52
UNDERSTANDING ADDICTION 9/4/2016 MUKTAA CHARITABLE OUNDATION-SAMVAD HELPLINE-020-26381234

UNDERSTANDING ADDICTION- IT'S BEYOND WILLPOWER

Embed Size (px)

Citation preview

Page 1: UNDERSTANDING ADDICTION- IT'S BEYOND WILLPOWER

UNDERSTANDING ADDICTION

9/4/2016 MUKTAA CHARITABLE OUNDATION-SAMVAD

HELPLINE-020-26381234

Page 2: UNDERSTANDING ADDICTION- IT'S BEYOND WILLPOWER

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.”

9/4/2016

MUKTAA CHARITABLE OUNDATION-SAMVAD HELPLINE-020-26381234

Page 3: UNDERSTANDING ADDICTION- IT'S BEYOND WILLPOWER

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

9/4/2016 MUKTAA CHARITABLE OUNDATION-SAMVAD

HELPLINE-020-26381234

Page 4: UNDERSTANDING ADDICTION- IT'S BEYOND WILLPOWER

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.

9/4/2016 MUKTAA CHARITABLE OUNDATION-SAMVAD

HELPLINE-020-26381234

Page 5: UNDERSTANDING ADDICTION- IT'S BEYOND WILLPOWER

9/4/2016 MUKTAA CHARITABLE OUNDATION-SAMVAD

HELPLINE-020-26381234

Addiction is a disease of Brain

Not a fault in character

Page 6: UNDERSTANDING ADDICTION- IT'S BEYOND WILLPOWER

“HIJACK”OF OUR SURVIVAL SYSTEM

Motivation

Decision making

Risk and reward assessment

Pleasure seeking

Impulse control/ inhibition

Emotion

Learning, memory

Stress control.

9/4/2016 MUKTAA CHARITABLE OUNDATION-SAMVAD

HELPLINE-020-26381234

Page 7: UNDERSTANDING ADDICTION- IT'S BEYOND WILLPOWER

VIDEO

9/4/2016 MUKTAA CHARITABLE OUNDATION-SAMVAD

HELPLINE-020-26381234

Page 8: UNDERSTANDING ADDICTION- IT'S BEYOND WILLPOWER

Di Chiara et al., Neuroscience, 1999.,Fiorino and Phillips, J. Neuroscience, 1997.

Natural Rewards Elevate

Dopamine Levels

0

50

100

150

200

0 60 120 180

Time (min)

% o

f B

asa

l D

A O

utp

ut NAc shell

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

Page 9: UNDERSTANDING ADDICTION- IT'S BEYOND WILLPOWER

0

100

200

300

400

500

600

700

800

900

1000

1100

0 1 2 3 4 5 hr

% o

f B

asa

l R

elea

se

DA DOPAC HVA

Accumbens

Amphetamine

0

100

200

300

400

0 1 2 3 4 5 hr

% o

f B

asa

l R

elea

se

DA DOPAC HVA

Accumbens

Cocaine

Time After Drug

Morphine

0

100

150

200

250

0 1 2 3 hr

Time After Drug

% o

f B

asa

l R

elea

se

Accumbens Caudate

Nicotine

Di Chiara and Imperato, PNAS, 1988

Effects of Drugs on Dopamine Release

% o

f B

asa

l R

elea

se

0

100

150

200

250

0 1 2 3 4 5 hr

Accumbens

0.5 1.0 2.5 10

Dose

mg/kg mg/kg

mg/kg mg/kg

9/4/2016 MUKTAA CHARITABLE OUNDATION-SAMVAD

HELPLINE-020-26381234

Page 10: UNDERSTANDING ADDICTION- IT'S BEYOND WILLPOWER

9/4/2016 MUKTAA CHARITABLE OUNDATION-SAMVAD

HELPLINE-020-26381234

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.

