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Pleasure Unwoven: A Personal Journey about Addiction companion handouts to the DVD Adapted from the lecture “Is Addiction Really a Disease?” by Kevin McCauley and produced by the Institute for Addiction Study, Salt Lake City, UT
Any good theory of addiction has to explain … ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
“ Choice”   vs.  “Disease” ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
The Disease Model (a CAUSAL model)
 
If ever we could fit addiction into this model, then it would win admission into ”The Disease Club”. . .
Addiction is a  BRAIN  disease ,[object Object],[object Object],[object Object],[object Object]
The Limbic (Emotional) Brain ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
The Key Parts of the Limbic Brain
The Frontal Cortex ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Orbitofrontal Cortex (OFC) ,[object Object],[object Object],[object Object],[object Object]
damage to  Orbitofrontal Cortex (OFC) ,[object Object],[object Object],[object Object],[object Object],[object Object]
Anterior Cingulate Cortex (ACC) ,[object Object],[object Object],[object Object],[object Object]
damage to  Anterior Cingulate Cortex (ACC) ,[object Object],[object Object],[object Object]
Prefrontal Cortex (PFC) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
damage to  Prefrontal Cortex (PFC) ,[object Object]
Failure of Executive Functioning ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Conditions associated with deficits in impulsive control ,[object Object],[object Object],[object Object],[object Object],[object Object]
But addiction does not begin in the Frontal Cortex … …  addiction begins at a deeper (and older) part of the brain: the “Midbrain”
The Midbrain is the  SURVIVAL  brain ,[object Object],[object Object],[object Object],[object Object]
The Midbrain (aka Limbic Brain) is your  SURVIVAL  brain. It handles: ,[object Object],[object Object],[object Object]
Drugs work in the  Midbrain ,[object Object],[object Object]
James Olds, PhD (1922 - 1976) ,[object Object],[object Object],[object Object]
Olds experiments:
Mice preferentially self-administer drugs of abuse like cocaine ONLY to the Reward Centers of the Midbrain ,[object Object],[object Object]
Mice get addicted to drugs, but … ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
In addiction, the drug hijacks the survival hierarchy and is so close to actual survival that it is indistinguishable from actual survival ,[object Object],[object Object],[object Object],[object Object]
In addiction, the  drug  is equated with  survival  at the level of the unconscious (i.e. the drug  IS  survival)
In addiction: a line is crossed ------------|------------> ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Addiction is a disorder in the brain’s Reward (Hedonic) System It is a broken “pleasure sense” in the brain
Brain Perceptual Systems (all of them): ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Addiction is a disorder of … ,[object Object],[object Object],[object Object],[object Object],[object Object]
Five Theories of Addiction ,[object Object],[object Object],[object Object],[object Object],[object Object]
Addiction is a disorder of … ,[object Object],[object Object],[object Object],[object Object],[object Object]
Genetic Vulnerability ,[object Object],[object Object],[object Object]
COMT gene & Impulsiveness  ,[object Object],[object Object],[object Object],[object Object]
Addiction is a disorder of … ,[object Object],[object Object],[object Object],[object Object],[object Object]
Addiction Neurochemical #1: Dopamine ,[object Object],[object Object],[object Object],[object Object],[object Object]
Drugs cause Dopamine Surges in the midbrain reward system
The Full Spectrum of Addiction ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Addiction is a disorder of … ,[object Object],[object Object],[object Object],[object Object],[object Object]
Addiction Neurochemical #2:  Glutamate ,[object Object],[object Object],[object Object],[object Object]
DOPAMINE (DA)  GLUTAMATE (Glu) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Relapse ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Addiction is a disorder of … ,[object Object],[object Object],[object Object],[object Object],[object Object]
STRESS  : a major player in addiction & relapse
We all face stress, yes . .. But we don’t all: ,[object Object],[object Object],[object Object],[object Object]
CHRONIC, SEVERE STRESS =   CRF and    CRF =   DAD2 receptors and   DAD2 receptors = Anhedonia  Anhedonia : Pleasure “deafness” ,[object Object],[object Object],[object Object]
Stress change the brain’s ability to process  Dopamine  (pleasure)
The Brain has a Hedonic “Set Point”
Another “set point” in the brain . . .
The Dopamine System changes in conditions of severe, chronic stress
High stress hormone levels reset the brain’s pleasure “set point”
Change in Hedonic Set Point: Old pleasures don’t show up
Anhedonia : Pleasure “deafness” ,[object Object],[object Object]
Drugs cause Dopamine Surges in the midbrain reward system
In addiction, the drug hijacks the survival hierarchy and is so close to actual survival that it is indistinguishable from actual survival ,[object Object],[object Object],[object Object],[object Object]
Addiction is a disorder of … ,[object Object],[object Object],[object Object],[object Object],[object Object]
The hypofrontal/craving brain state represents and imbalance between 2 brain drives ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
HYPOFRONTALITY: during craving states the cortex actually shuts off
The ventro-medial Prefrontal Cortex (vmPFC) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Craving / Drug Seeking ,[object Object],[object Object],[object Object],[object Object],[object Object]
Why the “Choice Argument” fails … ,[object Object],[object Object],[object Object],[object Object],[object Object]
How do we restore  the Frontal Cortex?
Addiction Part One: ,[object Object],[object Object],[object Object],[object Object]
Addiction Part Two: ,[object Object],[object Object],[object Object]
The Two Tasks of Addiction Treatment: ,[object Object],[object Object]
Then . . .
Definition of Addiction: ,[object Object],[object Object],[object Object],[object Object]
Addiction fits the “Disease Model!”
Questions? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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