what is addiction , types of addiction, causes ,effect on the body, signs and symptomes ,diagnosis, treatment and prevention

1. Republic of Iraq
Ministry of Higher Education
And Scientific Research
University of Baghdad
College of Medicine
‫صالح‬ ‫الكريم‬ ‫عبد‬ ‫صالح‬
ADDICTION
Neuroscience Module
Second Stage
2018
Prepared by:
Salih Abdul Kareem Salih
Student Selected Component

2. 1
Introduction :
Addiction is a complex condition, a brain disease that is manifested by
compulsive substance use despite harmful consequence.[1] Despite the involvement
of a number of psychosocial factors, a biological process – one which is induced by
repeated exposure to an addictive stimulus – is the core pathology that drives the
development and maintenance of an addiction.[2] The two properties that
characterize all addictive stimuli are that they are reinforcing (i.e., they increase the
likelihood that a person will seek repeated exposure to them) and intrinsically
rewarding (i.e., they are perceived as being inherently positive, desirable, and
pleasurable). [3,4]
Addiction is a disorder of the brain's reward system which arises
through transcriptional and epigenetic mechanisms and occurs over time from
chronically high levels of exposure to an addictive stimulus[5] :
People can develop an addiction to:
 Alcohol
 Marijuana
 Hallucinogens
 Inhalants, such as, paint thinners and glue
 Opioid pain killers, such as codeine and oxycodone, heroin
 Sedatives, hypnotics and anxiolytics (medicines for anxiety such as
tranquilizers)
 Cocaine, methamphetamine and other stimulants
 Tobacco
People with a substance use disorder have distorted thinking, behavior and
body functions. Changes in the brain’s wiring are what cause people to have intense
cravings for the drug and make it hard to stop using the drug. Brain imaging studies
show changes in the areas of the brain that relate to judgment, decision making,
learning, memory and behavior control.[6]

3. 2
Brain positron emission tomography images that compare
brain metabolism in a healthy individual and a cocaine
addict
Fig (1)
These substances can cause harmful changes in how the brain functions.
These changes can last long after the immediate effects of the drug — the
intoxication. Intoxication is the intense pleasure, calm, increased senses or a high
caused by the drug. Intoxication symptoms are different for each substance.
Over time people with addiction build up a tolerance, meaning they need
larger amounts to feel the effects. [7]
According to the National Institute on Drug Abuse, people begin taking
drugs for a variety of reasons, including:
 to feel good — feeling of pleasure, “high”
 to feel better — e.g., relieve stress
 to do better — improve performance
 curiosity and peer pressure
The addiction may cause health problems as well as problems at work and
with family members and friends. The misuse of drugs and alcohol is the leading
cause of preventable illnesses and premature death. Many people experience both
mental illness and addiction. The mental illness may be present before the
addiction. Or the addiction may trigger or make a mental disorder worse.[8]

4. 3
Types of Addiction :
Addictions to Substances [9] :
Alcohol
Tobacco
Opioids (like heroin)
Prescription drugs (sedatives, hypnotics, or anxiolytics like sleeping pills and
tranquilizers)
Cocaine
Cannabis (marijuana)
Amphetamines (like methamphetamine)
Hallucinogens
Inhalants
Phencyclidine (known as PCP or Angel dust)
Other substances
Addictions – Behavioral [10]
Food (eating)
Sex
Pornography (attaining, viewing)
Using computers / the internet
Playing video games
Working
Exercising
Spiritual obsession (as opposed to religious devotion)
Pain (seeking)
Cutting
Shopping

