The New Neurobiology of...
Transcript of The New Neurobiology of...
![Page 1: The New Neurobiology of Addictionnjms.rutgers.edu/departments/psychiatry/documents/2020/lc/Neurob… · Center of Excellence in Addiction Medicine Learning Collaborative Rutgers New](https://reader033.fdocuments.us/reader033/viewer/2022042307/5ed3826562e058372d439c16/html5/thumbnails/1.jpg)
Petros Levounis, MD, MAProfessor and Chair, Department of Psychiatry
Rutgers New Jersey Medical School
Center of Excellence in Addiction Medicine Learning Collaborative
Rutgers New Jersey Medical School
Newark, New Jersey
Monday, December 9, 2019
The New Neurobiology of
Addiction
![Page 2: The New Neurobiology of Addictionnjms.rutgers.edu/departments/psychiatry/documents/2020/lc/Neurob… · Center of Excellence in Addiction Medicine Learning Collaborative Rutgers New](https://reader033.fdocuments.us/reader033/viewer/2022042307/5ed3826562e058372d439c16/html5/thumbnails/2.jpg)
2
1. The Basic Model
2. Neurobiology of Addiction
3. New Neurobiological Concepts
4. Addiction Treatments
5. New Directions
Outline
2
![Page 3: The New Neurobiology of Addictionnjms.rutgers.edu/departments/psychiatry/documents/2020/lc/Neurob… · Center of Excellence in Addiction Medicine Learning Collaborative Rutgers New](https://reader033.fdocuments.us/reader033/viewer/2022042307/5ed3826562e058372d439c16/html5/thumbnails/3.jpg)
1The Basic Model
3
![Page 4: The New Neurobiology of Addictionnjms.rutgers.edu/departments/psychiatry/documents/2020/lc/Neurob… · Center of Excellence in Addiction Medicine Learning Collaborative Rutgers New](https://reader033.fdocuments.us/reader033/viewer/2022042307/5ed3826562e058372d439c16/html5/thumbnails/4.jpg)
4
~ 1980
![Page 5: The New Neurobiology of Addictionnjms.rutgers.edu/departments/psychiatry/documents/2020/lc/Neurob… · Center of Excellence in Addiction Medicine Learning Collaborative Rutgers New](https://reader033.fdocuments.us/reader033/viewer/2022042307/5ed3826562e058372d439c16/html5/thumbnails/5.jpg)
A Biopsychosocial Illness
Biological
Psychological
Social
Use Brain
Switch
Addiction
5
Olsen and Levounis, Sober Siblings, 2008.
![Page 6: The New Neurobiology of Addictionnjms.rutgers.edu/departments/psychiatry/documents/2020/lc/Neurob… · Center of Excellence in Addiction Medicine Learning Collaborative Rutgers New](https://reader033.fdocuments.us/reader033/viewer/2022042307/5ed3826562e058372d439c16/html5/thumbnails/6.jpg)
2Neurobiology of
Addiction6
![Page 7: The New Neurobiology of Addictionnjms.rutgers.edu/departments/psychiatry/documents/2020/lc/Neurob… · Center of Excellence in Addiction Medicine Learning Collaborative Rutgers New](https://reader033.fdocuments.us/reader033/viewer/2022042307/5ed3826562e058372d439c16/html5/thumbnails/7.jpg)
0
50
100
150
200
0 60 120 180
Time (min)
% o
f B
asa
l D
A O
utp
ut
Empty
Food Sex
Box Feeding
100
150
200
DA
Con
cen
tra
tio
n (
% B
ase
lin
e)
Sample
Number
1 2 3 4 5 6 7 8
Female Present
Natural Rewards
Adapted from: Di Chiara et al, Neuroscience, 1999
Adapted from: Fiorino and Phillips, J Neuroscience, 1997
7
![Page 8: The New Neurobiology of Addictionnjms.rutgers.edu/departments/psychiatry/documents/2020/lc/Neurob… · Center of Excellence in Addiction Medicine Learning Collaborative Rutgers New](https://reader033.fdocuments.us/reader033/viewer/2022042307/5ed3826562e058372d439c16/html5/thumbnails/8.jpg)
8
0
100
200
300
400
0 1 2 3 4 5 hr
% o
f B
as
al R
ele
as
e
COCAINE
0
100
150
200
250
0 1 2 3 hr
% o
f B
as
al R
ele
as
e
NICOTINE
Adapted from: Di Chiara and Imperato, Proceedings of the National Academy of Sciences USA, 1988; courtesy of
Nora D Volkow, MD
Effects of Drugs on Dopamine Levels
100
150
200
250
0 1 2 3 4hr
% o
f B
as
al R
ele
as
e
0.250.512.5
0
Dose (g/kg ip)
ETHANOL
MORPHINE
% o
f B
as
al R
ele
as
e
0
100
150
200
250
0 1 2 3 4 5 hr
0.51.02.510
Dose mg/kg
8
![Page 9: The New Neurobiology of Addictionnjms.rutgers.edu/departments/psychiatry/documents/2020/lc/Neurob… · Center of Excellence in Addiction Medicine Learning Collaborative Rutgers New](https://reader033.fdocuments.us/reader033/viewer/2022042307/5ed3826562e058372d439c16/html5/thumbnails/9.jpg)
9
0
100
200
300
400
500
600
700
800
900
1000
1100
0 1 2 3 4 5 hr
% o
f B
as
al R
ele
as
e
DA
Effects of Amphetamines on Dopamine Levels
AMPHETAMINE
Adapted from: Di Chiara and Imperato, Proceedings of the National Academy of Sciences USA, 1988; courtesy of
Nora D Volkow, MD.
