The Importance of Knowing Addiction as a Brain Disease Carlton Erickson, Ph.D. Director, Addiction Science Research and Education Center University of Texas at Austin, USA APIA-Singapore, 2004 What IS addiction? • heroin addiction • cocaine addiction • alcohol addiction (“alcoholism”) • marijuana addiction • amphetamine addiction • nicotine addiction What IS addiction? • sex addiction?? • gambling addiction?? • food addiction?? • shopping addiction???? • internet addiction???? • cell phone addiction???? A World Problem • The ability to solve a world problem is directly proportional to our ability to define it. • Are we dealing with a problem or a disease? A World Problem • The ability to solve a world problem is directly proportional to our ability to define it. • Are we dealing with a problem or a disease? • (Guess what? It doesn’t have to be one or the other. It could be BOTH!) How do we define addiction? • some people think it’s based upon problems people have when they are addicted - I have problems with my mother-in-law. Am I addicted to my mother-in-law? How do we define addiction? • some people think it’s based upon how much and how often the drug (activity) is carried out - university students drink a great amount of alcohol, usually many days a week. Are they all addicted to alcohol? How do we define addiction? • some people think it’s based upon a person’s personality or lack of will power - many addicts are high functioning, intelligent people with no other psychopathology - does this make sense? How do we define addiction? • I contend that “addiction” is not a useful scientific term - chocolate addiction, exercise addiction, television addiction • Is heroin addiction similar to exercise addiction? (Probably not..) • Has this dichotomy caused a problem in getting support for treatment, research, & education? In Fact, It’s Even Worse! • Stigma (against the disease) • Prejudice (against the addict) • Anger (toward the addict) • Misunderstanding (about what to do) SPAM leads to myths: widely-held inaccurate beliefs, as compared to research-generated facts) Too Many Myths! • “treatment doesn’t work” • “addicts are bad, crazy, stupid” • “crack is worse than cocaine” • “marijuana rots your brain” • “there is an addictive personality” • “sugar is addicting” The Facts…… • DSM and ICD: two drug problems • abuse: caused by rebellion, money, boredom, experimentation, thrillseeking, desperation, self-medication • dependence: caused by genetics, brain chemistry sensitivity, with input from the environment • we have medical and social criteria…. How to reduce these… • abuse - education, coercion, punishment, environmental change, maturation, pressure to stop, life events • dependence - “treatment” to positively affect abnormal brain function to reduce need for drug Where Drugs Work Medial Forebrain Bundle • ventral tegmental area (VTA) • (lateral) hypothalamus (LH) • nucleus accumbens (NAc) • frontal cortex (FC) - key portions - prefrontal cortex (pfc) - orbitofrontal cortex (ofc) Drugs Associated wth Neurotransmitters Why do people have “drugs of choice”? • Dopamine - amphets, cocaine, ETOH • Serotonin - LSD, ETOH • Endorphins - opioids, ETOH • GABA - benzos, ETOH • Glutamate -ETOH • Acetylcholine - nicotine, ETOH (Marijuana?) A Brain Chemistry Disease! • addicting drugs seem to “match” the transmitter system that is not normal • a chronic, relapsing, medical disease • there are mild, moderate, and severe forms • detox is traditionally the first step in the total treatment process • methadone and nicotine maintenance is evidence that some people require a chemical to overcome the non-normal transmitter system Important Point! Dependence is not a loss of “will power”, for two reasons: • The main problem with dependence lies in the subconscious MFB. • Problems with the frontal cortex produce a pathological impairment of decision-making. Thus, dependence is not primarily under conscious control! What Shall We Do? • remember that “addiction” is an imprecise term; use “dependence” to indicate disease • use “abuse” or “misuse” for overuse • remember that most people misunderstand “alcoholism” • try to use proper terminology in all technical and clinical situations Precedents for Change • Hansen’s Disease - leprosy • blood sugar disease - diabetes • Grave’s Disease - hyperthyroidism • common cold - influenza • Lou Gehrig’s Disease - ALS • Goldflam Disease - myasthenia gravis Today’s Options (It’s all about options….) • traditional: 12 step programs (abstinence) • talk: inpatient/outpatient/aftercare • misunderstood: harm reduction, MM • new: brief motivational counseling, CBT, MET, SO-involved therapy, vouchers • medical tx: new medications to enhance abstinence - anticraving meds, methadone, vaccines, drugs to alleviate withdrawal (MM= Moderation Management, CBT= cognitive behavioral therapy, MET= motivational enhancement therapy, SO = significant other) How does “talk therapy” work to help people stop using drugs? Logic Says: Behavioral Therapies Probably Change Brain Chemistry! We need more research! • There is lots of disagreement and misinformation in this field. • This is a result of not having all of the facts. • Facts come from good scientific research. • Facts reduce myths and stigma. RESEARCH VALIDITY ESTIMATE (RVE) (A Thoughtful Appraisal of High-Quality Scientific Research) 100 -0 High RVE • many large, well-controlled studies • replicable results • much peer-reviewed, published literature Low RVE • few replicable studies • highly speculative results • little peer-reviewed, published literature Things to Remember 100 • New research is changing our understanding of dependence (“addiction”). • Learning this new information requires a willingness to give up old ideas and learn new ones.