5. 4
Addiction fact and statistics
Alcohol use is the fourth leading cause of preventable death in the United States
(after smoking, high blood pressure, and obesity). According to the CDC, excessive
alcohol use led to approximately 88,000 deaths (approximately 62,000 men and 26,000
women) and 2.5 million years of potential life lost (YPLL) each year in the United States
from 2006 – 2010.[11,12] The economic costs of excessive alcohol consumption in 2010
were estimated at $249 billion, or $2.05 a drink. [13]
Nicotine addiction is the second-leading cause of death worldwide, and the leading
cause of preventable death. Cigarette smoking is responsible for more than 480,000 deaths
per year in the United States, including more than 41,000 deaths resulting from
secondhand smoke exposure. This is about one in five deaths annually, or 1,300 deaths
every day. [14]
Opioids are powerful pain killers that are highly addictive. Opioid dependence
affects nearly 5 million people in the United States and leads to approximately 17,000
deaths annually. [15] According to the CDC, the death rate from overdoses tripled from
6.1 per 100,000 people in 1999 to 19.8 in 2016 and rose 20% from 2015 to 2016. The
number of people fatally overdosing on fentanyl and other synthetic opiates more than
doubled from 9,580 in 2015 to 19,413 in 2016. [16] Half of deaths due to drug overdose
are related to prescription drugs, according to a report on the leading cause of deaths from
injury in the United States. [17] In 2017, researchers announced that US life expectancy
was down for a second straight year, the first 2-year decline since the early 1960s when flu
deaths were likely to blame. The current culprit is the opioid overdose epidemic. [18]

6. 5
What Is Drug Addiction?
Drug addiction is a chronic and relapsing brain disease that causes compulsive drug
seeking and use, despite harmful consequences. Because the abuse of drugs leads to
changes in the structure and function of the brain. Although it is true that for most people
the initial decision to take drugs is voluntary, over time the changes in the brain caused by
repeated drug abuse can impair a person's self-control and ability to make sound decisions,
and at the same time create an intense impulse to take drugs.[19]
As with other chronic diseases, such as diabetes, asthma, or heart disease, drug
addiction can be managed effectively. Yet, it is not uncommon for a person to relapse and
begin abusing drugs again. Relapse does not signal failure; rather, it indicates that
treatment should be reinstated or adjusted, or that alternate treatment is needed to help the
person regain control and recover.[19]
Behavioral addiction
The term behavioral addiction correctly refers to a compulsion to engage in
a natural reward – which is a behavior that is inherently rewarding (i.e., desirable or
appealing) – despite adverse consequences.[20,22] Preclinical evidence has
demonstrated that marked increases in the expression of ΔFosB gene through
repetitive and excessive exposure to a natural reward induces the same behavioral
effects and neuroplasticity as occurs in a drug addiction.[21,25]
Reviews of both clinical research in humans and preclinical studies involving
ΔFosB have identified compulsive sexual activity – specifically, any form of sexual
intercourse – as an addiction (i.e., sexual addiction).[23]
Moreover, reward cross-sensitization between amphetamine and sexual
activity, meaning that exposure to one increases the desire for both, has been shown
to occur preclinically and clinically as a dopamine dysregulation syndrome.[24]

7. 6
ΔFosB expression is required for this cross-sensitization effect, which
intensifies with the level of ΔFosB expression.[25] Reviews of preclinical studies
indicate that long-term frequent and excessive consumption of high fat or sugar
foods can produce an addiction (food addiction).[22]
Gambling is a natural reward which is associated with compulsive behavior
and for which clinical diagnostic manuals, namely the DSM-5(Diagnostic and
Statistical Manual of Mental Disorders, Fifth Edition) have identified diagnostic
criteria for an "addiction".[24] There is evidence from functional neuroimaging that
gambling activates the reward system and the mesolimbic pathway in
particular.[26] Similarly, shopping and playing videogames are associated with
compulsive behaviors in humans and have also been shown to activate the
mesolimbic pathway and other parts of the reward system.[21] Based upon this
evidence, gambling addiction, video game addiction and shopping addiction are
classified accordingly. [26]
Medical consequences of drug addiction
People who suffer from addiction often have one or more accompanying
medical issues, which may include lung or cardiovascular disease, stroke, cancer,
and mental disorders. Imaging scans, chest X-rays, and blood tests show the
damaging effects of long-term drug abuse throughout the body. For example,
research has shown that tobacco smoke causes cancer of the mouth, throat,
larynx, blood, lungs, stomach, pancreas, kidney, bladder, and cervix [27]. In
addition, some drugs of abuse, such as inhalants, are toxic to nerve cells and may
damage or destroy them either in the brain or the peripheral nervous system.
The Impact of Addiction Can Be Far-Reaching
 Cardiovascular disease
 Stroke
 Cancer
 HIV/AIDS
 Hepatitis B and C
 Lung disease
 Mental disorders

