The Importance of Knowing Addiction as a Brain Disease Carlton Erickson, Ph.D.

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.