Department of Pharmacology,Department of Pharmacology,

College of Medicine, Hallym UniversityCollege of Medicine, Hallym University

The Addicted BrainThe Addicted Brain

COPYRIGHT 2004 SCIENTIFIC AMERICAN, INC.

INTRODUCTIONINTRODUCTION

• Neurobiologists have long known that the euphoria Neurobiologists have long known that the euphoria induced by drugs of abuse arises because all these induced by drugs of abuse arises because all these chemicals ultimately boost the activity of the chemicals ultimately boost the activity of the brain’s brain’s reward system.reward system.

• New research indicates that chronic drug use New research indicates that chronic drug use induces induces changes in the structure and function of the changes in the structure and function of the system’s neuronssystem’s neurons that last for weeks, months or that last for weeks, months or years after the last fix.years after the last fix.

• Improved understanding of these neural alterations Improved understanding of these neural alterations should help provide better interventions for should help provide better interventions for addiction.addiction.

1) Mesolimbic dopamine pathway1) Mesolimbic dopamine pathway - Neurons from ventral tegmental area (VTA) to nucleus accumbens (major neurotransmitter:dopami- Neurons from ventral tegmental area (VTA) to nucleus accumbens (major neurotransmitter:dopami

ne)ne) - A critical pathway for drug addiction- A critical pathway for drug addiction

2) Amygdala: 2) Amygdala: - help to assess whether an experience is pleasurable or aversive - help to assess whether an experience is pleasurable or aversive - and whether it should be repeated or avoided- and whether it should be repeated or avoided - to forge connections between an experience and other cues- to forge connections between an experience and other cues

3) Hippocampus:3) Hippocampus: - recording the memories of an experience- recording the memories of an experience 4) Frontal regions:4) Frontal regions: - coordinate and process all this information and determine the ultimate- coordinate and process all this information and determine the ultimate behavior of the individual.behavior of the individual.

5) VTA-accumbens patheway5) VTA-accumbens patheway - acts as a rheostat of reward: it tells the other brain centers how rewarding an - acts as a rheostat of reward: it tells the other brain centers how rewarding an activity is. The more rewarding an acitivity is deemed, the more likely the organism is to remember activity is. The more rewarding an acitivity is deemed, the more likely the organism is to remember

it well and repeat itit well and repeat it

Key Components of the Reward CircuitryKey Components of the Reward Circuitry

VTA and Nucleus AccumbensVTA and Nucleus Accumbens-Experiment-Experiment

1) The animals are connected to an intravenous line.1) The animals are connected to an intravenous line. (same substances that humans abuse-cocaine, heroin, amphet(same substances that humans abuse-cocaine, heroin, amphet

amine and many other common habit-forming drugs)amine and many other common habit-forming drugs)2) Three groups2) Three groups - lever to receive an infusion of drug through the IV- lever to receive an infusion of drug through the IV lever to get a relatively uninteresting saline solutionlever to get a relatively uninteresting saline solution lever to request a food pelletlever to request a food pellet3) Result3) Result - HOW? Think.- HOW? Think.4) Mapped the regions of the brain’s reward circuit.4) Mapped the regions of the brain’s reward circuit.

5) The dopamine pathway from the VTA to the nucleus accumbens 5) The dopamine pathway from the VTA to the nucleus accumbens is critical for addictionis critical for addiction

VTA and Nucleus AccumbensVTA and Nucleus Accumbens

Using functional magnetic resonance imaging(fMRI) or positron emission tomography(PET).The same region react in compulsive gamblers suggesting that the VTA-accumbens pathwayhas a similarly critical role even in nondrug addictions

Questions:Questions:

1) How is it possible that diverse addictive substances – which ha1) How is it possible that diverse addictive substances – which have no common structural features and exert a variety of effecve no common structural features and exert a variety of effects on the body- all elicit similar response in the brain’s rewarts on the body- all elicit similar response in the brain’s reward circuitry?d circuitry?

2) How can cocaine, a stimulant that causes the heart to race, and 2) How can cocaine, a stimulant that causes the heart to race, and heroin, a pain-relieving sedative, be so opposite in some wayheroin, a pain-relieving sedative, be so opposite in some ways and yet alike in targeting the reward system?s and yet alike in targeting the reward system?

The answerThe answer is that all drugs of abuse, in addition to any other effeis that all drugs of abuse, in addition to any other effect cause the nucleus accumbens to receive a flood of dopamict cause the nucleus accumbens to receive a flood of dopamine and sometimes also dopamine-mimicking signals. ne and sometimes also dopamine-mimicking signals.