8. 7
How can addiction harm other people?
Beyond the harmful consequences for the person with the addiction, drug
abuse can cause serious health problems for others. Three of the more devastating
and troubling consequences of addiction are:
 Negative effects of prenatal drug exposure on infants and children.
 A mother's abuse of heroin or prescription opioids during pregnancy can cause a
withdrawal syndrome (called neonatal abstinence syndrome, or NAS) in her infant. It
is also likely that some drug-exposed children will need educational support in the
classroom to help them overcome what may be subtle deficits in developmental areas
such as behavior, attention, and thinking. Ongoing research is investigating whether
the effects of prenatal drug exposure on the brain and behavior extend into adolescence
to cause developmental problems during that time period.[28]
 Negative effects of secondhand smoke Secondhand tobacco smoke, also called
environmental tobacco smoke (ETS), is a significant source of exposure to a large
number of substances known to be hazardous to human health, particularly to
children. According to the Surgeon General’s 2006 Report, The Health Consequences
of Involuntary Exposure to Tobacco Smoke, involuntary exposure to secondhand
smoke increases the risks of heart disease and lung cancer in people who have
never smoked by 25–30 percent and 20–30 percent, respectively. [28]
 Increased spread of infectious diseases Injection of drugs such as heroin, cocaine,
and methamphetamine currently accounts for about 12 percent of new AIDS cases.
Injection drug use is also a major factor in the spread of hepatitis C, a serious,
potentially fatal liver disease. Injection drug use is not the only way that drug abuse
contributes to the spread of infectious diseases. All drugs of abuse cause some form
of intoxication, which interferes with judgment and increases the likelihood of risky
sexual behaviors. This, in turn, contributes to the spread of HIV/AIDS, hepatitis B
and C, and other sexually transmitted diseases.[29]

9. 8
Tobacco use is responsible for an estimated 5
million deaths worldwide each year [30]
Fig (2)
Addiction symptoms and signs :
In addition to addictive behaviors, addiction symptoms can run deeper. Signs
of addiction also exist within the addict themselves. Some of these addiction
symptoms will be visible to others, while some may be only apparent to the
addiction[30] :
• Craving
• Compulsivity
• Fixation on addiction
• Loss of control over addiction
• Psychological or physiological withdrawal if not engaging in addiction
• Feeling a need to engage in the addiction more and more
• Low self-esteem
• Feeling a loss of control
• A history of abuse
• Depression or another mental illness

10. 9
Risk factors
There are a range of genetic and environmental risk factors for developing an
addiction that vary across the population.[31] Roughly half of an individual's risk for
developing an addiction is derived from genetics, while the other half is derived from the
environment.[32] However, even in individuals with a relatively low genetic loading,
exposure to sufficiently high doses of an addictive drug for a long period of time (e.g.,
weeks–months) can result in an addiction.[31] In other words, anyone can become an
addict under the right circumstances .
Genetic factors
It has long been established that genetic factors along with environmental (e.g.,
psychosocial) factors are significant contributors to addiction vulnerability.
Epidemiological studies estimate that genetic factors account for 40–60% of the risk
factors for alcoholism. Similar rates of heritability for other types of drug addiction have
been indicated by other studies.[33] Knestler hypothesized in 1964 that a gene or group of
genes might contribute to predisposition to addiction in several ways. For example, altered
levels of a normal protein due to environmental factors could then change the structure or
functioning of specific brain neurons during development. These altered brain neurons
could change the susceptibility of an individual to an initial drug use experience. In
support of this hypothesis, animal studies have shown that environmental factors such as
stress can affect an animal's genotype.[33]
Overall, the data implicating specific genes in the development of drug addiction is
mixed for most genes. One reason for this may be that the case is due to a focus of current
research on common variants. Many addiction studies focus on common variants with an
allele frequency of greater than 5% in the general population, however when associated
with disease, these only confer a small amount of additional risk with an odds ratio of 1.1–
1.3 percent. On the other hand, the rare variant hypothesis states that genes with low
frequencies in the population (<1%) confer much greater additional risk in the
development of disease.[34]
Genome-wide association studies (GWAS) are a recently developed research method
which are used to examine genetic associations with dependence, addiction, and drug use.
These studies employ an unbiased approach to finding genetic associations with specific
phenotypes and give equal weight to all regions of DNA, including those with no

