HARI NUGROHO, MD
UPT TERAPI & REHABILITASI
BADAN NARKOTIKA NASIONAL
Permasalahan
Penyalahgunaan Narkoba
• Indonesia pasar
potensial peredaran
gelap narkoba
• Jumlah penyalahguna
semakin meningkat
• Adiksi merupakan
masalah Public Health
• Adiksi adalah “Brain
Disease”
Neurotoxicity
AIDS, Cancer
Mental illness,
Hepatitis
Homelessness
Crime
Violence
Health care
Productivity
Accidents
Estimated Economic Cost to Society Due
to Substance
Abuse and Addiction:
Illegal drugs:
Alcohol:
Tobacco:
$181 billion/year
$185 billion/year
$158 billion/year
Total:
$524 billion/year
Surgeon General’s Report, 2004; ONDCP, 2004; Harwood, 2000.
Why Do People Take Drugs in The
First Place?
To Feel Good
To Feel Better
To have novel:
feelings
sensations
experiences
AND
to share them
To lessen:
anxiety
worries
fears
depression
hopelessness
Your Brain on Drugs in the 1980’s
Your Brain on Drugs Today
YELLOW
shows places in
brain where
cocaine binds
(e.g., striatum)
Fowler et al., Synapse, 1989.
Addiction is Like Other Diseases…




It is preventable
It is treatable
It changes biology
If untreated, it can last a lifetime
Decreased Brain Metabolism
in Drug Abuser
Decreased Heart Metabolism
in Heart Disease Patient
High
Low
Healthy Brain
Diseased Brain/
Cocaine Abuser
Healthy
Heart
Research supported by NIDA addresses all of these
components of addiction.
Diseased Heart
Drugs can be “Imposters” of
Brain Messages
Movement
Motivation
Dopamine
Addiction
Reward & well-being
dopamine
transporters
But Dopamine is only Part of the Story
• Scientific research has shown that other
neurotransmitter systems are also affected:
– Serotonin
• Regulates mood, sleep, etc.
– Glutamate
• Regulates learning and memory, etc.
Functionally…
Dopamine D2 Receptors are Decreased by Addiction
Cocaine
Meth
Alcohol
Heroin
Control
Addicted
Konsekuensi dari perubahan di otak
• Gangguan mental dan
perilaku
[C-11]d-threo-methylphenidate
DAT Recovery
with prolonged
abstinence from
methamphetamine
Normal Control
high
Methamphetamine Abuser
(1 month abstinent)
Methamphetamine Abuser
(14 months abstinent)
Volkow et al., J. Neuroscience, 2001.
low
Pengaruh Terhadap Hati
• Hepatitis B
• Hepatitis C
• Sirrosis hati
Kanker hati
HIV / AIDS
• Terutama IDU
• Infeksi Oportunistik
• Butuh dukungan
keluarga
• Rutin terapi ARV
4 dari 10 kematian AIDS
berhubungan dengan Drug Abuse
Wajah drugs abuser
In Treating Addiction…
We Need to Keep Our Eye on
the Real Targets!
TERIMA KASIH