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Slide 1 - When Rationality Fails–Modern Theories of Addiction Michael A. Bozarth, Ph.D. Addiction Research UnitDepartment of PsychologyUniversity at BuffaloBuffalo, NY 14260-4110
Slide 2 - Rationality & Behavior When it comes to how to obtain our goals, rationality often wins we often plan and execute our behavior with machine-like efficiency When it comes to choosing our goals, rationality often fails we choose our goals based on biological, social, and experiential factors (often lacking apparent rationality)
Slide 3 - Drug Addiction & Rational Behavior Drug addiction seems to cause a break down in the rationality associated with many of our behaviors People seldom “voluntarily” give up their addiction According to NIDA director Alan Leshner, “Virtually no one wants drug treatment. Two of the primary reasons people seek drug treatment are because the courted ordered them to do so, or because loved ones urged them to seek treatment.” Addictive drugs chemically change our behavior, our values, and even our concept of the “self” Addictive drugs offer a portal to the “mind”
Slide 4 - What is Addiction? Addiction is a behavioral syndrome where drug procurement and use seem to dominate the individual’s motivation and where the normal constraints on the individual’s behavior are generally ineffective (e.g., self-perceived “loss of control”) motivational toxicity may be a defining characteristic physical dependence is neither a necessary nor a sufficient condition
Slide 5 - Continuum of Drug Use Experimental Drug Use Circumstantial Drug Use From Bozarth (1990); terms described on the continuum were suggested by Jaffe (1975).
Slide 6 - Addiction as aMotivational Problem Addiction is best understood by considering the drug’s impact on the individual’s motivation Experimental psychology and behavioral neuroscience provide the methods for analysis
Slide 7 - Dynamic Feature of theMotivational Hierarchy
Slide 8 - Choice Behavior and the Notion of “Self-Control” Response Selection food sex social drug
Slide 9 - Motivational Toxicity Motivational toxicity describes a disruption of the motivational hierarchy. This is manifest as increased motivational efficacy of the drug decreased motivational efficacy of natural rewards Motivational toxicity produces the intense motivational focusing characteristic of addiction and the apparent “enslavement” inherent in the etymology of this term
Slide 10 - Progressive Focusing of Motivational Energy on Drug
Slide 11 - Motivational Toxicity Producing a Self-Perceived “Loss of Control” Response Selection food sex social drug
Slide 12 - Heroin Intake DuringUnlimited Access Testing From Bozarth & Wise, 1985.
Slide 13 - Cocaine Intake During Unlimited Access Testing From Bozarth & Wise, 1985.
Slide 14 - Comparison of Fatalities from Unlimited Access to Intravenous Cocaine and Heroin From Bozarth & Wise, 1985.
Slide 15 - The Yin and Yang of Addictive Drugs
Slide 16 - The “Yin” Addictive drugs take a horrific toll on humanity personal social economic
Slide 17 - The “Yang” But addictive drugs also provide probes for understanding brain function addictive drugs provide a tool for probing the mind and its underlying neurochemical and neuroanatomical basis From Smith et al., 1998. From Bozarth, 1987.
Slide 18 - Notion of Brain Reward Systems Pioneering work of Hess (1940s) complex goal-directed behavior from electrical brain stimulation Olds & Milner (1950s-1960s) direct reinforcement from electrical brain stimulation Reid (1960s) similarities between reinforcement from direct electrical stimulation and “natural” rewards
Slide 19 - Experimental Preparation to Study Rewarding Effects of Electrical Brain Stimulation From Reid, 1987.
Slide 20 - Notion that Addictive Drugs May Work on Brain Reward Systems Opiate activation of substrate for electrical brain stimulation reward (1970s) Reid Korntesky Broekkamp Delineation of pharmacological and anatomical substrate for opiate and psychomotor stimulant reward (1970s-1980s) Wise; Bozarth & Wise Roberts & Fibiger
Slide 21 - Brain Reward Circuitry From Bozarth, 1987.
Slide 22 - Continued Progress in Understanding Drug Addiction Detailed analysis of the effects of addictive drugs on brain systems mediating reward and motivation (1980s-1990s) Extension of experimental findings to human studies (1990s) Exploration of CNS neuroadaptive effects produced by addictive drugs (1990s-2000s) Clinical applications (2000 and beyond)
Slide 23 - Opiate/Dopamine Link in Brain Reward Circuitry From Scientific American Medicine Online, 2000. From Bozarth, 1987.
Slide 24 - Dopamine Transporter Occupancy following Cocaine Administration From Volkow et al., 1997.
Slide 25 - Revised Role of the Mesolimbic Dopamine System in Drug Addiction Activation provides positive reinforcement and maintains initial drug use Neuroadaptive changes produce . . . negative reinforcement (normalization) enhanced positive reinforcement (sensitization) increased net change in affective tone (opponent processes) motivational toxicity (derived process) Simple activation of this dopamine system is not sufficient to produce addiction
Slide 26 - Importance of Neuroadaptive Effects in Drug Addiction Drug-induced neuroadaptive effects may distinguish the normal influence this brain reward system has on behavior from the extreme control characteristic of drug addiction Events that activate this system without producing neuroadaptive changes may lack the ability to produce an addiction
Slide 27 - Bio-Cognitive Reciprocity Brain chemistry influences “psychological” states “Psychological” states influence brain chemistry unconscious processes (e.g., conditioning) conscious processes (e.g., “thoughts”)
Slide 28 - Yes! Pharmacology Addiction, but other factors can be important too! Addiction is ultimately pharmacologically determined the result of the action of certain drugs on brain reward mechanisms Several factors can hasten the development of an addiction make certain individuals more likely to develop an addiction
Slide 29 - The Importance of “Psychological” Factors in the Genesis of Addiction Thrill-seeking personality (Bardo, LeMoal) e.g., hyperactive dopamine system Stress-induced “priming” (Goeders, Stewart) e.g., cross-sensitized dopamine system Reward deficiency syndrome (Blum) e.g., hypoactive dopamine system
Slide 30 - Some Possible Predisposing Factors for Drug Addiction Psychological specific trait (e.g., addictive personality) nonspecific trait (e.g., risk-taking behavior) Biochemical genetic (e.g., dopamine-receptor deficiency) acquired environmental (e.g., in utero drug exposure) conditioning (e.g., psychological stress)
Slide 31 - Role of Predisposing Factors Predisposing factors affect mainly the acquisition stage of drug addiction by influencing the tendency to experiment with the drug and to continue drug usage beyond the initial experimental stage by modulating the initial rewarding impact of the drug and its subsequent effects on neuroadaptive processes Pharmacological factors remain the primary determinant of drug addiction
Slide 32 - A Psychobiological Model of Drug Addiction From Bozarth, 1990.