11. 10
ostensible relationship to drug metabolism or response. These studies rarely identify genes
from proteins previously described via animal knockout models and candidate gene
analysis. Instead, large percentages of genes involved in processes such as cell adhesion
are commonly identified. This is not to say that previous findings, or the GWAS findings,
are erroneous. The important effects of endophenotypes are typically not capable of being
captured by these methods. Furthermore, genes identified in GWAS for drug addiction
may be involved either in adjusting brain behavior prior to drug experiences, subsequent to
them, or both. [35]
A study that highlights the significant role genetics play in addiction is the twin
studies. Twins have similar and sometimes identical genetics. Analyzing these genes in
relation to genetics has helped geneticists understand how much of a role genes play in
addiction. Studies performed on twins found that rarely did only one twin have an
addiction. In most cases where at least one twin suffered from an addiction, both did, and
often to the same substance.[36]
Environmental factors
Environmental risk factors for addiction are the experiences of an individual during
their lifetime that interact with the individual's genetic composition to increase or decrease
the his or her vulnerability to addiction. A number of different environmental factors have
been implicated as risk factors for addiction, including various psychosocial stressors;
however, an individual's exposure to an addictive drug is by far the most significant
environmental risk factor for addiction.[31] The National Institute on Drug Abuse cites
lack of parental supervision, the prevalence of peer substance use, drug availability, and
poverty as risk factors for substance use among children and adolescents.[37]
Adverse childhood experiences (ACEs) are various forms of maltreatment and
household dysfunction experienced in childhood. The Adverse Childhood Experiences
Study by the Centers for Disease Control and Prevention has shown a strong dose–
response relationship between ACEs and numerous health, social, and behavioral
problems throughout a person's lifespan, including those
associated with substance abuse.[41] Children's neurological development can be
permanently disrupted when they are chronically exposed to stressful events such as
physical, emotional, or sexual abuse, physical or emotional neglect, witnessing violence in
the household, or a parent being incarcerated or suffering from a mental illness. As a
result, the child's cognitive functioning or ability to cope with negative or disruptive
emotions may be impaired. Over time, the child may adopt substance use as a coping

12. 11
mechanism, particularly during adolescence.[38] A study of 900 court cases involving
children who experienced abuse found that a vast amount of them went on to suffer from
some form of addiction in their adolescence or adult life.[39] This pathway towards
addiction that is opened through stressful experiences during childhood can be avoided by
a change in environmental factors throughout an individuals life and opportunities of
professional help.[39]
Can addiction be treated successfully?
Yes. Addiction is a treatable disease. Research in the science of addiction and the
treatment of substance use disorders has led to the development of evidence-based
interventions that help people stop abusing drugs and resume productive lives.[42]
Can addiction be cured?
Not always but like other chronic diseases, addiction can be managed
successfully. Treatment enables people to counteract addiction’s powerful disruptive
effects on their brain and behavior and regain control of their lives.[43]
images showing the density of dopamine transporters in a brain area called the
striatum illustrate the brain’s remarkable potential to recover, at least partially, after a
long abstinence from drugs in this case, methamphetamine [43]
Fig (3)

13. 12
How can medications help treat drug addiction?
Different types of medications may be useful at different stages of treatment
to help a patient stop abusing drugs, stay in treatment, and avoid relapse.
 Treating Withdrawal. When patients first stop using drugs, they can
experience a variety of physical and emotional symptoms, including
depression, anxiety, and other mood disorders, as well as restlessness or
sleeplessness. Certain treatment medications are designed to reduce these
symptoms, which makes it easier to stop the drug use[44].
 Staying in Treatment. Some treatment medications are used to help the
brain adapt gradually to the absence of the abused drug. These medications
act slowly to stave off drug cravings and have a calming effect on body
systems. They can help patients focus on counseling and other
psychotherapies related to their drug treatment.[45]
 Preventing Relapse. Science has taught us that stress, cues linked to the
drug experience (such as people, places, things, and moods), and exposure
to drugs are the most common triggers for relapse. Medications are being
 developed to interfere with these triggers to help patients sustain recovery.
Medications Used To Treat Drug Addiction
 Tobacco Addiction
 Nicotine replacement therapies (available as a patch, inhaler, or
gum)
 Bupropion
 Varenicline
 Opioid Addiction
 Methadone
 Buprenorphine
 Naltrexone
 Alcohol and Drug Addiction
 Naltrexone
 Disulfiram
 Acamprosate