Page 11: UNDERSTANDING ADDICTION- IT'S BEYOND WILLPOWER

9/4/2016 MUKTAA CHARITABLE OUNDATION-SAMVAD

HELPLINE-020-26381234

Car with no brakes.

It’s no more a choice to say “stop”

Page 12: UNDERSTANDING ADDICTION- IT'S BEYOND WILLPOWER

DRUGS AFFECT BRAIN.

BUT DOES ADDICTIVE DRUGS

CHANGE THE BRAIN?

9/4/2016 MUKTAA CHARITABLE OUNDATION-SAMVAD

HELPLINE-020-26381234

Page 13: UNDERSTANDING ADDICTION- IT'S BEYOND WILLPOWER

CIRCUIT AND CHEMICAL

LOCHA?

9/4/2016 MUKTAA CHARITABLE OUNDATION-SAMVAD

HELPLINE-020-26381234

Page 14: UNDERSTANDING ADDICTION- IT'S BEYOND WILLPOWER

Control Addicted

Dopamine D2 Receptors are Decreased by Addiction

Functionally…

Cocaine

Alcohol

Heroin

Meth

9/4/2016 MUKTAA CHARITABLE OUNDATION-SAMVAD

HELPLINE-020-26381234

Page 15: UNDERSTANDING ADDICTION- IT'S BEYOND WILLPOWER

Amph

Neuronal Dendrites in the Nucleus Accumbens

Saline

Robinson & Kolb, Journal of Neuroscience, Volume: 1997

Structurally….

9/4/2016 MUKTAA CHARITABLE OUNDATION-SAMVAD

HELPLINE-020-26381234

Page 16: UNDERSTANDING ADDICTION- IT'S BEYOND WILLPOWER

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

9/4/2016 MUKTAA CHARITABLE OUNDATION-SAMVAD

HELPLINE-020-26381234

Page 17: UNDERSTANDING ADDICTION- IT'S BEYOND WILLPOWER

ADDICTION IS A PROGESSIVE DISEASE

AND

ONCE AN ADDICT ALWAYS AN ADDICT

9/4/2016 MUKTAA CHARITABLE OUNDATION-SAMVAD

HELPLINE-020-26381234

Page 18: UNDERSTANDING ADDICTION- IT'S BEYOND WILLPOWER

WHY CATCH THEM YOUNG?

9/4/2016 MUKTAA CHARITABLE OUNDATION-SAMVAD

HELPLINE-020-26381234

Page 19: UNDERSTANDING ADDICTION- IT'S BEYOND WILLPOWER

Basic Science Tells Us that Adolescents’ Brains

Are Still developing…and they are wired differently

9/4/2016 MUKTAA CHARITABLE OUNDATION-SAMVAD

HELPLINE-020-26381234

Page 20: UNDERSTANDING ADDICTION- IT'S BEYOND WILLPOWER

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

9/4/2016 MUKTAA CHARITABLE OUNDATION-SAMVAD

HELPLINE-020-26381234

Page 21: UNDERSTANDING ADDICTION- IT'S BEYOND WILLPOWER

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

HELPLINE-020-26381234

Page 22: UNDERSTANDING ADDICTION- IT'S BEYOND WILLPOWER

9/4/2016 MUKTAA CHARITABLE OUNDATION-SAMVAD

HELPLINE-020-26381234

Page 23: UNDERSTANDING ADDICTION- IT'S BEYOND WILLPOWER

“CATCH THEM YOUNG MOVEMENT”

WE NEED TO HAVE AN ARMY OF PROFESSIONSALS FOR PREVENTION OF

ADDICTIONS IN ADOLESCENTS

SHAALA PROJECT……..

UNPLUGGED INDIA…..

9/4/2016 MUKTAA CHARITABLE OUNDATION-SAMVAD

HELPLINE-020-26381234

Page 24: UNDERSTANDING ADDICTION- IT'S BEYOND WILLPOWER

Why do some people

become addicted to drugs

while others do not?

