eighth edition - north carolina foundation for alcohol and ......professor terry wiseth, northland...
TRANSCRIPT
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Eighth Edition
Part I: Current Science of Addiction,
Relapse & Recovery: Dispelling The Stigmas
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Evolution of our Human Brain: Spinal Cord to
Diencephalon to Mammalian-Meso Cortex to Neo
Cortex
Fish 500 mya
Reptiles 300 mya
Amphibians 315 mya
Mammals 220 mya
Primates 65 mya Hominids 5 mya
Earth 4.5 Billion Years, Life from 4 Billion Years
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CNS Addiction Pathway
Survival/Reinforcement Circuit
Control Circuit
GO!
STOP!
Our Brain’s Go & Stop Switch
Stop Switch
Go
Switch
Brains Addiction Pathway
Blum K. et al. (2014)
Glucose metabolism in Prefrontal Cortex & Cingulate Gyrus
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Stop Switch
Go
Switch
Control Circuitry
Reasoning, Impulse Control, Temporal Processing, Planning, Judgment
Medial PFC = Value
Lateral PFCs = Costs
or consequences
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Limbic Area
• Role: Drive Generation (SURVIVAL)
• Intervention: Pharmacotherapy
Prefrontal Cortex
• Role: Executive Function
• Intervention: Counseling
Prefrontal
Cortex
Nucleus
Accumbens
Arcuate
Nucleus Ventral
Tegmental
Area
Brain Reward Pathways
Dopamine
Opioid Peptides
Glutamate
Courtesy of Dr. John Hart, Portland, Oregon
Similar Findings: Bando, Kenneth et al.
Am. J. of Psychiatry, 168(2):183-192, 2011
Courtesy of Paulus, M.P.; Tapert, S.F.;
and Schuckit, M.A. l NIDA, Archives of
General Psychiatry, 62(7), 2005
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© Magal Mondin and Daniel Choquet, CNRS, Universite Bordeaux 2
All Addiction Memories are processed as emotional
memories via the amygdala, these are faster and
have a more powerful influence on Behavior than
hippocampal working memories
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Courtesy of Max Planck Institute of Neurobiology
Prefrontal
Cortex
Nucleus
Accumbens
Arcuate
Nucleus Ventral
Tegmental
Area
Brain’s Addiction Pathway
Dopamine
Opioid Peptides
Glutamate
Courtesy of Dr. John Hart, Portland, Oregon
1. Stress activates
hypothalamus
release of corti-
cotropin Releasing
factor (CRF)
2. CRF activates
pituitary release of
adrenocortico-
tropic hormone
(ACTH)
3.ACTH activates
kidney adrenal
glands to release
cortisol
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Fish Cat Chimpanzee Human fr. 5Ma
Old Brain = Survival (5X faster and more powerful) than Neocortex = Control,
Planning and Decision Making
Addiction is a battle between the
old primal brain and the new brain
Dr. James Olds, McGill University
Toronto, Canada 1954
Operant Conditioning
Dr. Terry Robinson
U of Mchg. 2004
Incentive Sensitization Research Confirmation
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Dr. Robert Heath,
Tulane University, 1959
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• is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.
– (ASAM definition, Short Version)
ADDICTION DEFINITON American Society of Addiction Medicine
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Courtesy, Takeichi Laboratory, Nagoya, Japan
Courtesy of UC, San Diego, Goda, Y., Sailor, M., Collins, B.
Cell Body
Myelin Sheath
of Axon
Dendrite
Synapse
Dendritic Spine
By Age 6 100 Billion Neurons and then
Development of a Quadrillion Syapses
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Professor Terry Wiseth, Northland College
Courtesy of Thomas Deerinck, NCMIR/Photo
Researchers, Inc.
Professor Terry Wiseth,
Northland College
Courtesy of Thomas Deerinck, NCMIR/Photo Researchers, Inc.
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All Addictive Substance
Involve Dopamine Activity
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0
50
100
150
200
0 60 120 180
Time (min)
% o
f B
asal
DA
Ou
tpu
t
NAc shell
Empty
Box Feeding
Di Chiara et al., Neuroscience, 1999.
FOOD
Mounts Intromissions Ejaculations
Fiorino and Phillips, J. Neuroscience, 1997.