14. 13
How do behavioral therapies treat drug addiction?
Behavioral treatments help engage people in substance use disorder
treatment, modifying their attitudes and behaviors related to drug use and
increasing their life skills to handle stressful circumstances and environmental
cues that may trigger intense craving for drugs and prompt another cycle of
compulsive use. Behavioral therapies can also enhance the effectiveness of
medications and help people remain in treatment longer.[45]
How do the best treatment programs help patients recover from
the pervasive effects of addiction?
Gaining the ability to stop abusing drugs is just one part of a long and
complex recovery process. When people enter treatment for a substance use
disorder, addiction has often taken over their lives. The compulsion to get drugs,
take drugs, and experience the effects of drugs has dominated their every waking
moment, and abusing drugs has taken the place of all the things they used to
enjoy doing. It has disrupted how they function in their family lives, at work, and
in the community, and has made them more likely to suffer from other serious
illnesses.[46] Because addiction can affect so many aspects of a person’s life,
treatment must address the needs of the whole person to be successful. This is
why the best programs incorporate a variety of rehabilitative services into their
comprehensive treatment regimens. Treatment counselors may select from a
menu of services for meeting the specific medical, psychological, social,
vocational, and legal needs of their patients to foster their recovery from
addiction.[46]

15. 14
 Cognitive Behavioral Therapy seeks to help patients recognize, avoid, and
cope with the situations in which they are most likely to abuse drugs.
 Contingency Management uses positive reinforcement such as providing
rewards or privileges for remaining drug free, for attending and participating
in counseling sessions, or for taking treatment medications as prescribed.
 Motivational Enhancement Therapyuses strategies to evoke rapid and
internally motivated behavior change to stop drug use and facilitate treatment
entry.
 Family Therapy (especially for youth)approaches a person’s drug problems
in the context of family interactions and dynamics that may contribute to drug
use and other risky behaviors.[47]
Preventing Drug Abuse: The Best Strategy
 Why is adolescence a critical time for preventing drug addiction?
 As noted previously, early use of drugs increases a person’s chances of developing
addiction. Remember, drugs change brains—and this can lead to addiction and
other serious problems. So, preventing early use of drugs or alcohol may go a long
way in reducing these risks. If we can prevent young people from experimenting
with drugs, we can prevent drug addiction.
Risk of drug abuse increases greatly during times of transition. For an adult, a
divorce or loss of a job may lead to drug abuse; for a teenager, risky times include
moving or changing schools.[48] In early adolescence, when children advance from
elementary through middle school, they face new and challenging social and

16. 15
academic situations. Often during this period, children are exposed to abusable
substances such as cigarettes and alcohol for the first time. When they enter high
school, teens may encounter greater availability of drugs, drug use by older teens, and
social activities where drugs are used.
 At the same time, many behaviors that are a normal aspect of their development,
such as the desire to try new things or take greater risks, may increase teen
tendencies to experiment with drugs. Some teens may give in to the urging of drug-
using friends to share the experience with them. Others may think that taking drugs
(such as steroids) will improve their appearance or their athletic performance or
that abusing substances such as alcohol or MDMA (ecstasy or “Molly”) will ease
their anxiety in social situations. A growing number of teens are abusing
prescription ADHD stimulants such as Adderall to help them study or lose weight.
Teens’ still-developing judgment and decision-making skills may limit their ability
to accurately assess the risks of all of these forms of drug use.[48]
 Using abusable substances at this age can disrupt brain function in areas critical to
motivation, memory, learning, judgment, and behavior control. So, it is not
surprising that teens who use alcohol and other drugs often have family and social
problems, poor academic performance, health-related problems (including mental
health), and involvement with the juvenile justice system.[49]
 National drug use surveys indicate some children are already abusing drugs by age
12 or 13.
Can research-based programs prevent drug addiction in youth?
Yes. The term “research-based” means that these programs have been
rationally designed based on current scientific evidence, rigorously tested, and
shown to produce positive results. Scientists have developed a broad range of
programs that positively alter the balance between risk and protective factors for
drug abuse in families, schools, and communities. Studies have shown that
research-based programs, such as those described in NIDA's can significantly
reduce early use of tobacco, alcohol, and illicit drugs.[51]

