WSADCP Conference Seattle, Wa. 10/18/13 Neuroscientific Basis of Addiction & Recovery Darryl S. Inaba, PharmD., CATC -V, CADCIII Neuroscience of Addiction & Recovery Continues 2 Stops Remaining • 1:15 pm Roots of Addiction • 2:45 pm Current Trends in Substance Abuse Part III: Roots of Addiction: Etiology of Substance-Related & Addictive Disorders 1:15 - 2:30pm with Break 2:30 - 4:00pm Darryl S. Inaba, PharmD., CATD V, CADC III Director of: Clinical and Behavioral Health Services - Addictions Recovery Center Research and Education - CNS Productions, Inc. Medford, Oregon Multiple Theories & Beliefs About the Cause of Addiction • Right Brain Predominance/Lateral Shift Impairment i.e. Dr. Evelyn Virshup • Non-Fixed Allergic Response i.e. Dr. Linus Pauling • Mosaic: Genetic, Stimulus Augmentation and Poor Bonding to Same Sex Parent i.e. Dr. Stan Gitlow • Family & Environmental Dynamics i.e. Drs. Jessor • Developmental Dynamics i.e. Dr. Steven Glenn • Protective and Resiliency Factors i.e. Dr. Mervlyn Kitashima • Behavioral via Social/Environmental Influences i.e. Stanton Peele • Isms, Biases, Exclusion i.e. Phil Diaz • Genetic Predisposition i.e. Drs. Blum & Noble • Neurochemical Imbalance i.e. Drs. Synder & Pert • Spiritual Aberration i.e. Fathers Leo Booth & Joseph Martin • Conditioning i.e. Alfred Lindesmith • Pathologic Belief System i.e. Drs. Weiss & O’Connor • Neuronal Dysfunction i.e. Drs. Childress & London Diathesis-Stress Model of Addiction & Related Disorders • HEREDITY – Type I • ENVIRONMENTAL – Type II Stress (esp. Trauma) & Poor Nutrition • PSYCHOACTIVE DRUG TOXICITY – Type III Note: each phenotype has to have elements of the others to be activated Type I: Heredity [Pioneering Research by Aristotle, D. Goodwin 1976, M. Schuckit 1986, K. Blum, E. Noble et al. 1990] Most Project 40 - 60% Contribution to Addiction • • • • • • • • • • • CREB CHRM2 GABRA2 Leu-Pro allele NQD2 ADH4 KMALDH1 COMTmet158met DRD2A1 Allele Tipsy Gene: CYP2E1 AUTS2 • • • • • • • • • • GABRG3 TAS2R16 SNCA OPRK1 PDYN CYP2D6 CHRNA4 DeltaFosB Novelty Gene: DRD4 Finnish Rage/Alcohol Gene: HTR2B 89 genes associated & > 900 suspected DRD2A1 is found in 20% of non-addicted people 30% of social drinkers 70% of severe alcoholics DRD2A1 is also found in: • 45% of compulsive overeaters • 48% of smokers • 52% of cocaine addicts • 51% of pathological gamblers • 76% of pathological gamblers with drug problems • 33% of US population have a DRD2A1 gene Dr. Kenneth Blum UT Austin now focusing on 9 Genes & 10 Alleles • MAOA • 5HTTLP • SLC6A3 & SLC6A4 • DRD4 • DRD2 • COMT • GABRG2, GABRA2 & GABRA6 These determine his Genetic Addiction Risk Score (GARS) Nicotine & Major Depression linked to 3p26-3p25 Gene Pergadia, ML, et al 2011 Type II: Environment: Stress & Nutrition Type III: Toxicology: Neurochemical & Neurofunctional Allostasis Type II: Environment • Early Childhood Trauma (physical, sexual, emotional abuse, tragic event, grief, anything that is traumatic to an individual) • Stress including Mental Health Disorders • Nutritional Deprivation and Imbalances All recently associated with epigenetic changes resulting in different expression of dominant and recessive traits or turning on or off of genes Major Traumatic Event: Impact on the Brain • 50% of U.S. population experiences at least one major traumatic event in their life, 75% of behavioral health workers and 90% of behavioral health patients • Trauma changes structure and chemistry of the brain making one more susceptible to addictions and mental health disorders • Increased vulnerability partly due to Epigenetic Expressions that result from trauma (stress) , toxins, diet and even behaviors Trauma & Adverse Childhood Experiences (ACE) Experience of Violence & Victimization (sexual/physical abuse, severe neglect, loss, domestic violence and/or witnessing of violence, terrorism or disasters) National Association of State Mental Health Program Directors 2006 Childhood trauma shapes a child’s beliefs about their identity, world view and even their spirituality Prevalence and Impact on Addictions • 61% of men 51% of women in US have experience at least 1 traumatic event Kessler et al., 1995 • 90% of Behavioral Health consumers have experienced at least 1 ACE and most have multiple ACE in their lifetimes Mueser et al., 2004 • 66.7% of men and women in treatment for addiction report childhood abuse & neglect SAMHSA, CSAT, 2000 Epigenetic Expression Chromosome Chromatin fiber Histones protein DNA wound on Nucleosomes like ‘beads