Addiction: It’s a Brain Disease Beyond a Reasonable Doubt.
-
Upload
hunter-sader -
Category
Documents
-
view
229 -
download
6
Transcript of Addiction: It’s a Brain Disease Beyond a Reasonable Doubt.
![Page 1: Addiction: It’s a Brain Disease Beyond a Reasonable Doubt.](https://reader035.fdocuments.us/reader035/viewer/2022062318/551bfc32550346a34f8b49aa/html5/thumbnails/1.jpg)
Addiction: It’s a Brain Disease
Beyond a Reasonable Doubt
![Page 2: Addiction: It’s a Brain Disease Beyond a Reasonable Doubt.](https://reader035.fdocuments.us/reader035/viewer/2022062318/551bfc32550346a34f8b49aa/html5/thumbnails/2.jpg)
Presentation Objectives
• Identify impact of substance abuse & addiction
• Examine contribution of nature vs. nurture
• Explain how drugs “work”• Understand how prolonged drug use changes brain circuitry
• Understand how appropriate treatment can help people recover from drug abuse and addiction.
![Page 3: Addiction: It’s a Brain Disease Beyond a Reasonable Doubt.](https://reader035.fdocuments.us/reader035/viewer/2022062318/551bfc32550346a34f8b49aa/html5/thumbnails/3.jpg)
NEUROTOXICITYAIDSCANCERMENTAL ILLNESS
NEUROTOXICITYAIDSCANCERMENTAL ILLNESS
NeurotoxicityAIDS, CancerMental illness
NeurotoxicityAIDS, CancerMental illness
Health careProductivityAccidents
Health careProductivityAccidents
HomelessnessCrimeViolence
HomelessnessCrimeViolence
![Page 4: Addiction: It’s a Brain Disease Beyond a Reasonable Doubt.](https://reader035.fdocuments.us/reader035/viewer/2022062318/551bfc32550346a34f8b49aa/html5/thumbnails/4.jpg)
Estimated Economic Cost
to Society from Substance Abuse and Addiction:Illegal drugs: $181 billion/yearAlcohol: $185 billion/yearTobacco: $158 billion/year
Total: $524 billion/year
Surgeon General’s Report, 2004; ONDCP, 2004; Harwood, 2000.
![Page 5: Addiction: It’s a Brain Disease Beyond a Reasonable Doubt.](https://reader035.fdocuments.us/reader035/viewer/2022062318/551bfc32550346a34f8b49aa/html5/thumbnails/5.jpg)
Contributors to the Economic Costs of Substance Abuse and Addiction• Health care expenditures
– Alcohol and drug abuse services– Medical consequences
• Productivity (lost earnings)– Premature death– Impaired job performance– Institutionalized population– Incarceration– Criminal victimization
• Other impacts on society– Crime– Social welfare administration– Vehicular accidents
Adapted from Harwood et al., Addiction, 1999.
![Page 6: Addiction: It’s a Brain Disease Beyond a Reasonable Doubt.](https://reader035.fdocuments.us/reader035/viewer/2022062318/551bfc32550346a34f8b49aa/html5/thumbnails/6.jpg)
Between 50% and 80% of Adult Male Arrestees Tested Positive for Illicit Drug Use in 2000
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%A
lba
ny
Alb
uq
ue
rqu
e
An
cho
rag
e
Atla
nta
Ch
ica
go
Cle
vela
nd
Da
llas
De
nve
r
De
tro
it
Ho
no
lulu
Ind
ian
ap
olis
Mia
mi
Ne
w O
rle
an
s
Ne
w Y
ork
Ph
ilad
elp
hia
Ph
oe
nix
Po
rtla
nd
Sa
cra
me
nto
Sa
n A
nto
nio
Sa
n D
ieg
o
Sa
n J
ose
Se
attl
e
Sp
oka
ne
Tu
sco
n
Drug Use Correlates with Crime
2000 Arrestee Drug Abuse Monitoring: Annual Report, April 2003.
![Page 7: Addiction: It’s a Brain Disease Beyond a Reasonable Doubt.](https://reader035.fdocuments.us/reader035/viewer/2022062318/551bfc32550346a34f8b49aa/html5/thumbnails/7.jpg)
• More than 50% of violent crimes • 60-80% of child abuse and neglect cases
• 50-70% of theft and property crimes• 75% of drug dealing
Belenko and Peugh, 1998; National Institute of Justice, 1999.