17. 16
How do research-based prevention programs work?
These prevention programs work to boost protective factors and eliminate or
reduce risk factors for drug use. The programs are designed for various ages and
can be designed for individual or group settings, such as the school and home.
There are three types of programs[52]:
 Universal programs address risk and protective factors common to all
children in a given setting, such as a school or community.
 Selective programs target groups of children and teens who have factors
that put them at increased risk of drug use.
 Indicated programs are designed for youth who have already begun using
drugs.
Are all prevention programs effective in reducing drug abuse?
When research-based substance use prevention programs are properly
implemented by schools and communities, use of alcohol, tobacco, and illegal
drugs is reduced. Such programs help teachers, parents, and health care
professionals shape youths’ perceptions about the risks of substance use. While
many social and cultural factors affect drug use trends, when young people
perceive drug use as harmful, they reduce their level of use.[50]
Fig (3)

18. 17
Prevention is the best strategy.
Fig(6)
Fig (5)
Cigarette smoking among teens is at its lowest point since NIDA began tracking
it in 1975. But marijuana use has increased over the past several years as
perception of its risks has declined.
Summery
Addiction is a serious public health problem that affects the brain and all part of the
body. It occurs almost every community and family in some way. Each year addiction
causes millions of serious illnesses or injuries among the population. There are two type of
addiction which drugs or substances addiction include Methamphetamine, Anabolic,
steroids, Club drugs, Cocaine, Heroin, Inhalants, Marijuana, Opioids and behavioral
addiction such as sex, Internet, food, work and others all these things play a role in many
major social problems, such as drugged driving, violence, stress, and child abuse.
Addiction can lead to homelessness, crime, and missed work or problems with keeping a
job. It harms unborn babies and destroys families. There are many signs and symptoms
that we could know if the person addicted or not such as depression , mental illness, loss of
control on body, physiological and psychological affect. There are genetic and
environmental factors that control addiction .We can treat addiction depending on type and
factors that causes it. There are many addiction prevent programs to avoid it such as
universal, selective, indicated programs .

