Rx ABUSE: BUILDING RESILIENCE
FROM THE BRAIN UP
Ruben Baler, Ph.D.
Science Policy Branch – NIDA - NIH
BRAIN
System 1 System 2
Fast
Automatic
Implicit
Effortless
Abstract
Slow
Conscious
Explicit
Effortful
Rule-based
Morewedge and K...
System 1 System 2
Fast Slow
Morewedge and Khaneman. Trends Cogn. Sci. 14(10):435-40. (2010)
RED BLUE GREEN RED
GREEN RED BLUE GREEN
BLUE GREEN RED BLUE
RED BLUE GREEN RED
GREEN RED BLUE GREEN
BLUE RED GREEN BLUE
intuition reasoning
What is it supposed to accomplished ?
look around eat reproduce
look around eat reproduce
look around eat reproduce
time
texting
while
driving
junk
food
virtual sex,
bizarre porn
look around eat reproduce
texting
while
driving
Junk
food
virtual sex,
bizarre porn
OBVIOUS
chronic stress heart disease mental illness addictions
NOT SO OBVIOUS …
Thinking about this problem in evolutionary terms is important …
efficient flexible
constant change
How does the brain achieve flexibility?
light noise
hormones stress hierarchy
nutrition
Our brains usually display high performance
in spite of environmental uncertainty
And just like thermostats, our brains are
ROBUST YET FRAGILE
■ robust to disturbances that the system is
designed to handl...
Seek the fattiest meat, the sweetest fruits, the most high-energy foods
the rise of processed foods
HighFructoseCornSyrup
(gr/capita)
SOURCE: U.S. Department of Justice
US Annual Production Quota (Kg)
~ 41% Rise in ADHD Dx Over the Past Decade (children 5-17)
Data collated from CDC, NSCH, and NHIS data
Boys
All children
G...
Fulton et al., Psychiatric Services 60(8):1075. (2009)
National Variation of ADHD Diagnostic Prevalence and Medication Use...
1 2
2
1
IncreaseStimulantConsumption(%)
The strength of accountability pressures (i.e., rewards + assistance +
sanctions),...
Obesity
18.5
3.5
11
2011
ADHD
6
2003
1997
1965
2008
HFCS
1972
High Fructose Corn Syrup
NCLB
2001
No Child left behind=
?
Rx Drugs Account for 7 out of the 14 most frequently abused drugs
Source: 2013 Monitoring the Future Study, University of ...
Misperceptions about their safety
Why?
Varied motivations for their abuse
Increasing environmental availability
look around eat reproduce
texting
while
driving
junk
food
virtual sex,
porn
ACQUIRE ROBUSTNESS
TO WHATEVER DROVE SELECTION
AT THE EXPENSE OF FRAGILITY
TO WHATEVER IT DID NOT
EVOLVED SYSTEMS
ROBUST YET FRAGILE
ROBUST YET FRAGILE
robust, yet
fragile
systems
are very
complex
100 Billion1 Quadrillion
But with some important differences
Connections billions quadrillions
Architecture simple nested
Adaptability primitive pl...
NEURO
TRANSMITTERS
Dopamine
Endocannabinoids
GABA
Glutamate
Serotonin
reward
Memory
emotion
reward
Memory
emotion
reward
motivation
Memory
emotion
reward
motivation
control
driverewar
d
memory
contr
ol
no go
go
cont
rol
reward
memor
y
drive
Volkow et al. The addicted human brain: insights from ...
Memory
emotion
reward
motivation
control
“As I sit to compose this plea I can’t say with any amount of certainty that my son
is alive. My son discovered narcotics ...
It’s not, it’s an operational failure
Volkow et al. The addicted brain:
Insights from imaging studies (2003)
is a moral fa...
tobacco
marijuana
analgesics
alcohol
cocaine
heroin
260M
meth
genetics
development
epigenetics
environment
parental style
education
• RESILIENCE
BRAIN
poverty
poor
parenting
deviant
peers
drug
availability
genes and development
environment
genes and development
increase risk
genes and development
increase risk
genes and development
Strategies to Empower System II
increase risk
genes and development
Strategies to Empower System IIincrease risk
genes and development
Ruben’s
Ten Suggestions
for raising
a balanced
brain
 Sleep hygiene
 Marshmallow-like games from early on
 Bilingualism
 Classroom-based physical activity
 Foster social ...
 Sleep hygiene
 Marshmallow-like games from early on
 Bilingualism
 Classroom-based physical activity
 Foster social ...
 Sleep hygiene
 Marshmallow-like games from early on
 Bilingualism
 Classroom-based physical activity
 Foster social ...
 Sleep hygiene
 Marshmallow-like games from early on
 Bilingualism
 Classroom-based physical activity
 Foster social ...
 Sleep hygiene
 Marshmallow-like games from early on
 Bilingualism
 Classroom-based physical activity
 Foster social ...
 Sleep hygiene
 Marshmallow-like games from early on
 Bilingualism
 Classroom-based physical activity
 Foster social ...
 Sleep hygiene
 Marshmallow-like games from early on
 Bilingualism
 Classroom-based physical activity
 Foster social ...
