Vision Session: National Institute on Drug Abuse (NIDA): Addiction Science - Building Resilience from the Brain Up, Dr. Ruben Baler

1. Rx ABUSE: BUILDING RESILIENCE
FROM THE BRAIN UP
Ruben Baler, Ph.D.
Science Policy Branch – NIDA - NIH

2. BRAIN

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. System 1 System 2
Fast Slow
Morewedge and Khaneman. Trends Cogn. Sci. 14(10):435-40. (2010)

5. RED BLUE GREEN RED
GREEN RED BLUE GREEN
BLUE GREEN RED BLUE

6. RED BLUE GREEN RED
GREEN RED BLUE GREEN
BLUE RED GREEN BLUE

8. intuition reasoning
What is it supposed to accomplished ?

9. look around eat reproduce

10. look around eat reproduce

11. look around eat reproduce
time
texting
while
driving
junk
food
virtual sex,
bizarre porn

12. look around eat reproduce
texting
while
driving
Junk
food
virtual sex,
bizarre porn

13. OBVIOUS

14. chronic stress heart disease mental illness addictions
NOT SO OBVIOUS …

15. Thinking about this problem in evolutionary terms is important …

16. efficient flexible
constant change

19. How does the brain achieve flexibility?

20. light noise
hormones stress hierarchy
nutrition

22. Our brains usually display high performance
in spite of environmental uncertainty

24. 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.

28. Seek the fattiest meat, the sweetest fruits, the most high-energy foods

32. the rise of processed foods
HighFructoseCornSyrup
(gr/capita)

36. SOURCE: U.S. Department of Justice
US Annual Production Quota (Kg)

37. ~ 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 %

39. 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

40. 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

41. 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=
?

42. Rx Drugs Account for 7 out of the 14 most frequently abused drugs
Source: 2013 Monitoring the Future Study, University of Michigan

43. Misperceptions about their safety
Why?
Varied motivations for their abuse
Increasing environmental availability

44. look around eat reproduce
texting
while
driving
junk
food
virtual sex,
porn

45. ACQUIRE ROBUSTNESS
TO WHATEVER DROVE SELECTION
AT THE EXPENSE OF FRAGILITY
TO WHATEVER IT DID NOT
EVOLVED SYSTEMS

46. ROBUST YET FRAGILE

47. ROBUST YET FRAGILE

48. robust, yet
fragile
systems
are very
complex

49. 100 Billion1 Quadrillion

51. But with some important differences
Connections billions quadrillions
Architecture simple nested
Adaptability primitive plastic

54. NEURO
TRANSMITTERS
Dopamine
Endocannabinoids
GABA
Glutamate
Serotonin

58. reward

59. Memory
emotion
reward

60. Memory
emotion
reward
motivation

61. Memory
emotion
reward
motivation
control

62. 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

63. Memory
emotion
reward
motivation
control

64. “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.

65. It’s not, it’s an operational failure
Volkow et al. The addicted brain:
Insights from imaging studies (2003)
is a moral failure.

66. tobacco
marijuana
analgesics
alcohol
cocaine
heroin
260M
meth

68. genetics
development
epigenetics
environment
parental style
education

69. • RESILIENCE

71. BRAIN

72. poverty

73. poor
parenting

74. deviant
peers

75. drug
availability

78. genes and development

79. environment
genes and development

80. increase risk
genes and development

81. increase risk
genes and development

82. Strategies to Empower System II
increase risk
genes and development

83. Strategies to Empower System IIincrease risk
genes and development

84. Ruben’s
Ten Suggestions
for raising
a balanced
brain

85.  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

86.  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

87.  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

88.  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

89.  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

90.  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

91.  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

92.  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

93.  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

94.  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)

95. balerr@mail.nih.gov