national institute on drug abuse (nida) understanding drug abuse and addiction… · 2019-01-17 ·...
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NationalInstituteonDrugAbuse(NIDA)
UnderstandingDrugAbuseandAddiction:WhatScienceSays
LastUpdatedFebruary2016https://www.drugabuse.gov
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TableofContents
UnderstandingDrugAbuseandAddiction:WhatScienceSays
SectionI
SectionII
SectionIII
SectionIV
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SectionI
1:UnderstandingDrugAbuseandAddiction:WhatScienceSays
2:Drugaddiction:acomplexillness
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Drugaddictionisacomplexillness.Thepathtodrugaddictionbeginswiththeactoftakingdrugs.Overtime,aperson'sabilitytochoosenottotakedrugsiscompromised.This,inlargepart,isaresultoftheeffectsofprolongeddruguseonbrainfunctioning,andthusonbehavior.Addiction,therefore,ischaracterizedbycompulsivedrugcraving,seeking,andusethatpersistseveninthefaceofnegativeconsequences.
3:Brainregionsandtheirfunctions
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Certainpartsofthebraingovernspecificfunctions.Forexample,thecerebellumisinvolvedwithcoordination;thehippocampuswithmemory.Nervecells(neurons)arethebasicunitofcommunicationinthebrain.Informationisrelayedfromoneareaofthebraintootherareasthroughcomplexcircuitsofinterconnectedneurons.Informationviaelectricalimpulsestransmittedfromoneneurontomanyothersisdonethroughaprocesscalled"neurotransmission."
4:Therewardpathway
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Onepathwayimportanttounderstandingtheeffectsofdrugsonthebrainiscalledtherewardpathway.Therewardpathwayinvolvesseveralpartsofthebrain,someofwhicharehighlightedinthisimage:theventraltegmentalarea(VTA),thenucleusaccumbens,andtheprefrontalcortex.Whenactivatedbyarewardingstimulus(e.g.,food,water,sex),informationtravelsfromtheVTAtothenucleusaccumbensandthenuptotheprefrontalcortex.
5:Wherecocainehasitseffectsinthebrain
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Usingcocaineasanexample,wecandescribehowdrugsinterferewithbrainfunctioning.Whenapersonsnorts,smokes,orinjectscocaine,ittravelstothebrainviathebloodstream.Althoughitreachesallareasofthebrain,itseuphoriceffectsaremediatedinafewspecificareas,especiallythoseassociatedwiththerewardpathwaydiscussedinthepreviousimage.
6:Neurotransmission
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Asmentionedearlier(image3),informationiscommunicatedinthebrainviaaprocesscalledneurotransmission.Neurotransmissioninvolvesavarietyofchemicalsubstancescalled"neurotransmitters."Onesuchneurotransmitteriscalled"dopamine."Inthenormalcommunicationprocess,dopamineisreleasedbyaneuronintothesynapse(thesmallgapbetweenneurons).Thedopaminethenbindswithspecializedproteinscalled"dopaminereceptors"(seeimage)ontheneighboringneuron,therebysendingasignaltothatneuron.
7:Neurotransmission(continued)
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Afterthesignalissenttotheneighboringneuron,dopamineistransportedbacktotheneuronfromwhichitwasreleasedbyanotherspecializedprotein,the"dopaminetransporter".
8:Cocaineandneurotransmission
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Drugsofabuseareabletointerferewiththisnormalcommunicationprocessinthebrain.Cocaine,forexample,blockstheremovalofdopaminefromthesynapsebybindingtothedopaminetransporters.Asshowninthisimage,thisresultsinabuildupofdopamineinthesynapse.Inturn,thiscausesacontinuousstimulationofreceivingneurons,probablyresponsiblefortheeuphoriareportedbycocaineabusers.
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SectionII
1:Measuringbrainactivityinresponsetodruguse
PositionEmissionTomography(PET)measuresemissionsfromradioactively-labeledchemicalsthathavebeeninjectedintothebloodstream,andusesthedatatoproduceimagesofthedistributionofthechemicalsinthebody.
