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  • Science of Addiction & Recovery Julie Cole, LMSW, CACII, NCACI Project Coordinator SC Department of Alcohol & Other Drug Abuse Services

  • Why am I doing this?

  • Learning Objectives

    Increase understanding of the neurobiology of substance use disorders, addiction and recovery

    Increase understanding of criteria by which addiction is defined as a chronic disorder

  • Why talk about neuroscience?

    Understand addiction

    Understand recovery

    How the brain behaves in health and disease may well be the most important question in our lifetime. Richard D. Broadwell, 1995

  • Attitudes about addiction Disease?

    Behavioral Problem?

    Self-Inflicted Vice?

    Moral/emotional weakness?

  • Is addiction a disease or a behavior? Prior to brain science, addiction was treated as a

    behavior. Some of the behaviors that were treated were:

    Lying -Being irresponsible

    Cheating -Denial

    Stealing -Selfishness

    Manipulating -Lack of Caring

  • Perceived causes of these behaviors Sociopathy

    Criminality

    Self-Centered

    Character Defects

    Gang Culture

    Bad Parenting

    Demonic Possession

  • What can neuroscience teach us about addiction and recovery? Abuse of alcohol and other drugs are preventable

    behaviors

    Many people choose to abuse alcohol & other drugs

    Changing language through the years has contributed to this confusion

    Alcoholic/Addict >>> Chemically Dependent >>> Substance Abusing

    To that end, the current focus on distinction and languaging is intended to address this issue

  • What can neuroscience teach us about addiction and recovery? Alcohol and drug addiction is a disorder that

    people can recover from

    Recovery from addiction is a reality and happens every day

  • Why the science of addiction and recovery is important For the individuals, family and for professionals:

    Helps explain the unexplainable

    Reduces stigma, blame, and anger

    What other diseases have seen a reduction in stigma and blame due to science?

  • Why the science of addiction and recovery is important For the person in recovery:

    Helps people in recovery understand their cravings

    Helps people on their recovery journey

    Facilitates the recovery process for the person and family members

  • Why do people use alcohol and other drugs?

    To have feelings

    To have sensations

    To have experiences

    To feel good (to create)

    To lessen anxiety, stress, fear, depressions, hopelessness

    To feel better (to remove)

  • Why do people use alcohol and drugs? A major reason is that they like what it does to their brain!

    Which leads to one of the most popular questions:

    Why do some people become addicted while others do not?

  • Vulnerability

    Previous theories about addiction:

    Environment people who were exposed to addiction become addicted

    Psychological people had underlying psychological issues that needed resolution

    Genetic it is in the genes and there is nothing a person can do.

  • Vulnerability

    Neurobiology

    Environmental

    Psychological

    Genetics

    There is one place that all of these factors converge one organ that is responsible for processing it all. Addiction, as a disease, irrefutably

    starts in once place: the brain.

  • Vulnerability We know there is a genetic contribution. In fact, we know this

    contribution is big.

    unpleasant response

    pleasant response

    Dopamine Receptor Levels & Response to Methylphenidate

    Subjects with low receptor levels found MP pleasant while those with high levels found it unpleasant.

    Source: Adapted from Volkow et al, American Journal of Psychiatry 156:9; 1999

  • Additional Vulnerability Factors

    History of trauma

    Chronic stress

    Drug used

    Route of Administration

    Dose

    Frequency Used

    Length of Use

    Availability

    Acceptability

    Settings

    Presence of conditioned cues

    Available alternatives

  • Back to the brain and its role in the development of addiction

    The brain is very complex and as such, the reasons people may or may not become addicted are as complex.

    The brain is responsible for everything that is the human experience:

    Every movement

    Every thought

    Every sensation

    Every emotion

  • The brains complexity

    Approximately 4-6 pounds

    Several thousand miles of interconnected nerve cells (100+ billion)

    10,000 varieties of neurons

    Trillions of supportive cells

    Trillions more synaptic connections

    Miles of blood vessels

  • Source: National Institute on Drug Abuse Teaching Packet

    The reward, memory and pain units of the brain make up the primitive part of the brain. It is the first part of the brain to mature and is responsible for survival, among

    other things.

  • Communication of the brain

    Neuron = nerve cell

    Nerve cells have many different shapes, depending on the specialization

    Communication between neurons start out as an electrical signal but then changes to a chemical signal

    There are hundreds of billions of neurons in the CNS. None of them actually touch. They communicate through neurochemicals.

    Source: National Institute on Drug Abuse Teaching Packet

  • 34

  • Other behaviors that Affect Dopamine Food

    Sex

    Relationships

    Gambling

    Performance (workaholics)

    Accumulation (shopaholics)

    Media/Entertainment

    Rage/Violence

  • Circuits involved in addiction

  • Back to why people use alcohol and other drugs Initially, a person uses a substance hoping to

    change their mood, perception, emotional state

    which means that they are hoping to change their brain.

  • And what happens with addiction The issue is that the brain is a complex system

    that sets behavioral priorities and this system becomes captured by the addicting drug.

    This creates a complex behavioral neurobiological disorder which in turn creates powerful emotional memories (both fear and pleasure) like those that drive survival behavior in all of us.

  • And what happens with addiction

    These emotional memories become kin to survival in the addicted brain

    For many people, drug = drug

    For some who misuse substances, drug = vital

    For someone with addiction, drug = survival

    Thus behavior that flies in the face of logic now makes sense

  • Brain Mechanisms

    -Previous history -Expectation -Learning

    -Trauma -Social Interactions -Stress -Conditioned Stimuli

    -Genetics -Disease States -Gender -Circadian Rhythms

    Historical

    Environmental

    Physiological

    Drugs

    Behavior

    Environment

  • Addiction is not

    Addiction is not just tolerance

    Reduced drug effect with repeated administration of the same dose of the drug, or a need for an increased dose to maintain the same level of effect

    Not just physical dependence

    When drug cessation produces pathologic symptoms and signs

  • Addiction is Compulsive non-medical use of a substance

    Loss of control over use despite negative consequences

    Can include physical dependence (but not necessarily)

  • More About Addiction as a Disorder

    An Acute Condition has:

    Rapid onset

    Short course

    May be severe

    Potential cure

    A Chronic Condition has:

    Gradual onset

    Lifetime course

    May have acute episodes

    No cure

  • Addiction is Addiction is a primary chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction

    in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is

    reflected in an individual pathologically pursuing reward and/or relief by substance use and other

    behavior. Addiction is characterized by inability to consistently abstain, impairment in behavior control,

    craving, diminished recognition of significant problems with ones behavior and interpersonal relationships and a dysfunctional emotional response. Like other chronic diseases, addiction often involves a cycle of relapse and

    remission. Without treatment or engagement in recovery activities, addiction is progressive and can

    result in disability or premature death. American Society of Addiction Medicine, 2011

  • DSM-5 Criteria for Substance Use Disorder Two or more of the following occurring at any time during the same 12 month period:

    1. Substance taken in larger amounts or over a longer period than was intended.

    2. Persistent desire or unsuccessful efforts to cut down or control use.

    3. A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects.

    4. Craving, or a strong desire or urge to use substances. 5. Recurrent use resulting in a failure to fulfill major role obligations

    at work, school, or home. 6. Continued substance use despite having persistent or recurrent

    social or interpersonal problems caused or exacerbated by the effects of the substance.

    7. Important social, occupational,