9/4/2016 MUKTAA CHARITABLE OUNDATION-SAMVAD

HELPLINE-020-26381234

Page 25: UNDERSTANDING ADDICTION- IT'S BEYOND WILLPOWER

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

Page 26: UNDERSTANDING ADDICTION- IT'S BEYOND WILLPOWER

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

HELPLINE-020-26381234

Page 27: UNDERSTANDING ADDICTION- IT'S BEYOND WILLPOWER

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”

9/4/2016 MUKTAA CHARITABLE OUNDATION-SAMVAD

HELPLINE-020-26381234

Page 28: UNDERSTANDING ADDICTION- IT'S BEYOND WILLPOWER

ITS’S TRUE THAT PEOPLE MAY CHOOSE TO TAKE DRUGS, BUT NO ONE CHOOSES TO BE AN ADDICT

THAT IS ALREADY DECIDED

9/4/2016 MUKTAA CHARITABLE OUNDATION-SAMVAD

HELPLINE-020-26381234

Page 29: UNDERSTANDING ADDICTION- IT'S BEYOND WILLPOWER

…addiction is not about drugs, it’s about brains.

9/4/2016 MUKTAA CHARITABLE OUNDATION-SAMVAD

HELPLINE-020-26381234

WO DIL KI MASTI HI HAI JO RANG LAATI HAI. NASHA SHARAB MEIN HOTA TO NACHTO BOTTLE

Page 30: UNDERSTANDING ADDICTION- IT'S BEYOND WILLPOWER

HUM SAATH SAATH HAI……

COMPULSIVE DRUG ABUSE

COMPULSIVE SHOPPING

COMPULSIVE EATING

GAMBLING

ALL HAVE COMMON LINKAGES

9/4/2016 MUKTAA CHARITABLE OUNDATION-SAMVAD

HELPLINE-020-26381234

Page 31: UNDERSTANDING ADDICTION- IT'S BEYOND WILLPOWER

PSYCHOLOGICAL RISKS

Depression and anxiety

Psychotic disorders such as schizophrenia

Conduct disorder

Attention deficit/hyperactivity disorder

Suicide

9/4/2016 MUKTAA CHARITABLE OUNDATION-SAMVAD

HELPLINE-020-26381234

Page 32: UNDERSTANDING ADDICTION- IT'S BEYOND WILLPOWER

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.

Page 33: UNDERSTANDING ADDICTION- IT'S BEYOND WILLPOWER

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

9/4/2016 MUKTAA CHARITABLE OUNDATION-SAMVAD

HELPLINE-020-26381234

Page 34: UNDERSTANDING ADDICTION- IT'S BEYOND WILLPOWER

ADDICTION PRONE PERSONALITY

Impulsivity

Aggressiveness

Sensation or novelty-seeking

High activity level

Risk taking tendencies

Lack of pain avoidance responses

Page 35: UNDERSTANDING ADDICTION- IT'S BEYOND WILLPOWER

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

Page 36: UNDERSTANDING ADDICTION- IT'S BEYOND WILLPOWER

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

9/4/2016

MUKTAA CHARITABLE OUNDATION-SAMVAD HELPLINE-020-26381234

Page 37: UNDERSTANDING ADDICTION- IT'S BEYOND WILLPOWER

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

9/4/2016 MUKTAA CHARITABLE OUNDATION-SAMVAD

HELPLINE-020-26381234

Page 38: UNDERSTANDING ADDICTION- IT'S BEYOND WILLPOWER

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

9/4/2016

MUKTAA CHARITABLE OUNDATION-SAMVAD HELPLINE-020-26381234

Page 39: UNDERSTANDING ADDICTION- IT'S BEYOND WILLPOWER

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

9/4/2016 MUKTAA CHARITABLE OUNDATION-SAMVAD

HELPLINE-020-26381234

Page 40: UNDERSTANDING ADDICTION- IT'S BEYOND WILLPOWER

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

Page 41: UNDERSTANDING ADDICTION- IT'S BEYOND WILLPOWER

Money –no problem

"Badi mehangi hui hai sharab, thodi thodi piya

karo"

