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…

ikoutzenok@ucsd.eduikoutzenok@ucsd.edu

858/551 2946858/551 2946