National Institute on Drug Abuse (NIDA) Understanding Drug ...

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NationalInstituteonDrugAbuse(NIDA)

UnderstandingDrugAbuseandAddiction:WhatScienceSays

LastUpdatedFebruary2016

https://www.drugabuse.gov

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TableofContents

UnderstandingDrugAbuseandAddiction:WhatScienceSays

SectionI

SectionII

SectionIII

SectionIV

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SectionI

1:UnderstandingDrugAbuseandAddiction:WhatScienceSays

2:Drugaddiction:acomplexillness

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Drugaddictionisacomplexillness.Thepathtodrugaddictionbeginswiththeactoftakingdrugs.Overtime,aperson'sabilitytochoosenottotakedrugsiscompromised.This,inlargepart,isaresultoftheeffectsofprolongeddruguseonbrainfunctioning,andthusonbehavior.Addiction,therefore,ischaracterizedbycompulsivedrugcraving,seeking,andusethatpersistseveninthefaceofnegativeconsequences.

3:Brainregionsandtheirfunctions

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Certainpartsofthebraingovernspecificfunctions.Forexample,thecerebellumisinvolvedwithcoordination;thehippocampuswithmemory.Nervecells(neurons)arethebasicunitofcommunicationinthebrain.Informationisrelayedfromoneareaofthebraintootherareasthroughcomplexcircuitsofinterconnectedneurons.Informationviaelectricalimpulsestransmittedfromoneneurontomanyothersisdonethroughaprocesscalled"neurotransmission."

4:Therewardpathway

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Onepathwayimportanttounderstandingtheeffectsofdrugsonthebrainiscalledtherewardpathway.Therewardpathwayinvolvesseveralpartsofthebrain,someofwhicharehighlightedinthisimage:theventraltegmentalarea(VTA),thenucleusaccumbens,andtheprefrontalcortex.Whenactivatedbyarewardingstimulus(e.g.,food,water,sex),informationtravelsfromtheVTAtothenucleusaccumbensandthenuptotheprefrontalcortex.

5:Wherecocainehasitseffectsinthebrain

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Usingcocaineasanexample,wecandescribehowdrugsinterferewithbrainfunctioning.Whenapersonsnorts,smokes,orinjectscocaine,ittravelstothebrainviathebloodstream.Althoughitreachesallareasofthebrain,itseuphoriceffectsaremediatedinafewspecificareas,especiallythoseassociatedwiththerewardpathwaydiscussedinthepreviousimage.

6:Neurotransmission

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Asmentionedearlier(image3),informationiscommunicatedinthebrainviaaprocesscalledneurotransmission.Neurotransmissioninvolvesavarietyofchemicalsubstancescalled"neurotransmitters."Onesuchneurotransmitteriscalled"dopamine."Inthenormalcommunicationprocess,dopamineisreleasedbyaneuronintothesynapse(thesmallgapbetweenneurons).Thedopaminethenbindswithspecializedproteinscalled"dopaminereceptors"(seeimage)ontheneighboringneuron,therebysendingasignaltothatneuron.

7:Neurotransmission(continued)

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Afterthesignalissenttotheneighboringneuron,dopamineistransportedbacktotheneuronfromwhichitwasreleasedbyanotherspecializedprotein,the"dopaminetransporter".

8:Cocaineandneurotransmission

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Drugsofabuseareabletointerferewiththisnormalcommunicationprocessinthebrain.Cocaine,forexample,blockstheremovalofdopaminefromthesynapsebybindingtothedopaminetransporters.Asshowninthisimage,thisresultsinabuildupofdopamineinthesynapse.Inturn,thiscausesacontinuousstimulationofreceivingneurons,probablyresponsiblefortheeuphoriareportedbycocaineabusers.

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SectionII

1:Measuringbrainactivityinresponsetodruguse

PositionEmissionTomography(PET)measuresemissionsfromradioactively-labeledchemicalsthathavebeeninjectedintothebloodstream,andusesthedatatoproduceimagesofthedistributionofthechemicalsinthebody.