“CHAR BOTTLE VODKA, KAAM MERA ROJKA”

9/4/2016 MUKTAA CHARITABLE OUNDATION-SAMVAD

HELPLINE-020-26381234

Page 42: UNDERSTANDING ADDICTION- IT'S BEYOND WILLPOWER

Addiction Involves Multiple Factors

9/4/2016 MUKTAA CHARITABLE OUNDATION-SAMVAD

HELPLINE-020-26381234

Page 43: UNDERSTANDING ADDICTION- IT'S BEYOND WILLPOWER

NATURE Vs NURTURE

Environmental factors : Initiation

Genetic factors: transition from regular use to the development of addiction.

9/4/2016 MUKTAA CHARITABLE OUNDATION-SAMVAD

HELPLINE-020-26381234

Page 44: UNDERSTANDING ADDICTION- IT'S BEYOND WILLPOWER

UNDERSTANDING ADDICTION LECTURE CHA FAYDA KAI?????

9/4/2016 MUKTAA CHARITABLE OUNDATION-SAMVAD

HELPLINE-020-26381234

Page 45: UNDERSTANDING ADDICTION- IT'S BEYOND WILLPOWER

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

9/4/2016

MUKTAA CHARITABLE OUNDATION-SAMVAD HELPLINE-020-26381234

Page 46: UNDERSTANDING ADDICTION- IT'S BEYOND WILLPOWER

PHARMACOLOGAL TREATMENT

AVERSIVE DRUGS

DETERRANT DRUGS

ANTICRAVING DRUGS

SUBSTITUTION THERAPY

9/4/2016 MUKTAA CHARITABLE OUNDATION-SAMVAD

HELPLINE-020-26381234

Page 47: UNDERSTANDING ADDICTION- IT'S BEYOND WILLPOWER

BEHAVIOURAL TREATMENT

MOTIVATION ENHANCEMENT THERAPY

COGNITIVE BEHAVIOURAL THERAPY

RELAPSE PREVENTION THERAPY

9/4/2016 MUKTAA CHARITABLE OUNDATION-SAMVAD

HELPLINE-020-26381234

Page 48: UNDERSTANDING ADDICTION- IT'S BEYOND WILLPOWER

WHY CATCH THEM YOUNG?

9/4/2016 MUKTAA CHARITABLE OUNDATION-SAMVAD

HELPLINE-020-26381234

Page 49: UNDERSTANDING ADDICTION- IT'S BEYOND WILLPOWER

MOST IMPORTANT………CHANGE IN OUR ATTITUDE

DURITANCHE TIMIR JAAVO VISHWA

SARWADHARM SURYA PAHO

9/4/2016 MUKTAA CHARITABLE OUNDATION-SAMVAD

HELPLINE-020-26381234

Page 50: UNDERSTANDING ADDICTION- IT'S BEYOND WILLPOWER

WE MAY NOT BE ABLE TO ERRADICATE DRUG ADDICTION, BUT IN FUTURE WE

CAN ATLEAST FACE OUR CHILDERN AND SAY

“” I TRIED””

9/4/2016 MUKTAA CHARITABLE OUNDATION-SAMVAD

HELPLINE-020-26381234

Page 51: UNDERSTANDING ADDICTION- IT'S BEYOND WILLPOWER

LET’ S BEGIN AND DO OUR BIT……..LET’S ATRAT TODAY

9/4/2016 MUKTAA CHARITABLE OUNDATION-SAMVAD

HELPLINE-020-26381234

Page 52: UNDERSTANDING ADDICTION- IT'S BEYOND WILLPOWER

Thank you

Dr Madhu Oswal Thakkar Muktaa Charitable Foundation

www.mcf.org.in Email: [email protected]

9/4/2016 MUKTAA CHARITABLE OUNDATION-SAMVAD

HELPLINE-020-26381234