The Perpetrator is Involved in Drug Use in…
![Page 8: Addiction: It’s a Brain Disease Beyond a Reasonable Doubt.](https://reader035.fdocuments.us/reader035/viewer/2022062318/551bfc32550346a34f8b49aa/html5/thumbnails/8.jpg)
However… advances in science have revolutionized our fundamental views of drug abuse and addiction, showing us that:
► abuse is a preventable behavior
► addiction is a treatable disease
![Page 9: Addiction: It’s a Brain Disease Beyond a Reasonable Doubt.](https://reader035.fdocuments.us/reader035/viewer/2022062318/551bfc32550346a34f8b49aa/html5/thumbnails/9.jpg)
used to be
![Page 10: Addiction: It’s a Brain Disease Beyond a Reasonable Doubt.](https://reader035.fdocuments.us/reader035/viewer/2022062318/551bfc32550346a34f8b49aa/html5/thumbnails/10.jpg)
Your Brain on Drugs Today
1-2 Min 3-4 5-6
6-7 7-8 8-9
9-10 10-20 20-30
YELLOW shows places in brain where cocaine goes (striatum)
Front of Brain
Back of Brain
Fowler et al., Synapse, 1989.
![Page 11: Addiction: It’s a Brain Disease Beyond a Reasonable Doubt.](https://reader035.fdocuments.us/reader035/viewer/2022062318/551bfc32550346a34f8b49aa/html5/thumbnails/11.jpg)
Common Myths About Drug Abuse…
• Drug abuse equates to drug addiction• Alcohol is not a drug• Addiction is a moral weakness• You have to hit rock bottom to recover• You have to want treatment for it to be successful
• Drug abuse is more common among minorities
![Page 12: Addiction: It’s a Brain Disease Beyond a Reasonable Doubt.](https://reader035.fdocuments.us/reader035/viewer/2022062318/551bfc32550346a34f8b49aa/html5/thumbnails/12.jpg)
What is Addiction?
• A brain disease expressed as a compulsive behavior
• The continued abuse of drugs despite negative consequences
• A chronic, potentially relapsing disorder
![Page 13: Addiction: It’s a Brain Disease Beyond a Reasonable Doubt.](https://reader035.fdocuments.us/reader035/viewer/2022062318/551bfc32550346a34f8b49aa/html5/thumbnails/13.jpg)
Why Do People Take Drugs in The First
Place?To feel
goodTo have novel:
feelingssensationsexperiences
ANDto share
them
To feel betterTo lessen:anxietyworriesfearsdepressionhopelessness
![Page 14: Addiction: It’s a Brain Disease Beyond a Reasonable Doubt.](https://reader035.fdocuments.us/reader035/viewer/2022062318/551bfc32550346a34f8b49aa/html5/thumbnails/14.jpg)
Why do some people become addicted while others do not?
Vulnerability
![Page 15: Addiction: It’s a Brain Disease Beyond a Reasonable Doubt.](https://reader035.fdocuments.us/reader035/viewer/2022062318/551bfc32550346a34f8b49aa/html5/thumbnails/15.jpg)
We Know There’s aWe Know There’s aBig Genetic Contribution toBig Genetic Contribution to
Drug Abuse and Addiction…Drug Abuse and Addiction…
…….Overlapping with Environmental .Overlapping with Environmental Influences that Help Make Influences that Help Make
Addiction a Complex Disease.Addiction a Complex Disease.