Indrugabuseresearch,PETisbeingusedforavarietyofreasonsincluding:toidentifythebrainsiteswheredrugsandnaturallyoccurringneurotransmittersact;toshowhowquicklydrugsreachandactivatereceptors;todeterminehowlongdrugsoccupythesereceptors;andtofindouthowlongtheytaketoleavethebrain.PETisalsobeingusedtoshowbrainchangesfollowingchronicdrugabuse,duringwithdrawalfromdruguse,andduringtheexperienceofdrugcraving.Inaddition,PETcanbeusedtoassesstheeffectsofpharmacologicalandbehavioraltherapiesfordrugaddictiononthebrain.

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2:Positronemissiontomography(PET)scanofapersonusingcocaine

Cocainehasotheractionsinthebraininadditiontoactivatingthebrain'srewardcircuitry.Usingbrainimagingtechnologies,suchasPETscans,scientistscanseehowcocaineactuallyaffectsbrainfunctioninpeople.PETallowsscientiststoseewhichareasofthebrainaremoreorlessactivebymeasuringtheamountofglucosethatisusedbydifferentbrainregions.Glucoseisthemainenergysourceforthebrain.Whenbrainregionsaremoreactive,theywillusemoreglucoseandwhentheyarelessactivetheywilluseless.TheamountofglucosethatisusedbythebraincanbemeasuredwithPETscans.Theleftscanistakenfromanormal,awakeperson.Theredcolorshowsthehighestlevelofglucoseutilization(yellowrepresentslessutilizationandblueindicatedtheleast).Therightscanistakenfromsomeonewhoisoncocaine.Thelossofredareasintherightscancomparedtotheleft(normal)scanindicatesthatthebrainisusinglessglucoseandthereforeislessactive.Thisreductioninactivityresultsindisruptionofmanybrainfunctions.

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3:Principlesofdrugabuseprevention

In1997,NIDApublishedthefirstresearch-basedguideonpreventingdruguseamongchildrenandadolescents.Usingaquestion-and-answerformat,thisguidepresentsanoverviewoftheresearchabouttheoriginsandpathwaysofdrugabuse,thebasicprinciplesderivedfromeffectivedrugabusepreventionresearch,andtheapplicationoftheseresearchfindings.Keycomponentsofthispublicationarepresentedinthefollowingimages.

Theguideisavailableforviewingonline.

4:RiskandProtectiveFactors

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Riskfactors:Challengeanindividual’semotional,socialandacademicdevelopment

Protectivefactors:Canlessentheimpactofriskfactors.Theirimpactvariesalongthedevelopmentalprocess.

Commonriskfactorsarefoundformultipleadolescentproblembehaviors–e.g.,substanceuse,teenpregnancy,delinquency,schooldropout,violence

Evidence-basedpreventioninterventionsmaytargetriskandprotectivefactorsintheindividual,family,peer,schoolandcommunitydomains.

TheAimofPreventionApproachesistoreduceriskfactorsandenhanceprotectivefactors.

5:Targetsallformsofdruguse

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Preventionprogramsshouldtargetallformsofdruguseincludingtheuseoftobacco,alcohol,marijuana,andinhalants.Inaddition,preventionprogramsshouldbeculturallysensitivetothecontextandneedsoftheindividual,thefamily,andthecommunity.

6:Skills-basedtraining

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Preventionprogramsshouldincludeskillstrainingtohelpchildrenandadolescentsresistdrugs,strengthenpersonalcommitmentsagainstdruguse,increasesocialcompetency(e.g.,communications,peerrelationships,selfefficacy,andassertiveness),andreinforceattitudesagainstdruguse.Programsshoulduseinteractivemethods(e.g.,groupdiscussion)ratherthandidacticteachingmethodsalone.

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SectionIII

1:DrugAbusePrevention

Evidence-basedpreventionprogramstargetindividuals,families,schools,communities,ormultipletargets.

Evidence-baseddrugabusepreventionprogramsoftenincorporateadevelopmentalperspective.

2:Family-FocusedPreventionPrograms

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Family-focusedpreventionprogramstargetparentsorthefamilies,takingintoconsiderationthestageofthechild’sdevelopment.Programsmayprovidetrainingoneffectiveparentingskillsandmonitoringtohelpreduceconductproblemsandotherriskfactorsfordrugabuse,andimproveparent-childcommunicationandrelationships.

3:CommunityandSchoolPreventionPrograms

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Communityprogramsthatincludemediacampaignsandpolicychanges,suchasnewregulationsthatrestrictaccesstoalcohol,tobacco,orotherdrugs,aremoreeffectivewhentheyareaccompaniedbyschoolorfamilyinterventions.Communityprogramsneedtostrengthennormsagainstdruguseinalldrugabusepreventionsettings,includingthefamilyandtheschool.Inaddition,preventionprogrammingshouldbeadaptedtoaddressthespecificnatureofthedrugabuseprobleminthelocalcommunity.

