Neurobiological Advances in Addiction

Neurobiological Advances in Addiction

• Addiction is a chronic brain disease characterized by compulsive substance use despite harmful consequences.
• Chronic substance use alters brain circuits involved in reward, stress, and self-control, contributing to compulsion.
• Reward circuitry: Drugs increase dopamine, reinforcing drug-taking behavior.
• Stress systems: Chronic drug use dysregulates stress systems, leading to increased stress sensitivity and negative emotions during withdrawal.
• Executive function: Impairments in the prefrontal cortex affect decision-making and impulse control, making it difficult to resist cravings.

Implications for Treatment

• Understanding addiction as a brain disease emphasizes the need for medical interventions alongside behavioral therapies.
• Advances in neurobiology have led to medications targeting addiction, reducing cravings or normalizing brain function.

Public Policy Considerations

• Recognizing addiction as a brain disorder reduces stigma and supports treatment over punishment.
• Investment in research and healthcare infrastructure is essential for effective addiction treatment.
• Continued research into the neurobiology of addiction will enhance prevention and treatment strategies and improve patient outcomes.

Opioid-Related Harms (Diagnosis, Treatment, and Prevention)

• Opioid-related health crisis in North America (especially Canada), attributed to both prescription and illicit opioid use (e.g., fentanyl).
• Key signs of opioid overdose: decreased respiratory rate (<12 breaths per minute), depressed mental status, and constricted pupils (miosis).
• Differential diagnoses: stroke, sepsis, metabolic disturbances, & co-ingestion.
• Diagnostic investigations: basic hematologic and electrolyte profiles, serum glucose and creatinine kinase, and screening for co-ingestants (acetaminophen, salicylates, alcohol).
• Urine drug screens are helpful but not always required.
• Treatment of opioid overdose: initial stabilization with respiratory support (including ventilation if needed), naloxone (antidote), and close monitoring of vital signs.
• Naloxone, administered parenterally, start at 0.04 mg and titrate upward; repeated doses or continuous infusions may be necessary.
• Close monitoring of vital signs and consciousness levels is essential.

Prevention Strategies

• Supervised Injection Facilities (e.g., Insite in Vancouver): provide sterile injection equipment, supervision, and reduce overdose deaths, improving cost-effectiveness of public health.
• Physician Education: enhance knowledge on safe opioid prescribing (avoiding overlapping/long-term prescriptions, utilizing opioid agreements/contracts, monitoring for signs of misuse, avoiding co-prescription with sedatives).

Policy Recommendations

• Collaborative action among policymakers, clinicians, and regulatory bodies to implement harm reduction programs for opioid-related deaths.

Combined Treatment for Substance Use Disorders

• Combining CBT with pharmacotherapy is more effective than usual care with pharmacotherapy for treating SUDs.
• Combined treatment did not show superior outcomes over other evidence-based therapies (i.e., motivational enhancement therapy, contingency management).
• Introducing CBT into standard care alongside pharmacotherapy yielded mixed results, indicating variability in its added benefit.
• Research included 30 randomized clinical trials with 62 effect sizes, analyzing alcohol (50%), cocaine (23%), and opioid (20%) dependence cases.
• Average participant age: 39 years; 28% female.
• Naltrexone, acamprosate, methadone or combination buprenorphine and naltrexone were the pharmacotherapies utilized.
• Disulfiram and other/mixed pharmacotherapies: utilized in 8% and 32% respectively.