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Funding for this module was provided by a Science Education Drug Abuse Partnership Award (SEDAPA) from the National Institute on Drug Abuse, a component of the National Institutes of Health, Department of Health and
Human Services. #1 R25 DA 020472-01A1
To educate students about the neuroscience of addiction & its relevance for working with clients with addictive disorders
O ve r a l l G o a l
# 1 R25 DA 020472-01A1
Curriculum Learning Objectives
• Developaworkingdefinitionof addiction• Describetheprevalence&public healthimpactofaddiction• Identifyriskfactorsthatincreasethe vulnerabilitytoaddiction• Understandthebrainrewardpathway &itscentralroleintheneurobiology ofaddiction• Recognizeresearch-basedprinciples ofaddictionprevention&treatment
# 1 R25 DA 020472-01A1
Mod
ule
1Exploring
Our Beliefs about Addiction
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Module 1 Learning Objectives 1. Toexaminesomepre-conceivedideasaboutwhat definesaddictionaswellasattitudesandbeliefs aboutthepeoplewhobecomeaddictedandtheir behavior.
2. Todevelopapractical“working”definitionofaddiction basedonthewayscientistsandresearchersdefineit.
3. Tolearnsomeofthekey developmentalriskfactorsthat increasethevulnerabilitytoaddiction.
4. Tounderstandtheprevalence,costs,and publichealthimpactofaddiction.
# 1 R25 DA 020472-01A1
What Do You Believe About Addiction?
1.Whydopeoplebecomeaddicted?
2.Canaddictionbeprevented?(Why or why not)
3.Iftreatmentworks,whydosomanypeoplegointo treatmentmultipletimes?
4.Peoplewithaddictionsare ? (List three characteristics of people with an addiction.)
# 1 R25 DA 020472-01A1
Why Do People Use Alcohol & Drugs
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ClassroomExercises
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“Addiction is a choice… they could stop if they really tried.”
# 1 R25 DA 020472-01A1
How is Addiction Defined
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How do YOU define Addiction?
1.Comeupwithabriefstatementofhowyouwould defineaddiction.2.Shareyourdefinitionwiththeclass.
# 1 R25 DA 020472-01A1
How Clinicians & Researchers Define Addiction
# 1 R25 DA 020472-01A1
Substance Use Disorders… a maladaptive pattern of use leading to clinically significant
impairment as manifested by …Substance Abuse: One or more of the following in a 12 month period• Recurrentuseleadingtofailuretofulfillobligationsatwork,school,orhome• Useinhazardoussituations• Socialorinterpersonalproblemsbecauseofuse• Recurrentsubstancerelatedlegalproblems
Substance Dependence (Addiction): Three or more of the following in a 12 month period • Needlargeramounttogetthesameeffect(tolerance)• Experiencewithdrawalsymptomsoruseofsubstancetoavoidwithdrawalsymptoms• Difficultycontrollinguse(substancetakeninlargeramountsoroverlongerperiodsthan intended)• Unsuccessfulineffortstocutdown• Importantsocial,occupational/school,orrecreationalactivitiesreducedorgivenup becauseofuse• Increasingamountoftimespentobtainingsubstances,usingorrecoveringfromuse• Continuedusedespitenegativephysical,mental,social,orlegalproblemsrelatedto substanceuse
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Working Definition of Addiction
Continued compulsive use despite negative consequences
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How Do People Become Addicted
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Casual, Experimental Use
Regular Use (negative consequences are rare)
Misuse (some negative consequences)
Abuse (frequent negative consequences)
Dependence or Addiction (Use Despite Negative Consequence)
Addiction
The Downward Spiral of Drug Addiction
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• Genetic predisposition• Poorcopingskills• Early,persistentantisocialbehavior• Mentalhealthdisorders• Earlyinitiationofsubstanceuse
• Favorableattitudestowardsuse• Perception of peers using • Substanceusingpeers• Ganginvolvement
• Substanceabusehistory• Major/frequentfamily conflictordisruptions
• Parentalsubstanceuseattitudes• Crime,violence,abuse/neglect
• Learningproblemsordisabilities• Lackofcommitment• Behaviorproblemsatschool
• Earlyacademicfailure• Lowlevelsofreadingability• Expulsion/suspension
• Availabilityofdrugs/alcohol• Highcrimerate• Normsfavorabletosubstanceuse