4:Principlesofdrugaddictiontreatment

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Threedecadesofscientificresearchandclinicalpracticehaveyieldedavarietyofeffectiveapproachestodrugaddictiontreatment.InApril1998,NIDAheldTheNationalConferenceonDrugAddictionTreatment:FromResearchtoPracticewhichsummarizedthisextensivebodyofresearch.Basedonthefindingsreportedatthisconference,NIDApublishedinOctober1999,PrinciplesofDrugAddictionTreatment:AResearch-BasedGuidetofostermorewidespreaduseofscientifically-basedcomponentsofdrugaddictiontreatment.Keycomponentsofthisguidearehighlightedinthefollowingimages.

Note:ThecurrentversionofthispublicationwasrevisedinApril2009.

5:Componentsofcomprehensivedrugaddictiontreatment

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Avarietyofscientifically-basedapproachestodrugaddictiontreatmentexist.Drugaddictiontreatmentcanincludebehavioraltherapy(e.g.,counseling,cognitivetherapy,orpsychotherapy),medications,ortheircombination.Casemanagementandreferraltoothermedical,psychological,andsocialservicesarecrucialcomponentsoftreatmentformanypeopleaswell.Thebestprogramsprovideacombinationoftherapiesandotherservicestomeettheneedsoftheindividualpatient,whichareshapedbysuchissuesasage,race,culture,sexualorientation,gender,pregnancy,parenting,housing,andemployment,aswellasphysicalandsexualabuse.

Severalofthekeyprinciplesunderlyingthisapproachtotreatmentfollow.

6:Matchingpatientstoindividualneeds

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Nosingletreatmentisappropriateforallindividuals.Matchingtreatmentsetting,interventions,andservicestoeachindividual'sparticularproblemsandneedsiscriticaltohisorherultimatesuccessinreturningtoproductivefunctioninginthefamily,workplace,andsociety.

Effectivetreatmentattendstomultipleneedsoftheindividual,notjusthisorherdruguse.Tobeeffective,treatmentmustaddresstheindividual'sdruguseandanyassociatedmedical,psychological,social,vocational,andlegalproblems.

7:Durationoftreatment

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Individualsprogressthroughdrugaddictiontreatmentatvariousspeeds,sothereisnopredeterminedlengthoftreatment.However,researchhasshownunequivocallythatgoodoutcomesarecontingentonadequatelengthsoftreatment.Generally,forresidentialoroutpatienttreatment,participationforlessthan90daysisoflimitedornoeffectiveness,andtreatmentslastingsignificantlylongeroftenareindicated.Formethadonemaintenance,12monthsoftreatmentistheminimum,andsomeopiate-addictedindividualswillcontinuetobenefitfrommethadonemaintenancetreatmentoveraperiodofyears.

8:Medicaldetoxification

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Medicaldetoxificationsafelymanagestheacutephysicalsymptomsofwithdrawalassociatedwithstoppingdruguse.However,medicaldetoxificationisonlythefirststageofaddictiontreatmentandbyitselfdoeslittletochangelong-termdruguse.Althoughdetoxificationaloneisrarelysufficienttohelpaddictsachievelong-termabstinence,forsomeindividualsitisastronglyindicatedprecursortoeffectivedrugaddictiontreatment.

9:Counselingandotherbehavioraltherapies

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Counseling(individualand/orgroup)andotherbehavioraltherapiesarecriticalcomponentsofeffectivetreatmentforaddiction.Intherapy,patientsaddressissuesofmotivation,buildskillstoresistdruguse,replacedrug-usingactivitieswithconstructiveandrewardingnondrug-usingactivities,andimproveproblem-solvingabilities.Behavioraltherapyalsofacilitatesinterpersonalrelationshipsandtheindividual'sabilitytofunctioninthefamilyandcommunity.

