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Suzanne Erb

PSYC62: Drugs and the Brain Lecture 5: Addiction “ADDICTION”: KEY MESSAGES 1. Addiction is a brain disease o Recent advances suggest that addiction like other brain diseases is a disease that develops over time and changes the brain in structure, function, and persistent long after - the changes are responsible for the distortions - the addicted brain looks completely different from someone who just used the drugs 2. Relapse is part of the disease o Relapse is very much an ongoing part of the addiction cycle - take a drug, stop taking the drug, and then resumption of drug taking - relapse is a very important feature over the long term also 3. Addiction is a treatable illness o It is a difficult disease to treat - don't know if it is curable yet - best treatment is medication, social services, rehabilitation services - pharmacy therapy must be combined with other interventions to be effective 4. The sooner an addict gets treatment the better 5. The longer an addict stays in treatment, the greater the chances that treatment will be effective o motivation also has to do with whether someone stays in treatment 6. Addiction is NOT a moral failure o There are physiological and genetic factors very susceptible to drugs - that and the so called right place and right time could make the person take drugs - this is not to say that addicts are victims of their genetics - there is a personal factor - once the addict spirals into addiction - the loss of control is the manifest of addiction - important part 7. Drugs and alcohol can highjack the brain’s reward system o Drugs are mediated by the same systems for the regular reward system 8. The risk factors for addiction may include genetic and environmental factors such as stress and availability o There are both environmental and genetic triggers 9. Drug and alcohol abuse usually begins in adolescence, when the brain is still undergoing dramatic changes in both structure and function o One theory is that adolescence because of the changes in the brain during this time, may be more sensitive to the rewarding effects and less sensitive to the aversive effects Alan Leshner (former director of NIDA):  “If we as a society ever hope to make any real progress in dealing with drug problems, we are going to have to rise above the moral outrage that addicts have ‘done it to themselves’ and develop strategies that are as sophisticated and as complex as the problem itself.” 1. Human face to addiction and set a context for the more research segments 2. Human face to addiction and set a context for the more research segments 3. The science of relapse 4. Adolescent addict 5. Brain imaging 6. Pharmacal treatment strategies 7. Pharmacal treatment strategies ADDICTION MOVIE NOTES Saturday night in dallas hospital ER  95% of all adults dependent on or abusing alcohol started drinking before age 21  At Parkland Memorial Hospital, there are over 30 000 injury related visits to the emergency room, almost half of them involving drugs or alcohol o A stabbing victim who was high on cocaine when attacked o A man who snapped his ankle after a night of drinking o An underage accident victim who celebrated his 20th birthday by downing 15-20 whiskey shots o A level 1 trauma patient who dies in the OR (had been on marijuana) Mother’s desperation  Donna as had a warrant issued for her daughter’s (Aubrey) arrest  Aubrey is 23 and a heroin addict for 7 years o Been in/out of rehab 12 times o She was in the gifted program at school, cheerleading, singing, but she never liked herself  People ask Donna where were you when this happened? She was right there  Aubrey turned herself in after 5 weeks  Aubrey was released the first time on her own recognizance The science of relapses  The tendency to relapse is very strong and part of the disorder, not a failure of treatment  William, addicted to crack cocaine, has entered a study at the university of Pennsylvania that is investigating the brain’s response to drug cues  In the brain we have the go system for helping us respond to natural rewards, and the stop system, that is important for telling us when it is important not to go, to stop  The stop system evolved to help us weigh the consequences of our impulses  With patients, it’s like the two systems are disconnected and the go system has run off on its own  The patient sees, smells, experiences reminding them of the drugs  Backlivan sort of reduces the go system The adolescent addict  15 year old Dylan has drug problem after being left by father at 10  Adolescents are more susceptible to lure of drugs than adult brains  Dylan’s stepfather says be became a cutter and used a slingshot to shoot out windows in a fit of  rage  Many families are unwilling to look outside the home for help  Less than 1 in 10 adolescents who meet clinical criteria for abuse or dependence are showing up to treatment  Dylan liked marijuana the most for its calming effect  Dylan would hurt himself or material things, not other people  His mom had to call the sheriff when he had a raging moment  They’re doing a bad job of identifying and getting kids who have problems into treatment, often parents and teachers think they will just grow out of it Brain imaging  John, a 43 year old methamphetamine user, is shown at MRI image of his brain next to a normal one,  Despite the visual evidence of damage, he is ambivalent about quitting  The brain has the tremendous capacity for recovery  Dopamine is the neurotransmitter that defines the brain’s pleasure pathways  Denial is a core feature of this disorder Opiate addiction: a new medication  In the 1960s, methadone was found to be successful in treating addiction to opiates like heroin. More recently, buprenorphine, which can be prescribed by physicians under the brand name Suboxone, has taken the treatment one step further. Amanda, 20, has been addicted to opioids (painkillers and heroin) for three years; her boyfriend Justin, 23, has been addicted six years. Together, they attend an orientation session at Acadia Hospital in Maine, learning about replacement therapy and Suboxone from Scott Farnum, Administrator of Substance Abuse Services. Explaining that the stimulation from opiates is "way mo
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