• Lowneighborhoodattachment• Extremeeconomicdeprivation
Individual Risk Factors
Family Risk Factors
School Risk Factors
Community Risk Factors
# 1 R25 DA 020472-01A1
• Activitieswithnon-usingpeers• Parentalmonitoringof friendsandactivities
• Resilienttemperament• Positivesocialorientation
• Bonding/attachmentto positivefamilymembers• Healthyfamilybeliefs• Favorableparentalattitudes
• Clear standards regarding substanceuse&behavior• Recognitionforpositive behaviors,successes
• Successinschool• Parentalmonitoringofacademic performance/schoolbehavior
• Involvementingroupactivities• Positiverecognitionforgood behaviors,successes
• Healthycommunitysubstance use&behaviornorms• Positivecommunity activities/rolemodels
• Work• Anti-drugusepolicies,policies limitingavailabilityofalcohol
Individual Protective Factors
Family Protective Factors
School Protective Factors
Community Protective Factors
Prevalence, Public Health Impact, & Costs of Addiction
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In 2009, an estimated 9.0% of Americans (22 million individuals) aged 12 or older met the
criteria for substance abuse or dependence
(SAMHSA,2009)# 1 R25 DA 020472-01A1
Substance Use Across the Lifespan
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Perc
ent U
sing
in th
e Pa
st M
onth
Age
(SAMHSA,2010)
Past Month Illicit Drug Use among Persons Aged 12 & Older, 2009
4%
9%
17%
22% 21%
14%
7%
3% 1% 0
10
20
30
12-13 14-15 16-17 18-20 21-25 26-29 30-59 60-64 65+
# 1 R25 DA 020472-01A1
Past Month Illicit Drug Use by Age Category, 2009
10.0%
21.2%
6.3%
0
5
10
15
20
25
12-17 years 18-25 years 26 + years
(SAMHSA,2010)
Perc
ent U
sing
in th
e Pa
st M
onth
# 1 R25 DA 020472-01A1
Alcohol Use across the LifespanPe
rcen
t
Age(SAMHSA,2010)
3.5 13.0
26.3
49.7
70.2 66.4
58.7
50.3
39.1
1.6 7.0
17.0
34.7
46.5
38.8
25.4
12.5 9.8
0.2 1.4 4.5 11.3
15.4 10.8 7.1 3.8 2.2 0
20
40
60
80
12-13 14-15 16-17 18-20 21-25 26-29 30-59 60-64 65+
Alcohol-Current use Alcohol-Binge use Alcohol-Heavy use
Age # 1 R25 DA 020472-01A1
• 50%ofindividualswilldevelopsubstanceabuseordependenceatsome pointduringtheirlifetime• 47%ofadolescentsexperimentwithdrugsoralcoholbeforegraduating fromhighschool• Mostaddictedadultsbeganusingwhentheywereadolescents• Most“experimenters”donotbecomeaddicted,butthosewhohave developmentalvulnerabilitiesareatgreaterrisk
Research shows that approximately...
# 1 R25 DA 020472-01A1
Public Health Impact & Costs
Associated with Addiction
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Substance Abuse & Addiction Cost about $1 Trillion per Year
Lost Productivity
71%
Other 20%
Healthcare Costs 9%
For example: • Criminal justice costs • Child abuse/neglect • Homelessness
For example: • ED visits • HIV/AIDS • FASDs
For example: • Poor job performance • Increased employee turnover • Illness/absenteeism • Work-related accidents • Victims of crime • Incarceration
# 1 R25 DA 020472-01A1 (Califano,2007)
Substance Abuse Impact on the Child & Family Assistance System
(SAMHSA,2009)
Combined data from 2002 to 2007 indicate that over 8.3 million children under 18 years of age (11.9%) lived with at least one parent
who was dependent on or abused substance.
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• 11%ofchildabuse/neglectcases• 75%ofout-of-homechildwelfareplacements
(http://sparkaction.org/content/impact-substance-abuse-foster-care;http://www.acf.hhs.gov/programs/opre/abuse_neglect/natl_incid/index.html,2010)
Substance abuse is shown to be a factor in at least
# 1 R25 DA 020472-01A1
Average length of time spent in out-of-home
care is longer for children of addicted parents
(27 months) compared to
non-addicted parents (10 months)
(http://sparkaction.org/content/impact-substance-abuse-foster-care;http://www.acf.hhs.gov/programs/opre/abuse_neglect/natl_incid/index.html,2010)
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Underage drinking costs society $68 billion per year for youth violence, traffic accidents, property crime,
academic underachievement, high-risk sex, & FASDs among teen mothers
(OJJDP,2007)# 1 R25 DA 020472-01A1
Substance Abuse Impact on the Criminal Justice System
Of the $38 billion spent on corrections in 1996, more than $30 billion was spent incarcerating individuals who had alcohol or drug problems, or committed alcohol or drug related crimes.