 Sleep hygiene
 Marshmallow-like games from early on
 Bilingualism
 Classroom-based physical activity
 Foster social ...
 Sleep hygiene
 Marshmallow-like games from early on
 Bilingualism
 Classroom-based physical activity
 Foster social ...
 Sleep hygiene
 Marshmallow-like games from early on
 Bilingualism
 Classroom-based physical activity
 Foster social ...
balerr@mail.nih.gov
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Vision Session: National Institute on Drug Abuse (NIDA): Addiction Science - Building Resilience from the Brain Up, Dr. Ruben Baler

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  • Between 1999 and 2003 a 1 point increase in the strength of the accountability index translated into a 2.3 increase in consumption.
  • VS_NIDA_Baler

    1. 1. Rx ABUSE: BUILDING RESILIENCE FROM THE BRAIN UP Ruben Baler, Ph.D. Science Policy Branch – NIDA - NIH
    2. 2. BRAIN
    3. 3. System 1 System 2 Fast Automatic Implicit Effortless Abstract Slow Conscious Explicit Effortful Rule-based Morewedge and Khaneman. Trends Cogn. Sci. 14(10):435-40. (2010)
    4. 4. System 1 System 2 Fast Slow Morewedge and Khaneman. Trends Cogn. Sci. 14(10):435-40. (2010)
    5. 5. RED BLUE GREEN RED GREEN RED BLUE GREEN BLUE GREEN RED BLUE
    6. 6. RED BLUE GREEN RED GREEN RED BLUE GREEN BLUE RED GREEN BLUE
    7. 7. intuition reasoning What is it supposed to accomplished ?
    8. 8. look around eat reproduce
    9. 9. look around eat reproduce
    10. 10. look around eat reproduce time texting while driving junk food virtual sex, bizarre porn
    11. 11. look around eat reproduce texting while driving Junk food virtual sex, bizarre porn
    12. 12. OBVIOUS
    13. 13. chronic stress heart disease mental illness addictions NOT SO OBVIOUS …
    14. 14. Thinking about this problem in evolutionary terms is important …
    15. 15. efficient flexible constant change
    16. 16. How does the brain achieve flexibility?
    17. 17. light noise hormones stress hierarchy nutrition
    18. 18. Our brains usually display high performance in spite of environmental uncertainty
    19. 19. And just like thermostats, our brains are ROBUST YET FRAGILE ■ robust to disturbances that the system is designed to handle. ■ fragile to rare events and flaws in the design.
    20. 20. Seek the fattiest meat, the sweetest fruits, the most high-energy foods
    21. 21. the rise of processed foods HighFructoseCornSyrup (gr/capita)
    22. 22. SOURCE: U.S. Department of Justice US Annual Production Quota (Kg)
    23. 23. ~ 41% Rise in ADHD Dx Over the Past Decade (children 5-17) Data collated from CDC, NSCH, and NHIS data Boys All children Girls 1997 1998 1999 2000 2001 2002 2003 2004-6 2007-9 2011-2 Year(s) Percent 16 14 12 10 8 6 4 2 0 historic rate of 3-7 %
    24. 24. Fulton et al., Psychiatric Services 60(8):1075. (2009) National Variation of ADHD Diagnostic Prevalence and Medication Use v 5 4 3 2 School Accountability Index
    25. 25. 1 2 2 1 IncreaseStimulantConsumption(%) The strength of accountability pressures (i.e., rewards + assistance + sanctions), helps explain both the variation over time and across states in the aggregate consumption of ADHD drugs. Bohhari and Schneider. School accountability laws and the consumption of psychostimulants. J. Health Econ. 30(2): 355-72 (2011). Strength of the accountability index
    26. 26. Obesity 18.5 3.5 11 2011 ADHD 6 2003 1997 1965 2008 HFCS 1972 High Fructose Corn Syrup NCLB 2001 No Child left behind= ?
    27. 27. Rx Drugs Account for 7 out of the 14 most frequently abused drugs Source: 2013 Monitoring the Future Study, University of Michigan
    28. 28. Misperceptions about their safety Why? Varied motivations for their abuse Increasing environmental availability
    29. 29. look around eat reproduce texting while driving junk food virtual sex, porn
    30. 30. ACQUIRE ROBUSTNESS TO WHATEVER DROVE SELECTION AT THE EXPENSE OF FRAGILITY TO WHATEVER IT DID NOT EVOLVED SYSTEMS
    31. 31. ROBUST YET FRAGILE
    32. 32. ROBUST YET FRAGILE
    33. 33. robust, yet fragile systems are very complex
    34. 34. 100 Billion1 Quadrillion
    35. 35. But with some important differences Connections billions quadrillions Architecture simple nested Adaptability primitive plastic
    36. 36. NEURO TRANSMITTERS Dopamine Endocannabinoids GABA Glutamate Serotonin
    37. 37. reward
    38. 38. Memory emotion reward
    39. 39. Memory emotion reward motivation
    40. 40. Memory emotion reward motivation control
    41. 41. driverewar d memory contr ol no go go cont rol reward memor y drive Volkow et al. The addicted human brain: insights from imaging studies (2003) Normal brainAddicted brain
    42. 42. Memory emotion reward motivation control
    43. 43. “As I sit to compose this plea I can’t say with any amount of certainty that my son is alive. My son discovered narcotics at the age of 13, [after] he experienced a severe orthopedic sports injury. There seems to be nothing that can induce him to stop for any appreciable length of time. I had him arrested May of 2006 for heroin possession and identity fraud, he stole 900 dollars from our checking account while I was in Connecticut burying my dad and his sister . He tells me he cannot stop. Our family is being destroyed . We have exhausted our savings and retirement. Everything seems so hopeless.” Volkow, Baler, Goldstein. Addiction: pulling at the neural threads of social behaviors. Neuron. 2011 Feb 24;69(4):599-602.
