The neurobiology of addiction PDF
Preview The neurobiology of addiction
The Neurobiology of Addiction Brain Disorders Cells of the Nervous System The Forebrain The Hindbrain Learning and Memory Meditation and Hypnosis The Midbrain The Neurobiology of Addiction Sleep and Dreaming The Spinal Cord The Neurobiology of Addiction James D. Stoehr Professor Colleges of Medicine and Health Sciences Midwestern University CHELSEA HOUSE PUBLISHERS VP,NEWPRODUCTDEVELOPMENT Sally Cheney DIRECTOROFPRODUCTION Kim Shinners CREATIVEMANAGER Takeshi Takahashi MANUFACTURINGMANAGER Diann Grasse PRODUCTIONEDITOR Noelle Nardone PHOTOEDITOR Sarah Bloom STAFFFORTHE NEUROBIOLOGY OFADDICTION PROJECTMANAGEMENT Dovetail Content Solutions DEVELOPMENTALEDITOR Carol Field PROJECTMANAGER Pat Mrozek PHOTOEDITOR Robin Landry SERIESANDCOVERDESIGNER Terry Mallon LAYOUT Maryland Composition Company,Inc. ©2006 by Chelsea House Publishers, a subsidiary ofHaights Cross Communications. All rights reserved.Printed and bound in the United States ofAmerica. www.chelseahouse.com First Printing 10 9 8 7 6 5 4 3 2 1 Library ofCongress Cataloging-in-Publication Data Stoehr,James D. The neurobiology ofaddiction / James D.Stoehr. p.cm.—(Gray matter) Includes bibliographical references and index. ISBN 0-7910-8574-0 1. Substance abuse—Physiological aspects. 2. Neuropsychology. 3. Brain. I. Title. II. Series. RC564.S76 2005 616.86—dc22 2005011989 All links,web addresses,and Internet search terms were checked and verified to be correct at the time ofpublication.Because ofthe dynamic nature ofthe web,some addresses and links may have changed since publication and may no longer be valid. Contents 1. Drug and Alcohol Addiction:Overview. . . . . . . . . . . . . . . . . . . 1 2. The Brain and Our Behavior . . . . . . . . . . . . . . . . . . . . . . . . . . 6 3. Brain Regions Involved in Addiction. . . . . . . . . . . . . . . . . . . . 18 4. Stimulants and Hallucinogens. . . . . . . . . . . . . . . . . . . . . . . . 36 5. Depressants and Marijuana. . . . . . . . . . . . . . . . . . . . . . . . . . 52 6. The Cycle of Addiction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 7. Addiction Treatments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 Glossary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88 Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96 Further Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 Websites. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 Drug and Alcohol Addiction: 1 Overview T he human brain is capable of creating complex and beau- tiful things. It is capable of undying love and compassion for others and of true selflessness and generosity. However, the human brain is also capable of intolerance and cruelty, and the brain itself is not immune to its own destructive powers. The needs and wants of the human brain can overcome its abilities for reason and rational thought to the point of self- destruction and even death. This can be the case in drug and alcohol addiction. To fully understand the problem of drug and alcohol ad- diction, one must appreciate the processes that occur in the human brain during the phases of drug use, abuse, depen- dence, and addiction. Fundamental to this appreciation is the concept that drug and alcohol addiction is a brain disease. Sci- entific evidence implicates the human brain as both the un- derlying cause and ultimate solution to the problem of addic- tion. Our brains are responsible for all of our thoughts, motivations, and actions. The human brain is susceptible to all drugs of abuse. Ultimately these drugs change the chem- istry and functioning of the human brain and lead to im- paired judgments and actions that can result in chronic drug use. Yet the same human brain is capable of understanding its 1 2 The Neurobiology of Addiction susceptibilities, accepting its limits and, ultimately, striving for continual self-improvement and health. The economic cost of drug and alcohol addiction is staggering. According to estimates from the National Institute on Drug Abuse (NIDA) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the total annual economic cost of drug and alcohol abuse exceeds $250 billion. This includes the costs of the legal consequences of drug abuse (law enforcement, incarceration of prisoners, drug traffic control), lost work productivity (of both victims and perpetrators), property damage, and health-related costs (premature deaths, drug-related illnesses, and healthcare). Although some of us have not experienced these consequences first-hand, we may know someone who abuses drugs. They may smoke or drink too much, misuse prescription medications, or use illicit drugs occasionally. What they have in common is that they are all taking risks with their health and safety. Drug and al- cohol abuse is our number one public health concern. Nevertheless, the benefits of science-based drug education and prevention programs are beginning to be realized. Recent trends in the attitudes and behaviors of high school students indicate that, in general, drug use is on the decline by school-aged children and teenagers. Consider the following statistics from the Univer- sity of Michigan’s annual Monitoring the Future Survey of more than 48,000 school children from around the country in 2003: • The use of marijuana and MDMA (Ecstasy) declined in 8th graders since 2002. • The use of amphetamines, tranquilizers, and MDMA by 10th and 12thgraders also declined. • The use of heroin, crack cocaine, and steroids declined among 10thgraders. • However, inhalant use by 8th graders increased from the previous year, and the use of Vicodin®and OxyContin®con- tinues to rise in all age groups. Drug and Alcohol Addiction: Overview 3 Furthermore, consider the absolute numbers of these chil- dren who are using these drugs (when 1% roughly equals 40,000 kids nationwide): • Within the last month 17% of these individuals used to- bacco products, 33% used alcohol, 15% used marijuana, and 4% used amphetamines. • Each day approximately 3,000 teenagers start smoking cigarettes; one third will become daily smokers. • Peak lifetime drug use occurs in the young adult age group (ages 18–25). • Within the last month non-medical use of prescription painkillersby young adults jumped by 15%. • More than 60% of all patients who enter drug treatment programs started using drugs at age 20 or younger. Most drug and alcohol use starts at an early age. Recent studies have also suggested that approximately a third of ado- lescent alcohol users will progress to alcohol abuse or depen- dence, and approximately half of adolescent drug users will make the transition to drug abuse or dependence. Drug and al- cohol use typically starts as an experiment. Curiosity and peer pressure may be significant factors during this stage. Recre- ational or social use may follow as the user increases the fre- quency of drug or alcohol use. As the user starts to become adapted to the drug, more (larger doses) will be required to achieve the same feeling or effect (tolerance). At this point, drug abuse can rapidly progress to addiction (compulsivedrug use despite harmful consequences). See Table 1.1 for typical signs and symptoms of drug or alcohol addiction. Addiction is chronic (persistent and long lasting), progressive (increasing in severity), and characterized by relapse(regression or transition into worsening state following partial recovery). The pace with which abusers may progress through these stages
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