Addiction and The Brain Inova Template 002

For Educational Use Only
ADDICTION AND THE BRAIN
HUSAM ALTHARI, MD
INOVA CATS
Addiction is a Complex Disease (CD is

a CD)
…with biological,
sociological and
psychological
components
How does the brain become addicted?
Drug use of any type activates the same circuits as do

behaviors linked to survival and pleasure
 Eating
 Bonding
 Sex
The drug causes a surge in levels of a brain chemical

called dopamine, which result in increased feelings of
pleasure. The brain remembers this pleasure and wants
it repeated.
Why do people take drugs in the first place?
To feel good To feel better

To have novel: To lessen:
 feelings  anxiety
 sensations  worries
 experiences  fear
 depression
AND  hopelessness
Movement Motivation
Dopamine
Addiction Reward & Well-being

Continued drug abuse
This begins as a choice – Brain imaging studies from

drug-addicted individuals show physical changes in areas
of the brain that are critical to:
 judgment
 decision making
 learning and memory
 behavior control
Scientists believe that these changes alter the way the
brain works, and may help explain the compulsive and
destructive behaviors of addiction.
Measuring Pleasure
Drugs boost the normal brain levels of the neurotransmitter

dopamine, which produces feelings of pleasure and increases
energy. Drugs causes an excessive spike in dopamine. Scientists
say the excessive release contributes to the drug’s destruction of the
brain.
Dopamine Index
 Cheeseburger 1.5
 Sex 2.0
 Nicotine 2.0
 Cocaine 4.1
 Methamphetamine 11.0
The Cycle of Addiction
What is addiction?
Addiction is a Brain Disease

Characterized by:
 compulsive behavior
 continued abuse of drugs despite negative consequences
 persistent changes in the brain’s structure and function
Addiction is like other diseases…
 It is preventable
 It is treatable
 It changes the biology of the body
 If untreated, it can lead to increased risk of
Mortality, Morbidity and can severely affect the
quality of the life of the patient
Effect of prolonged use - Tolerance
• Take higher doses

• Dose more frequently
• Change their method of drug
intake
• “Run” - forego food and sleep
while binging
• Strong cravings cause
impairment in judgment with
increase in impulsivity
Brain Reward Pathways
BIOCHEMICAL
Biologically Alcohol & other Drugs interfere with alter

neurotransmitters that allow neurons to communicate with each
other, tell our body what to do, how to react, what to experience, etc.
These things all happen in the “primitive” brain. (survival section)
The four major neurons addressed in addiction abuse are:
1. DOPAMINE – responsible for pleasure and reward

2. SEROTONIN – responsible for mood, sleep, appetite, perceptions
3. GABA – responsible for calming, sedation, anti-anxiety
4. ENDORPHINS – responsible for pain
5. Glutamate- Excitatory chemical responsible for the withdrawal
Vulnerability
Why do some people get addicted to drugs while others do not?
Risk Factors
Genetics
Genetics is a Big The Nature of this

Contributor to the Contribution Is
Risk of Addiction Extremely Complex
What environmental factors
contribute to addiction?
• Stress
• Trauma - Early physical or sexual abuse
• Trauma - Witnessing violence
• Peers who use drugs
• Drug availability
No singleForfactor
Educational Use Only
determines whether a
person will become addicted to drugs
• Genetic factors account for 40-60% of a person’s vulnerability
to addiction including the effects of environment on these
factors
• Parents or older family members who abuse alcohol or drugs,
or who engage in criminal behavior, can increase children's
risks of developing their own drug problems
• The earlier a person begins to use drugs the more likely they
are to progress to more serious abuse
• Method of administration. Smoking a drug or injecting it into a
vein increases its addictive potential
• Some people will never develop diabetes because they never
go over a certain weight –much like some people will never
become drug dependent because they never try drugs. If they
did, they would in both cases
Addiction is a developmental disease: It starts early
First Marijuana Use by % of Initiates

80
70 67%
60
50
40
30 26%
20
10 5.5%
1.5%
0
Child <12 Teen 12-17 Young Adult Adult >25
18-25
Does drugForabuse
cause mental disorders,
or vice versa?
• Drug abuse and mental disorders often co-exist. In

some cases, mental diseases may precede addiction;
in other cases, drug abuse may trigger or exacerbate
mental disorders, particularly in individuals with
specific vulnerabilities.
• 50-75% of all clients have some psychiatric disorder
Family Response to Addiction
• Behavioral observations
• Recognition
• Disenchantment
• Disaster
Matrix IOP 8-21

Family Members’ Response to
Drug Use
Observation Phase For Educational Use Only
• Unaware of problem
• Confusion regarding
occasional odd behaviors
• Concerned about occasional
neglect of responsibilities
Matrix IOP 8
Drug Use
Recognition PhaseFor Educational Use Only
• Are aware of the problem

