Addictions and the Brain

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Dr. Daniel Boone, Medical Director of La Hacienda Treatment Center, discusses the correlation between addictions and our brains.

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Addictions and the Brain

  1. 1. Addictions and the Brain
  2. 2. Acknowledgements <ul><li>La Hacienda Treatment Center </li></ul><ul><li>American Society of Addiction Medicine </li></ul><ul><li>National Institute of Drug Abuse </li></ul>
  3. 3. Definition <ul><li>A primary, progressive biochemical, psychosocial, genetically transmitted chronic disease of relapse who’s hallmarks are denial, loss of control and unmanageability. </li></ul>
  4. 4. DSM IV Criteria for dependency: At least 3 of the 7 below <ul><li>Withdrawal </li></ul><ul><li>Tolerance </li></ul><ul><li>The substance is taken in larger amounts or over a longer period than was intended. </li></ul><ul><li>There is a persistent desire or unsuccessful efforts to cut down or control substance use. </li></ul><ul><li>A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects. </li></ul><ul><li>Important social, occupational, or recreational activities are given up or reduced because of the substance use. </li></ul><ul><li>The substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance. </li></ul>
  5. 5. Dispute between behavior and disease
  6. 6. Present understanding of the Hypothalamus location of the disease hypothesis.
  7. 12. Dispute regarding behavior versus disease
  8. 17. Natural Rewards Elevate Dopamine Levels 0 50 100 150 200 0 60 120 180 Time (min) % of Basal DA Output NAc shell Empty Box Feeding Source: Di Chiara et al. FOOD 100 150 200 DA Concentration (% Baseline) Mounts Intromissions Ejaculations 15 0 5 10 Copulation Frequency Sample Number 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 Scr Scr Bas Female 1 Present Scr Female 2 Present Scr Source: Fiorino and Phillips SEX
  9. 18. 0 100 200 300 400 500 600 700 800 900 1000 1100 0 1 2 3 4 5 hr Time After Amphetamine % of Basal Release DA DOPAC HVA Accumbens AMPHETAMINE 0 100 200 300 400 0 1 2 3 4 5 hr Time After Cocaine % of Basal Release DA DOPAC HVA Accumbens COCAINE 0 100 150 200 250 0 1 2 3 4 5hr Time After Morphine % of Basal Release Accumbens 0.5 1.0 2.5 10 Dose (mg/kg) MORPHINE 0 100 150 200 250 0 1 2 3 hr Time After Nicotine % of Basal Release Accumbens Caudate NICOTINE Source: Di Chiara and Imperato Effects of Drugs on Dopamine Levels
  10. 19. Post-Chronic Amphetamine (10 days) Pre-Amphetamine/Control Striatal FDOPA Activity 4 weeks 6 months 1 year 2 years Superior Inferior
  11. 22. Dopamine Transporters in Methamphetamine Abusers Methamphetamine abusers have significant reductions in dopamine transporters. Normal Control Methamphetamine Abuser p < 0.0002 Dopamine Transporters (Bmax/Kd) 1.0 1.2 1.4 1.6 1.8 2.0 2.2 2.4 BNL - UCLA - SUNY NIDA - ONDCP - DOE Normal Controls Meth Abusers
  12. 23. Dopamine Transporters in Methamphetamine Abusers BNL/UCLA/SUNY NIDA, ONDCP, DOE Motor Task Loss of dopamine transporters in the meth abusers may result in slowing of motor reactions. Memory Task Loss of dopamine transporters in the meth abusers may result in memory impairment. Time Gait (seconds) Delayed Recall (words remembered) Dopamine Transporter Bmax/Kd 7 8 9 10 11 12 13 1.0 1.2 1.4 1.6 1.8 2.0 4 6 8 10 12 14 16 1.0 1.2 1.4 1.6 1.8 2.0
  13. 24. Cocaine Food DA D2 Receptor Availability Meth Alcohol Dopamine D2 Receptors in Addiction Experimental groups Control groups
  14. 33. Drug Use Addiction Treatment Normal Challenge:
  15. 36. Three Major Relapse Pathways <ul><li>Cross Addicting Drugs </li></ul><ul><li>People/Place/Things </li></ul><ul><li>B.H.A.L.T. </li></ul>
  16. 37. Cross Addicting Drugs <ul><li>Chemical of choice </li></ul><ul><li>Related drugs </li></ul><ul><li>Tobacco </li></ul><ul><li>Life long relapse pathway </li></ul>
  17. 38. People/Place/Things <ul><li>History of discovery </li></ul><ul><li>Three month limit for relapse </li></ul>
  18. 39. B.H.A.L.T. <ul><li>Boredom </li></ul><ul><li>Hunger </li></ul><ul><li>Anger/emotions </li></ul><ul><li>Loneliness </li></ul><ul><li>Tiredness </li></ul>
  19. 40. Relapse Prevention Medications <ul><li>Antabuse </li></ul><ul><li>Campral </li></ul><ul><li>ReVia </li></ul><ul><li>Vivitrol </li></ul><ul><li>Off label </li></ul>
  20. 41. Antabuse <ul><li>Mechanism of action </li></ul><ul><li>Dosing </li></ul><ul><li>Side Effects </li></ul><ul><li>Efficacy </li></ul>
  21. 42. Campral <ul><li>Mechanism of action </li></ul><ul><li>Dosing </li></ul><ul><li>Side Effects </li></ul><ul><li>Efficacy </li></ul>
  22. 43. ReVia <ul><li>Mechanism of action </li></ul><ul><li>Dosing </li></ul><ul><li>Side Effects </li></ul><ul><li>Efficacy </li></ul>
  23. 44. Vivitrol <ul><li>Mechanism of action </li></ul><ul><li>Dosing </li></ul><ul><li>Side Effects </li></ul><ul><li>Efficacy </li></ul>
  24. 45. Off label
  25. 46. Cabergoline Disulfiram (Antabuse) Reserpine Selegiline Cocaine Methamphetamine Bupropion Lofexidine Opiates Phase 3 Clinical Trials On A Number of Promising Drugs
  26. 48. Dual Diagnosis <ul><li>Prevalence </li></ul><ul><li>Testing </li></ul><ul><li>Treatment </li></ul>
  27. 50. <ul><li>Spiritual Component of Recovery </li></ul>
  28. 51. <ul><li>Dr. Daniel Boone </li></ul><ul><li>La Hacienda Treatment Center </li></ul><ul><li>800-749-6160 </li></ul><ul><li>[email_address] </li></ul>

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