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The Importance of Knowing Addiction as a Brain Disease. Carlton Erickson, Ph.D. Director, Addiction Science Research and Education Center University of Texas at Austin, USA APIA-Singapore, 2004. What IS addiction?.

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the importance of knowing addiction as a brain disease

The Importance of Knowing Addiction as a Brain Disease

Carlton Erickson, Ph.D.

Director, Addiction Science Research and Education Center

University of Texas at Austin, USA

APIA-Singapore, 2004

what is addiction
What IS addiction?
  • • heroin addiction
  • • cocaine addiction
  • • alcohol addiction (“alcoholism”)
  • • marijuana addiction
  • • amphetamine addiction
  • • nicotine addiction
what is addiction1
What IS addiction?
  • • sex addiction??
  • • gambling addiction??
  • • food addiction??
  • • shopping addiction????
  • • internet addiction????
  • • cell phone addiction????
a world problem
A World Problem
  • • The ability to solve a world problem is directly proportional to our ability to define it.
  • • Are we dealing with a problem or a disease?
a world problem1
A World Problem
  • • The ability to solve a world problem is directly proportional to our ability to define it.
  • • Are we dealing with a problem or a disease?
  • • (Guess what? It doesn’t have to be one or the other. It could be BOTH!)
how do we define addiction
How do we define addiction?
  • • some people think it’s based upon problems people have when they are addicted
  • - I have problems with my mother-in-law. Am I addicted to my mother-in-law?
how do we define addiction1
How do we define addiction?
  • • some people think it’s based upon how much and how often the drug (activity) is carried out
  • - university students drink a great amount of alcohol, usually many days a week. Are they all addicted to alcohol?
how do we define addiction2
How do we define addiction?
  • • some people think it’s based upon a person’s personality or lack of will power
  • - many addicts are highfunctioning, intelligent people with no other psychopathology
  • - does this make sense?
how do we define addiction3
How do we define addiction?
  • • I contend that “addiction” is not a useful scientific term
  • - chocolate addiction, exercise
  • addiction, television addiction
  • • Is heroin addiction similar to exercise addiction? (Probably not..)
  • • Has this dichotomy caused a problem in getting support for treatment, research, & education?
in fact it s even worse
In Fact, It’s Even Worse!
  • • Stigma (against the disease)
  • • Prejudice (against the addict)
  • • Anger (toward the addict)
  • • Misunderstanding (about what to do)
  • SPAM leads to myths: widely-held inaccurate beliefs, as compared to research-generatedfacts)
too many myths
Too Many Myths!
  • • “treatment doesn’t work”
  • • “addicts are bad, crazy, stupid”
  • • “crack is worse than cocaine”
  • • “marijuana rots your brain”
  • • “there is an addictive personality”
  • • “sugar is addicting”
the facts
The Facts……
  • • DSM and ICD: two drug problems
  • • abuse: caused by rebellion, money, boredom, experimentation, thrill-seeking, desperation, self-medication
  • • dependence: caused by genetics, brain chemistry sensitivity, with input from the environment
  • • we have medical and social criteria….
how to reduce these
How to reduce these…
  • • abuse - education, coercion, punishment, environmental change, maturation, pressure to stop, life events
  • • dependence - “treatment” to positively affect abnormal brain function to reduce need for drug
medial forebrain bundle
Medial Forebrain Bundle
  • • ventral tegmental area (VTA)
  • • (lateral) hypothalamus (LH)
  • • nucleus accumbens (NAc)
  • • frontal cortex (FC) - key portions
  • - prefrontal cortex (pfc)
  • - orbitofrontal cortex (ofc)
drugs associated wth neurotransmitters
Drugs Associated wth Neurotransmitters
  • Why do people have “drugs of choice”?
  • • Dopamine - amphets, cocaine, ETOH
  • • Serotonin - LSD, ETOH
  • • Endorphins - opioids, ETOH
  • • GABA - benzos, ETOH
  • • Glutamate -ETOH
  • • Acetylcholine - nicotine, ETOH
  • (Marijuana?)
a brain chemistry disease
A Brain Chemistry Disease!
  • • addicting drugs seem to “match” the transmitter system that is not normal
  • • a chronic, relapsing, medical disease
  • • there are mild, moderate, and severe forms
  • • detox is traditionally the first step in the total treatment process
  • • methadone and nicotine maintenance is evidence that some people require a chemical to overcome the non-normal transmitter system
important point
Important Point!
  • Dependence is not a loss of“will power”, for two reasons:
  • • The main problem with dependence
  • lies in the subconsciousMFB.
  • • Problems with the frontal cortex
  • produce a pathological impairment of
  • decision-making.
  • Thus, dependence is not primarily under conscious control!
what shall we do
What Shall We Do?
  • • remember that “addiction” is an imprecise term; use “dependence” to indicate disease
  • • use “abuse” or “misuse” for overuse
  • • remember that most people misunderstand “alcoholism”
  • • try to use proper terminology in all technical and clinical situations
precedents for change
Precedents for Change
  • • Hansen’s Disease - leprosy
  • • blood sugar disease - diabetes
  • • Grave’s Disease - hyperthyroidism
  • • common cold - influenza
  • • Lou Gehrig’s Disease - ALS
  • • Goldflam Disease - myasthenia gravis
today s options it s all about options
Today’s Options (It’s all about options….)
  • • traditional: 12 step programs (abstinence)
  • • talk: inpatient/outpatient/aftercare
  • • misunderstood: harm reduction, MM
  • • new: brief motivational counseling, CBT, MET, SO-involved therapy, vouchers
  • • medical tx: new medications to enhance abstinence - anticraving meds, methadone, vaccines, drugs to alleviate withdrawal
  • (MM= Moderation Management, CBT= cognitive behavioral therapy,
  • MET= motivational enhancement therapy, SO = significant other)
we need more research
We need more research!
  • • There is lots of disagreement and misinformation in this field.
  • • This is a result of not having all of the facts.
  • • Facts come from good scientific research.
  • • Facts reduce myths and stigma.
research validity estimate rve

RESEARCH VALIDITY ESTIMATE (RVE)

(A Thoughtful Appraisal of

High-Quality Scientific Research)

High RVE

• many large, well-controlled studies

• replicable results

• much peer-reviewed, published literature

Low RVE

• few replicable studies

• highly speculative results

• little peer-reviewed, published literature

100

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things to remember
Things to Remember
  • • New research is changing our understanding of dependence (“addiction”).
  • • Learning this new information requires a willingness to give up old ideas and learn new ones.

100