Download Addiction

PATHOPHYSIOLOGY
Mental Illness and Cognitive Disorders Project
Mrs. Bowman
Student Name: Nemmer R. Miari
April 7th, 2015
Etiology

Although addiction usually (but not always) begins with
a conscious decision to use a drug, changes that occur
in the brain at some point can turn drug use and then
abuse into a chronic, relapsing illness.

Some genetically predisposed individuals, however,
become "addicted" almost immediately, with very little
progression from use to abuse to dependency.
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Common Signs and Symptoms of
Drug Abuse

You’re neglecting your responsibilities at school, work,
or home (e.g. flunking classes, skipping work, neglecting
your children) because of your drug use.

You’re using drugs under dangerous conditions or
taking risks while high, such as driving while on drugs,
using dirty needles, or having unprotected sex.

Your drug use is getting you into legal trouble, such as
arrests for disorderly conduct, driving under the
influence, or stealing to support a drug habit.

Your drug use is causing problems in your
relationships, such as fights with your partner or family
members, an unhappy boss, or the loss of old friends.
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Common Signs and Symptoms of
Drug Addiction

You’ve built up a drug tolerance. You need to use more of the drug to
experience the same effects you used to attain with smaller amounts.

You take drugs to avoid or relieve withdrawal symptoms. If you go too long
without drugs, you experience symptoms such as nausea, restlessness, insomnia,
depression, sweating, shaking, and anxiety.

You’ve lost control over your drug use. You often do drugs or use more than
you planned, even though you told yourself you wouldn’t. You may want to stop
using, but you feel powerless.

Your life revolves around drug use. You spend a lot of time using and thinking
about drugs, figuring out how to get them, and recovering from the drug’s
effects.

You’ve abandoned activities you used to enjoy, such as hobbies, sports, and
socializing.

You continue to use drugs, despite knowing it’s hurting you. It’s causing major
problems in your life—blackouts, infections, mood swings, depression, paranoia—
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but you use them anyway.
Diagnosis Methods

Some speculate that two events must occur for the addictive process to
be initiated. First, there is an activation of the brain's "pleasure pathway."
This occurs in the medial forebrain bundle, which runs from the brain
stem and midbrain through the hypothalamus to a variety of sites in the
forebrain that are concerned with emotion, motivation, reward, and
decision-making.

Dopamine is the transmitter that ascends to the subcortical and cortical
structures of the limbic system (in the forebrain). Dopamine's role seems
to be to provide steady (tonic) regulation of the activity of the nerve cells
in the limbic system.

When levels of dopamine rise significantly beyond physiologic levels (as
with cocaine or amphetamine exposure), the entire medial forebrain
bundle system linking dopamine-containing cell bodies with many regions
of the forebrain may begin to function aberrantly.
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Diagnosis Methods – Cont.

Second, for the addictive response to be initiated, the neural response to
the drug exposure must have a rapid onset and must also rebound below
the initial baseline of neural activity before returning to it. For example,
in the case of inhaled cocaine, the drug blocks the transport of dopamine
back into the nerve terminal, thereby elevating dopamine levels greatly.
Dopamine levels rise rapidly to a peak that is typically several-fold
greater than that achievable through physiologic stimulation (emotion,
exercise) alone.

Next, dopamine levels fall rapidly and drop below the normal baseline
before returning to stable values. When exposure to cocaine is repeated,
the brain adapts to these drug-induced effects.

Two adaptations are of particular relevance to addiction: sensitization, an
increased nerve cell response to repeated drug exposure; and learning, a
reflection of enduring changes in the emotional brain as a direct result of
aspects of the drug exposure that resemble other types of conditioned
behavior.
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Abuse vs. Dependency

There are important differences between
abuse of and dependency on a drug.

Drug abuse refers to the intentional misuse or
overuse of drugs. Drug abusers maintain
control over their behavior. They do not have a
medical disease; they have a self-imposed
problem.

Drug dependency involves "impaired control"
over use of the drug (this applies to all
substances except certain mood-altering drugs
that do not have a major effect on the medial
forebrain bundle), which refers to an obsessive
preoccupation with the use of the drug.
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Expected Lifespan

The majority of long-term,
hard-core drug addicts are
dying in their 40s and 50s.

The life expectancy of a
drug addict is 15 to 20
years after they start being
a drug addict.
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Effective Treatment Approaches

Medication and behavioral therapy, especially when combined,
are important elements of an overall therapeutic process that
often begins with detoxification, followed by treatment and
relapse prevention.