on a string’ DNA Double helix Methylation, Acetylation, Phosphorylation of genetic peptide and 5hmC tags result in altered expression of genes Epigenetic Expression Identical Twin Mice with Divergent Epigenetic Expression Even Identical Twin with Epigenetic Expression of Different Races MAOA Gene Expression, Childhood Trauma and Antisocial Behavior MAOA gene related to improved Neural transmission in the brain Type III: Neurotransmitters Homeostasis/Allostasis Tolerance, Tissue Dependence, up/down regulation, enzyme induction, auto receptors, drug dispositional, pharmacodynamics, altered transporter mechanisms, epigenetic expressions, et al. Psychoactive Drugs Affect Perception, Mood, and States of Consciousness by mimicking or Disrupting the Natural Chemistry of the Brain Expanded Definition = Any Behaviors (e.g. Gambling) that Alter Moods and Affect the Brain’s Addiction Circuitries and Pathways Drugs Mimic, Disrupt, or Block Neurotransmitters SOME EXAMPLES UPPERS: Catecholamines (Norepinephrine, Epinephrine, Dopamine) + Serotonin and Acetylcholine DOWNERS: Endorphin, Enkephalin, GABA, Serotonin PSYCHEDELICS: Serotonin, Acetylcholine, Alpha Psychosin, Norepinephrine, Dopamine, Anandamide & endocannabinoids Neurotransmitters Acetylcholine Norepinephrine Epinephrine Dopamine Endorphin Enkephalin Serotonin (5HT) GABA Substance “P” Anandamide Glycine Histamine Nitric oxide Glutamic acid Cortisone Aspartic Acid © 2007, CNS Productions, Inc. All Addictive Substance Involve Dopamine Activity 2012 UCSF Research Confirms Role of Endogenous Opioid Neurotransmitters in Reward Circuitry as well as Dopamine Beta Endorphin Met-Enkephalin Also Excess Nor Epinephrine (Nor Adrenaline) and Less Transporters in Pathological Gamblers Expanding Role of GABA & Glutamate Inhibitory Excitatory Serotonin aka 5-hydroxytryptamine also involved with all addictions? All addictive drugs and behaviors force brain cells to adapt and adjust to what it views as an imbalance of its own neurotransmitters thus resulting in an allostasis that requires continued drug use or addictive behaviors to maintain its functioning even though it is an imbalanced abnormal functioning Neuron Homeostasis: Brain in Dynamic Equilibrium Secondary Terminal Axon Terminal Auto Receptors on Axon Synaptic Vesicles Neurotransmitters Axonal Transport Dendrite Receptors Dendrite Brain on Cocaine Minutes after shooting or smoking Courtesy of Nora Volkow, Ph.D. Normal Normal Normal CourtesyCourtesy of Volkow,ofWang, & Begleiter, al.) Volkow, Wang, &etBegleiter, et al.) Normal Dopamine Depletion in Addiction = Endogenous Craving and Anhedonia Nicotine Evokes Addictive Brain Changes With Just One Puff Courtesy of Daniel Amen, M.D. Marijuana Abuse Courtesy of Daniel Amen, M.D. Diathesis-Stress Model of Addiction & Related Disorders • HEREDITY – Type I • ENVIRONMENTAL – Type II Stress (esp. Trauma) & Poor Nutrition • PSYCHOACTIVE DRUG TOXICITY – Type III Note: each phenotype has to have elements of the others to be activated Hereditary hater of alcohol Hereditary lover of alcohol Alcoholic mouse DBA/2j = Genetic alcohol/Drug avoiding mice C57bl/6j = Genetic alcohol/drug loving mice DBA/2J C57bL/6J Conclusion – Questions? Understanding: Addiction is a set of biologic & psychological anomalies in neurocellular, neuro-chemical, and neurofunctioning of vulnerable Individuals that result from a combination of Genetic, Environmental and Toxicological influences. Conclusion • Addiction is not about morals, will power or character. It’s about anomalous neurocellular, neurochemical and neurofunctional features of vulnerable brains that hijacks their reward and control circuits resulting in behaviors that are defined as Addiction. • Good news is that the brain is resilient, it’s plastic, it has the ability to bring itself back to healthy functionality if given the chance to. Treatment Works! • • • • • • 3 to 5 Yrs. Continued sobriety = 50% (1yr 80%) Decrease Crime = 75% $7-$12 Savings for every $1 Spent Positive results from 6-8 mo. Treatment Coerced treatment better than voluntary Decreased Psychiatric (40%), Family/Social (50-60%), Medical (15-20%), Employment Problems (15-20%) • Culturally consistent better than generic treatments Belenko, et al. 2005 Courtesy of Nora Volkow, et al. Journal of Neuroscience, 21, 9414-9418, 2001 Thank You! Darryl Inaba, PharmD., CATC V, CADC III Disclosures: Dominion Diagnostics North Kingstown, RI; CNS Productions Medford, OR; J. of Psychoactive Drugs, San Francisco, CA Break Time