# Presentation: 005476

## What should all psychiatry 

**residents know about treating **
**ADDICTION?**

**May 21, 2007**
**Charles P. O’Brien, MD, PhD**
**University of Pennsylvania**
**Philadelphia VA Medical Center**

## Disclosures

**Consultant to**
**	****  ****Forest (Campral)**
**	****  ****Alkermes/Cephalon (Naltrexone)**
**	**

## What is Addiction/Dependence?

**Drug use “out of control”**
**NOT necessarily**
**	****	****	****Daily use**
**	****	****	****Tolerance**
**	****	****	****Physiological Dependence**
**	****	****	****Withdrawal**

##    Why do people take    drugs to excess?   Why do they repeatedly   relapse?

## Drug Categories

**	****Nicotine**
**	****Alcohol****	**
**	****Marijuana**
**	****Anabolic Steroids**
**	****Inhalants**
**	****Club Drugs**
**	****Stimulants**
**	****Sedatives**
**	****Heroin**

## Slide 6

**Notes:**
Slide 30:  Summary;  addictive drugs activate the reward system via increasing dopamine neurotransmission
In this last slide, the reward pathway is shown along with several drugs that have addictive potential.  Just as heroin (morphine) and cocaine activate the reward pathway in the VTA and nucleus accumbens, other drugs such as nicotine and alcohol activate this pathway as well, although sometimes indirectly (point to the globus pallidus, an area activated by alcohol that connects to the reward pathway). While each drug has a different mechanism of action, each drug increases the activity of the reward pathway by increasing dopamine transmission.  Because of the way our brains are designed, and because these drugs activate this particular brain pathway for reward, they have the ability to be abused.   Thus, addiction is truely a disease of the brain.  As scientists learn more about this disease, they may help to find an effective treatment strategy for the recovering addict.

## Addiction = Memory

**  ****Drugs are reinforcers**
**   ****Pavlov’s lab- 1920s**
**   ****Wikler- 1940s, Lexington**
**   ****Proneness to relapse after**
**   ****months to years abstinent**

## New Medications

**	**
**	****Buprenorphine**
**	****	****Bup/Naloxone (Suboxone)**
**	****Varenicline **
**	****Naltrexone for alcoholism**
**	****	****Depot Naltrexone**
**	****Acamprosate**
**	****Modafinil**
**	****Topiramate, Baclofen, GVG**
**	****Ondansatron**
**	****Bupropion**
**	****Rimonabant**
**	****Dronabinol**

## Manual Guided Therapies

**Cognitive Behavioral (CBT)**
**Drug Counseling (DC)**
**Twelve Step Facilitation (TSF)**
**Motivation Enhancement Therapy (MET)**
**BRENDA (Biopsychosocial, Nurse)**
**Interpersonal Therapy (IPT)**
**Family Therapy**
**Group Therapy****	**

## Best Treatment

**Medications **
**Plus**
**Psychosocial Intervention**

## Penn/VA Center Team

**Arthur Alterman****	****	****	****James McKay**
**Wade Berrettini****	****	****	****A. Thomas McLellan**
**John Cacciola****	****	****	****David Metzger**
**Anna Rose Childress****	****	****David Oslin**
**James Cornish****	****	****	****Helen Pettinati**
**Charles Dackis****	****	****	****Michael Stromberg**
**Ronald Ehrman****	****	****	****Elmer Yu**
**Teresa Franklin****	****	****	****George Woody**
**Kyle Kampman****	****	****	****Joe Volpicelli**
**	****	****	****	****	**

- _[obrien@mail.trc.upenn.edu](mailto:obrien@mail.trc.upenn.edu)_
- http://www.uphs.upenn.edu/trc