Addiction is a Chronic Disease

1
(No Transcript)
2
Overall Goal

• To educate students about the neuroscience of
  addiction in preparation for working with clients
  with addictive disorders.

3
Learning Objectives for the 3-Hour Neuroscience
of Addiction Curriculum

• Have a good working definition of addiction
• Understand the prevalence and public health
  impact of addiction
• Understand genetic, biological, environmental
  risk factors that increase the vulnerability to
  addiction
• Understand the brain reward pathway and its
  central role in the neurobiology of addiction
• Understand research-based principles of
  prevention and treatment

4
Module 1
Exploring Addiction
5
Module 1 Learning Objectives

• To examine some of our pre-conceived ideas about
  what defines addiction as well as our ideas and
  judgments about the people who become addicted
  and their behavior.
• To develop a practical working definition of
  addiction based on the way scientists and
  researchers define it
• To learn some of the key developmental risk
  factors that increase the vulnerability to
  addiction
• To understand the prevalence of addiction as well
  as costs and public health impact of addiction
  nationally and locally at the University of
  Nevada at Reno (UNR)

6
Exploring Our Beliefs About Addiction

7
Common Beliefs About Addiction

• Addiction is a willpower problemthey could stop
  if they wanted to
• High relapse rates are evidence that drug
  treatment doesnt work
• You can/cant get addicted if you only try it
  once
• .all my friends smoked marijuana in high
  schooland they arent addicted

8
PEERS, GLAMOUR, THE RUSH AVAILABILITY of
Alcohol and Drug Use
9
How do YOU define addiction?

• Break into small groups
• Come up with a brief definition of what addiction
  is
• Report back to the class

10
How Do Researchers and Clinicians Define
Addiction?
11
Substance Use Disorders
A maladaptive pattern of use leading to
clinically significant impairment as manifested
by
Substance Dependence (Addiction)
Substance Abuse

• 3 or more of the following in a
• 12 month period
• Need larger amount to get
• the same effect (tolerance)
• Experience withdrawal symptoms
• or use of substance to avoid withdrawal symptoms
• Difficulty controlling use (substance taken in
  larger amounts or over longer periods than
  intended)
• Unsuccessful in efforts to cut down
• Important social, occupational/school, or
  recreational activities reduced or given up
  because of use
• increasing amount of time spent in obtaining
  substances, using or recovering from use
• Continued use despite negative physical, mental,
  social, or legal problems related to substance
  use

• One or more of the following
• in a 12 month period
• Recurrent use leading to failure to
• fulfill obligations at work, school, or home
• Use in hazardous situations
• Social or interpersonal problems
• because of use

American Psychiatric Association, DSM-IV-TR (2000)
12
What Does Science Say?Why Do People Become
Addicted?How Do People Become Addicted?Why Do
People Continue to Compulsively Use Despite
Negative Consequences?
13
What is Drug Addiction? Downward Spiral of Drug
Addiction
Casual, Experimental Use
Craving / Compulsive Behavior
Seeking
Use / Inability to Stop
Use Despite Negative Consequence
ADDICTION
14
Resiliency
Slide was re- created per your suggestions Please
review next slide
FamilySUD, abuse, neglect
Peers Deviant, Drug Involved
School Failure Truancy
Genetics
Onset of Substance Use
10
0
5
20
15
Life time, years

• Impedes Development of
• Coping Skills
• Social Interpersonal Skills
• Communication Skills
• Identity values consolidation
• Affect identification/regulation
• Self-Efficacy/external locus control
• Pro-Social Network

Mental Health Psychiatric Disorders ADHD,
Depression, Mood Disorders
Individual
15
Deviant Peers, Drug Involved
School, Failure, Truancy
The Individual
Family, SUD, Abuse, Neglect
Genetics
16
Prevalence Public Health Impact and Costs of
Addiction
17
Prevalence of Substance Use Disorders