![Page 16: Addiction: It’s a Brain Disease Beyond a Reasonable Doubt.](https://reader035.fdocuments.us/reader035/viewer/2022062318/551bfc32550346a34f8b49aa/html5/thumbnails/16.jpg)
Biology/genes
Environment
Biology/EnvironmentInteractions
![Page 17: Addiction: It’s a Brain Disease Beyond a Reasonable Doubt.](https://reader035.fdocuments.us/reader035/viewer/2022062318/551bfc32550346a34f8b49aa/html5/thumbnails/17.jpg)
high
low
High DA receptor
Low DA receptor
DA Receptors and the Response to Methylphenidate (MP)
As a group, subjects with low receptor levels found MP pleasant while those with high levels found MP unpleasantAdapted from Volkow et al., Am. J. Psychiatry, 1999.
Dopamine receptor level
![Page 18: Addiction: It’s a Brain Disease Beyond a Reasonable Doubt.](https://reader035.fdocuments.us/reader035/viewer/2022062318/551bfc32550346a34f8b49aa/html5/thumbnails/18.jpg)
Drug Abuse Drug/Alcohol Related Traffic Accidents
Delinquency
Academic Failure and DroppingOut of School
Juvenile Depression
Sexually Transmitted Diseases (Including HIV/AIDS)
Running Away From Home
Unwanted Pregnancies
Suicidal Behavior
Community
Peer Cluster
Family
Individual
![Page 19: Addiction: It’s a Brain Disease Beyond a Reasonable Doubt.](https://reader035.fdocuments.us/reader035/viewer/2022062318/551bfc32550346a34f8b49aa/html5/thumbnails/19.jpg)
How Do Drugs “Work”?
![Page 20: Addiction: It’s a Brain Disease Beyond a Reasonable Doubt.](https://reader035.fdocuments.us/reader035/viewer/2022062318/551bfc32550346a34f8b49aa/html5/thumbnails/20.jpg)
Initially, a person takes a drug
hoping to change his or her mood,
perception, or emotional state
Translation – …hoping to change their
brains.
![Page 21: Addiction: It’s a Brain Disease Beyond a Reasonable Doubt.](https://reader035.fdocuments.us/reader035/viewer/2022062318/551bfc32550346a34f8b49aa/html5/thumbnails/21.jpg)
We know that despitetheir many
differences, most abused substances enhance the dopamine
and serotonin pathways
![Page 22: Addiction: It’s a Brain Disease Beyond a Reasonable Doubt.](https://reader035.fdocuments.us/reader035/viewer/2022062318/551bfc32550346a34f8b49aa/html5/thumbnails/22.jpg)
![Page 23: Addiction: It’s a Brain Disease Beyond a Reasonable Doubt.](https://reader035.fdocuments.us/reader035/viewer/2022062318/551bfc32550346a34f8b49aa/html5/thumbnails/23.jpg)
Basolateral Amygdala
Prefrontal Cortex
Mediodorsal Thalamus
Motor Nuclei
Ventral Pallidum
Nucleus Accumbens
Ventral Tegmental Area
GABA and Glutamate Role in Motivation
Adapted from Kalivas and Nakamura, Curr. Opin. Neurobiol., 1999.