- Cocaine and other Stimulants;- Cocaine and other Stimulants;

disable the transporter protein that returns the neurotransmitter disable the transporter protein that returns the neurotransmitter to the VTA neuron terminals, thereby leaving excess dopamine to the VTA neuron terminals, thereby leaving excess dopamine to act on the nucleus accumbensto act on the nucleus accumbens

- Morphine, Heroin and other Opoids;- Morphine, Heroin and other Opoids;

bind to neurons (ex:GABA neurons) in the VTA that normally shbind to neurons (ex:GABA neurons) in the VTA that normally shut down the dopamine-producing VTA neuronsut down the dopamine-producing VTA neurons

Opioids can also generate a strong “reward” message by actinOpioids can also generate a strong “reward” message by acting directly on the nucleus accumbensg directly on the nucleus accumbens

- But drugs do more than provide dopamine jolt that induces euph- But drugs do more than provide dopamine jolt that induces euphoria and mediates the initial reward and reinforcement. Overtimoria and mediates the initial reward and reinforcement. Overtime and with repeated exposure, they initiate the gradual adaptatie and with repeated exposure, they initiate the gradual adaptations in the reward circuitry that give rise to addiction ons in the reward circuitry that give rise to addiction

CREBCREB

- Both tolerance and dependence occur because frequent drug- Both tolerance and dependence occur because frequent drug

use can, ironically, suppress parts of the brain’s reward circuituse can, ironically, suppress parts of the brain’s reward circuit

- CREB (cAMP response element-binding protein)- CREB (cAMP response element-binding protein)

- CREB is a transcription factor, a protein that regulates the - CREB is a transcription factor, a protein that regulates the

expression, or activity, of genes and thus the overall behaviorexpression, or activity, of genes and thus the overall behavior

of nerve cellsof nerve cells

**Drug abuse->dopamine concentration increase in nucleus**Drug abuse->dopamine concentration increase in nucleus

accumbens->cyclic AMP increase in dopamine responsive cellaccumbens->cyclic AMP increase in dopamine responsive cell

->activation of CREB->activation of CREB

- CREB controls the production of dynorphin, a natural molecule- CREB controls the production of dynorphin, a natural molecule with opium-like effects. Dynorphin is synthesized by a subset owith opium-like effects. Dynorphin is synthesized by a subset o

f neurons in the nucleus accumbens that loop back and inhibitf neurons in the nucleus accumbens that loop back and inhibit neurons in the VTA.neurons in the VTA.

- Induction of dynorphin by CREB thereby stifles the brain’s- Induction of dynorphin by CREB thereby stifles the brain’s reward circuitary, inducing tolerance by making the same-old dreward circuitary, inducing tolerance by making the same-old d

ose of drug less rewarding.ose of drug less rewarding.

CREBCREB

VTA and Nucleus AccumbensVTA and Nucleus Accumbens

Delta FosBDelta FosB

The CREB is switched off within days after The CREB is switched off within days after drug use stops.drug use stops.

So CREB cannot account for the longer-lasSo CREB cannot account for the longer-lasting grip that abused substances have on tting grip that abused substances have on the brain.he brain.

Although it might sound counterintuitive, tAlthough it might sound counterintuitive, the same drug can evoke both tolerance anhe same drug can evoke both tolerance and sensitizationd sensitization

To understand the roots of sensitization, wTo understand the roots of sensitization, we found another transcription factor:e found another transcription factor:delta Fos B- Road to relapse!delta Fos B- Road to relapse!

• Delta FosB appears to function very differently in addiction than CREB does

• The protein is extraordinarily stable, it remains active in these nerve cells for weeks to months after drug administration, a persistence that would enable it to maintain changes in gene expression long after drug taking ceased

• Prolonged induction of this molecule causes animals to become hypersensitive to drugs

• Delta FosB concentration could well contribute to long-term increases in sensitivity in the reward pathways of humans.

• More general role in the development of compulsive behavior toward a wide range of rewarding stimuli

(ex. Repetitious nondrug reward-excessive wheel running and sugar consumption)

Delta FosB

• How sensitization could persist even after delta Fos B concentrationHow sensitization could persist even after delta Fos B concentrations return to normal?s return to normal?

