science of addiction & recovery - ? Â· science of addiction & recovery julie cole, lmsw, cacii,...
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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?
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?
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?
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
Manipulating -Lack of Caring
Perceived causes of these behaviors Sociopathy
What can neuroscience teach us about addiction and recovery? Abuse of alcohol and other drugs are preventable
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?
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.
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.
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
Route of Administration
Length of Use
Presence of conditioned cues
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:
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
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
Other behaviors that Affect Dopamine Food
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
-Previous history -Expectation -Learning
-Trauma -Social Interactions -Stress -Conditioned Stimuli
-Genetics -Disease States -Gender -Circadian Rhythms
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:
May be severe
A Chronic Condition has:
May have acute episodes
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,