Dopamine
Glutamate
GABA
![Page 24: Addiction: It’s a Brain Disease Beyond a Reasonable Doubt.](https://reader035.fdocuments.us/reader035/viewer/2022062318/551bfc32550346a34f8b49aa/html5/thumbnails/24.jpg)
Circuits Involved In Drug Abuse and Addiction
All of these must be consideredin developing strategies to effectively treat addiction
All of these must be consideredin developing strategies to effectively treat addiction
![Page 25: Addiction: It’s a Brain Disease Beyond a Reasonable Doubt.](https://reader035.fdocuments.us/reader035/viewer/2022062318/551bfc32550346a34f8b49aa/html5/thumbnails/25.jpg)
Alcohol vs. Other Drugs
We know that alcohol impairs the brain and results in addiction
with repeated use in the same way as other drugs
![Page 26: Addiction: It’s a Brain Disease Beyond a Reasonable Doubt.](https://reader035.fdocuments.us/reader035/viewer/2022062318/551bfc32550346a34f8b49aa/html5/thumbnails/26.jpg)
Storage
Synthesis
Precursor
Release
Reuptake
Degradation
Synaptic Cleft
= vesicle = neurotransmitters= receptor
![Page 27: Addiction: It’s a Brain Disease Beyond a Reasonable Doubt.](https://reader035.fdocuments.us/reader035/viewer/2022062318/551bfc32550346a34f8b49aa/html5/thumbnails/27.jpg)
![Page 28: Addiction: It’s a Brain Disease Beyond a Reasonable Doubt.](https://reader035.fdocuments.us/reader035/viewer/2022062318/551bfc32550346a34f8b49aa/html5/thumbnails/28.jpg)
dopamine transporters
![Page 29: Addiction: It’s a Brain Disease Beyond a Reasonable Doubt.](https://reader035.fdocuments.us/reader035/viewer/2022062318/551bfc32550346a34f8b49aa/html5/thumbnails/29.jpg)
0
50
100
150
200
0 60 120 180
Time (min)
% of Basal DA Output
NAc shell
Empty
Box Feeding
Di Chiara et al., Neuroscience, 1999.
FOOD
MountsIntromissionsEjaculations
Fiorino and Phillips, J. Neuroscience, 1997.
Natural Rewards Elevate Dopamine Levels
100
150
200
DA Concentration (% Baseline)
15
0
5
10
Copulation Frequency
SampleNumber
1 2 3 4 5 6 7 8
SEX
Female Present
![Page 30: Addiction: It’s a Brain Disease Beyond a Reasonable Doubt.](https://reader035.fdocuments.us/reader035/viewer/2022062318/551bfc32550346a34f8b49aa/html5/thumbnails/30.jpg)
![Page 31: Addiction: It’s a Brain Disease Beyond a Reasonable Doubt.](https://reader035.fdocuments.us/reader035/viewer/2022062318/551bfc32550346a34f8b49aa/html5/thumbnails/31.jpg)
0100200300400500600700800900
10001100
0 1 2 3 4 5 hr
Time After Amphetamine
% of Basal Release
DADOPACHVA
Accumbens AMPHETAMINE
0
100
200
300
400
0 1 2 3 4 5 hrTime After Cocaine
% of Basal Release
DADOPACHVA
AccumbensCOCAINE
0
100
150
200
250
0 1 2 3 4 5hrTime After Morphine
% of Basal Release Accumbens
0.51.02.510
Dose (mg/kg)
MORPHINE
0
100
150
200
250
0 1 2 3 hrTime After Nicotine
% of Basal Release
AccumbensCaudate
NICOTINE
Di Chiara and Imperato, PNAS, 1988
Effects of Drugs on Dopamine Release
![Page 32: Addiction: It’s a Brain Disease Beyond a Reasonable Doubt.](https://reader035.fdocuments.us/reader035/viewer/2022062318/551bfc32550346a34f8b49aa/html5/thumbnails/32.jpg)
prolonged drug use changes
the brain in fundamental
and long-lasting ways
Science has generated muchevidence showing that…
![Page 33: Addiction: It’s a Brain Disease Beyond a Reasonable Doubt.](https://reader035.fdocuments.us/reader035/viewer/2022062318/551bfc32550346a34f8b49aa/html5/thumbnails/33.jpg)
DA
D2
Re
cep
tor
Av
aila
bili
ty
Control Addicted
CocaineCocaine
AlcoholAlcohol
DA
DA
DA DA DA
DA
Reward Circuits
DA DA DA DA
DA
Reward Circuits
DA
DA
DA
DA DA
DA
Drug Abuser
Non-Drug Abuser
HeroinHeroin
MethMeth
Dopamine D2 Receptors are Lower in Addiction
DA
![Page 34: Addiction: It’s a Brain Disease Beyond a Reasonable Doubt.](https://reader035.fdocuments.us/reader035/viewer/2022062318/551bfc32550346a34f8b49aa/html5/thumbnails/34.jpg)
Dopamine Transporters in Methamphetamine AbusersDopamine Transporters in Methamphetamine Abusers
Normal Control
Methamphetamine Abuser
Motor TaskLoss of dopamine transporters in the meth abusers may result in slowing of motor reactions.
