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UNDERSTANDING ADDICTION
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THE “MORAL” MODEL
Failure of personal responsibility or morality
Leads to shame, stigma and discrimination
Decrease the chances that the addicted individual will seek or receive effective treatment
Punishable offence
“Sinner,” “irresponsible,” “selfish,” “stupid,” “loser,” “undisciplined,” “pathetic” and “weak.”
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THE DISEASE MODEL
In 1956, the American Medical Association (AMA) declared that alcoholism is an illness and should be treated within the medical profession
No need for personal responsibility and the need for self control
Hopelessness with regard treatment and the possibility of recovery
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THE BRAIN –BEHAVIOUR MODEL
Addiction is a complex brain disease significant behavioural characteristics.
Multiple factors influence drug use and its progression to addiction
If untreated, it can become a chronic and relapsing condition, requiring on-going
treatment and management.
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Addiction is a disease of Brain
Not a fault in character
“HIJACK”OF OUR SURVIVAL SYSTEM
Motivation
Decision making
Risk and reward assessment
Pleasure seeking
Impulse control/ inhibition
Emotion
Learning, memory
Stress control.
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VIDEO
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Di Chiara et al., Neuroscience, 1999.,Fiorino and Phillips, J. Neuroscience, 1997.
Natural Rewards Elevate
Dopamine Levels
0
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0 60 120 180
Time (min)
% o
f B
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utp
ut NAc shell
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Food Sex
Box Feeding
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% B
ase
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e)
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Number
1 2 3 4 5 6 7 8
Female Present
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Accumbens
Amphetamine
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0 1 2 3 4 5 hr
% o
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DA DOPAC HVA
Accumbens
Cocaine
Time After Drug
Morphine
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0 1 2 3 hr
Time After Drug
% o
f B
asa
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Accumbens Caudate
Nicotine
Di Chiara and Imperato, PNAS, 1988
Effects of Drugs on Dopamine Release
% o
f B
asa
l R
elea
se
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0 1 2 3 4 5 hr
Accumbens
0.5 1.0 2.5 10
Dose
mg/kg mg/kg
mg/kg mg/kg
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It is because drugs activate these
brain regionsusually more
effectively and for longer periods of
time than natural rewardsthat they
have an inherent risk of being
abused.
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Car with no brakes.
It’s no more a choice to say “stop”
DRUGS AFFECT BRAIN.
BUT DOES ADDICTIVE DRUGS
CHANGE THE BRAIN?
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CIRCUIT AND CHEMICAL
LOCHA?
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Control Addicted
Dopamine D2 Receptors are Decreased by Addiction
Functionally…
Cocaine
Alcohol
Heroin
Meth
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Amph
Neuronal Dendrites in the Nucleus Accumbens
Saline
Robinson & Kolb, Journal of Neuroscience, Volume: 1997
Structurally….
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Healthy Brain Diseased Heart
Decreased Heart Metabolism in Heart Disease Patient
Decreased Brain Metabolism in Drug Abuser
Diseased Brain/
Cocaine Abuser Healthy
Heart
High
Low
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ADDICTION IS A PROGESSIVE DISEASE
AND
ONCE AN ADDICT ALWAYS AN ADDICT
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WHY CATCH THEM YOUNG?
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Basic Science Tells Us that Adolescents’ Brains
Are Still developing…and they are wired differently
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Copyright ©2004 by the National Academy of Sciences Gogtay, Giedd, et al. Proc. Natl. Acad. Sci., 2004
MRI Scans of Healthy
Children and Teens Over Time
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When Reading Emotion… Adults Rely More on the Frontal Cortex While Teens Rely More on the Amygdala
Deborah Yurgelon-Todd 2000. 9/4/2016 MUKTAA CHARITABLE OUNDATION-SAMVAD
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“CATCH THEM YOUNG MOVEMENT”
WE NEED TO HAVE AN ARMY OF PROFESSIONSALS FOR PREVENTION OF
ADDICTIONS IN ADOLESCENTS
SHAALA PROJECT……..
UNPLUGGED INDIA…..
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Why do some people
become addicted to drugs
while others do not?
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ROLE OF GENETICS IN DRUG ABUSE AN ADDICTION
Heritability estimates for nicotine, alcohol, and drug addiction are in the
range of 50% to 60%. (Heath et al., 1997;Tsuang et al., 1998;Kendler et al., 2003;Li, 2006)
Inherited differences among individuals affect their response to drugs.