    44. 44. It’s not, it’s an operational failure Volkow et al. The addicted brain: Insights from imaging studies (2003) is a moral failure.
    45. 45. tobacco marijuana analgesics alcohol cocaine heroin 260M meth
    46. 46. genetics development epigenetics environment parental style education
    47. 47. • RESILIENCE
    48. 48. BRAIN
    49. 49. poverty
    50. 50. poor parenting
    51. 51. deviant peers
    52. 52. drug availability
    53. 53. genes and development
    54. 54. environment genes and development
    55. 55. increase risk genes and development
    56. 56. increase risk genes and development
    57. 57. Strategies to Empower System II increase risk genes and development
    58. 58. Strategies to Empower System IIincrease risk genes and development
    59. 59. Ruben’s Ten Suggestions for raising a balanced brain
    60. 60.  Sleep hygiene  Marshmallow-like games from early on  Bilingualism  Classroom-based physical activity  Foster social interaction  Grant age-appropriate control over life  Contemplative practice (e.g., meditation)  Reliable environments  Stance toward “Intellectual Struggle”  Embrace different brain architectures
    61. 61.  Sleep hygiene  Marshmallow-like games from early on  Bilingualism  Classroom-based physical activity  Foster social interaction  Grant age-appropriate control over life  Contemplative practice (e.g., meditation)  Reliable environments  Stance toward “Intellectual Struggle”  Embrace different brain architectures
    62. 62.  Sleep hygiene  Marshmallow-like games from early on  Bilingualism  Classroom-based physical activity  Foster social interaction  Grant age-appropriate control over life  Contemplative practice (e.g., meditation)  Reliable environments  Stance toward “Intellectual Struggle”  Embrace different brain architectures
    63. 63.  Sleep hygiene  Marshmallow-like games from early on  Bilingualism  Classroom-based physical activity  Foster social interaction  Grant age-appropriate control over life  Contemplative practice (e.g., meditation)  Reliable environments  Stance toward “Intellectual Struggle”  Embrace different brain architectures
    64. 64.  Sleep hygiene  Marshmallow-like games from early on  Bilingualism  Classroom-based physical activity  Foster social interaction (e.g., GBG Barrish, Saunders,&Wolf)  Grant age-appropriate control over life  Contemplative practice (e.g., meditation)  Reliable environments  Stance toward “Intellectual Struggle”  Embrace different brain architectures
    65. 65.  Sleep hygiene  Marshmallow-like games from early on  Bilingualism  Classroom-based physical activity  Foster social interaction (e.g., GBG Barrish, Saunders,&Wolf)  Grant age-appropriate control over life  Contemplative practice (e.g., meditation)  Reliable environments  Stance toward “Intellectual Struggle”  Embrace different brain architectures
    66. 66.  Sleep hygiene  Marshmallow-like games from early on  Bilingualism  Classroom-based physical activity  Foster social interaction (e.g., GBG Barrish, Saunders,&Wolf)  Grant age-appropriate control over life  Contemplative practices (e.g., meditation)  Reliable environments  Stance toward “Intellectual Struggle”  Embrace different brain architectures
    67. 67.  Sleep hygiene  Marshmallow-like games from early on  Bilingualism  Classroom-based physical activity  Foster social interaction (e.g., GBG Barrish, Saunders,&Wolf)  Grant age-appropriate control over life  Contemplative practices (e.g., meditation)  Reliable environments (Celeste Kidd)  Stance toward “Intellectual Struggle”  Embrace different brain architectures
    68. 68.  Sleep hygiene  Marshmallow-like games from early on  Bilingualism  Classroom-based physical activity  Foster social interaction (e.g., GBG Barrish, Saunders,&Wolf)  Grant age-appropriate control over life  Contemplative practices (e.g., meditation)  Reliable environments (Celeste Kidd)  Praise. Fixed vs. Growth mindsets (Carol Dweck)  Embrace different brain architectures
    69. 69.  Sleep hygiene  Marshmallow-like games from early on  Bilingualism  Classroom-based physical activity  Foster social interaction (e.g., GBG Barrish, Saunders,&Wolf)  Grant age-appropriate control over life  Contemplative practices (e.g., meditation)  Reliable environments (Celeste Kidd)  Praise. Fixed vs. Growth mindsets (Carol Dweck)  Embrace different brain architectures (Ken Robinson)
    70. 70. balerr@mail.nih.gov

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