19. 18
References :
1. Malenka RC, Nestler EJ, Hyman SE . "Chapter 15: Reinforcement and Addictive Disorders". In Sydor A, Brown
RY. Molecular Neuropharmacology: A Foundation for Clinical Neuroscience (2nd ed.). New York: McGraw-Hill
Medical.2009 , pp. 364–365, 375
2. Nestler EJ . "Cellular basis of memory for addiction". Dialogues Clin. Neurosci. 15 (4): 431–443, December 2013
3. "Glossary of Terms". Mount Sinai School of Medicine. Department of Neuroscience. Retrieved 9 February 2015.
4. Taylor SB, Lewis CR, Olive MF. "The neurocircuitry of illicit psychostimulant addiction: acute and chronic effects
in humans". Subst. Abuse Rehabil. 4: 29–43, February 2013
5. Olsen CM . "Natural rewards, neuroplasticity, and non-drug addictions". Neuropharmacology. 61 (7): 1109–
1122, December 2011
6. American Society for Addiction Medicine (2012). "Definition of Addiction"
7. Ruffle JK . "Molecular neurobiology of addiction: what's all the (Δ)FosB about?". Am. J. Drug Alcohol Abuse. 40
(6): 428–437, November 2014.
8. Physician Review BY Ranna Parekh, M.D., M.P.H. January 2017, AMERICAN PSYCHATRIC ASSOCIATION
9. Wikipedia, Addiction: http: //en.wikipedia.org/wiki/Addiction
10. Medscape Reference, Psychiatric Illnesses Associated with Criminality:
http://emedicine.medscape.com/article/294626
11. CDC. Alcohol-Related Disease Impact (ARDI) . Center for Disease Control and Prevention. March 4,2016
12. Stahre M; Roeber J; Kanny D; Brewer RD; Zhang X. Contribution of excessive alcohol consumption to deaths and
years of potential life lost in the United States. Prev Chronic Dis. 2014 Jun26. 11:E109
13. Sacks JJ; Gonzales KR; Bouchery EE; Tomedi LE; Brewer RD. National and State Costs of Excessive Alcohol
Consumption.Am J Prev Med. 2015 Nov.49 (5):e73-9
14. U.S. Department of Health and Human Services. The Health Consequences of Smoking 50 Years of Progress: A
Report of the Surgeon General. August 10, 2017
15. Substance Abuse and Mental Health Services Administration, Result from the 2011 National Survey On Drug Use
And Health: Summary of National Finding, NSDUH series H-44, HHS Publication No. (SMA) 12-4713. Rockville,
MD: Substance Abuse and Mental Health Services Administration,2012
16. CDC. Increases in Drug and Opioid-Involved Overdose Deaths — United States, 2010–2015.CDC. December 30,
2016 / 65(50-51);1445–1452
17. Trust for America’s Health and Report Wood Johnson Foundation. The Facts Hurt: A State-By-State Injury
Prevention Policy Report, June 2015
18. Mortality in the United States, Centers for Disease Control and Prevention, December 2017
19. https://www.webmd.com/mental-health/addiction/drug-abuse-addiction#1 , [WebMd, drug abuse and brain
addiction]
20. Malenka RC, Nestler EJ, Hyman SE. "Chapter 15: Reinforcement and Addictive Disorders". In Sydor A, Brown
RY. Molecular Neuropharmacology: A Foundation for Clinical Neuroscience (2nd ed.). New York: McGraw-Hill
Medical. pp. 364–365, 375, 2009.
21. Olsen CM "Natural rewards, neuroplasticity, and non-drug addictions". Neuropharmacology. 61 (7): 1109–1122,
December 2011.
22. Robison AJ, Nestler EJ. "Transcriptional and epigenetic mechanisms of addiction". Nat. Rev. Neurosci. 12 (11):
623–637, November 2011 .
23. Karila L, Wéry A, Weinstein A, Cottencin O, Petit A, Reynaud M, Billieux J "Sexual addiction or hypersexual
disorder: different terms for the same problem? A review of the literature". Curr. Pharm. Des. 20(25): 4012–4020,
2014 .
24. Pitchers KK, Vialou V, Nestler EJ, Laviolette SR, Lehman MN, Coolen LM "Natural and drug rewards act on
common neural plasticity mechanisms with ΔFosB as a key mediator". The Journal of Neuroscience. 33 (8):
3434–3442, February 2013.
25. Beloate LN, Weems PW, Casey GR, Webb IC, Coolen LM "Nucleus accumbens NMDA receptor activation
regulates amphetamine cross-sensitization and deltaFosB expression following sexual experience in male
rats". Neuropharmacology. 101: 154–164, February 2016.
26. Grant JE, Potenza MN, Weinstein A, Gorelick DA . "Introduction to behavioral addictions". Am. J. Drug Alcohol
Abuse. 36 (5): 233–241, September 2010
27. U.S. Department of Health and Human Services. The health consequences of smoking: a report of the Surgeon
General. Atlanta, Georgia. U.S. Department of Health and Human Services, Centers for Disease Control and
Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and
Health; Washington, DC, 2004.
28. U.S. Department of Health and Human Services. The health consequences of involuntary exposure to tobacco
smoke: a report of the Surgeon General. Atlanta, Georgia: U.S. Department of Health and Human Services,