Indrugabuseresearch,PETisbeingusedforavarietyofreasonsincluding:toidentifythebrainsiteswheredrugsandnaturallyoccurringneurotransmittersact;toshowhowquicklydrugsreachandactivatereceptors;todeterminehowlongdrugsoccupythesereceptors;andtofindouthowlongtheytaketoleavethebrain.PETisalsobeingusedtoshowbrainchangesfollowingchronicdrugabuse,duringwithdrawalfromdruguse,andduringtheexperienceofdrugcraving.Inaddition,PETcanbeusedtoassesstheeffectsofpharmacologicalandbehavioraltherapiesfordrugaddictiononthebrain.
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2:Positronemissiontomography(PET)scanofapersonusingcocaine
Cocainehasotheractionsinthebraininadditiontoactivatingthebrain'srewardcircuitry.Usingbrainimagingtechnologies,suchasPETscans,scientistscanseehowcocaineactuallyaffectsbrainfunctioninpeople.PETallowsscientiststoseewhichareasofthebrainaremoreorlessactivebymeasuringtheamountofglucosethatisusedbydifferentbrainregions.Glucoseisthemainenergysourceforthebrain.Whenbrainregionsaremoreactive,theywillusemoreglucoseandwhentheyarelessactivetheywilluseless.TheamountofglucosethatisusedbythebraincanbemeasuredwithPETscans.Theleftscanistakenfromanormal,awakeperson.Theredcolorshowsthehighestlevelofglucoseutilization(yellowrepresentslessutilizationandblueindicatedtheleast).Therightscanistakenfromsomeonewhoisoncocaine.Thelossofredareasintherightscancomparedtotheleft(normal)scanindicatesthatthebrainisusinglessglucoseandthereforeislessactive.Thisreductioninactivityresultsindisruptionofmanybrainfunctions.
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3:Principlesofdrugabuseprevention
In1997,NIDApublishedthefirstresearch-basedguideonpreventingdruguseamongchildrenandadolescents.Usingaquestion-and-answerformat,thisguidepresentsanoverviewoftheresearchabouttheoriginsandpathwaysofdrugabuse,thebasicprinciplesderivedfromeffectivedrugabusepreventionresearch,andtheapplicationoftheseresearchfindings.Keycomponentsofthispublicationarepresentedinthefollowingimages.
Theguideisavailableforviewingonline.
4:RiskandProtectiveFactors
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Riskfactors:Challengeanindividual’semotional,socialandacademicdevelopment
Protectivefactors:Canlessentheimpactofriskfactors.Theirimpactvariesalongthedevelopmentalprocess.
Commonriskfactorsarefoundformultipleadolescentproblembehaviors–e.g.,substanceuse,teenpregnancy,delinquency,schooldropout,violence
Evidence-basedpreventioninterventionsmaytargetriskandprotectivefactorsintheindividual,family,peer,schoolandcommunitydomains.
TheAimofPreventionApproachesistoreduceriskfactorsandenhanceprotectivefactors.
5:Targetsallformsofdruguse
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Preventionprogramsshouldtargetallformsofdruguseincludingtheuseoftobacco,alcohol,marijuana,andinhalants.Inaddition,preventionprogramsshouldbeculturallysensitivetothecontextandneedsoftheindividual,thefamily,andthecommunity.
6:Skills-basedtraining
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Preventionprogramsshouldincludeskillstrainingtohelpchildrenandadolescentsresistdrugs,strengthenpersonalcommitmentsagainstdruguse,increasesocialcompetency(e.g.,communications,peerrelationships,selfefficacy,andassertiveness),andreinforceattitudesagainstdruguse.Programsshoulduseinteractivemethods(e.g.,groupdiscussion)ratherthandidacticteachingmethodsalone.
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SectionIII
1:DrugAbusePrevention
Evidence-basedpreventionprogramstargetindividuals,families,schools,communities,ormultipletargets.
Evidence-baseddrugabusepreventionprogramsoftenincorporateadevelopmentalperspective.
2:Family-FocusedPreventionPrograms
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Family-focusedpreventionprogramstargetparentsorthefamilies,takingintoconsiderationthestageofthechild’sdevelopment.Programsmayprovidetrainingoneffectiveparentingskillsandmonitoringtohelpreduceconductproblemsandotherriskfactorsfordrugabuse,andimproveparent-childcommunicationandrelationships.
3:CommunityandSchoolPreventionPrograms
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Communityprogramsthatincludemediacampaignsandpolicychanges,suchasnewregulationsthatrestrictaccesstoalcohol,tobacco,orotherdrugs,aremoreeffectivewhentheyareaccompaniedbyschoolorfamilyinterventions.Communityprogramsneedtostrengthennormsagainstdruguseinalldrugabusepreventionsettings,includingthefamilyandtheschool.Inaddition,preventionprogrammingshouldbeadaptedtoaddressthespecificnatureofthedrugabuseprobleminthelocalcommunity.