• Chronic exposure to cocaine and other drugs of abuse induce the siChronic exposure to cocaine and other drugs of abuse induce the signal-receiving branches of nucleus accumbens neuron.gnal-receiving branches of nucleus accumbens neuron.

(dendritic spines-bolster the cell’s connection to other neurons.(dendritic spines-bolster the cell’s connection to other neurons.

• Delta FosB may be responsible for the added spines.Delta FosB may be responsible for the added spines.

• The dendritic changesThe dendritic changes may, in the end, be the key adaptation that a may, in the end, be the key adaptation that accounts for the intransigence of addictionccounts for the intransigence of addiction

Delta FosBDelta FosB

GlutamateGlutamate

• How are other brain regions-namely, the amygdala, hippocampus aHow are other brain regions-namely, the amygdala, hippocampus and frontal cortex-involved in addiction and communicate back and fond frontal cortex-involved in addiction and communicate back and forth with the VTA and nucleus accumbens? –rth with the VTA and nucleus accumbens? –Glutamate!Glutamate!

• Change in sensitivity to glutamate in the reward pathway enhance bChange in sensitivity to glutamate in the reward pathway enhance both the release of dopamine from the VTA and responsiveness to dooth the release of dopamine from the VTA and responsiveness to dopamine in the nucleus accumbenspamine in the nucleus accumbens

• The mechanism by which drugs alter sensitivity to glutamate in neurThe mechanism by which drugs alter sensitivity to glutamate in neurons of reward pathway is not yet known.ons of reward pathway is not yet known.

ConclusionsConclusions

• During prolonged drug use, and shortly after use cease, changes in During prolonged drug use, and shortly after use cease, changes in the concentrations of cyclic AMP and the activity of CREB in neuronthe concentrations of cyclic AMP and the activity of CREB in neurons in the reward pathway predominate.s in the reward pathway predominate.

• These alteration cause tolerance and dependence, reducing sensitivThese alteration cause tolerance and dependence, reducing sensitivity to the drug and rendering the addict depressed and lacking motivity to the drug and rendering the addict depressed and lacking motivation.ation.

• With more prolonged abstention, changes in delta FosB activity and With more prolonged abstention, changes in delta FosB activity and glutamate signaling predominate.-incresing sensitivity to the drug’s glutamate signaling predominate.-incresing sensitivity to the drug’s effects if it is used again after a lapse and by eliciting powerful respoeffects if it is used again after a lapse and by eliciting powerful responses to memories of past highs and to cues that bring those memorinses to memories of past highs and to cues that bring those memories to mind.es to mind.

A common Cure?A common Cure?

• Addiction’s obvious physical and psychological damage, the conditioAddiction’s obvious physical and psychological damage, the condition is a leading cause of medical illness.(alcohol-liver cirrhosis, smoken is a leading cause of medical illness.(alcohol-liver cirrhosis, smoker-lung cancer, heroin-HIV (share needle)r-lung cancer, heroin-HIV (share needle)

• Addiction’s toll on health and productivity in the U.S. has been estimAddiction’s toll on health and productivity in the U.S. has been estimated at more than ated at more than $ 300 billion a year!$ 300 billion a year!

• Today’s treatment fail to cure most addicts. Although some medicatiToday’s treatment fail to cure most addicts. Although some medications prevent the drug from getting to its target, theses measures leavons prevent the drug from getting to its target, theses measures leave users with an “addicted brain” and intense drug carving.e users with an “addicted brain” and intense drug carving.

• And these medications may merely replace one habit with another.And these medications may merely replace one habit with another.

• Although psychological, social and environmental factors certainly aAlthough psychological, social and environmental factors certainly are important, studies in susceptible families suggest that in humans re important, studies in susceptible families suggest that in humans about 50 percent of the risk for drug addiction is about 50 percent of the risk for drug addiction is genetic.genetic.

• Because emotional and social factors operate in addiction, we cannBecause emotional and social factors operate in addiction, we cannot expect medications to fully treat the syndrome of addictionot expect medications to fully treat the syndrome of addiction

• Compounds that interact specifically with the receptors that bind to gCompounds that interact specifically with the receptors that bind to glutamate or dopamine in the nucleus accumbens, or chemicals that lutamate or dopamine in the nucleus accumbens, or chemicals that prevent CREB or delta FosB from acting on their target genes in thaprevent CREB or delta FosB from acting on their target genes in that area, could potentially loosen a drug’s grip on an addict.t area, could potentially loosen a drug’s grip on an addict.

A common Cure?A common Cure?