Addiction is a disease that affects your brain and behavior. When you’re addicted to drugs, you can’t resist the urge to use them, no matter how much harm the drugs may cause. The earlier you get treatment for drug addiction (also called substance use disorder) the more likely you are to avoid some of the more dire consequences of the disease. Drug addiction isn’t about just heroin, cocaine, or other illegal drugs. You can get addicted to alcohol, nicotine, sleep and anti-anxiety medications, and other legal substances. You can also get addicted to prescription or illegally obtained narcotic pain medications, or opioids. This problem is at epidemic levels in the United States. In 2018, opioids played a role in two-thirds of all drug overdose deaths. At first, you may choose to take a drug because you like the way it makes you feel. You may think you can control how much and how often you use it. But over time, drugs change how your brain works. These physical changes can last a long time. They make you lose control and can lead to damaging behaviors.

1. HIV/AIDS Research
Treatment Interventions
(New Targets & New Strategies)
Prevention Research (Children & Adolescents)
genetics
environment
development
co-morbidity
Priority Areas for NIDA

2. 1
10
100
Child Teen Young Adult Adult
1.5%
67%
5.5%
<12 12-17 18-25 >25
Addiction is a Developmental Disease:
It Starts Early
26%

3. Basic Science Tells Us that Adolescents’
Brains Are Still Developing…

4. Copyright ©2004 by the National Academy of Sciences Gogtay, Giedd, et al. (2004) Proc. Natl. Acad. Sci. USA 101, 8174-8179
MRI Scans of Healthy Children and Teens Over Time

5. When Reading Emotion…
Adults Rely More on the Frontal Cortex
While Teens Rely More on the Amygdala
Source: Deborah Yurgelon-Todd 2000.

6. Do Adolescents React Differently
than Adults to
Substances of Abuse?

7. Rats Exposed to Nicotine in Adolescence
Self-Administer More Nicotine Than
Rats First Exposed as Adults
Sources: Collins et al, 2004, Levin et al, 2003, NIDA Notes
v19.2

8. Do We Need Fundamentally
Different Strategies At
Different Stages of Adolescence?

9. Why do some people
become addicted while
others do not?
Vulnerability

10. We Know There’s A
Big Genetic Contribution To
Drug Abuse and Addiction…
And the Nature of this Contribution
Is Extremely Complex

11. high
low
High DA
receptor
w DA receptor
DA Receptors and the Response to
Methylphenidate (MP)
As a group, subjects with low receptor levels found MP pleasant
while those with high levels found MP unpleasant
Adapted from Volkow et al., Am. J. Psychiatry, 1999.
Dopamine
receptor
level

12. Becomes Subordinate
Stress remains
Individually
Housed
Group
Housed
Morgan, D. et al. Nature Neuroscience, 5: 169-174, 2002.
Effects of a Social Stressor on Brain DA D2
Receptors and Propensity to Administer Drugs
*
*
S.003 .01 .03 .1
0
10
20
30
40
50
Cocaine (mg/kg/injection)
Dominant
Subordinate
Becomes Dominant
No longer stressed

13. What Other Environmental
Factors Contribute to Addiction?
Co-morbid mental illness
Early physical or sexual abuse
Witnessing violence
Stress
Peers who use drugs
Drug availability

14. COMORBIDITY
Drug Users have a Higher Risk of
Developing Mental Disorders
•Psychosis
•Depression
•Anxiety
•Panic attacks
Example: SMOKING EPIDEMIOLOGY
normal population: 23%
alcoholism: 90%+
other addictions: 90%+
schizophrenia: 85%
depression: 80%

15. Why do Mental Illnesses and Substance
Abuse Co-occur?
• Self-medication hypothesis
– substance abuse begins as a means
to alleviate symptoms of mental
illness
• Causal effects of substance
abuse
– Substance abuse may increase
vulnerability to mental illness
• Common or correlated causes
– the life processes and risk factors
that give rise to mental illness and
substance abuse may be related or
overlap

16. Prevention Works

17. 0
10
20
30
40
50
60
'75 '77 '79 '81 '83 '85 '87 '89 '91 '93 '95 '97 '99 '01 '03
Past Year Use of Marijuana
Perceived Risk of Occasional Marijuana Use
Source: Monitoring the Future Study, 2003.
Changes in Attitudes Lead to
Changes in Use

18. HIV/AIDS Research
Prevention Research (Children & Adolescents)
genetics
environment
development
co-morbidity
Treatment Interventions
(New Targets & New Strategies)
Priority Areas for NIDA

19. Source: Adapted from Volkow et al., Neuropharmacology, 2004.
Drive
Saliency
Memory
Control
Non-Addicted Brain
NO
GO
Addicted Brain
Drive
Memory
Control
GO
Saliency
Why Can’t Addicts Just Quit?
Because Addiction Changes Brain Circuits

