal Release Amphetamine Accumbens DA DOPAC HVA hr Nicotine hr Time After Drug Di Chiara and Imperato, PNAS, 1988 Accumbens Caudate % of Basal Release % of Basal Release Accumbens Cocaine DA DOPAC HVA hr Accumbens Morphine Dose 0.5 mg/kg 1.0 mg/kg 2.5mg/kg 10 mg/kg hr Time After Drug

28 Initially, a person takes a drug hoping to change their mood, perception, or emotional state TRANSLATION... Hoping to change their brain.

29 The system that becomes captured by the addicting drug is a complex system that sets behavioral priorities.

30 Circuits Involved in Drug Abuse and Addiction All of these brain regions must be considered in developing strategies to effectively treat addiction 36

31 Why Can t Addicts Just Quit? Non-Addicted Brain Control Addicted Brain Control Saliency Drive NO GO Saliency Drive GO Memory Memory Because Addiction Changes Brain Circuits Adapted from Volkow et al., Neuropharmacology, 2004.

32 Markers that addiction is a disease - Reliably produced and easily recognized in animals. Patterns of intake resemble humans - drug for drug. Follows behavioral symptoms of other chronic diseases - resistance, denial, anger, relapse, etc.

33 Where addiction starts Called by many names (mesolimbic( system, old brain, primitive brain, etc) As it reacts to environment : creates powerful emotional memories at a biochemical level (both fear and pleasure) that drive behavior in all of us for survival.

34 What Is Addiction? Not Just Tolerance Reduced drug effect with repeated administration of the same dose of a drug, or need for an increased dose to maintain the same level of effect. Not Just Physical Dependence When drug cessation produces pathologic symptoms and signs.

35 Addiction is A kind of dependence which manifests as: compulsive non-medical use of a substance loss of control over its use despite negative consequences

36 Science Has Generated Much Evidence Showing That Prolonged use of potentially addicting drugs changes the brain in fundamental and long-lasting ways. and. These changes can be both structural and functional.

37 DA D2 Receptor Availability Dopamine D2 Receptors are Lower in Addiction Cocaine DA DA DA DA DA DA DA DA DA DA DA DA Meth Reward Circuits Non-Addicted DA DA Alcohol DA DA DA DA Heroin Control Addicted Reward Circuits Addicted Adapted from Volkow et al., Neurobiology of Learning and Memory 78: , 2002.

38 Understanding people s s behavior while Key Concept: addicted Parts of the brain that have become changed (from addiction) override the factual memory storage (hippocampus) and logical reasoning of prefrontal cortex. Thus behavior (e.g.. repeated relapses) that flies in the face of logic now makes sense.

39 What about relapse? Complex triggers and anchors (internal and/or external) can set off physiological chain reaction in the body coming from the brain. Examples of external triggers: cash Fridays using buddies

40 Relapse Cont d Examples of internal triggers: loneliness celebration emotional pain

41 Amygdala Nature Video Cocaine Video Anterior Cingulate

42 Are there differences in reactions to drugs in adolescent brains vs adults?

43 MRI Scans of Healthy Children and Teens Over Time Copyright 2004 by the National Academy of Sciences Gogtay, Giedd, et al. Proc. Natl. Acad. Sci., 2004

44 Dichotomy of Adolescence Adolescents are experiencing pubertal changes at younger ages. Look like adults but the brain is still growing!

45 The Adolescent Brain Responds to Drugs Differently than the Adult Brain Treatment of adolescent rats (but not young adults) with Nicotine leads to Increases in Nicotine Self Administration Increases in Nicotine Receptors Source: Adriana, W. et al., J of Neurosci, 23(11), pp , June 1, 2003.

46 Are Adolescents More Susceptible than Adults to Becoming Addicted?

47 Brief exposure to nicotine during adolescence has been shown to enhance the reinforcing value of other abused drugs, such as cocaine and amphetamine

48 What Do We Know about the Adolescent Brain Risky Decision Making?

49 Emotions When reading emotion, teens (left) rely more on the amygdala, while adults (right) rely more on the frontal cortex. Deborah Yurgelon-Todd, 2000

50 Source: Dr. Susan Tapert; University of California- San Diego

51 Recovery can and does happen Research has shown that: Brain has remarkable ability to adapt, heal and change. Key is length of time and experiences after drug leaves system.

52 The recovery process takes time! For the brain to heal To reduce the effects of relapse cues To learn new ways of reacting to the environment

53 Partial Recovery of Brain Dopamine Transporters in Methamphetamine (METH) Abuser After Protracted Abstinence 3 0 Normal Control METH Abuser (1 month detox) METH Abuser (14 months detox) ml/gm Source: Volkow, ND et al., Journal of Neuroscience 21, , 2001.

54 Effect of Cocaine Abuse on Dopamine D2 Receptors normal subject cocaine abuser (1 month post) cocaine abuser (4 months post)

55 Sources: Volkow, et al., Synapse, 11: , 1992 & Volkow, et al., Synapse, 14: , 1993

56 Addiction is Similar to Other Chronic Illnesses Because: It has biological and behavioral components, both of which must be addressed during treatment. Recovery from it-- --protracted abstinence and restored functioning-- --is often a long-term process requiring repeated episodes of treatment.

57 Relapses can occur during or after treatment, and signal a need for treatment adjustment or reinstatement. Participation in support programs during and following treatment can be helpful in sustaining long-term recovery

58 Treating a Biobehavioral Disorder Must Go Beyond Just Fixing the Chemistry We Need to Treat the Whole Person! Pharmacological Treatments (Medications) Behavioral Therapies Medical Services Social Services In Social Context

59 Additional Resources National Institute on Drug Abuse (NIDA) National Institute on Alcohol Abuse and Alcoholism (NIAAA) Substance Abuse and Mental Health Services Administration (SAMHSA) and Center for Substance Abuse Treatment (CSAT) HBO s s Addiction Join Together