9
![Page 10: The New Neurobiology of Addictionnjms.rutgers.edu/departments/psychiatry/documents/2020/lc/Neurob… · Center of Excellence in Addiction Medicine Learning Collaborative Rutgers New](https://reader033.fdocuments.us/reader033/viewer/2022042307/5ed3826562e058372d439c16/html5/thumbnails/10.jpg)
10
Pleasure-Reward Pathways
National Institute on Drug Abuse, www.nida.nih.gov, 2000.
![Page 11: The New Neurobiology of Addictionnjms.rutgers.edu/departments/psychiatry/documents/2020/lc/Neurob… · Center of Excellence in Addiction Medicine Learning Collaborative Rutgers New](https://reader033.fdocuments.us/reader033/viewer/2022042307/5ed3826562e058372d439c16/html5/thumbnails/11.jpg)
3New Neurobiological
Concepts11
![Page 12: The New Neurobiology of Addictionnjms.rutgers.edu/departments/psychiatry/documents/2020/lc/Neurob… · Center of Excellence in Addiction Medicine Learning Collaborative Rutgers New](https://reader033.fdocuments.us/reader033/viewer/2022042307/5ed3826562e058372d439c16/html5/thumbnails/12.jpg)
12
2019
![Page 13: The New Neurobiology of Addictionnjms.rutgers.edu/departments/psychiatry/documents/2020/lc/Neurob… · Center of Excellence in Addiction Medicine Learning Collaborative Rutgers New](https://reader033.fdocuments.us/reader033/viewer/2022042307/5ed3826562e058372d439c16/html5/thumbnails/13.jpg)
13
Motivational Circuitry
Antireward Pathways
Interoception
13
Three Novel Areas
Levounis, Journal of Medical Toxicology, 2016.
![Page 14: The New Neurobiology of Addictionnjms.rutgers.edu/departments/psychiatry/documents/2020/lc/Neurob… · Center of Excellence in Addiction Medicine Learning Collaborative Rutgers New](https://reader033.fdocuments.us/reader033/viewer/2022042307/5ed3826562e058372d439c16/html5/thumbnails/14.jpg)
1414
Motivation: The Stinking Thinking Part
![Page 15: The New Neurobiology of Addictionnjms.rutgers.edu/departments/psychiatry/documents/2020/lc/Neurob… · Center of Excellence in Addiction Medicine Learning Collaborative Rutgers New](https://reader033.fdocuments.us/reader033/viewer/2022042307/5ed3826562e058372d439c16/html5/thumbnails/15.jpg)
Reward and Antireward Systems
Gardner, Chronic Pain and Addiction, 2011.
15
![Page 16: The New Neurobiology of Addictionnjms.rutgers.edu/departments/psychiatry/documents/2020/lc/Neurob… · Center of Excellence in Addiction Medicine Learning Collaborative Rutgers New](https://reader033.fdocuments.us/reader033/viewer/2022042307/5ed3826562e058372d439c16/html5/thumbnails/16.jpg)
16
![Page 17: The New Neurobiology of Addictionnjms.rutgers.edu/departments/psychiatry/documents/2020/lc/Neurob… · Center of Excellence in Addiction Medicine Learning Collaborative Rutgers New](https://reader033.fdocuments.us/reader033/viewer/2022042307/5ed3826562e058372d439c16/html5/thumbnails/17.jpg)
4Addiction
Treatments17
![Page 18: The New Neurobiology of Addictionnjms.rutgers.edu/departments/psychiatry/documents/2020/lc/Neurob… · Center of Excellence in Addiction Medicine Learning Collaborative Rutgers New](https://reader033.fdocuments.us/reader033/viewer/2022042307/5ed3826562e058372d439c16/html5/thumbnails/18.jpg)
Medications
Motivational Interviewing
Mutual Help (12-step)
The Current Approach
Nunes, Selzer, Levounis, Davies, Substance Dependence and Co-Occurring Psychiatric Disorders, 2010.
Levounis, Arnaout, and Marienfeld, Motivational Interviewing for Clinical Practice, 2017.
Renner, Levounis, and LaRose, Office-Based Buprenorphine Treatment of Opioid Use Disorder, 2nd Ed., 2018.
18
![Page 19: The New Neurobiology of Addictionnjms.rutgers.edu/departments/psychiatry/documents/2020/lc/Neurob… · Center of Excellence in Addiction Medicine Learning Collaborative Rutgers New](https://reader033.fdocuments.us/reader033/viewer/2022042307/5ed3826562e058372d439c16/html5/thumbnails/19.jpg)
5New Directions
19
![Page 20: The New Neurobiology of Addictionnjms.rutgers.edu/departments/psychiatry/documents/2020/lc/Neurob… · Center of Excellence in Addiction Medicine Learning Collaborative Rutgers New](https://reader033.fdocuments.us/reader033/viewer/2022042307/5ed3826562e058372d439c16/html5/thumbnails/20.jpg)
“Between stimulus and response there is
a space. In that space is our power to
choose our response. In our response lie
our growth and our freedom.”
Viktor E. Frankl
4th Wave: Mindfullness
20Frankl V, Man’s Search for Meaning, 1959.
Zerbo, Schlechter, Desai, and Levounis, Becoming Mindful, 2017.
![Page 21: The New Neurobiology of Addictionnjms.rutgers.edu/departments/psychiatry/documents/2020/lc/Neurob… · Center of Excellence in Addiction Medicine Learning Collaborative Rutgers New](https://reader033.fdocuments.us/reader033/viewer/2022042307/5ed3826562e058372d439c16/html5/thumbnails/21.jpg)
Thank you
NJMS.Rutgers.edu/Psychiatry
21