This document provides an overview of addiction as a brain disease, summarizing how drugs affect the brain's reward system and neurotransmitters. It describes the central nervous system, neurons, and key brain areas involved in addiction like the ventral tegmental area, nucleus accumbens, and prefrontal cortex. Withdrawal symptoms for different drug classes like alcohol, sedatives, stimulants, and opioids are outlined. Long term recovery involves outpatient support, meetings, counseling and potentially residential care.

1. Addiction –a brain disease
An overview for the
Cupcake Girls
• Nalini Velayudhan D.O.
• Board Certified Family
Practice
• Board Certified
Addiction Medicine
• June 2012

2. The Nervous System
• Made up of two parts:
– Central Nervous System
• Brain, nerve cells (neurons)
– Peripheral Nervous System
• Spinal Cord, and nerve cells

3. Neurons
• 100 billions nerve cells
• Send and receive
messages
• Nerve cells use
chemicals to
communicate with each
other.

4. Neurotransmitters
• Brain’s chemical
messengers
• Chemicals made in the
neuron, released in the
synapse and attach to
nearby neuron.

5. Brain
• Command center of
the body
• Weighs 3 lbs
• Drugs affect
different areas of
the brain:
– Brain stem
– Limbic system
– Cerebral Cortex

6. Brain
• Brain Stem: controls involuntary
functions such as heartbeat, breathing,
blood pressure, coughing, sneezing
• Cerebrum: learning, memory,
reasoning, controls muscles, hearing,
smelling, seeing, touching
• Cerebellum: controls balance, posture

7. Brain Areas involved in
• Brainstem: the ventral tegmental area
(VTA) at the top of the brainstem
contain nerve cells that use the
neurotransmitter DOPAMINE to relay
messages.
• Limbic System: the nucleus accumbens
receive the messages from dopamine-
containing neurons in the VTA.
• Cerebral Cortex: receive messages
from other parts of the brain to make

8. Brain

9. Brain
• Limbic System: located on top of the
brainstem and buried under the cortex
• More primitive brain structures
(amygdala, hippocampus)
• Involved in emotions and motivations,
particularly those related to survival~
fear, anger, and sexual behavior
• Also related to feeling of pleasure that
are related to survival such as eating,

10. Limbic System

11. Brain
Hijacked
• Drugs of abuse act directly on this
primitive area of the brainstem and
limbic system hijacking the higher
functioning cerebral cortex’s ability to
stay in control.
• Drugs override the cortex and there is
loss of reasoning and control.

12. Effects of Drugs of Abuse on the
Brain
• Drugs of abuse produce a pleasurable
event or “reward.”
• The brain is wired to repeat behaviors
that are rewarding.
• Drugs of abuse are mistakenly believed
to be essential to survival (like eating
and drinking water) in an addicted
brain.
• Drugs of abuse are many more times

13. Effects of drug abuse on the

14. Effects of drugs of abuse on the
brain
• Almost all drugs change the way the
brain works by altering chemical
neurotransmission.
– Dopamine *
– GABA
– NMDA
– Glutamate

15. Effects of drugs of abuse on the
• Nicotine: activate the nicotinic Ach
receptors.
• Alcohol: alters the balance between
neurotransmitters like GABA and
NMDA.
• Opiates (heroin, pain pills): mimic
effects of natural neurotransmitters at
mu receptors

16. Alcohol interacts with brain
chemicals

17. Opiates and the reward

18. Effects of drugs of abuse on the
brain
• PCP: blocks receptors and prevents
neuronal messages from getting
through.
• Methamphetamines: act by causing
neurotransmitters to be released in
greater amounts than normal into
synaptic cleft.
• Cocaine: interferes with the molecules

19. Cocaine and the reward

20. Effects of drugs of abuse on the
brain
• Prolonged drug use changes the brain
in fundamental and long-lasting ways.
• Drugs of abuse interfere with the way
nerve cells normally send, receive, and
process information.
• Drugs of abuse “hijack” the brain’s
ability to make the right decision

21. Addiction is a chronic disease
• Drug addiction is a chronic disorder
like diabetes, high blood pressure or
asthma.
• Treatment is essential- sometimes
repeated treatment and prolonged
treatment is needed.
• Treatment is behavior-based and
medical based.

22. How to catch a problem
• 1. Have you ever ridden in a car driven by
someone who had been using alcohol or
drugs?
• 2. Do you ever use alcohol or drugs to
relax, to feel better about yourself, or to
fit in?
• 3. Do you ever use alcohol or drugs when
you are alone?
• 4.Do you ever forget things you did while
using alcohol or drugs?
• 5. Do family or friends ever tell you to cut
down on your use of alcohol or drugs?

