Addiction A Brain Disease

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Addiction A Brain Disease

• Mark Publicker, MD FASAM
• Medical Director
• Mercy Recovery Center

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Addiction is

• A brain disease and
• a behavioral disorder
• with a spiritual as well as medical cure

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Spirituality

• Having a sense of meaning and purpose in ones
  life
• Being able to give and receive support
• Being able to give and receive love

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Spirituality
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In active addiction

• The purpose of life is to get high
• Support and community is progressively lost
• The object of love is the drug

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genetics

• no single gene
• 40 genetic
• cloningers twin study
• coga
• p 300 waves

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co-morbid psychiatric disorders

• depression
• anxiety disorders
• bipolar disorder

• schizophrenia
• adhd
• ptsd
• asp

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Neural Circuitry of Reward

• Present in all animals
• Produces pleasure for behaviors needed for
  survival
• eating
• drinking
• sex
• nurturing

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All drugs abuse increase dopamine in the Reward
Center

• Alcohol
• Cocaine
• Heroin
• Marijuana
• Nicotine

• Amphetamines
• Sedatives
• Hallucinogens
• PCP
• Caffeine

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Dopamine

• Neurotransmitter - a chemical messenger
• Levels increase in the reward center when animals
  do those behaviors which ensure survival

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Injection of drugs or electrical stimulation into
the Reward Center
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Cocaine

• Plugs into the reward center nerve cells
• increases dopamine release
• blocks dopamine from being recycled

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Opiates

• Receptors for natural opiates (endorphin) found
  throughout the brain
• Increase dopamine levels in the Reward Center

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Marijuana (cannabis)

• Receptors for natural cannabinoids
• involved in pain control and in dumping memory

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All drugs of abuse bind to the neural circuitry
of reward
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Drugs of abuse hijack the Reward Center

• Instead of eating, drinking and making love,
  drugs tell you that you need to take them in
  order to survive.
• This is obviously a lie, and one that leads to
  sickness and death.

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Neuroadaptation

• Neuro brain or nervous system
• adaptation means change
• The brain is designed to maintain itself in the
  face of change

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Neuroadaptation

• Drugs change the brains balance
• The brain has mechanisms to oppose this change
• The balancing action overshoots
• The stronger the drug, the higher the dosage and
  the longer the use, the more the opposing change

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NeuroadaptationAlcoholics drink

• to get high
• to get sedated
• to get numb

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Positive reinforcers

• Euphoria
• Sedation
• Anesthesia (numbing)

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Neuroadaptation Alcohol

• High
• Sedated
• Numb

• Depressed
• Anxious and sleepless
• Anguish and pain

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Negative reinforcers

• Depression
• Anxiety
• Insomnia
• Boredom
• Loss of pleasure

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Alcohol quick high, long down
5 plus days
2 hours
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Neuroadaptation

• Cocaine addicts use cocaine
• To get high
• To get high
• To get high

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NeuroadaptationCocaine

• High
• High
• High

• Depressed
• Depressed
• Depressed

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Cocaine and mood changes
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NeuroadaptationCocaine

• Pet scan images show the brain in action
• Red working
• Blue blue

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Cocaine brain scan
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alcohol

• intoxication

sober
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• heroin

• marijuana

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Conditioning

• Ivan Pavlov
• Conditioned dogs to salivate when they heard a
  bell
• 7-11

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Amygdala

• Emotional responses
• Filters all incoming sensations
• Identifies both high risk and high pleasure
  stimuli
• Very rapid response

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Brain organization
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Brain organization

• The right brain thinks with images, not words
• There is no DONT ELEPHANT in the right brain
• DONT ELEPHANT ELEPHANT!!

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Which step says Dont drink?

• None of them

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Medications

• Naltrexone (Revia)
• Disulfiram (Antabuse)
• Bupropion (Zyban, Wellbutrin)
• Nicotine replacement
• Methadone
• Buprenorphine
• Acamprosate

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Revia

• Effective in treatment of alcoholism and opiate
  addiction
• Blocks craving
• Blocks the high and increases the negatives

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Suboxone

• New treatment for opiate addiction
• Can be prescribed by addiction medicine
  specialists
• Effective in stopping opiate use
• Blocks withdrawal
• Blocks craving
• Blocks euphoria

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Zyban (bupropion)

• Antidepressant
• decreases craving
• decreases withdrawal
• can increase abstinence rates
• side effects GI, anxiety, headaches

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Nicotine replacement

• Patches
• Gum
• Inhalers
• Decrease craving
• Improve abstinence rates
• Can be used with Zyban