Addiction is a Brain Disease Michael L. Johnson, MS Nancy A. Roget, MS.
Addiction as a Brain Disease - ASAM Home Page...Addiction as a Brain Disease: Use of Medications in...
17
Addiction as a Brain Disease: Use of Medications in the Clinical Setting Jack B. Stein, Ph.D. Director Office of Science Policy and Communications National Institute on Drug Abuse National Institutes of Health Department of Health and Human Services
Transcript of Addiction as a Brain Disease - ASAM Home Page...Addiction as a Brain Disease: Use of Medications in...
Addiction as a Brain Disease: Use of Medications in the Clinical Setting
Jack B. Stein, Ph.D. Director
Office of Science Policy and Communications National Institute on Drug Abuse
National Institutes of Health Department of Health and Human Services
Why Do People Become Addicted to Drugs?
Development of Addiction Involve Multiple Factors
Addiction
DRUG/ALCOHOL USE
Brain Mechanisms
Biology Genes/Development
Environment
Advances in neuroscience have revolutionized our fundamental
understanding of addiction.
The Brain on Drugs
1-2 Min 3-4 5-6
6-7 7-8 8-9
9-10 10-20 20-30
YELLOW shows places in brain where cocaine binds (Striatum)
Front of brain
Back of brain
Healthy Heart Diseased Heart
Decreased Heart Metabolism in Heart Disease Patient
Addiction: A Disease of the Brain
Control Cocaine Abuser
Decreased Brain Metabolism in Substance Use Disorder Patient
Sources: From the laboratories of Drs. N. Volkow and H. Schelbert
High
Low
OFC SCC
MOTIVATION/ DRIVE
Hipp
Amyg
MEMORY/ LEARNING
Brain Circuits Involved In Addiction
NAcc VP
REWARD
PFC
ACG
EXECUTIVE FUNCTION/ INHIBITORY
CONTROL
NAcc VP
REWARD
1. Reward Circuit
Di Chiara et al., Neuroscience, 1999.,Fiorino and Phillips, J. Neuroscience, 1997.
Natural Rewards Elevate Dopamine Levels
0
50
100
150
200
0 60 120 180 Time (min)
% o
f Bas
al D
A O
utpu
t NAc shell
Empty
Food Sex
Box Feeding
100
150
200
DA
Con
cent
ratio
n (%
Bas
elin
e) Sample Number
1 2 3 4 5 6 7 8
Female Present
0 100 200 300 400 500 600 700 800 900
1000 1100
0 1 2 3 4 5 Hrs. after amphetamine
% o
f Bas
al R
elea
se AMPHETAMINE
0
100
150
200
250
0 1 2 3 4 5 Hrs. after morphine
% o
f Bas
al R
elea
se
MORPHINE
0
100
150
200
250
0 1 2 3 Hrs. after nicotine
% o
f Bas
al R
elea
se
NICOTINE
Source: Di Chiara and Imperato
Drugs Elevate Dopamine Levels More/Longer
0
100
200
300
400
0 1 2 3 4 5 Hrs. after cocaine
% o
f Bas
al R
elea
se
COCAINE
ACG
OFC SCC
Hipp
NAcc VP
Amyg
REWARD
INHIBITORY CONTROL
MEMORY/ LEARNING
EXECUTIVE FUNCTION
PFC
MOTIVATION/ DRIVE
Balance in Brain Systems Severely Disrupted in Addiction
Addiction Medications • Opiates
– Methadone – Buprenorphine – Naltrexone
• Alcohol – Acomprosate – Disulfiram – Naltrexone
• Nicotine
– Nicotine replacement products – Buproprion – Varenicline
Low Uptake of Pharmacotherapy in Specialty Programs in 2007
As % of all programs surveyed
(N=345)
Within adopting programs, % of eligible patients
receiving Rx
Psychiatric meds 54.5 70.1
Opioid tx meds: Methadone 7.8 41.3
Buprenorphine 20.9 37.3
Tablet naltrexone 22.0 10.9
Alcohol meds: Disulfiram 23.8 8.1
Tablet naltrexone 32.2 12.4
Acamprosate 32.5 17.5
Injectable naltrexone 15.9 (too new to report)
Knudsen et al, 2011, J Addict Med; 5:21-27 14
Methadone Study: 6 Mo Post Release (N=201)
Addiction Medication Use in the Criminal Justice System
-- signif. diff from referral -- signif. diff from treatment only on release
Source: Gordon, M.S., Kinlock, T.W., Schwartz, R.P., O’Grady, K.E. (2008). Addiction. A Randomized Clinical Trial of Methadone Maintenance for Prisoners: Findings at 6-Months Post-Release.
Advances in Medication Development
16
•Addiction Vaccines •Nicotine, cocaine*, heroin, methamphetamine
•Long-Acting Forms
•Vivitrol (injectable naltrexone) •Probuphine (buprenorphine implant)
•Medication Combinations •Cocaine, marijuana
