Hostname: page-component-848d4c4894-75dct Total loading time: 0 Render date: 2024-05-04T03:09:26.125Z Has data issue: false hasContentIssue false
  • English
  • Français

Substance Abuse is a Disease of the Human Brain: Focus on Alcohol

Published online by Cambridge University Press:  01 January 2021

Raymond Anton
Get access Rights & Permissions [Opens in a new window]

Extract

It is useful in an article of this kind to inform the reader of the author’s background, biases, and rationale for the format and content. As a clinically trained psychiatrist and addiction specialist/researcher, my training and experience have led me to best understand the “clinical side” of alcoholism and substance abuse. A large part of my career has been devoted to treating individuals with alcohol use disorders, especially in the context of clinical trials devoted to finding new medications to reduce craving, drinking, and preventing relapse. I also teach professionals about the diagnosis and treatment of alcohol and other substance abuse disorders. While my focus has been mainly on alcohol use disorders, much of what is known about the neuroscience of addiction is applicable to many, if not all, substances of abuse. I have seen the ravages of these diseases, including death, but I more commonly see the milder forms of these diseases that make people’s lives just plain miserable and/or less enjoyable or productive than they would have been without their addiction.

Type
Symposium
Information
Journal of Law, Medicine & Ethics , Volume 38 , Issue 4 , Winter 2010 , pp. 735 - 744
Copyright
Copyright © American Society of Law, Medicine and Ethics 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Leshner, A. I., “Addiction Is a Brain Disease,” Issues in Science and Technology (Spring, 2001): 75–80.Google Scholar
Rush, B., An Inquiry into the Effects of Ardent Spirits upon the Human Body and Mind: With an Account of the Means of Preventing, and of the Remedies for Curing Them (Philadelphia: Thomas Dobson, 1808).Google Scholar
Substance Abuse and Mental Health Services Administration, Results from the 2003 National Survey on Drug Use and Health: National Findings, NSDUH Series H-25, DHHS Publication No. SMA 04–3694 (Rockville, MD: Office of Applied Studies, 2004).Google Scholar
Hasin, D. S. et al., “Prevalence, Correlates, Disability, and Comorbidity of DSM-IV Alcohol Abuse and Dependence in the United States: Results from the National Epidemiologic Survey on Alcohol and Related Conditions,” Archives of General Psychiatry 64, no. 7 (2007): 830–842.CrossRefGoogle Scholar
Id.Google Scholar
Substance Abuse and Mental Health Services Administration, Results from the 2006 National Survey on Drug Use and Health: National Findings, NSDUH Series H-32, DHHS Publication No. Sma 07–4293 (Rockville, MD: Office of Applied Studies, SAMSHA, 2007).Google Scholar
Harwood, H. and The Lewin Group for the National Institute on Alcohol Abuse and Alcoholism, Updating Estimates of the Economic Costs of Alcohol Abuse in the United States: Estimates, Update Methods, and Data (Rockville, MD: U.S. Department of Health and Human Services, National Institute on Alcohol Abuse and Alcoholism, 2000).Google Scholar
Michaud, C. M. et al., “The Burden of Disease and Injury in the United States 1996,” Population Health Metrics 4, no. 11 (2006): 535–539.CrossRefGoogle Scholar
Mokdad, A. H. et al., “Actual Causes of Death in the United States, 2000,” JAMA 291, no. 10 (2004): 1238–1245; Mokdad, A. H. et al., “Correction: Actual Causes of Death in the United States, 2000,” JAMA 293, no. 3 (2005): 293–294.CrossRefGoogle Scholar
Substance Abuse and Mental Health Services Administration, National Survey on Drug Use and Health: National Findings, NSDUH Series H-34, DHHS Publication No. SMA 08–4343 (Rockville, MD: Office of Applied Studies, 2008).Google Scholar
Grant, B. F. et al., “The 12-Month Prevalence and Trends in Dsm-Iv Alcohol Abuse and Dependence: United States, 1991–1992 and 2001–2002,” Drug and Alcohol Dependence 74, no. 3 (2004): 223–234.CrossRefGoogle Scholar
