The Importance of Knowing Addiction as a Brain Disease

1. The Importance of Knowing Addiction as a Brain Disease Carlton Erickson, Ph.D. Director, Addiction Science Research and Education Center University of Texas at Austin, USA APIA-Singapore, 2004

2. What IS addiction? • • heroin addiction • • cocaine addiction • • alcohol addiction (“alcoholism”) • • marijuana addiction • • amphetamine addiction • • nicotine addiction

3. What IS addiction? • • sex addiction?? • • gambling addiction?? • • food addiction?? • • shopping addiction???? • • internet addiction???? • • cell phone addiction????

5. A World Problem • • The ability to solve a world problem is directly proportional to our ability to define it. • • Are we dealing with a problem or a disease?

6. A World Problem • • The ability to solve a world problem is directly proportional to our ability to define it. • • Are we dealing with a problem or a disease? • • (Guess what? It doesn’t have to be one or the other. It could be BOTH!)

7. How do we define addiction? • • some people think it’s based upon problems people have when they are addicted • - I have problems with my mother-in-law. Am I addicted to my mother-in-law?

8. How do we define addiction? • • some people think it’s based upon how much and how often the drug (activity) is carried out • - university students drink a great amount of alcohol, usually many days a week. Are they all addicted to alcohol?

9. How do we define addiction? • • some people think it’s based upon a person’s personality or lack of will power • - many addicts are highfunctioning, intelligent people with no other psychopathology • - does this make sense?

10. How do we define addiction? • • I contend that “addiction” is not a useful scientific term • - chocolate addiction, exercise • addiction, television addiction • • Is heroin addiction similar to exercise addiction? (Probably not..) • • Has this dichotomy caused a problem in getting support for treatment, research, & education?

11. In Fact, It’s Even Worse! • • Stigma (against the disease) • • Prejudice (against the addict) • • Anger (toward the addict) • • Misunderstanding (about what to do) • SPAM leads to myths: widely-held inaccurate beliefs, as compared to research-generatedfacts)

12. Too Many Myths! • • “treatment doesn’t work” • • “addicts are bad, crazy, stupid” • • “crack is worse than cocaine” • • “marijuana rots your brain” • • “there is an addictive personality” • • “sugar is addicting”

13. The Facts…… • • DSM and ICD: two drug problems • • abuse: caused by rebellion, money, boredom, experimentation, thrill-seeking, desperation, self-medication • • dependence: caused by genetics, brain chemistry sensitivity, with input from the environment • • we have medical and social criteria….

14. How to reduce these… • • abuse - education, coercion, punishment, environmental change, maturation, pressure to stop, life events • • dependence - “treatment” to positively affect abnormal brain function to reduce need for drug

15. Where Drugs Work

17. Medial Forebrain Bundle • • ventral tegmental area (VTA) • • (lateral) hypothalamus (LH) • • nucleus accumbens (NAc) • • frontal cortex (FC) - key portions • - prefrontal cortex (pfc) • - orbitofrontal cortex (ofc)

18. Drugs Associated wth Neurotransmitters • Why do people have “drugs of choice”? • • Dopamine - amphets, cocaine, ETOH • • Serotonin - LSD, ETOH • • Endorphins - opioids, ETOH • • GABA - benzos, ETOH • • Glutamate -ETOH • • Acetylcholine - nicotine, ETOH • (Marijuana?)

19. A Brain Chemistry Disease! • • addicting drugs seem to “match” the transmitter system that is not normal • • a chronic, relapsing, medical disease • • there are mild, moderate, and severe forms • • detox is traditionally the first step in the total treatment process • • methadone and nicotine maintenance is evidence that some people require a chemical to overcome the non-normal transmitter system

20. Important Point! • Dependence is not a loss of“will power”, for two reasons: • • The main problem with dependence • lies in the subconsciousMFB. • • Problems with the frontal cortex • produce a pathological impairment of • decision-making. • Thus, dependence is not primarily under conscious control!

21. What Shall We Do? • • remember that “addiction” is an imprecise term; use “dependence” to indicate disease • • use “abuse” or “misuse” for overuse • • remember that most people misunderstand “alcoholism” • • try to use proper terminology in all technical and clinical situations

22. Precedents for Change • • Hansen’s Disease - leprosy • • blood sugar disease - diabetes • • Grave’s Disease - hyperthyroidism • • common cold - influenza • • Lou Gehrig’s Disease - ALS • • Goldflam Disease - myasthenia gravis

23. Today’s Options (It’s all about options….) • • traditional: 12 step programs (abstinence) • • talk: inpatient/outpatient/aftercare • • misunderstood: harm reduction, MM • • new: brief motivational counseling, CBT, MET, SO-involved therapy, vouchers • • medical tx: new medications to enhance abstinence - anticraving meds, methadone, vaccines, drugs to alleviate withdrawal • (MM= Moderation Management, CBT= cognitive behavioral therapy, • MET= motivational enhancement therapy, SO = significant other)

24. How does “talk therapy” work to help people stop using drugs?

25. Logic Says:Behavioral Therapies Probably Change Brain Chemistry!

26. We need more research! • • There is lots of disagreement and misinformation in this field. • • This is a result of not having all of the facts. • • Facts come from good scientific research. • • Facts reduce myths and stigma.

28. RESEARCH VALIDITY ESTIMATE (RVE) (A Thoughtful Appraisal of High-Quality Scientific Research) High RVE • many large, well-controlled studies • replicable results • much peer-reviewed, published literature Low RVE • few replicable studies • highly speculative results • little peer-reviewed, published literature 100 - 0

29. Things to Remember • • New research is changing our understanding of dependence (“addiction”). • • Learning this new information requires a willingness to give up old ideas and learn new ones. 100