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(Top 10 of 36 Problems)
Drug abuse
82%
Cancer
78%
Drunk driving
75%
Heart disease
74%
HIV/AIDS
73%
Violence
Child abuse
Smoking
71%
69%
68%
Alcohol abuse
65%
Stress
65%
For Example
Dopamine Pathways
striatum
frontal
cortex
Functions
reward (motivation)
pleasure,euphoria
motor function
(fine tuning)
compulsion
perserveration
decision making
hippocampus
substantia
nigra/VTA
Serotonin Pathways
nucleus
accumbens
raphe
Functions
mood
memory
processing
sleep
Neuronal structure
(receiving)
(sending)
stimulation
vesicle
Neuronal terminal
Drug :
transporter
cocaine
ritalin
Vmat
/serotonin
transporter
Vmat
serotonin/
DA/5HT
Accumbens
1100
1000
900
800
700
600
500
400
300
200
100
0
AMPHETAMINE
Much greater
DA
Activity thanDOPAC
any
HVA
Other drug of abuse
-causes neurotoxicity
% of Basal Release
400
250
Accumbens
Caudate
150
100
% of Basal Release
200
DA
DOPAC
HVA
100
250
NICOTINE
COCAINE
200
5 hr
Accumbens
300
% of Basal Release
% of Basal Release
2
3
4
Time After Cocaine
Accumbens
5 hr
ETHANOL
Dose (g/kg ip)
200
0.25
0.5
1
2.5
150
100
0
0
3 hr
1
2
3
Time After Ethanol
4hr
% of Basal DA Output
NAc shell
150
100
Empty
50
Box Feeding
SEX
200
150
100
15
10
5
0
0
60
120
Time (min)
180
ScrScr
BasFemale 1 Present
Sample 1 2 3 4 5
Number
6 7 8
Scr
Scr
Female 2 Present
9 10 11 12 13 14 15 16 17
Mounts
Intromissions
Ejaculations
Copulation Frequency
DA Concentration (% Baseline)
FOOD
Implication:
Elucidation of the mechanism of
drug addiction will help to
understand other addictive and
motivational behaviors/disorders
Pharmacodynamic mechanism
of Tolerance
PFC
ACG
Hipp
SCC
MOTIVATION/
DRIVE
(saliency)
REWARD
NAcc
VP
Amyg
MEMORY/
LEARNING
Reward Pathways:
Role of Opioids
A
B
C
behavior
expressed
C
B
dopamine initiated
Orbitofrontal cortex
Prefrontal
Cortex
Orbitofrontal cortex
C
A
Addiction
B
B
BB behavior
expressed
dopamine
AND
BRAIN IMAGING
Positron Emission Tomography
Decreases in Metabolism
in Orbito Frontal Cortex (OFC)
control
cocaine abuser
Comparison Subject
METH Abuser
Delayed recall
R = 0.64
p < 0.01
MOTOR FUNCTION
Slowed gait
Impaired balance
Implication:
Brain changes resulting from
prolonged use of psychostimulants,
such as methamphetamine
may be reflected in compromised
cognitive and motor functioning
Is There Recovery?
Good News: After 2 years some
of the dopamine deficits are
recovering
Bad News: Functional deficits
persist
What does this mean???
Cocaine
Alcohol
Food
treated
METH
Ability to Experience
Rewards Is Damaged
Less
Their Brains
Get Rewired
by Drug Use
INHERITED FACTORS
(genetic vulnerability-not
inevitability)
17
r-SA
r-candidate
22
Complex genetics
VULNERABILITY to What?
Starting Drug Use?
Liking Drugs More?
Continuing Drug Use?
Becoming Addicted?
Specific to A Particular Drug?
NicotineLiability to initiate=56%
Transition to dependence=70%
Smoking persistence= >50%
(Lerman & Berrettine, Amer. J. Med. Gen. 54 (2003) 48)
Genetics
Gene/
Environment
Interaction
Environment
PET Images:
Dopamine Receptor Density
More
likely
to selfadminister
Cocaine
National Comorbidity
Survey (NCS)
Nearly half of individuals with a past year
substance use disorder also had a mental
disorder
Mental disorders found to be most prevalent
included affective disorders, anxiety disorders,
personality disorders, and psychotic disorders
(Note: can we have parity for mental health without considering drug abuse?)
Drug
Cocaine and Methamphetamine
Disorder
Schizophrenia, paranoia,
anhedonia, compulsive
behavior
Stimulants
Synaptic vesicle
Serotonin/dopamine synaptic
terminal
transporter
Prozac,
Ritalin, &
Cocaine
block
Postsynaptic
target
Causes an effect
Activate transmitter receptors
Mechanism of action
of amphetamine and
cocaine
Mental
Disorder
Comorbid
Disorders
Addictive
Disorder
CRF
Pituitary
Gland
ACTH
CRF:
Corticotropin
Releasing
Factor
Adrenal
Glands
Kidneys
Stress
Responses
Stress
Responses
Stress
StressResponses
Responses
CORTISOL
Anxiety
DRUG USE
(Self-Medication)
CRF
STRESS
CRF
Anxiety
Anxiety
Prolonged
What
DRUG
USE
RELAPSE
Abstinence
Cocaine-trained rats
100
80
60
40
Alcohol-trained rats
Inactive Lever
Active Lever
20
0
Saline
Cocaine Footshock
Responses
Nicotine-trained rats
100
80
60
40
20
0
Saline
Nicotine
Footshock
Saline
Heroin Footshock
Alcohol-trained rats
45
30
15
0
Responses (3 hr)
60
Responses (1 hr)
60
Cocaine-trained rats
No stress
Intermittent Footshock
45
30
*
*
15
15
30
15
30
15
30
Objectives of Intervention:
Rearrange dominance of behavior tracks
contingency management (vouchers)
motivational enhancement
therapeutic communities
Prefrontal
Cortex
A
B
C
behavior
expressed
dopamine initiated
Orbitofrontal cortex
C
B
Prefrontal
Cortex
A
B
C
behavior
expressed
dopamine initiated
Orbitofrontal cortex
C
B
Prefrontal
Cortex
A
B
C
behavior
expressed
dopamine initiated
Orbitofrontal cortex
C
B
Prefrontal
Cortex
A
B
C
behavior
expressed
dopamine initiated
Orbitofrontal cortex
C
B
Targets of Medication
Methadone, LAAM and Buprenorphine
Activate opioid receptors
Naloxone
Block opioid receptors
Nicotine gum/patch
Activate nicotinic receptors
stimulation
Vmat
vesicle
Neuronal terminal
transporter
DA
Psychostimulants
Enhancing GABA-ergic inhibition
(baclofen-muscle relaxant; anti-seizureTiagabine)
Cannabinoid antagonist (rimonabant)
Prefrontal
Cortex
behavior
expressed
dopamine initiated
Orbitofrontal cortex
C
B
CRF
Abstinence
RELAPSE
No cure