Centers for Disease Control and Prevention, Alcohol-Related Disease Impact (Ardi): Alcohol Attributable Deaths Report, 2001–2005, available at <https://apps.nccd.cdc.gov/ardi/Homepage.aspx> (last visited September 3, 2010); Scott, K. D. et al., “The Role of Alcohol in Physical Assault Perpetration and Victimization,” Journal of Studies on Alcohol 60, no. 4 (1999): 528–536.CrossRefGoogle Scholar
Gmel, G. et al., “How Stable Is the Risk Curve between Alcohol and All-Cause Mortality and What Factors Influence the Shape? A Precision-Weighted Hierarchical Meta-Analysis,” European Journal of Epidemiology 18, no. 7 (2003): 631–642.CrossRefGoogle Scholar
Nestler, E. J. and Malenka, R. C., “The Addicted Brain,” Scientific American 290, no. 3 (2004): 78–85.CrossRefGoogle Scholar
Koob, G. and Kreek, M. J., “Stress, Dysregulation of Drug Reward Pathways, and the Transition to Drug Dependence,” American Journal of Psychiatry 164, no. 8 (2007): 1149–1159.CrossRefGoogle Scholar
Kalivas, P. W. and Volkow, N. D., “The Neural Basis of Addiction: A Pathology of Motivation and Choice,” American Journal of Psychiatry 162, no. 8 (2005): 1403–1413.CrossRefGoogle Scholar
Myrick, H. et al., “Differential Brain Activity in Alcoholics and Social Drinkers to Alcohol Cues: Relationship to Craving,” Neuropsychopharmacology 29 (2004): 393–402.CrossRefGoogle Scholar
Volkow, N. D. et al., “Dopamine in Drug Abuse and Addiction: Results from Imaging Studies and Treatment Implications,” Molecular Psychiatry 9, no. 6 (2004): 557–569.CrossRefGoogle Scholar
See Kalivas, and Volkow, , supra note 16.Google Scholar
Anton, R. F. et al., “Naltrexone and Cognitive Behavioral Therapy for the Treatment of Outpatient Alcoholics: Results of a Placebo-Controlled Trial,” American Journal of Psychiatry 156, no. 11 (1999): 1758–1764.Google Scholar
Kilpatrick, D. G. et al., “The Serotonin Transporter Genotype and Social Support and Moderation of Posttraumatic Stress Disorder and Depression in Hurricane-Exposed Adults,” American Journal of Psychiatry 164, no. 11 (2007): 1693–1699.CrossRefGoogle Scholar
Brady, K. T. et al., “Cold Pressor Task Reactivity: Predictors of Alcohol Use among Alcohol-Dependent Individuals with and without Comorbid Posttraumatic Stress Disorder,” Alcoholism: Clinical and Experimental Research 30, no. 6 (2006): 938–946.CrossRefGoogle Scholar
Jacobson, I. G. et al., “Alcohol Use and Alcohol-Related Problems before and after Military Combat Deployment,” JAMA 300, no. 6 (2008): 663–675.CrossRefGoogle Scholar
Sullivan, E. V. et al., “Pattern of Motor and Cognitive Deficits in Detoxified Alcoholic Men,” Alcoholism: Clinical & Experimental Research 24, no. 5 (2000): 611–621; Sullivan, E. V. et al., “Disruption of Frontocerebellar Circuitry and Function in Alcoholism,” Alcoholism: Clinical and Experimental Research 27, no. 2 (2003): 301–309.CrossRefGoogle Scholar
Crews, F. T. et al., “Neurogenesis in Adolescent Brain Is Potently Inhibited by Ethanol,” Neuroscience 137, no. 2 (2006): 437–445.CrossRefGoogle Scholar
See Kalivas, and Volkow, , supra note 16.Google Scholar
Id.Google Scholar
See Koob, and Kreek, , supra note 15.Google Scholar
See Kalivas, and Volkow, , supra note 16.Google Scholar
Stinson, F. S. et al., “Comorbidity between DSM-IV Alcohol and Specific Drug Use Disorders in the United States: Results from the National Epidemiologic Survey on Alcohol and Related Conditions,” Drag & Alcohol Dependence 80, no. 1 (2005): 105–116.CrossRefGoogle Scholar
Nurnberger, J. I. and Bierut, L. J., “Seeking the Connections: Alcoholism and Our Genes,” Scientific American 296, no. 4 (2007): 46–53.CrossRefGoogle Scholar
Id.Google Scholar
See Kilpatrick, et al., supra note 21.Google Scholar
Oslin, D. W. et al., “A Functional Polymorphism on the M-Opioid Receptor Gene Is Associated with Naltrexone Response in Alcohol-Dependent Patients,” Neuropsychopharmacology 28 (2003): 1546–1552; Anton, R. F. et al., “An Evaluation of μ-Opioid Receptor (Oprm1) as a Predictor of Naltrexone Response in the Treatment of Alcohol Dependence: Results from the Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence (Combine) Study,” Archives of General Psychiatry 65, no. 2 (2008): 135–144.CrossRefGoogle Scholar
Myrick, H. et al., “Effect of Naltrexone and Ondansetron on Alcohol Cue-Induced Activation of the Ventral Striatum in Alcohol-Dependent People,” Archives of General Psychiatry 65, no. 4 (2008): 466–475.CrossRefGoogle Scholar