4:Principlesofdrugaddictiontreatment
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Threedecadesofscientificresearchandclinicalpracticehaveyieldedavarietyofeffectiveapproachestodrugaddictiontreatment.InApril1998,NIDAheldTheNationalConferenceonDrugAddictionTreatment:FromResearchtoPracticewhichsummarizedthisextensivebodyofresearch.Basedonthefindingsreportedatthisconference,NIDApublishedinOctober1999,PrinciplesofDrugAddictionTreatment:AResearch-BasedGuidetofostermorewidespreaduseofscientifically-basedcomponentsofdrugaddictiontreatment.Keycomponentsofthisguidearehighlightedinthefollowingimages.
Note:ThecurrentversionofthispublicationwasrevisedinApril2009.
5:Componentsofcomprehensivedrugaddictiontreatment
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Avarietyofscientifically-basedapproachestodrugaddictiontreatmentexist.Drugaddictiontreatmentcanincludebehavioraltherapy(e.g.,counseling,cognitivetherapy,orpsychotherapy),medications,ortheircombination.Casemanagementandreferraltoothermedical,psychological,andsocialservicesarecrucialcomponentsoftreatmentformanypeopleaswell.Thebestprogramsprovideacombinationoftherapiesandotherservicestomeettheneedsoftheindividualpatient,whichareshapedbysuchissuesasage,race,culture,sexualorientation,gender,pregnancy,parenting,housing,andemployment,aswellasphysicalandsexualabuse.
Severalofthekeyprinciplesunderlyingthisapproachtotreatmentfollow.
6:Matchingpatientstoindividualneeds
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Nosingletreatmentisappropriateforallindividuals.Matchingtreatmentsetting,interventions,andservicestoeachindividual'sparticularproblemsandneedsiscriticaltohisorherultimatesuccessinreturningtoproductivefunctioninginthefamily,workplace,andsociety.
Effectivetreatmentattendstomultipleneedsoftheindividual,notjusthisorherdruguse.Tobeeffective,treatmentmustaddresstheindividual'sdruguseandanyassociatedmedical,psychological,social,vocational,andlegalproblems.
7:Durationoftreatment
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Individualsprogressthroughdrugaddictiontreatmentatvariousspeeds,sothereisnopredeterminedlengthoftreatment.However,researchhasshownunequivocallythatgoodoutcomesarecontingentonadequatelengthsoftreatment.Generally,forresidentialoroutpatienttreatment,participationforlessthan90daysisoflimitedornoeffectiveness,andtreatmentslastingsignificantlylongeroftenareindicated.Formethadonemaintenance,12monthsoftreatmentistheminimum,andsomeopiate-addictedindividualswillcontinuetobenefitfrommethadonemaintenancetreatmentoveraperiodofyears.
8:Medicaldetoxification
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Medicaldetoxificationsafelymanagestheacutephysicalsymptomsofwithdrawalassociatedwithstoppingdruguse.However,medicaldetoxificationisonlythefirststageofaddictiontreatmentandbyitselfdoeslittletochangelong-termdruguse.Althoughdetoxificationaloneisrarelysufficienttohelpaddictsachievelong-termabstinence,forsomeindividualsitisastronglyindicatedprecursortoeffectivedrugaddictiontreatment.
9:Counselingandotherbehavioraltherapies
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Counseling(individualand/orgroup)andotherbehavioraltherapiesarecriticalcomponentsofeffectivetreatmentforaddiction.Intherapy,patientsaddressissuesofmotivation,buildskillstoresistdruguse,replacedrug-usingactivitieswithconstructiveandrewardingnondrug-usingactivities,andimproveproblem-solvingabilities.Behavioraltherapyalsofacilitatesinterpersonalrelationshipsandtheindividual'sabilitytofunctioninthefamilyandcommunity.
