Neurobiology of Addiction & Recovery 2013 Fall Conference Addiction Professionals of North Carolina Carolina Beach, NC October 16-18, 2013 John Femino, MD, FASAM, MRO Medical Consultant, Dominion Diagnostics Medical Director, Meadows Edge Recovery Center Fellow and former member of national board of directors American Society of Addiction Medicine Educational Objectives •Describe anatomy and physiology of reward circuitry •Rate contribution of SNP genetic variants on patterns of addictive behavior •Assess patients for reward deficiency syndrome •Assess set points of self administration to measure tolerance and physical dependence •Better prepared to discuss medical indications and mechanism of actions of anti-addiction medications •Apply 12 step sayings and slogans to increase patient understanding of biology of active behaviors Jellinek Definition of Dependence Focused on a predictable course of a disease with potential subtypes based on: – The clinical course – Hypothesized causes – Evidence of physiological damage AA Sayings: Description of Illness • I didn’t get into trouble every time I drank, but every time I got in trouble I was drinking • You can always tell an alcoholic, but you can’t tell them much • Instant A..hole, just add alcohol • My best friend became my worst enemy • I did my drinking from Park Avenue to park bench AA Sayings: Pathophysiology • I’m a normal person, minus two drinks • One drink is too many and a thousand is not enough • Insanity is defined as doing the same thing over and over again, expecting different results • Alcoholics heal from the outside in, but feel from the inside out • Alcoholism is the only disease that tells you, you don’t have it • Death, insanity or recovery Substance Dependence (DSM-IV) • Tolerance * • Withdrawal * • Loss of control in limiting intake • Inability to / Persistent desire to cut down or control • Great deal of time spent obtaining, using, or recovering from (compulsion to seek and take drug) • Important activities given up or reduced • Use despite problems caused or exacerbated by use – (* Diagnosis with physiological dependence) NCADD & ASAM Definition Addiction is a primary chronic disease with genetic, psychosocial and environmental factors influencing its development and manifestations: • The disease is often progressive and fatal • It is characterized by continuous or periodic – Impaired control over substance use – Preoccupation with the drug – Use of substances despite adverse consequences – Distortions of thinking, most notably denial