(ONDCP,2002;http://www.suite101.com/content/the-economics-of-alcoholism-and-drug-abuse-a85770#ixzz11Wv4mwGz)# 1 R25 DA 020472-01A1
Costs associated with driving while intoxicated were estimated at $230 billion
in 2001 due to highway collisions(Califano,2007;Weisman,2006)# 1 R25 DA 020472-01A1
(12,371 agencies; 2009 estimated population 239,839,971)(http://www.fbi.gov/ucr/cius2009/data/table_38.html#overview)# 1 R25 DA 020472-01A1
46.8% of all arrests for drug abuse violations were persons under the age of 25
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Substance Abuse Impact on Worker Productivity
In 2005, the reported annual cost to employers for alcohol-related injuries to employees &
their dependents was $28.6 billion
(Zaloshnja,etal.,2006)# 1 R25 DA 020472-01A1
Substance Abuse Impact on the Health Care System
More than 116 million hospital emergency department visits in 2007
• Averagepervisitcostestimatedat$1038• Roughly1.9millionweredrugmisuse/abuserelated, withoverhalf(52%)involvingillicitdrugsaloneorin combinationwithpharmaceuticalsand/oralcohol
(http://DAWNinfo.samhsa.gov)# 1 R25 DA 020472-01A1
Fetal Alcohol Spectrum Disorders could cost up to $4 million in health care and related specialized services over the course of the child’s lifetime.
# 1 R25 DA 020472-01A1 (Califano,2007;Weisman,2006)
An estimated 1 million people in the United States are living with HIV/AIDS
(http://www.drugabuse.gov/Infofacts/DrugAbuse.html)
• Roughly1/3ofthosecasesarelinked directlyorindirectlytoinjectiondruguse• Approximately4of10AIDSdeathsare drugabuserelated• About400,000peopleareco-infected withHIV&HepatitisC
# 1 R25 DA 020472-01A1 (Califano,2007)
Co-occurring substance abuse & medical conditions
• LungandCardiovasculardisease• Stroke• Cancer• Mentaldisorders• Celldamageinthebrainorperipheralnervoussystem
(http://www.drugabuse.gov/Infofacts/infofactsindex.html)# 1 R25 DA 020472-01A1
Co-Occurring Substance Abuse & Mental Health Disorders
• Substanceabuse&addiction increasestheriskofmentalhealth problemsorpsychiatricdisorders (e.g.,conductdisorder,ADHD, depression)• Mentalhealthproblemsorpsychiatric illnessesincreasetheriskofsubstance abuse• 60-80%ofadolescentswhoenterdrug treatmentprogramshaveco-occurring psychiatricdisorders
# 1 R25 DA 020472-01A1 (http://www.drugabuse.gov/PDF/RRComorbidity.pdf)
National College Survey Data
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(CoreInstitute,2006)
National Profile of Substance Use among College Students (2006)
Tobacco 39.5% Marijuana 30.1% Other drugs 27.2% Alcohol 84.1% • Heavy or frequent drinkers
(defined as 5 or more drinks in one sitting, 3 times or more/week)
24.0%
• Average number of drinks/week 5.42 drinks
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Consequences of Alcohol & Other Drug Use
(COREInstitute,2006)# 1 R25 DA 020472-01A1
Does our campus social environment promote substance use?
# 1 R25 DA 020472-01A1
Module 1Take Home
Points
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Working definition of addiction: continued compulsive use despite
negative consequences# 1 R25 DA 020472-01A1
The majority of high school students experiment with substances without
developing a substance use disorder.
However…# 1 R25 DA 020472-01A1
… a major concern is about doing STUPID things while under the influence.
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… no one knows ALL of their that can shift experimentation
to addiction.
RISK FACTORS
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Even those with few risk or protective factors can become addicted by repeatedly
using alcohol or drugs.# 1 R25 DA 020472-01A1
(Washton,2001)# 1 R25 DA 020472-01A1
Alcohol & drug problems are prevalent & intricately intertwined with other mental
health problems & medical conditions.
...impacts us all.
# 1 R25 DA 020472-01A1