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Understanding Substance Use Disorders Igor Koutsenok, MD University of California San Diego School of Medicine Center for Addiction Research, Training.

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Presentation on theme: "Understanding Substance Use Disorders Igor Koutsenok, MD University of California San Diego School of Medicine Center for Addiction Research, Training."— Presentation transcript:

1 Understanding Substance Use Disorders Igor Koutsenok, MD University of California San Diego School of Medicine Center for Addiction Research, Training & Application

2 Why study substance use disorders ? You will encounter it You will encounter it It could happen to you It could happen to you You need to know how to deal with it You need to know how to deal with it Help eliminate the negative prejudice and stigma Help eliminate the negative prejudice and stigma Substance abuse & addiction are treatable Substance abuse & addiction are treatable You can make a difference You can make a difference

3 S.P.A.M. Stigma Prejudice Anger Misunderstanding All of these lead to myths: widely spread inaccurate believes as compared to research-generated facts "Absinthe Drinker“ Pablo Picasso (1910)

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5 Why do we call certain chemicals “psychoactive substances”?

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7 Drug Categories Based on usual effects at usual doses

8 Drug Categories Depressants Depressants Stimulants Stimulants Opiates Opiates Cannabinols Cannabinols Hallucinogens Hallucinogens PCP PCP Solvents Solvents Others Others

9 Effects of CNS depressants

10 Effects of CNS stimulants (amphetamines)

11 Effects of CNS stimulants

12 Caffeine addiction

13 Definitions Abuse - intentional overuse in cases of celebration, anxiety, despair, self- medication or ignorance. Tends to decline with consequences. Abuse - intentional overuse in cases of celebration, anxiety, despair, self- medication or ignorance. Tends to decline with consequences. Dependence - impaired control over drug use, caused by a dysfunction of the mesolymbic system, or “pleasure pathway”. Dependence - impaired control over drug use, caused by a dysfunction of the mesolymbic system, or “pleasure pathway”. Dependence = Addiction Dependence = Addiction

14 Addiction is:  A pattern of chronic, relapsing, compulsive drug-taking behavior  Characterized by impaired control over drug use

15 Remember... Addiction is a disorder no one chooses to have It is marked by a resistance to give up drugs

16 Why only some people develop problems?

17 Common risk factors and vulnerabilities Alcoholism and drug addiction are primarily psychological problems Alcoholism and drug addiction are primarily psychological problems Alcoholism and drug addiction are primarily socio-environmental problems Alcoholism and drug addiction are primarily socio-environmental problems Alcoholism and drug addiction are medical problems – diseases Alcoholism and drug addiction are medical problems – diseases

18 Addictive Personality- ??? Addictive Personality- ???  Self Medication  Personality Disorders (anti-social, OCD, etc..)  Self Esteem Problems  Excessive Risk Taking  Low Tolerance for Tension Drugs Reduce Tension = People Use it and Get this Response = Reinforcement Psychological Models

19 Socio-Cultural Explanations  Attitude Toward Drug Taking  Availability  Cultural Acceptance

20 Medical/Biological Explanation Genetic evidence Genetic evidence -Adoption and twin studies -Tolerance in sons of alcoholics -Genes as protective factors -What gets genetically transferred? -Genetically determined vs.genetically influenced

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22 Mesolymbic Dopamin System Ventral-tagmental area (VTA) Ventral-tagmental area (VTA) Lateral hypothalamus (LH) Lateral hypothalamus (LH) Nucleus accumbens (NA) Nucleus accumbens (NA) Fronto-orbital cortex (FOC) Fronto-orbital cortex (FOC) Extended Amigdala (EA) Extended Amigdala (EA)

23 Axon Neurotransmitter Synaps Dendrite Receptors Reuptace МАО Signal storage G-proteine

24 Neurotransmitters most involved in dependence Dopamine (cocaine, alcohol) Dopamine (cocaine, alcohol) Serotonin (5-НТ) – (amphetamines, alcohol) Serotonin (5-НТ) – (amphetamines, alcohol) Endorphines – (opiates, alcohol) Endorphines – (opiates, alcohol) GABA - (BZ, alcohol, MDMA (?) GABA - (BZ, alcohol, MDMA (?) Glutamate – (alcohol, amphet. (?), THC (?) Glutamate – (alcohol, amphet. (?), THC (?) Acetylecholine (THC, nicotine, alcohol ) Acetylecholine (THC, nicotine, alcohol )

25 A Brain Chemistry Disease Drugs seem to “match” the transmitter system that is not normal

26 In other words… The problem of dependence is not in the bottle or syringe The problem is in the brain dysfunction

27 Constellation of Factors ADDICT ConditioningEnvironment Personality Traits Genetic SocialPsychological Biological

28 Risk Factors  Adolescence  Academic Difficulties  Family History of Drug Use  Excessive Risk Taking Behavior No One Is Immune

29 Pathways to Addiction 1. Experimentation 2. Active Seeking 3. Preoccupation 4. Addiction

30 “ Not at all, I just told him that I hid the drugs in the backyard” “Look, his behavior is improving!”

31 If you have more questions… 858/

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