DRUG ABUSE

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DRUG ABUSE MENTAL ILLNESS Progress in
Understanding COMORBIDITY
Donald R. Vereen, Jr., M.D., M.P.H. Special
Assistant to the Director National Institute on
Drug Abuse
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Effects of Drugs on Dopamine Levels
COCAINE
AMPHETAMINE
Accumbens
1100
Dopamine Pathways Principal Pleasure System of
the Brain
Accumbens
400
1000
900
DA
800
300
DA
700
600
of Basal Release
500
200
of Basal Release
400
300
100
200
100
0
0
0
1
2
3
4
5 hr
0
1
2
3
4
5 hr
Time After Amphetamine
Time After Cocaine
Source Di Chiara and Imperato
Natural Rewards Elevate Dopamine Levels
FOOD
SEX
200
200
NAc shell
150
150
100
100
of Basal DA Output
15
10
Empty
DA Concentration ( Baseline)
50
Copulation Frequency
Box
Feeding
5
0
0
Scr
Scr
Scr
Scr
0
60
120
180
Bas
Female 1 Present
Female 2 Present
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
Time (min)
Sample Number
Di Chiara et al.
Fiorino and Phillips
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Brain Dopamine System
DA
DA
Anatomy
DA
DA
DA
DA
DA
DA Transporters
signal
Dopamine Cell
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Dopamine D2 Receptors in Addiction
Cocaine
Meth
DA D2 Receptor Availability
Alcohol
Food
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Individually Housed
Group Housed
50
40
30

Reinforcers (per session)

Dominant
20
10
0
S
.003
.01
.03
.1
Cocaine (mg/kg/injection)
Subordinate
Morgan, D. et al. Nature Neuroscience, 5
169-174, 2002.
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Research Tells Us That STRESS Can Be A Major
Factor In the Initiation of Drug Use
And One of the Most Powerful Triggers for Relapse
In Recovering Addicts
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The Stress Hormone Cycle
Kidneys
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DRUG USE(Self-Medication)
What Role Does Stress Play In Initiating Drug
Use?
STRESS
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RELAPSE
What Happens When A Person Stops Taking A Drug?
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Addictive DisordersOften Co-Exist WithMental
Disorders
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Addictive Disorders Often Co-Exist with or
Predispose to Mental Disorders
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Lifetime Prevalence of Drug Disorders
Among Persons With Various Mental Disorders (vs.
any Drug Disorder Alone)
45
40
35
30
25
20
15
10
5
0
Schizo- phrenia
Anxiety
OCD
Depression
Any Drug Disorder (alone)
Panic Disorder
Bipolar Disorder
APD
Source Regier,D.A. et al., JAMA 264(19), pp.
2511-2518, November 21, 1990.
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What Do Mental and Addictive Disorders Have in
Common?
Both are Behavioral Dysfunctions With Similar
Neurobiological Basis
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Because of this overlap, drugs of abuse can cause
symptoms that mimic most forms of mental illness
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Dopamine D2 Receptors in Addiction
Experimental groups
Control groups
Cocaine
DA D2 Receptor Availability
Meth
Alcohol
Food
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Some drugs of abuse have a mechanism of action
similar to that of drugs used as
psychotherapeutic agents
Significance rationale for self-administration
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serotonin synaptic terminal
transporter
Synaptic vesicle
Prozac Cocaine block
Postsynaptic target
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Chronic use of some of these drugs may alter
the way the brain functions, making persons
particularly susceptible to mental illness
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Comorbid Disorders
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Increasing Knowledge About Any One of
These Commonly Co-existing Problems May Help Us
Better Understand the Others
Drug Abuse
Depression
HIV/AIDS
Risky Sexual Behavior
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Email from a Drug Addicted Subject 11.05.2003
I am a Dutch 30 year old male very addicted to
marihuana, alcohol and crack cocaine. I have no
social life and no job and feel more and more
isolated and have less and less hope to brake
free of this hell. . My life is a mess and did
several attempts to brake with my addictions in
the past. Now as I am so tired of trying I find
it very difficult to keep on fighting, even more
so, because of the depressed moods and feeling of
dissatisfaction while being clean. I do not feel
whole without the damned drugs any way