Memory taskLoss of dopamine transporters in the meth abusers may result in memory impairment.
7 8 9 10 11 12 131.0
1.2
1.4
1.6
1.8
2.0
Time Gait(seconds)
468101214161.01.2
1.4
1.6
1.8
2.0
Delayed Recall(words remembered)
Do
pam
ine
Tra
nsp
ort
erB
max
/Kd
Volkow et al., Am. J. Psychiatry, 2001. .
![Page 35: Addiction: It’s a Brain Disease Beyond a Reasonable Doubt.](https://reader035.fdocuments.us/reader035/viewer/2022062318/551bfc32550346a34f8b49aa/html5/thumbnails/35.jpg)
Implication:
Brain changes resulting from
prolonged use of drugs may compromise mental and motor
functions
![Page 36: Addiction: It’s a Brain Disease Beyond a Reasonable Doubt.](https://reader035.fdocuments.us/reader035/viewer/2022062318/551bfc32550346a34f8b49aa/html5/thumbnails/36.jpg)
Nature Video Cocaine Video
Conditioned Association Conditioned Association
1.5
0
.5
1.0
2.0
2.5
CRAVING INDUCTION IN A PET SETTING
N = 13
CR
AV
ING 5
43210-1 Neutral Cocaine
STIMULI
Childress et al., Am. J. Psychiatry, 1999
![Page 37: Addiction: It’s a Brain Disease Beyond a Reasonable Doubt.](https://reader035.fdocuments.us/reader035/viewer/2022062318/551bfc32550346a34f8b49aa/html5/thumbnails/37.jpg)
Memories Appear to Memories Appear to Be Be
A Critical Part of A Critical Part of AddictionAddiction
““Its about people, Its about people, places and places and things…”things…”
![Page 38: Addiction: It’s a Brain Disease Beyond a Reasonable Doubt.](https://reader035.fdocuments.us/reader035/viewer/2022062318/551bfc32550346a34f8b49aa/html5/thumbnails/38.jpg)
Cocaine Film
Cocaine Craving:Population (Cocaine Users, Controls) x Film (cocaine, erotic)
Garavan et al., Am. J. Psychiatry, 2000.
IFG
Ant. Cing.
Cingulate
Sig
nal
Inte
nsi
ty (
AU
)
Cocaine FilmErotic Film
Controls Cocaine Users
![Page 39: Addiction: It’s a Brain Disease Beyond a Reasonable Doubt.](https://reader035.fdocuments.us/reader035/viewer/2022062318/551bfc32550346a34f8b49aa/html5/thumbnails/39.jpg)
Drugs Are Usurping Drugs Are Usurping Brain CircuitsBrain Circuits
and and MotivationMotivational al PrioritiesPriorities
![Page 40: Addiction: It’s a Brain Disease Beyond a Reasonable Doubt.](https://reader035.fdocuments.us/reader035/viewer/2022062318/551bfc32550346a34f8b49aa/html5/thumbnails/40.jpg)
Treatment and the Cycle of Addiction
![Page 41: Addiction: It’s a Brain Disease Beyond a Reasonable Doubt.](https://reader035.fdocuments.us/reader035/viewer/2022062318/551bfc32550346a34f8b49aa/html5/thumbnails/41.jpg)
Addiction is the
Quintessential Biobehavioral
Disorder
![Page 42: Addiction: It’s a Brain Disease Beyond a Reasonable Doubt.](https://reader035.fdocuments.us/reader035/viewer/2022062318/551bfc32550346a34f8b49aa/html5/thumbnails/42.jpg)
DrugsDrugs
Brain MechanismsBrain
Mechanisms
BehaviorBehavior
EnvironmentEnvironment
Historical
Environmental
- Prior experience- Expectation- Learning
- Social interactions- Stress- Conditioned stimuli
- Genetics- Circadian rhythms- Disease states- Gender
Physiological
Drug Addiction: A Complex Behavioral and Neurobiological
Disorder
![Page 43: Addiction: It’s a Brain Disease Beyond a Reasonable Doubt.](https://reader035.fdocuments.us/reader035/viewer/2022062318/551bfc32550346a34f8b49aa/html5/thumbnails/43.jpg)
Source: Adapted from Volkow et al., Neuropharmacology, 2004.