• As many as half of individuals in the United
  States will develop problem substance use, abuse
  or dependence (addiction) at some point during
  their lifetime
• Research surveys show that as many as 85-90 of
  adolescents experiment with drugs or alcohol
  before graduating from high school
• Most adults with addiction began using when they
  were teenagers
• Most experimenters do not become addicted, but
  those who have developmental vulnerabilities are
  at greater risk

18
Prevalence of Substance Use Disorders

• Substance abuse and addiction increases risk of
  mental health problems or psychiatric disorders
  (eg ADHD, depression, anxiety disorders)
• Mental health problems or psychiatric illness
  increase the risk of addiction
• 1/2 of psychiatric disorders begin by age 14
  3/4 have onset by age 24
• 60-80 of adolescents who enter drug treatment
  programs have co-occurring psychiatric disorders

19
Prevalence of Substance Use Disorders and
Addiction Across the Lifespan

• Add current data showing prevalence of substance
  abuse /dependence in various age groups across
  the lifespan --to complement previous slide on
  developmental risk factors /etiology and
  adolescent onset
• Many good sources of this information on NIDA
  website

20

Public Health Impact of Addiction

• How Much Does This Chronic Illness Cost Society?

21
The Cost of Substance Abuse 1992-2002Estimated
annual economic impact in the US was over half a
trillion dollars

• 181 billion for illicit drugs
• 168 billion for tobacco
• 185 billion for alcohol

(http//drugabuse.gov/drugpages/hbo_faqs.html)
22
The Cost of Illicit Substance Abuse
1992-2002181 Billion

• Loss in Productivity - 129 billion
• Other - 36 billion
• Health care - 16 billion

http//www.whitehousedrugpolicy.gov/publications/e
conomic_costs/
23

• How does substance abuse at UNR compare to
  national and college survey data?

24
Does the UNR social environment promote
25
Survey http//www.siu.edu/departments/coreinst/pu
blic_html/ Data S. Meredith, Personal
communication, 2007
26
Comparison Of Reported Drug Use between UNR
Undergraduates (2006) and Reference College
Students (2005)
Survey http//www.siu.edu/departments/coreinst/pu
blic_html/ Data S. Meredith, Personal
communication, 2008
27
Comparison Of Reported Drug Use between UNR
Undergraduates and Reference College Students
(2008)
Survey http//www.siu.edu/departments/coreinst/pu
blic_html/ Data S. Meredith, Personal
communication, 2008
28
Comparison Of Reported Drug Use between UNR
Undergraduates in 2006 and 2008
Survey http//www.siu.edu/departments/coreinst/pu
blic_html/ Data S. Meredith, Personal
communication, 2008
29
College Students (UNR and National Sample)
Self-Reported Experiences Following Use of
Alcohol or Drugs 6 Or More Times in the Past
Year (2005)
30
UNR Students Reported Experiences Following Use
of Alcohol or Drugs 6 Or More Times in the Past
Year (2006)

• Have you ever felt the need to Cut down on your
  drinking?
• Have you ever felt Annoyed by someone criticizing
  your drinking?
• Have you ever felt bad or Guilty about your
  drinking?
• Have you ever had a drink first think in the
  morning to steady your nerves and get rid of a
  hangover (Eye-opener)?

• Hangover (25)
• Nausea / Vomiting (10)
• Driven a car while under the influence (8)
• Missed class (6)
• Done something they later regretted (5)
• Got into an argument or fight (4)
• Been criticized by someone they know (3)

Answering YES to two or more questions indicates
there may be a problem
JA Ewing (1984) 'Detecting Alcoholism The CAGE
Questionnaire', Journal of the American Medical
Association 252 1905-1907.
31
Summary of Module 1 Take Home Points
UCD Michelle, Joyce Nancy--do you want to add a
slide that instructors can use to introduce
module 2?

• Identified a working definition continued,
  compulsive use despite negative consequences
• The majority of individuals experiment with
  substances of abuse before the age of 25.
  However, most do not develop addiction.
• Biological and environmental risk factors
  increase the chances that experimentation may
  progress to addiction.
• Even those with few risk factors can become
  addicted by repeatedly using alcohol or drugs.
• Addiction impacts us all