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SectionIV

1:Medicationsfordrugaddiction

Medicationsareanimportantelementoftreatmentformanypatients,especiallywhencombinedwithcounselingandotherbehavioraltherapies.Methadoneandlevo-alpha-acetylmethadol(LAAM)areveryeffectiveinhelpingindividualswhoareaddictedtoheroinorotheropiatesstabilizetheirlivesandreducetheirillicitdruguse.Naltrexoneisalsoaneffectivemedicationforsomeopiateaddictsandsomepatientswithco-occurringaddictiontoalcohol.Forpersonsaddictedtonicotine,anicotinereplacementproduct(suchaspatchesorgum)oranoralmedication(suchasbupropion)canbeaneffectivecomponentoftreatment.Forpatientswithmentaldisorders,bothbehavioraltreatmentsandmedicationscanbecriticallyimportant.

2:Motivationtoenter/sustaintreatment

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Treatmentdoesnotneedtobevoluntarytobeeffective.Strongmotivationcanfacilitatethetreatmentprocess.Sanctionsorenticementsinthefamily,employmentsetting,orcriminaljusticesystemcanincreasesignificantlybothtreatmententryandretentionratesandthesuccessofdrugtreatmentinterventions.Individualswhoentertreatmentunderlegalpressurehaveoutcomesasfavorableasthosewhoentertreatmentvoluntarily.

3:HIV/AIDS,hepatitisandotherinfectiousdiseases

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DruginjectorswhodonotentertreatmentareuptosixtimesmorelikelytobecomeinfectedwithHIVthaninjectorswhoenterandremainintreatment.Drugabuserswhoenterandcontinueintreatmentreduceactivitiesthatcanspreaddisease,suchassharinginjectionequipmentandengaginginunprotectedsexualactivity.Participationintreatmentalsopresentsopportunitiesforscreening,counseling,andreferralforadditionalservices.ThebestdrugabusetreatmentprogramsprovideHIVcounselingandofferHIVtestingtotheirpatients.

4:Effectivenessoftreatment

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Accordingtoseveralstudies,drugtreatmentreducesdruguseby40to60percentandsignificantlydecreasescriminalactivityduringandaftertreatment.Forexample,astudyoftherapeuticcommunitytreatmentfordrugoffendersdemonstratedthatarrestsforviolentandnonviolentcriminalactswerereducedby40percentormore.Methadonetreatmenthasbeenshowntodecreasecriminalbehaviorbyasmuchas50percent.ResearchshowsthatdrugaddictiontreatmentreducestheriskofHIVinfectionandthatinterventionstopreventHIVaremuchlesscostlythantreatingHIV-relatedillnesses.Treatmentcanimprovetheprospectsforemployment,withgainsofupto40percentaftertreatment.(Note:Althoughtheseeffectivenessratesholdingeneral,individualtreatmentoutcomesdependontheextentandnatureofthepatient'spresentingproblems,theappropriatenessofthetreatmentcomponentsandrelatedservicesusedtoaddressthoseproblems,andthedegreeofactiveengagementofthepatientinthetreatmentprocess.)

5:Self-helpanddrugaddictiontreatment

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Self-helpgroupscancomplementandextendtheeffectsofprofessionaldrugaddictiontreatment.Themostprominentself-helpgroupsarethoseaffiliatedwithAlcoholicsAnonymous(AA),NarcoticsAnonymous(NA),andCocaineAnonymous(CA),allofwhicharebasedonthe12-stepmodelandSmartRecovery.Mostdrugaddictiontreatmentprogramsencouragepatientstoparticipateinaself-helpgroupduringandafterformaltreatment.

6:Costeffectivenessofdrugtreatment

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Drugaddictiontreatmentiscost-effectiveinreducingdruguseanditsassociatedhealthandsocialcosts.Treatmentislessexpensivethanalternatives,suchasnottreatingaddictsorsimplyincarceratingaddicts.Forexample,theaveragecostfor1fullyearofmethadonemaintenancetreatmentisapproximately$4,700perpatient,whereas1fullyearofimprisonmentcostsapproximately$18,400perperson.

Accordingtoseveralconservativeestimates,every$1investedinaddictiontreatmentprogramsyieldsareturnofbetween$4and$7inreduceddrug-relatedcrime,criminaljusticecosts,andtheftalone.Whensavingsrelatedtohealthcareareincluded,totalsavingscanexceedcostsbyaratioof12to1.Majorsavingstotheindividualandtosocietyalsocomefromsignificantdropsininterpersonalconflicts,improvementsinworkplaceproductivity,andreductionsindrug-relatedaccidents.

7:ForMoreInformation

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