Download - Understanding Substance Use Disorders
Understanding Understanding Substance Use Substance Use
DisordersDisorders
Igor Koutsenok, MDUniversity of California San Diego
School of MedicineCenter for Addiction Research, Training & Application
Why study substance use Why study substance use disorders ?disorders ?
You will encounter itYou will encounter it It could happen to youIt could happen to you You need to know how to deal with itYou need to know how to deal with it Help eliminate the negative prejudice Help eliminate the negative prejudice
and stigmaand stigma Substance abuse & addiction are Substance abuse & addiction are
treatabletreatable You can make a differenceYou can make a difference
S.P.A.M.•Stigma
•Prejudice
•Anger
•Misunderstanding
All of these lead to myths: widely spread inaccurate believes as compared to research-generated facts
"Absinthe Drinker“ Pablo Picasso (1910)
Why do we call certain Why do we call certain chemicals chemicals
“psychoactive “psychoactive substances”?substances”?
Drug CategoriesDrug Categories
Based on usual effects at Based on usual effects at usual dosesusual doses
Drug CategoriesDrug Categories DepressantsDepressants StimulantsStimulants OpiatesOpiates CannabinolsCannabinols HallucinogensHallucinogens PCPPCP SolventsSolvents OthersOthers
Effects of CNS depressants
Effects of CNS stimulants (amphetamines)
Effects of CNS stimulants
Caffeine addiction
DefinitionsDefinitions
AbuseAbuse - intentional overuse in cases of - intentional overuse in cases of celebration, anxiety, despair, self-celebration, anxiety, despair, self-medication or ignorance. Tends to decline medication or ignorance. Tends to decline with consequences.with consequences.
DependenceDependence - impaired control over drug - impaired control over drug use, caused by a dysfunction of the use, caused by a dysfunction of the mesolymbic system, or “pleasure pathway”.mesolymbic system, or “pleasure pathway”.
Dependence = AddictionDependence = Addiction
Addiction is:Addiction is:
A pattern of chronic, relapsing, A pattern of chronic, relapsing, compulsive drug-taking behaviorcompulsive drug-taking behavior
Characterized by impaired control Characterized by impaired control over drug useover drug use
Remember...
Addiction is a disorder no one Addiction is a disorder no one chooses to havechooses to have
It is marked by a resistance to give It is marked by a resistance to give up drugsup drugs
Why only some Why only some people develop people develop
problems?problems?
Common risk factors and Common risk factors and vulnerabilitiesvulnerabilities
Alcoholism and drug addiction are Alcoholism and drug addiction are primarily psychological problemsprimarily psychological problems
Alcoholism and drug addiction are Alcoholism and drug addiction are primarily socio-environmental primarily socio-environmental problemsproblems
Alcoholism and drug addiction are Alcoholism and drug addiction are medical problems – diseasesmedical problems – diseases
Addictive Personality- ???Addictive Personality- ??? Self MedicationSelf Medication Personality Disorders (anti-social, OCD, etc..)Personality Disorders (anti-social, OCD, etc..) Self Esteem ProblemsSelf Esteem Problems Excessive Risk Taking Excessive Risk Taking Low Tolerance for TensionLow Tolerance for Tension
Drugs Reduce Tension = Drugs Reduce Tension =
People Use it and Get this Response = People Use it and Get this Response = ReinforcementReinforcement
Psychological ModelsPsychological Models
Socio-Cultural ExplanationsSocio-Cultural Explanations
Attitude Toward Drug TakingAttitude Toward Drug TakingAvailabilityAvailabilityCultural AcceptanceCultural Acceptance
Medical/Biological ExplanationMedical/Biological Explanation
Genetic evidence Genetic evidence -Adoption and twin studies-Adoption and twin studies
-Tolerance in sons of alcoholics -Tolerance in sons of alcoholics
-Genes as protective factors -Genes as protective factors
-What gets genetically transferred?-What gets genetically transferred?
-Genetically determined vs.genetically -Genetically determined vs.genetically influencedinfluenced
Environment40% Genetics
60%
Mesolymbic Dopamin SystemMesolymbic Dopamin System
Ventral-tagmental Ventral-tagmental areaarea ( (VTAVTA))
Lateral hypothalamusLateral hypothalamus ((LHLH))
Nucleus accumbens Nucleus accumbens (NA)(NA)
Fronto-orbital cortex Fronto-orbital cortex (FOC)(FOC)
Extended Amigdala Extended Amigdala (EA)(EA)
Axon
Neurotransmitter
Synaps
Dendrite
Receptors
Reuptace
МАО
Signal
storage
G-proteine
Neurotransmitters most Neurotransmitters most involved in dependenceinvolved in dependence
DopamineDopamine ( (cocaine, alcoholcocaine, alcohol)) SerotoninSerotonin (5-НТ) – ( (5-НТ) – (amphetamines, amphetamines,
alcoholalcohol)) EndorphinesEndorphines – ( – (opiates, alcoholopiates, alcohol)) GABAGABA - ( - (BZ, alcoholBZ, alcohol, , MDMA (?)MDMA (?) Glutamate – (alcohol, amphet.Glutamate – (alcohol, amphet. (?), (?), THC (?)THC (?) AcetylecholineAcetylecholine ( (THC, nicotine, alcohol THC, nicotine, alcohol ))
A Brain Chemistry DiseaseA Brain Chemistry Disease
Drugs seem to “match” the Drugs seem to “match” the transmitter system that is transmitter system that is
not normalnot normal
In other words…In other words…
The problem of dependence is not The problem of dependence is not in the bottle or syringein the bottle or syringe
The problem is in the brain The problem is in the brain dysfunctiondysfunction
Constellation of FactorsConstellation of Factors
Biological
Psychological
Social Genetic
PersonalityTraits
Environment
Conditioning
ADDICT
Risk FactorsRisk Factors
AdolescenceAdolescence Academic DifficultiesAcademic Difficulties Family History of Drug UseFamily History of Drug Use Excessive Risk Taking BehaviorExcessive Risk Taking Behavior
No One Is ImmuneNo One Is Immune
Pathways to Addiction
1. Experimentation
2. Active Seeking
3. Preoccupation
4. Addiction
“Not at all, I just told him that I hid the drugs in the backyard”
“Look, his behavior is improving!”
If you have more If you have more questions…questions…
[email protected]@ucsd.edu
858/551 2946858/551 2946