Natural Rewards Elevate Dopamine Levels
100
150
200
DA
Co
ncen
trati
on
(%
Baselin
e)
15
0
5
10
Co
pu
latio
n F
req
ue
nc
y
Sample
Number
1 2 3 4 5 6 7 8
SEX
Female Present
Natural and Drug Reinforcers
Increase Dopamine in NAc
VTA/SN
nucleus accumbens
frontal cortex
Drugs of abuse increase DA in the Nucleus Accumbens, which is believed
to trigger the neuroadaptions that result in addiction
0 100 200 300 400 500 600 700 800 900
1000 1100
0 1 2 3 4 5 hr
AMPHETAMINE
% o
f B
asa
l Re
lea
se
0
50
100
150
200
0 60 120 180 Time (min)
% o
f B
asa
l Re
lea
se
Empty
Box Feeding
Di Chiara et al., 1997
FOOD
150 125 100
0 20 40 60 80
MARIJUANA
% o
f B
asa
l Re
lea
se
Tanda, et al, Scienceb 1997
Di Chiara et al., 1997
0
100
200
300
400
500
600
700
800
900
1000
1100
0 1 2 3 4 5 hr
Time After Amphetamine
% o
f B
as
al R
ele
as
e
DA DOPAC HVA
Accumbens AMPHETAMINE
0
100
200
300
400
0 1 2 3 4 5 hr Time After Cocaine
% o
f B
as
al R
ele
as
e
DA DOPAC HVA
Accumbens COCAINE
0
100
150
200
250
0 1 2 3 4 5hr Time After Morphine
% o
f B
as
al R
ele
as
e Accumbens
0.5 1.0 2.5 10
Dose (mg/kg)
MORPHINE
0
100
150
200
250
0 1 2 3 hr
Time After Nicotine
% o
f B
as
al R
ele
as
e
Accumbens Caudate
NICOTINE
Di Chiara and Imperato, PNAS, 1988
Effects of Drugs on Dopamine Release Addiction: About 9% of Pot users may become dependent,
1 in 6 who start in adolescence and 25-50% of daily users
32
15
9
17
118
5
23
0
5
10
15
20
25
30
35
Per
cen
t
* Nonmedical Use Source: Anthony JC et al., 1994
Estimated Prevalence of Dependence Among Users
* *
American Psychiatric Association’s Diagnostic Manual (DSM) has included marijuana use disorders since
1980. DSM-5 added Marijuana Withdrawal as a diagnosis.
2012 UCSF Research Confirms Role of Endogenous Opioid
Neurotransmitters in Reward Circuitry as well as Dopamine
Beta Endorphin Met-Enkephalin
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Inhibitory Excitatory Labeled neurons in rodent reward circuitry that starts in dorsal raphe with
glutamate stimulation releasing dopamine to the VTA (pictured — ventral
tegmental area). Image courtesy Dr. Marisela Morales, NIDA IRP
Brain Imaging
//upload.wikimedia.org/wikipedia/commons/1/17/L-Glutamic-acid-zwitterion-3D-balls.pnghttp://en.wikipedia.org/wiki/File:Serotonin-Spartan-HF-based-on-xtal-3D-sf-web.png
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Multiple Brain Imaging Techniques
Normal Normal Normal Normal
Courtesy of Volkow, Wang, & Begleiter, et al.) Courtesy of Wang,Volkow, Panayotis & Fowler (2004)
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Control 1 Puff 3 Puffs 1 Cigarette 3 Cigarettes MRI
3.1 hour after smoking these amounts calculated PET
Brody,Al, et al (2008) Intl J Neuropsychopharm.
Courtesy of Daniel Amen, M.D.
Courtesy of Daniel Amen, M.D.
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http://1.bp.blogspot.com/_IA5nokOFh84/SxAA_9hHXGI/AAAAAAAAD0Y/3yHUqHbI_6M/s1600/internet+addiction.jpghttp://www.socioaffectiveneuroscipsychol.net/index.php/snp/article/viewFile/11814/19312/50652
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Brain scans of newly in love viewing photos of love vs. others show VTA
activity to NAcS to Frontal Cortex same as drug addiction. Major Symptoms of
Romantic Love: Craving for Emotional Union, Intense Thinking / Compulsion,
and Motivation to win the person that are involuntary and hard to control
Questions?
Expanding Sciences of Pain and Recovery
CNS Productions, InCNS Productions, Inc.
Medford, Oregon Eighth Edition
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