DriveSaliency
Memory
Control
Non-Addicted Brain
NOT GO
Addicted Brain
Drive
Memory
Control
GOSaliency
Addiction Changes Brain Circuits
![Page 44: Addiction: It’s a Brain Disease Beyond a Reasonable Doubt.](https://reader035.fdocuments.us/reader035/viewer/2022062318/551bfc32550346a34f8b49aa/html5/thumbnails/44.jpg)
This is why treatment is essential
This is why addicts can’t just quit
![Page 45: Addiction: It’s a Brain Disease Beyond a Reasonable Doubt.](https://reader035.fdocuments.us/reader035/viewer/2022062318/551bfc32550346a34f8b49aa/html5/thumbnails/45.jpg)
Treating a Biobehavioral Disorder Must Go Beyond Just
Fixing the Chemistry
• Pharmacological (medications)• Behavioral Therapies• Medical and Social Services
![Page 46: Addiction: It’s a Brain Disease Beyond a Reasonable Doubt.](https://reader035.fdocuments.us/reader035/viewer/2022062318/551bfc32550346a34f8b49aa/html5/thumbnails/46.jpg)
We Need to Treat theWe Need to Treat theWhole Person!Whole Person!
In Social ContextIn Social Context
![Page 47: Addiction: It’s a Brain Disease Beyond a Reasonable Doubt.](https://reader035.fdocuments.us/reader035/viewer/2022062318/551bfc32550346a34f8b49aa/html5/thumbnails/47.jpg)
Treatment Can Work
![Page 48: Addiction: It’s a Brain Disease Beyond a Reasonable Doubt.](https://reader035.fdocuments.us/reader035/viewer/2022062318/551bfc32550346a34f8b49aa/html5/thumbnails/48.jpg)
But, drug addiction is a chronic illness with relapse rates similar
to those of hypertension, diabetes,
and asthma
McLellan et al., JAMA, 2000.
![Page 49: Addiction: It’s a Brain Disease Beyond a Reasonable Doubt.](https://reader035.fdocuments.us/reader035/viewer/2022062318/551bfc32550346a34f8b49aa/html5/thumbnails/49.jpg)
Relapse Rates Are Similar for Drug
Addiction & Other Chronic Illnesses
Drug Addiction
Type I Diabetes
0
10
20
30
40
50
60
70
80
90
100
Hypertension Asthma
40 to 60%
40 to 60%
30 to 50%
30 to 50%
50 to 70%
50 to 70%
50 to 70%
50 to 70%
Percent of Patients Who Relapse
McLellan et al., JAMA, 2000.
![Page 50: Addiction: It’s a Brain Disease Beyond a Reasonable Doubt.](https://reader035.fdocuments.us/reader035/viewer/2022062318/551bfc32550346a34f8b49aa/html5/thumbnails/50.jpg)
Addiction is Similar to Other Chronic Illnesses Because:• Recovery from it--protracted abstinence
and restored functioning--is often a long-term process requiring repeated treatments
• Relapses to drug abuse can occur during or after successful treatment episodes
• Participation in self-help support programs during and following treatment can be helpful in sustaining long-term recovery
Therefore…
![Page 51: Addiction: It’s a Brain Disease Beyond a Reasonable Doubt.](https://reader035.fdocuments.us/reader035/viewer/2022062318/551bfc32550346a34f8b49aa/html5/thumbnails/51.jpg)
012345678
Pre During Post
Hypertension Tx
Stage of Tx
YES
012345678
Pre During Post
Addiction Tx
Stage of Tx
NO
There is a right way and a wrong way to
Measure the Outcome of Treating Chronic Illnesses like Addiction
![Page 52: Addiction: It’s a Brain Disease Beyond a Reasonable Doubt.](https://reader035.fdocuments.us/reader035/viewer/2022062318/551bfc32550346a34f8b49aa/html5/thumbnails/52.jpg)
Full recovery is a challenge but it is possible …
![Page 53: Addiction: It’s a Brain Disease Beyond a Reasonable Doubt.](https://reader035.fdocuments.us/reader035/viewer/2022062318/551bfc32550346a34f8b49aa/html5/thumbnails/53.jpg)
DAT Recoverywith prolongedabstinence frommethamphetamine
[C-11]d-threo-methylphenidate
Volkow et al., J. Neuroscience, 2001.