• Attempt to solve the
problem
• Take on all responsibilities
Matrix IOP 8-23

Drug Use
Disenchantment Phase
• Avoidance of problem
• Blaming the person who is using
• Blaming selves
• Guilt and shame
Matrix IOP 8-24

Drug Use
Disaster Phase For Educational Use Only
• Separation
• Internalization of
bad feelings
• Resignation and
hopelessness
• Establishment of
unhealthful family
rules
Matrix IOP 8-25

Benefits of Family Involvement
• Participation by family members is associated with better

treatment compliance and outcome.
• Family members gain a clearer understanding of
recovery.
• Family members and the person in recovery understand
their respective roles and goals.
• Family members and the person in recovery get support
in the recovery process.
Matrix IOP 8-26

Treating aFor
Biobehavioral
Educational Use Disorder
Only Must Go
Beyond Just Fixing the Chemistry
We need to treat the whole person.
Pharmacological Behavioral Therapies

Treatments
(Medications)
Medical Services Social Services
In Social Context
Basic Treatment
For EducationalConsiderations
Use Only
Many substance dependent

individuals demonstrate:
1. Low Impulse Control
2. Low Tolerance for Frustration
3. High Likelihood of Psychiatric
Complications (paranoia, delusions,
agitated depression)
4. High Risk for Explosive, Violent
Behavior
5. High Risk of Depression and High
Risk of Suicide
6. Very Strong Craving
7. Cognitive and Memory Impairment
8. Brief Attention Span
Biopsychoosocial Treatment
Biological treatment: medical detox, anti craving

medications, treatment of Comorbid medical and
psychiatric disorders
Psychological treatment: Motivational counseling,

CBT, Intensive outpatient treatment
Psychoeducation, Family therapy
Social treatment: 12 step programs (AA, NA, Smart
recovery, Sober housing, drug courts
Treatment Can Work
• No single treatment is appropriate for all
individuals.
• Treatment needs to be readily available.
• Treatment must attend to multiple needs
of the individual, not just drug use.
• Multiple courses of treatment may be
required for success.
• Remaining in treatment for an adequate
period of time is critical for treatment
effectiveness.
What Does Work?
Treat them with respect:
• Listen to their concerns and reasons for continued or
relapse.
• Meet our clients where they are emotionally and
intellectually, not where we are.
• Use drug testing
• Clients must be held accountable and have to face
consequences for their actions.
Relapse
• 60% of people who successfully complete treatment will

relapse within the first year after leaving a facility.
• The leading cause for relapse is failure to follow the
prescribed continuing care plan set up at discharge.
The Memory of Drugs
Full recovery is a challenge, but it

is possible!
Relapse Rates are Similar
For Educational Usefor
OnlyDrug Addiction
and other Chronic Illnesses

ChronicFor
Medical Diseases’ Similarity
To Alcohol/Drug Dependence
Similarities to other chronic diseases:
• Less than 50% take medications as prescribed
• Less than 30% of patients comply with prescribed
behavioral change
• Relapse rates of 40% - 60% per year
• Re-emergence of symptoms following discontinuation
of treatment
Drug addiction is a chronic illness with relapse

rates similar to those of hypertension, diabetes,
and asthma.
Relapse – Lessons to Learn
• Demonstrates the recovering person’s continued

vulnerability
• Could show them that recovery is a life-long process
• Relapse can progress fast with progressive
psychological and behavioral changes
• Can start hours, days, weeks or months before a person
uses mood-altering chemicals
Remember
Resources
For More Information
NIDA Public Information:

www.nida.nih.gov
www.drugabuse.gov
NIDA International
Program:
www.international.drugab
use.gov

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For Educational Use Only

ADDICTION AND THE BRAIN

Addiction is a Complex Disease (CD is

Drug use of any type activates the same circuits as do

The drug causes a surge in levels of a brain chemical

To feel good To feel better

Addiction Reward & Well-being

This begins as a choice – Brain imaging studies from

Drugs boost the normal brain levels of the neurotransmitter

Addiction is a Brain Disease

• Take higher doses

Biologically Alcohol & other Drugs interfere with alter

1. DOPAMINE – responsible for pleasure and reward

Genetics is a Big The Nature of this

First Marijuana Use by % of Initiates

• Drug abuse and mental disorders often co-exist. In

Matrix IOP 8-21

• Are aware of the problem

Matrix IOP 8-23

Matrix IOP 8-24

Matrix IOP 8-25

• Participation by family members is associated with better

Matrix IOP 8-26

Pharmacological Behavioral Therapies

Medical Services Social Services

Many substance dependent

Biological treatment: medical detox, anti craving

Psychological treatment: Motivational counseling,

• 60% of people who successfully complete treatment will

Full recovery is a challenge, but it

and other Chronic Illnesses

Drug addiction is a chronic illness with relapse

• Demonstrates the recovering person’s continued

NIDA Public Information:

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