Easing withdrawal symptoms can be important in the initiation
of treatment; preventing relapse is necessary for maintaining
its effects. And sometimes, as with other chronic conditions,
episodes of relapse may require a return to prior treatment
components.

A continuum of care that includes a customized treatment
regimen—addressing all aspects of an individual's life, including
medical and mental health services—and follow–up options
(e.g., community–or family-based recovery support systems)
can be crucial to a person's success in achieving and
maintaining a drug–free lifestyle.
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HISTORY
- previous history
- expectation
- learning
DRUGS
BIOLOGY
- genetics
- circadian rhythms
- disease states
- gender
BRAIN
MECHANISMS
ADDICTION
ENVIRONMENT
- social interactions
- stress
- conditioned stimuli
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Stress and Drug Addiction
Research Tells Us That STRESS
Can Be A Major Factor In the
Initiation of Drug Use…
And One of the Most Powerful
Triggers for Relapse
In Recovering Addicts
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Stress and Drug Addiction – Cont.
Research Has Also Shown That There Is
Overlap Between Neuro-circuits That
Respond To Drugs and Those That
Respond To Stress
Piazza PV and Le Moal, M, Trends in Pharmacological Science, 19, February 1998;
Kreek, MJ and Koob, G, Drug Alcohol Depend, 51, 1998.
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The Stress Hormone Cycle
Hypothalamus
CRF
Pituitary
Gland
ACTH
Adrenal
Glands
Kidneys
Stress Responses
CORTISOL
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Anxiety
DRUG USE
(Self-Medication)
CRF
What Role Does
Stress Play In
Initiating Drug Use?
CRF
STRESS
Anxiety
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Anxiety
Prolonged
DRUG
USE
CRF
RELAPSE
What Happens When
A Person Stops
Taking A Drug?
Abstinence
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What Do Mental and Addictive
Disorders Have in Common?
 Both are Behavioral Dysfunctions
With Similar Neurobiological Basis
 Because of this overlap, drugs of
abuse can cause symptoms that mimic
most forms of mental illness
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Addictive Disorder
Addictive Disorders
Often Co-Exist With
Mental Disorders
Mental Disorder
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Examples of Dual Disorders

ADDICTION
DISORDERS

MENTAL DISORDERS

Schizophrenia

Alcohol Abuse/Dependency

Bi-polar

Cocaine/ Amphetamine

Schizoaffective

Opiates

Major Depression

Marijuana

Borderline Personality

Poly-substance combinations

Post Traumatic Stress

Prescription drugs

Social Phobia

Others
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Drug
Cocaine and Methamphetamine
Disorder
Schizophrenia, paranoia,
anhedonia, compulsive
behavior
Stimulants
Anxiety, panic attacks,
mania and sleep disorders
LSD, Ecstasy & psychedelics
Delusions and hallucinations
Alcohol, sedatives, sleep-aids
and narcotics
PCP & Ketamine
Depression and mood
disturbances
Antisocial behavior
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Long-Term Effects
• Nearly half of individuals
with a past year substance
use disorder also had a
mental disorder
• Mental disorders found to
be most prevalent included
affective disorders, anxiety
disorders, personality
disorders, and psychotic
disorders
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Lifetime Prevalence of Drug Disorders Among
Persons With Various Mental Disorders
(vs. any Drug Disorder Alone)
45
40
35
30
25
20
15
10
5
0
Any Drug SchizoDisorder phrenia
(alone)
Anxiety
APD
OCD
Panic
Disorder
Depression
Bipolar
Disorder
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Source: Regier,D.A. et al., JAMA 264(19), pp. 2511-2518, November 21, 1990.
Drug Abuse
 Some drugs of abuse have a
mechanism of action similar to
that of drugs used as
psychotherapeutic agents.

Significance: rationale for
self-administration
 Chronic use of some of these drugs
may alter the way the brain
functions,
making persons particularly
susceptible to mental illness
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Works Cited
1.
http://www.helpguide.org/articles/addiction/drug-abuse-andaddiction.htm
2.
http://www.mayoclinic.org/diseases-conditions/drugaddiction/basics/definition/con-20020970
3.
http://www.webmd.com/mental-health/addiction/drug-abuseaddiction
4.
https://ncadd.org/learn-about-drugs/signs-and-symptoms
5.
http://www.medicinenet.com/drug_abuse/page2.htm
6.
http://www.thefix.com/content/10-hardest-addictive-drugsto-kick7055
7.
http://en.wikipedia.org/wiki/Substance_dependence
8.
http://www.drugabuse.gov/publications/drugfacts/treatmentapproaches-drug-addiction
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