low
high
Normal Control
Methamphetamine Abuser(1 month detoxification)
Methamphetamine Abuser (24 month abstinent)
![Page 54: Addiction: It’s a Brain Disease Beyond a Reasonable Doubt.](https://reader035.fdocuments.us/reader035/viewer/2022062318/551bfc32550346a34f8b49aa/html5/thumbnails/54.jpg)
Treatment Reduces Drug Use and Recidivism
No treatment
CREST Dropouts
CREST Completers
CREST Completers
+ Aftercare
No treatment
CREST Dropouts
CREST Completers
CREST Completers
+ Aftercare
Delaware Work Release Therapeutic Community (CREST) + Aftercare
3 Years After Release (N=448)
p < 0.05, compared to No Treatment group
Percentage of
Participants
Drug-Free Arrest-Free
![Page 55: Addiction: It’s a Brain Disease Beyond a Reasonable Doubt.](https://reader035.fdocuments.us/reader035/viewer/2022062318/551bfc32550346a34f8b49aa/html5/thumbnails/55.jpg)
We Need to Keep Our Eye onWe Need to Keep Our Eye on the Real Targetthe Real Target
Abstinence
Functionalit
y in
Family, Work
and Communit
y
In Treating Addiction…In Treating Addiction…
![Page 56: Addiction: It’s a Brain Disease Beyond a Reasonable Doubt.](https://reader035.fdocuments.us/reader035/viewer/2022062318/551bfc32550346a34f8b49aa/html5/thumbnails/56.jpg)
Since it was established in 1974, NIDA has supported research on drug abuse treatment for individuals who are involved with the criminal justice system.
![Page 57: Addiction: It’s a Brain Disease Beyond a Reasonable Doubt.](https://reader035.fdocuments.us/reader035/viewer/2022062318/551bfc32550346a34f8b49aa/html5/thumbnails/57.jpg)
Surgeon General’s Report, 2004; ONDCP, 2004; Harwood, 2000.
Adapted from Harwood et al., Addiction, 1999.
2000 Arrestee Drug Abuse Monitoring: Annual Report, April 2003.
Belenko and Peugh, 1998; National Institute of Justice, 1999.
Fowler et al., Synapse, 1989.
Adapted from Volkow et al., Am. J. Psychiatry, 1999.
Adapted from Kalivas and Nakamura, Curr. Opin. Neurobiol., 1999.Di Chiara et al., Neuroscience, 1999.Fiorino and Phillips, J. Neuroscience, 1997.Di Chiara and Imperato, PNAS, 1988
Volkow et al., Am. J. Psychiatry, 2001
Garavan et al., Am. J. Psychiatry, 2000.
Childress et al., Am. J. Psychiatry, 1999.Childress et al., Am. J. Psychiatry, 1999.
Source: Adapted from Volkow et al., Neuropharmacology, 2004.
McLellan et al., JAMA, 2000.
McLellan et al., JAMA, 2000.
Volkow et al., J. Neuroscience, 2001.
![Page 58: Addiction: It’s a Brain Disease Beyond a Reasonable Doubt.](https://reader035.fdocuments.us/reader035/viewer/2022062318/551bfc32550346a34f8b49aa/html5/thumbnails/58.jpg)
We want to thank TASC, Inc., of Illinois for their contribution to this presentation.