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SectionIV
1:Medicationsfordrugaddiction
Medicationsareanimportantelementoftreatmentformanypatients,especiallywhencombinedwithcounselingandotherbehavioraltherapies.Methadoneandlevo-alpha-acetylmethadol(LAAM)areveryeffectiveinhelpingindividualswhoareaddictedtoheroinorotheropiatesstabilizetheirlivesandreducetheirillicitdruguse.Naltrexoneisalsoaneffectivemedicationforsomeopiateaddictsandsomepatientswithco-occurringaddictiontoalcohol.Forpersonsaddictedtonicotine,anicotinereplacementproduct(suchaspatchesorgum)oranoralmedication(suchasbupropion)canbeaneffectivecomponentoftreatment.Forpatientswithmentaldisorders,bothbehavioraltreatmentsandmedicationscanbecriticallyimportant.
2:Motivationtoenter/sustaintreatment
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Treatmentdoesnotneedtobevoluntarytobeeffective.Strongmotivationcanfacilitatethetreatmentprocess.Sanctionsorenticementsinthefamily,employmentsetting,orcriminaljusticesystemcanincreasesignificantlybothtreatmententryandretentionratesandthesuccessofdrugtreatmentinterventions.Individualswhoentertreatmentunderlegalpressurehaveoutcomesasfavorableasthosewhoentertreatmentvoluntarily.
3:HIV/AIDS,hepatitisandotherinfectiousdiseases
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DruginjectorswhodonotentertreatmentareuptosixtimesmorelikelytobecomeinfectedwithHIVthaninjectorswhoenterandremainintreatment.Drugabuserswhoenterandcontinueintreatmentreduceactivitiesthatcanspreaddisease,suchassharinginjectionequipmentandengaginginunprotectedsexualactivity.Participationintreatmentalsopresentsopportunitiesforscreening,counseling,andreferralforadditionalservices.ThebestdrugabusetreatmentprogramsprovideHIVcounselingandofferHIVtestingtotheirpatients.
4:Effectivenessoftreatment
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Accordingtoseveralstudies,drugtreatmentreducesdruguseby40to60percentandsignificantlydecreasescriminalactivityduringandaftertreatment.Forexample,astudyoftherapeuticcommunitytreatmentfordrugoffendersdemonstratedthatarrestsforviolentandnonviolentcriminalactswerereducedby40percentormore.Methadonetreatmenthasbeenshowntodecreasecriminalbehaviorbyasmuchas50percent.ResearchshowsthatdrugaddictiontreatmentreducestheriskofHIVinfectionandthatinterventionstopreventHIVaremuchlesscostlythantreatingHIV-relatedillnesses.Treatmentcanimprovetheprospectsforemployment,withgainsofupto40percentaftertreatment.(Note:Althoughtheseeffectivenessratesholdingeneral,individualtreatmentoutcomesdependontheextentandnatureofthepatient'spresentingproblems,theappropriatenessofthetreatmentcomponentsandrelatedservicesusedtoaddressthoseproblems,andthedegreeofactiveengagementofthepatientinthetreatmentprocess.)
5:Self-helpanddrugaddictiontreatment
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Self-helpgroupscancomplementandextendtheeffectsofprofessionaldrugaddictiontreatment.Themostprominentself-helpgroupsarethoseaffiliatedwithAlcoholicsAnonymous(AA),NarcoticsAnonymous(NA),andCocaineAnonymous(CA),allofwhicharebasedonthe12-stepmodelandSmartRecovery.Mostdrugaddictiontreatmentprogramsencouragepatientstoparticipateinaself-helpgroupduringandafterformaltreatment.
6:Costeffectivenessofdrugtreatment
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Drugaddictiontreatmentiscost-effectiveinreducingdruguseanditsassociatedhealthandsocialcosts.Treatmentislessexpensivethanalternatives,suchasnottreatingaddictsorsimplyincarceratingaddicts.Forexample,theaveragecostfor1fullyearofmethadonemaintenancetreatmentisapproximately$4,700perpatient,whereas1fullyearofimprisonmentcostsapproximately$18,400perperson.
Accordingtoseveralconservativeestimates,every$1investedinaddictiontreatmentprogramsyieldsareturnofbetween$4and$7inreduceddrug-relatedcrime,criminaljusticecosts,andtheftalone.Whensavingsrelatedtohealthcareareincluded,totalsavingscanexceedcostsbyaratioof12to1.Majorsavingstotheindividualandtosocietyalsocomefromsignificantdropsininterpersonalconflicts,improvementsinworkplaceproductivity,andreductionsindrug-relatedaccidents.
7:ForMoreInformation