20. This is why treatment is essential
This is why addicts can’t just quit

21. Treating a Biobehavioral Disorder Must Go
Beyond Just Fixing the Chemistry
Pharmacological
(medications)
We Need to Treat the
Whole Person!
In Social Context
Behavioral Therapies
Medical and Social Services

22. Treatment Can Work

23. Genetics Mechanisms Treatments
We Are Using Science to
Develop Even Better Treatments

24. Opiate agonists stabilize brain
function in heroin addicts
CB1 KO mice have decreased
responses to multiple drugs of
abuse
Smokers who are poor nicotine
metabolizers smoke less
Stress triggers relapse in animal
models of addiction and CRF
antagonists interfere with the
response to stress
CB1 Antagonists
Inhibitors of
metabolizing
enzymes
CRF Antagonists
Medication
Basic Research
Agonist Therapy
Methadone
Buprenorphine

25. But, drug addiction is a chronic
illness with relapse rates similar to
those of hypertension, diabetes,
and asthma
McLellan et al., JAMA, 2000.

26. Relapse Rates Are Similar for Drug
Addiction & Other Chronic Illnesses
Drug
Addiction
Type I
Diabetes
0
10
20
30
40
50
60
70
80
90
100
Hypertension Asthma
40
to
60%
30
to
50%
50
to
70%
50
to
70%
Percent
of
Patients
Who
Relapse
McLellan et al., JAMA, 2000.

27. Addiction is Similar to Other
Chronic Illnesses Because:
• Recovery from it--protracted abstinence and restored functioning--
is often a long-term process requiring repeated treatments
• Relapses to drug abuse can occur during or after successful
treatment episodes
• Participation in self-help support programs during and following
treatment can be helpful in sustaining long-term recovery
Therefore…

28. Full recovery is a challenge
but it is possible …

29. DAT Recovery
with prolonged
abstinence from
methamphetamine
[C-11]d-threo-methylphenidate
Volkow et al., J. Neuroscience, 2001.
low
high
Normal Control
Methamphetamine Abuser
(1 month detoxification)
Methamphetamine Abuser
(24 month abstinent)

30. Treatment Reduces Drug Use and Recidivism
Delaware Work Release Therapeutic Community (CREST) + Aftercare
3 Years After Release (N=448)
p < 0.05,
compared to No Treatment group
Percentage
of
Participants
Drug-Free Arrest-Free

31. We Need to Keep Our Eye on
the Real Target
In Treating Addiction…

32. Treatment Interventions
(New Targets & New Strategies)
Prevention Research (Children & Adolescents)
genetics
environment
development
co-morbidity
Priority Areas for NIDA
HIV/AIDS Research

33. Drug Use Has Played a Prominent
Role in the HIV/AIDS Epidemic
In Several Ways
Disease Transmission
• IV Drug Use
• Drug User Disinhibition Leading to
High Risk Sexual Behaviors
Progression of Disease

34. Seronegative HIV HIV + Drug
Acceleration of HIV Degeneration of
Dopamine Cells With Cocaine

35. Proportions of AIDS Cases in Adults &
Adolescents by Exposure in the USA
Source: Centers for Disease Control and Prevention (CDC)
Men who have sex with men (MSM)
Injection drug use
Heterosexual contact
MSM who inject drugs
Year of Diagnosis
%
of
Cases
70
60
50
40
30
20
10
0
1985 1987 1989 1991 1993 1995 1997 1999 2001 2003
Drugs of Abuse Have Had A Major Impact
on the HIV/AIDS Epidemic

36. International
Research
Collaboration
NIDA International
Program Components
Post-Doctoral Research Fellowship
Technical
Consultation
Scientific
Exchange
Information Dissemination

37. Why focus on drug abuse
internationally?
I. Drug abuse is a global
phenomenon
5 percent of people aged 15-64
II. Intertwined dual-epidemics of
drug addiction & HIV/AIDS
HIV Infections Attributed to
Injection Drug Use and Risky
Sexual Behaviors Related to
Drug Abuse
Millions of Users
160.9
26.2
13.7
15.9
7.9 Cannabis
Amphetamines
Ecstasy
Cocaine
Opiates
UNODC 2005 World Drug Report
III. Take advantage of unique opportunities to advance scientific
knowledge through research

38. NIDA Supports International Drug
Abuse Research In Numerous Ways
Fund international research
Provide training and exchange opportunities
Set international research priorities
Organize & sponsor conferences and meetings
Binational agreements
Dissemination of information

39. Where Do We Need
to Go From Here?
We Need to…
Advance the SCIENCE
Erase the STIGMA
and to…
Erase the STIGMA
and to…

40. For More Information
NIDA Public Information:
www.nida.nih.gov
www.drugabuse.gov
NIDA International Program:
www.international.drugabuse.gov
www.drugabuse.gov