23. WITHDRAWAL

24. WITHDRAWAL
• Alcohol
• Sedative
• Stimulant
• Opioid

25. Alcohol Withdrawal
• Among patients who consume 20 standard
alcoholic drinks/day symptomatic
withdrawal is likely with abstinence.
• Three main categories of Alcohol Withdrawal
Syndrome:
– 1. Central nervous system excitation:
restlessness, agitation, seizures
– 2. Autonomic nervous system excessive activity:
nausea, vomiting, tachycardia, tremulousness,
hypertension
– 3. Cognitive dysfunction

26. Alcohol Withdrawal
• Three stages of withdrawal

27. Alcohol Withdrawal
• Stage 1: “minor withdrawal”
– Begins five to eight hours after last drink
– Characterized by anxiety, restlessness, agitation,
mild nausea, decreased appetite, sleep
disturbance, facial sweating, mild tremulousness,
and fluctuation tachycardia and hypertension

28. Alcohol Withdrawal
• Stage 2: “major withdrawal”
– Occurs 24 to 72 hours after last drink
– Characterized by marked restlessness and agitation,
moderate tremulousness with constant eye movement,
diaphoresis, nausea, vomiting, anorexia and diarrhea.
– Patients have marked tachycardia (>120 bpm) and elevated
systolic blood pressure (>160 mm Hg)
– “Alcoholic hallucinosis” may be present- can be auditory or
visual
– Patient may be confused but easily reoriented
– Seizures- typically grand mal- may occur, usually single,
last < 5mins. Status epilepticus is not associated with
alcohol withdrawal and indicates another problem

29. Alcohol Withdrawal
• Stage 3: “delirium tremens”
– Can occur from 72 to 96 hours after last drink
– Associated with fever, severe hypertension,
tachycardia, deliriums, drenching sweats, and
marked tremulousness
– Causes of death include head trauma,
cardiovascular complications, infections,
aspiration pneumonia and fluid & electrolyte
abnormalities

30. Sedative Withdrawal
• Sedative hypnotic drugs include:
– Alcohol
– Benzodiazepines
– Barbiturates
– Other sleeping pills

31. Sedative Withdrawal
• Signs of withdrawal may not be seen
for 7 to 10 days after last intake of
substance
– This is because many benzodiazepines
have long-acting metabolites
– Many individuals also take more than one
or more substance of abuse

32. Stimulant Withdrawal
• Amphetamines and Cocaine are the
most prevalent stimulants abused
• Amphetamines:
– Methamphetamine
– MDMA- ecstasy
• Cocaine:
– Cocaine HCL
– “crack”- alkaloid form of cocaine (smoked)

33. Stimulant Withdrawal
• “Crash” drastic • Malaise
reduction in mood and • Problems with memory,
energy concentration
• Craving the stimulant
• Occasional suicidal
• Craving for sleep, hyper ideation
somnolence
• Depressed mood • Craving can last months
to years after the last
• Anxiety
stimulant use
• Paranoia
• Hyperphagia- “the

34. Opioid Withdrawal
• Include Heroin, Methadone, Narcotic
pain medications like: Vicodin, Lortab,
Soma, Oxycodone, Percocet, Fentanyl,
Morphine

35. Opioid Withdrawal
• Watery eyes • Generalized body aches
• Sniffles / runny nose • Abdominal cramps
• Yawning • Pupillary dilation
• Muscle twitching • Anorexia
• Diarrhea/ loose stools
• Nausea and vomiting

36. Opioid Withdrawal
• Peak withdrawal symptoms most
severe with discontinuing heroin use
• Longest duration of withdrawal
symptoms with methadone but with
lower peak severity

37. Withdrawal
• Alcohol and Sedative withdrawal can be
lethal and life threatening sometimes
requiring hospitalization.
– Need monitoring and medical management
for withdrawal seizures, delirium tremens,
falls, head injury, aspiration
– Need treatment to replenish fluids, vitamins,
nutrients, support blood pressure, heart rate
• Opioid and Stimulant withdrawal less
likely to be lethal.

38. Long Term Recovery
• Long term care involves outpatient
support of medical condition
• 12 Step Recovery meetings like AA or
NA
• Intensive Outpatient Programs
• Counseling
• Residential Care
• Spiritual connection with family,

39. Outline
Resources:
Alcoholics Anonymous (AA): www.aa.org
National Council on Alcoholism and Drug
Dependence, Inc. (NCADD): 800-622-2255
or www.ncadd.org
Substance Abuse and Mental Health Services
Administration (SAMHSA): 800-622-HELP or
www.samsha.gov/treatment
National Institute on Alcohol Abuse and
Alcoholism (NIAAA): 301-443-3860 or
www.niaaa.nih.gov

40. THANK YOU!
TREAT ADDICTION SAVE LIVES !