The Genetic Basis of Addiction, Chad Epps and Elizabeth Laura Wright
high
low
High DA
receptor
Low DA receptor
BRAIN DECIDES YOUR LIKING FOR
DRUGS
As a group, subjects with low receptor levels found MP pleasant while those
with high levels found MP unpleasant
Adapted from Volkow et al., Am. J. Psychiatry, 1999. 9/4/2016 MUKTAA CHARITABLE OUNDATION-SAMVAD
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Genetics and drugs
ALCOHOL: ALDH2 is protective as it causes hypersensitivity to alcohol
NICOTINE: Gene cluster (CHRNA6, CHRNB3 on chromosome 8
NICOTINE: CYP2A6: NICOTINE TO COTININE
OPOIDS: OPRM1 Common genes for nicotine and alcohol:
Alpha4 nicotine receptor Common gene for all drugs of abuse”
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ITS’S TRUE THAT PEOPLE MAY CHOOSE TO TAKE DRUGS, BUT NO ONE CHOOSES TO BE AN ADDICT
THAT IS ALREADY DECIDED
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…addiction is not about drugs, it’s about brains.
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WO DIL KI MASTI HI HAI JO RANG LAATI HAI. NASHA SHARAB MEIN HOTA TO NACHTO BOTTLE
HUM SAATH SAATH HAI……
COMPULSIVE DRUG ABUSE
COMPULSIVE SHOPPING
COMPULSIVE EATING
GAMBLING
ALL HAVE COMMON LINKAGES
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PSYCHOLOGICAL RISKS
Depression and anxiety
Psychotic disorders such as schizophrenia
Conduct disorder
Attention deficit/hyperactivity disorder
Suicide
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Stress, drug use and addiction
Stress activates reward systems
It increases physiological sensitivity to drugs
It increases desire to improve mood with drugs after exposure to stress.
PSYCHOLOGICAL RISKS
MAANA KI LOG KARTE HAI NAFRAT SHARAB SE
HUMKO TO MILI HE JEENE KI RAAHAT SHARAB SE
HAI LAAKH BURI SHARAAB,YEH KAISE MAN LU
SIKHI HAI GHAM BHULANE KI AADAT SHARAB SE
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ADDICTION PRONE PERSONALITY
Impulsivity
Aggressiveness
Sensation or novelty-seeking
High activity level
Risk taking tendencies
Lack of pain avoidance responses
Addictive thinking
Low self esteem Distorted thinking Self deception Guilt and shame Difficulty in dealing with conflict Emotional Hypersensitivity Manipulation Denial. Projection, rationalisation The Confining wall
*Addictive thinking by Abraham Twerski, MD.
35
Risks at School
Academic failure, truancy
High number of classmates who fail
Little commitment or sense of belonging to school
Learning disabilities
Parents not involved
Availability of drugs near school premises
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PEER RISK
Presence of deviant peer group
Peer drug use
Peer pressure or coercion
Peer approval of drugs
Inappropriate sexual activity among peers
IT’S COOL
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FAMILY RISKS
Parental attitudes favourable to drug use
Domestic violence/Physical abuse
Family quarrels, family relationship problems
Parental separation/divorce
Failing to set consistent expectations and limits
Inadequate parent-child attachment
Low parental supervision
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COMMUNITY RISKS
Discrimination and social exclusion
No sense of connection
Laws and norms permissive for drug use
Drug availability
Acceptance of drug use by society
Social and cultural beliefs
Poor enforcement of laws
Exposure to advertisements that glamorize drugs
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AVAILIBILTY AND COSTS
High rates reduce the consumption of alcohol and tobacco.
Easy assess and increase in sales outlets 0r sales hours increases consumption of drugs
BOTH –NOT A PROBLEM TODAY
Money –no problem
"Badi mehangi hui hai sharab, thodi thodi piya
karo"
“CHAR BOTTLE VODKA, KAAM MERA ROJKA”
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Addiction Involves Multiple Factors
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NATURE Vs NURTURE
Environmental factors : Initiation
Genetic factors: transition from regular use to the development of addiction.
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UNDERSTANDING ADDICTION LECTURE CHA FAYDA KAI?????
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SCREENING FOR EARLY DIAGNOSIS AND TREATMENT
LIKE WE TAKE PULSE
LIKE WE TAKE BP
LIKE WE CHECK BSL
LIKE WE ASK FOR LMP IN ALL WOMEN
WE SHOULD ASK FOR H/O OF DRUG USE IN EACH AND EVERY PATIENT
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PHARMACOLOGAL TREATMENT
AVERSIVE DRUGS
DETERRANT DRUGS
ANTICRAVING DRUGS
SUBSTITUTION THERAPY
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BEHAVIOURAL TREATMENT
MOTIVATION ENHANCEMENT THERAPY
COGNITIVE BEHAVIOURAL THERAPY
RELAPSE PREVENTION THERAPY
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WHY CATCH THEM YOUNG?
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MOST IMPORTANT………CHANGE IN OUR ATTITUDE
DURITANCHE TIMIR JAAVO VISHWA
SARWADHARM SURYA PAHO
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WE MAY NOT BE ABLE TO ERRADICATE DRUG ADDICTION, BUT IN FUTURE WE
CAN ATLEAST FACE OUR CHILDERN AND SAY
“” I TRIED””
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LET’ S BEGIN AND DO OUR BIT……..LET’S ATRAT TODAY
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Thank you
Dr Madhu Oswal Thakkar Muktaa Charitable Foundation
www.mcf.org.in Email: [email protected]
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