20. 19
Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for
Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2006.
29. Centers for Disease Control and Prevention. HIV/AIDS Statistics Overview. See
http://www.cdc.gov/hiv/statistics/index.html
30. Fig(2) ,Centers for Disease Control and Prevention. HIV Surveillance Report, Published February 2013.
Accessed May 2,2014.
31. Nestler EJ. "Cellular basis of memory for addiction". Dialogues Clin. Neurosci. 15 (4): 431–443, December 2013
32. Vassoler FM, Sadri-Vakili G. "Mechanisms of transgenerational inheritance of addictive-like
behaviors". Neuroscience. 264: 198–206 , 2014.
33. Kendler KS, Neale MC, Heath AC, Kessler RC, Eaves LJ "A twin-family study of alcoholism in women". Am J
Psychiatry. 151 (5): 707–15 , May 1994 .
34. Clarke TK, Crist RC, Kampman KM, Dackis CA, Pettinati HM, O'Brien CP, Oslin DW, Ferraro TN, Lohoff FW,
Berrettini WH . "Low frequency genetic variants in the μ-opioid receptor (OPRM1) affect risk for addiction to
heroin and cocaine". Neuroscience Letters. 542: 71–5 , 2013.
35. Hall, F. Scott; Drgonova, Jana; Jain, Siddharth; Uhl, George R. "Implications of genome wide association studies
for addiction: Are our a priori assumptions all wrong?". Pharmacology & Therapeutics. 140 (3): 267–279,
December 2013.
36. Crowe, J.R. "Genetics of alcoholism". Alcohol health and research world: 1–11. Retrieved 13 December 2017.
37. Abuse, National Institute on Drug. "What are risk factors and protective factors?". Retrieved 13 December 2017.
38. "Adverse Childhood Experiences". samhsa.gov. Rockville, Maryland, United States: Substance Abuse and Mental
Health Services Administration. Retrieved 26 September 2016
39. Enoch, Mary. "The role of early life stress as a predictor for alcohol and drug dependence"
. Psychopharmacology: 17–31, 2010 .
40. Center for Behavioral Health Statistics and Quality (CBSHQ). National Survey on Drug Use and Health: Detailed
Tables. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2015.
41. Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report, 2005. Vol. 17. Rev ed. Atlanta: U.S.
Department of Health and Human Services, Centers for Disease Control and Prevention; 2007
42. Richard Peto and Alan D Lopez. Global Health in the 21st Century, published by Jossey-Bass, New York, edited by
C Everett Koop, Clarence E Pearson and M Roy Schwarz, 2000
43. Volkow ND, Chang L, Wang GJ, Fowler JS, Franceschi D, Sedler M, Gatley SJ, Miller E, Hitzemann R, Ding YS,
Logan J. Loss of dopamine transporters in methamphetamine abusers recovers with protracted abstinence. J
Neurosci 21(23):9414-9418, 2001.
44. Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report, 2005. Vol. 17. Rev ed. Atlanta: U.S.
Department of Health and Human Services, Centers for Disease Control and Prevention; 2007
45. U.S. Department of Health and Human Services. The health consequences of involuntary exposure to tobacco
smoke: a report of the Surgeon General. Atlanta, Georgia: U.S. Department of Health and Human Services,
Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for
Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2006.
46. McLellan AT, Lewis DC, O’Brien CP, Kleber HD. Drug dependence, a chronic medical illness: implications for
treatment, insurance, and outcomes evaluation. JAMA 284(13):1689-1695, 2000
47. Leukefeld, C.G.; Tims, F.; and Farabee, D., Eds. Treatment of Drug Offenders: Policies and Issues. NY, NY:
Springer, 2002
48. Friedmann, P.D.; Rhodes, A.G.; and Taxman, F.S.; for the Step’n Out Research Group of CJ-DATS.
Collaborative behavioral management: integration and intensification of parole and outpatient addiction
treatment services in the Step’n Out study. J Exp Criminol 5(3):227–243, 2009.
49. McClelland, G.M., Elkington, K.S., Teplin, L.A., and Abram, K.M. Multiple substance use disorders in juvenile
detainees. J Am Acad Child Adolesc Psychiatry 43(10):1215–1224, 2004.
50. Martin, S.S.; Butzin, C.A.; Saum, C.A; and Inciardi, J.A. Three-year outcomes of therapeutic community treatment
for drug-involved offenders in Delaware: From prison to work release to aftercare. The Prison Journal
79(3):294–320, 1999.
51. McClelland, G.M.; Teplin, L.A.; and Abram, K.M. Detection and prevalence of substance use among juvenile
detainees. Juvenile Justice Bulletin. Washington, DC: U.S. Department of Justice, Office of Justice Programs,
Office of Juvenile Justice and Delinquency Prevention, 2004
52. Fig(1) https://en.wikipedia.org/wiki/Addiction
53. Fig(3) SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health,
2011 and 2012
54. Fig(4) Monitoring the Future survey. University of Michigan, with funding from the National Institute on Drug
Abuse 2013