Transcription
The New Neurobiology ofAddictionPetros Levounis, MD, MAProfessor and Chair, Department of PsychiatryRutgers New Jersey Medical SchoolCenter of Excellence in Addiction Medicine Learning CollaborativeRutgers New Jersey Medical SchoolNewark, New JerseyMonday, December 9, 2019
Outline1. The Basic Model2. Neurobiology of Addiction3. New Neurobiological Concepts4. Addiction Treatments5. New Directions2
1The Basic Model3
19804
A Biopsychosocial ainSwitch5Olsen and Levounis, Sober Siblings, 2008.
2Neurobiology ofAddiction6
Natural RewardsDA Concentration (% Baseline)Food% of Basal DA Output200150100Empty50Box FeedingSex200150100Female Present0060120180Time (min)Adapted from: Di Chiara et al, Neuroscience, 1999Adapted from: Fiorino and Phillips, J Neuroscience, 1997Sample 1 2Number3456787
Effects of Drugs on Dopamine LevelsCOCAINEMORPHINE% of Basal ReleaseDose mg/kg0.51.02.510200150100001234% of Basal Release40025030020010005 hr012345 hr250% of Basal Release% of Basal ReleaseETHANOLNICOTINE2502001501000123 hr0.250.512.515010000Dose (g/kg ip)20001234hr8Adapted from: Di Chiara and Imperato, Proceedings of the National Academy of Sciences USA, 1988; courtesy ofNora D Volkow, MD
Effects of Amphetamines on Dopamine Levels11001000AMPHETAMINE% of Basal Release900800DA7006005004003002001000012345 hr9Adapted from: Di Chiara and Imperato, Proceedings of the National Academy of Sciences USA, 1988; courtesy ofNora D Volkow, MD.
Pleasure-Reward Pathways10National Institute on Drug Abuse, www.nida.nih.gov, 2000.
3New NeurobiologicalConcepts11
201912
Three Novel Areas Motivational Circuitry Antireward Pathways Interoception13Levounis, Journal of Medical Toxicology, 2016.
Motivation: The Stinking Thinking Part14
Reward and Antireward Systems15Gardner, Chronic Pain and Addiction, 2011.
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4AddictionTreatments17
The Current Approach Medications Motivational Interviewing Mutual Help (12-step)Nunes, Selzer, Levounis, Davies, Substance Dependence and Co-Occurring Psychiatric Disorders, 2010.18Levounis, Arnaout, and Marienfeld, Motivational Interviewing for Clinical Practice, 2017.Renner, Levounis, and LaRose, Office-Based Buprenorphine Treatment of Opioid Use Disorder, 2nd Ed., 2018.
5New Directions19
4th Wave: Mindfullness“Between stimulus and response there isa space. In that space is our power tochoose our response. In our response lieour growth and our freedom.”Viktor E. FranklFrankl V, Man’s Search for Meaning, 1959.Zerbo, Schlechter, Desai, and Levounis, Becoming Mindful, 2017.20
Thank youNJMS.Rutgers.edu/Psychiatry21
Addiction 5 Olsen and Levounis, Sober Siblings, 2008. 2 Neurobiology of Addiction 6. 0 50 100 150 200 0 60 120 180 Time (min) utput Empty Food Sex Box Feeding 100 150 seline) 200 Sample . Motivation: The Stinking Thinking Part. Reward and Antireward Systems Gardner, Chronic Pain and Addiction, 2011. 15. 1
