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NIDA. NATIONAL INSTITUTE ON DRUG ABUSE. Drug Abuse & Addiction. Bringing the Full Power of Science to Bear on. Addiction. Medical. Medical. Neurotoxicity AIDS, Cancer Mental illness. NEUROTOXICITY AIDS CANCER MENTAL ILLNESS. DRUGS. Economic. Social. Health care Productivity

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slide1

NIDA

NATIONAL INSTITUTE ON DRUG ABUSE

Drug Abuse

& Addiction

Bringing the

Full Power of Science

to Bear on

slide2

Addiction

Medical

Medical

Neurotoxicity

AIDS, Cancer

Mental illness

NEUROTOXICITY

AIDS

CANCERMENTAL ILLNESS

DRUGS

Economic

Social

Health care

Productivity

Accidents

Homelessness

Crime

Violence

estimated economic cost to society from substance abuse and addiction
Estimated Economic Cost to Society from Substance Abuse and Addiction:

Illegal drugs: $181 billion/year

Alcohol: $185 billion/year

Tobacco: $158 billion/year

Total: $524 billion/year

Surgeon General’s Report, 2004; ONDCP, 2004; Harwood, 2000.

what is addiction addiction is a brain disease
What is Addiction?Addiction is A Brain Disease
  • Characterized by compulsive behavior
  • The continued abuse of drugs despite negative consequences
  • A chronic, potentially relapsing disorder
slide8

1-2 Min

3-4

5-6

6-7

7-8

8-9

9-10

10-20

20-30

Your Brain on Drugs Today

YELLOW shows places in brain where cocaine binds (striatum)

Front of Brain

Back of Brain

Fowler et al., Synapse, 1989.

slide9

High

Low

  • Addiction is Like Other Diseases…
    • It is preventable.
    • It is treatable
    • It changes biology.
    • If untreated, it can last a lifetime.

Decreased Heart Metabolism inHeart Disease Patient

Decreased Brain Metabolism

inDrug Abuser

Healthy Brain

Diseased Brain/

Cocaine Abuser

Diseased Heart

Healthy Heart

Research supported by NIDA addresses all of these components of addiction

slide11

Addiction Is A Developmental Disease

that starts in adolescence and childhood

1.8%

1.8%

TOBACCO

CANNABIS

1.6%

1.6%

ALCOHOL

1.4%

1.4%

1.2%

1.2%

1.0%

1.0%

% in each age group who develop first-time dependence

0.8%

0.8%

0.6%

0.6%

first

0.4%

0.4%

0.2%

0.2%

0.0%

0.0%

5

10

15

21

25

30

35

40

45

50

55

60

65

5

10

15

21

25

30

35

40

45

50

55

60

65

Age

Age

Age at

tobacco

,

alcohol

and

cannabis

dependence per DSM IV

National Epidemiologic Survey on Alcohol and Related Conditions

, 2003.

National Epidemiologic Survey on Alcohol and Related Conditions

, 2003.

why do people take drugs in the first place

Why Do People Take Drugs in The First Place?

To feel better

To lessen:

anxiety

worries

fears

depression

hopelessness

To feel good

To have novel:

feelings

sensations

experiences

AND

to share them

slide13

Why Do People

Abuse Drugs?

Drugs of Abuse

Engage Systems in

the Motivationand

Pleasure Pathways

of the Brain

dopamine
Dopamine

motivation

Reward& well-being

addiction

movement

slide16

Dendrites

Axon

Cell body

(the cell’s life

Terminal

support center)

branches of

axon

Neuronal Impulse

Myelin

sheath

The Neuron: How the Brain’s Messaging System Works

Donald Bliss, MAPB, Medical Illustration

slide18

dopamine

transporters

slide19

15

10

Copulation Frequency

5

0

Mounts

1

2

3

4

5

6

7

8

Intromissions

Ejaculations

Natural Rewards Elevate Dopamine Levels

SEX

FOOD

200

200

NAc shell

150

150

DA Concentration (% Baseline)

100

100

% of Basal DA Output

Empty

50

Box

Feeding

0

0

60

120

180

Female Present

Time (min)

Sample

Number

Di Chiara et al., Neuroscience, 1999.

Fiorino and Phillips, J. Neuroscience, 1997.

slide21

Effects of Drugs on Dopamine Release

COCAINE

AMPHETAMINE

Accumbens

1100

Accumbens

400

1000

900

DA

800

DA

300

DOPAC

700

DOPAC

HVA

% of Basal Release

HVA

600

% of Basal Release

500

200

400

300

100

200

100

0

0

0

1

2

3

4

5 hr

Time After Amphetamine

Time After Cocaine

NICOTINE

MORPHINE

250

Accumbens

250

Dose (mg/kg)

200

Accumbens

0.5

200

Caudate

1.0

2.5

150

% of Basal Release

10

150

% of Basal Release

100

0

1

2

3 hr

100

0

1

2

3

4

5 hr

0

0

0

1

2

3

4

5hr

Time After Nicotine

Time After Morphine

Di Chiara and Imperato, PNAS, 1988

slide22

But Dopamine is only Part of the Story

Other neurotransmitter systems are

also affected:

  • Serotonin: mood regulation, sleep
  • Glutamate: learning and memory
slide24

Science Has Generated Much

Evidence Showing That…

Prolonged Drug Use Changes

the Brain In Fundamental

and Long-Lasting Ways

slide25

AND…

We Have Evidence That

These Changes Can Be Both

Structuraland Functional

slide26

Structurally…

NAC

Amph

Saline

Source: Robinson & Kolb, Journal of Neuroscience, Volume: 1997

slide27

Functionally…

Dopamine D2 Receptors are Lower in Addiction

Cocaine

DA

DA

DA

DA

DA

DA

DA

DA

DA

DA

DA

DA

Meth

Reward Circuits

DA D2 Receptor Availability

Non-Drug Abuser

DA

DA

Alcohol

DA

DA

DA

DA

Heroin

Reward Circuits

Drug Abuser

Control

Addicted

slide28

2.0

1.8

1.6

1.4

1.2

Dopamine Transporter

Time Gait

Bmax/Kd

1.0

7

8

9

10

11

12

13

(seconds)

2.0

1.8

1.6

1.4

1.2

Delayed Recall

(words remembered)

1.0

16

14

12

10

8

6

4

Dopamine Transporters in Methamphetamine Abusers

Motor Task

Loss of dopamine

transporters in the meth

abusers may result in

slowing of motor

reactions.

Normal Control

Memory task

Loss of dopamine transporters

in the meth abusers may result

in memory impairment.

Volkow et al., Am. J. Psychiatry, 2001.

Methamphetamine Abuser

slide29

Implication:

Brain changes resulting from

prolonged use of drugs

may compromise

mental and motor functions

slide30

Circuits Involved In Drug Abuse and Addiction

All of these must be considered in developing strategies to effectively treat addiction