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Addiction Science
Addiction Science
Characterized by:
Compulsive Behavior Continued abuse of drugs despite negative consequences Persistent changes in the brains structure and function
Advances in science have revolutionized our fundamental views of drug abuse and addiction.
Low
Healthy Brain
Healthy Heart
Diseased Heart
5 5
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
Age at tobacco, alcohol, and cannabis dependence per DSM IV
National Epidemiologic Survey on Alcohol and Related Conditions, 2003.
To Feel Better
To lessen: anxiety worries fears depression hopelessness
Movement Motivation
Dopamine
Addiction
dopamine transporters
DA Concentration (% Baseline)
Food
% of Basal DA Output NAc shell
150
Sex
200
150
100
100
Empty
50 Box Feeding
Female Present
0 0 60 120 180
Time (min)
Sample 1 Number
Cocaine
% of Basal Release
300 200
% of Basal Release
DA DOPAC HVA
100 0
0 250
5 hr
5 hr
Nicotine
Accumbens Caudate
250 Accumbens
Morphine
Dose 0.5 mg/kg 1.0 mg/kg 2.5 mg/kg 10 mg/kg
% of Basal Release
% of Basal Release
0 0 1 2 3 hr
5 hr
Glutamate
Regulates learning and memory, etc.
Prolonged Drug Use Changes the Brain In Fundamental and Long-Lasting Ways
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
Meth
Alcohol
Heroin
Control Addicted
9 10 11 12 13
Normal Control
Memory Task
Loss of dopamine transporters in methamphetamine abusers may result in memory impairment.
Methamphetamine Abuser
Implication?
Brain changes resulting from prolonged use of drugs may compromise mental AND motor function.
All of these brain regions must be considered in developing strategies to effectively treat addiction
Treatment Research
(New Targets & New Strategies)
HIV/AIDS Research
67%
26%
10
5.5%
1.5%
Rats Exposed to Nicotine in Adolescence Self-Administer More Nicotine Than Rats First Exposed as Adults
Vulnerability
Why do some people become addicted to drugs while others do not?
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
35 30
60
Percent
25 20 15
Percent
40 20
10 5 0
0
COMORBIDITY
Causal effects
Substance abuse may increase vulnerability to mental illness
Subordinate Dominant
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
Treatment Research
(New Targets & New Strategies)
HIV/AIDS Research
Saliency
Drive
NO GO
Saliency
Drive GO
Memory
Memory
and
This is why treatment is essential.
Medical Services
Social Services
In Social Context
Genetics
Mechanisms
Treatments
Basic Research
Opiate agonists stabilize brain function in heroin addicts CB1 KO mice have decreased responses to multiple drugs of abuse Smokers who are poor nicotine metabolizers smoke less
Medication
Agonist Therapy Methadone Buprenorphine CB1 Antagonists
Stress triggers relapse in animal models of addiction and CRF antagonists interfere with the response to stress
CRF Antagonists
But, drug addiction is a chronic illness with relapse rates similar to those of hypertension, diabetes, and asthma.
Relapse Rates Are Similar for Drug Addiction & Other Chronic Illnesses
Percent of Patients Who Relapse 100 90 80 70 60 50 40 30 20 10 0
50 to 70%
40 to 60%
30 to 50%
Drug Addiction
Type I Diabetes
Hypertension
Asthma
50 to 70%
Therefore
[C-11]d-threo-methylphenidate
Normal Control
high
low
Percentage of Participants
In Treating Addiction
We Need to Keep Our Eye on the Real Targets!
Treatment Research
(New Targets & New Strategies)
HIV/AIDS Research
Drug Use Has Played a Prominent Role in the HIV/AIDS Epidemic In Several Ways
Disease Transmission - IV Drug UseNeedle sharing - Drug Intoxication: Impaired judgment, disinhibition, leading to risky sexual behaviors Disease Progression
Neurological Complications
% of Cases
40
30 20 10 0
1985 1987 1989 1991 1993 1995
1997
1999
2001
2003
Year of Diagnosis
Centers for Disease Control and Prevention (CDC)
Respondent-Driven Sampling
(n=448 2004)
HIV Prevalence
20
20
13% CI 12-15% 12% CI 9-16%
15
10 5 0
15 10 5
15% CI 11-19%
17% CI 12-21%
% of Cases
40 30 20 10 0
Asian/Pacific Islander
1985
1987
1989
1991
1993
Year of Diagnosis
Centers for Disease Control and Prevention (CDC)
Technical Consultation
Scientific Exchange
Information Dissemination
Millions of Users
Cannabis Amphetamines Ecstasy Cocaine Opiates 160.9
III. Take advantage of unique opportunities to advance scientific knowledge through research
www.drugabuse.gov
NIDA