Kleber, H. D. et al., “Treatment of Patients with Substance Use Disorders, Second Edition. American Psychiatric Association,” American Journal of Psychiatry 164, no. 4, Supp. (2007): 5–123.Google Scholar
Dawson, D. A. et al., “Maturing out of Alcohol Dependence: The Impact of Transitional Life Events,” Journal of Studies on Alcohol 67, no. 2 (2006): 195–203; Russell, M. et al., “Natural Recovery in a Community-Based Sample of Alcoholics: Study Design and Descriptive Data,” Substance Use & Misuse 36, no. 11 (2001): 1417–1441.CrossRefGoogle Scholar
Miller, W. R. et al., “When Worlds Collide: Blending the Divergent Traditions of Pharmacotherapy and Psychotherapy Outcome Research,” Journal of Studies on Alcohol Supp. no. 15 (2005): 17–23; Miller, W. R. and Wilbourne, P. L., “Mesa Grande: A Methodological Analysis of Clinical Trials of Treatments for Alcohol Use Disorders,” Addiction 97, no. 3 (2002): 265–277.CrossRefGoogle Scholar
Id. (Miller, and Wilbourne, ); McLellan, A. T. et al., “Drug Dependence, a Chronic Medical Illness: Implications for Treatment, Insurance, and Outcomes Evaluation,” Journal of the American Medical Association 284, no. 13 (2000): 1689–1695.Google Scholar
Miller, G., “Tackling Alcoholism with Drugs,” Science 320, no. 5873 (2008): 168–170.CrossRefGoogle Scholar
Kalivas, P. W., “Neurobiology of Cocaine Addiction: Implications for New Pharmacotherapy,” American Journal on Addictions 16, no. 2 (2007): 71–78.CrossRefGoogle Scholar
Karila, L. et al., “New Treatments for Cocaine Dependence: A Focused Review,” International Journal of Neuropsychopharmacology 11, no. 3 (2008): 425–438.CrossRefGoogle Scholar
Rose, M. E. and Grant, J. E., “Pharmacotherapy for Methamphetamine Dependence: A Review of the Pathophysiology of Methamphetamine Addiction and the Theoretical Basis and Efficacy of Pharmacotherapeutic Interventions,” Annals of Clinical Psychiatry 20, no. 3 (2008): 145–155.CrossRefGoogle Scholar
Haile, C. N. et al., “Pharmacogenetic Treatments for Drug Addiction: Alcohol and Opiates,” American Journal of Drug & Alcohol Abuse 34, no. 4 (2008): 355–381.CrossRefGoogle Scholar
Hughes, J. R., “Combining Behavioral Therapy and Pharmacotherapy for Smoking Cessation: An Update,” in Onken, L. S., Blaine, J. D., Boren, J. J., eds., Integrating Behavioral Therapies with Medications in the Treatment of Drug Dependence, vol. 150 (Bethesda, MD, NIDA Research Monograph, 1995): 92–109.Google Scholar
Schneider Institute for Health Policy and Brandeis University, Substance Abuse: The Nation's Number One Health Problem, Key Indicators for Policy: Update (Princeton, NJ: Robert Wood Johnson Foundation, 2001).Google Scholar
Center for Substance Abuse Treatment, Substance Abuse in Brief (Columbia, MD: Substance Abuse and Mental Health Services Administration, 1999).Google Scholar
Holder, H. D. and Blose, J. O., “The Reduction of Health Care Costs Associated with Alcoholism Treatment: A 14-Year Longitudinal Study,” Journal of Studies on Alcohol 53, no. 4 (1992): 293–302; Parthasarathy, S. et al., “Association of Outpatient Alcohol and Drug Treatment with Health Care Utilization and Cost: Revisiting the Offset Hypothesis,” Journal of Studies on Alcohol 62, no. 1 (2001): 89–97CrossRefGoogle Scholar
Fleming, M. F. et al., “Brief Physician Advice for Problem Drinkers: Long-Term Efficacy and Benefit-Cost Analysis,” Alcoholism: Clinical and Experimental Research 26, no. 1 (2002): 36–43; Solberg, L. I. et al., “Primary Care Intervention to Reduce Alcohol Misuse Ranking Its Health Impact and Cost Effectiveness,” American Journal of Preventive Medicine 34, no. 2 (2008): 143–152.CrossRefGoogle Scholar
D'Onofrio, G. and Degutis, L. C., “Preventive Care in the Emergency Department: Screening and Brief Intervention for Alcohol Problems in the Emergency Department: A Systematic Review,” Academic Emergency Medicine 9, no. 6 (2002): 627–638.CrossRefGoogle Scholar
Gentilello, L. M. et al., “Alcohol Interventions for Trauma Patients Treated in Emergency Departments and Hospitals: A Cost Benefit Analysis,” Annals of Surgery 241, no. 4 (2005): 541–550.CrossRefGoogle Scholar
Levy Merrick, E. S. et al., “Revisiting Employee Assistance Programs and Substance Use Problems in the Workplace: Key Issues and a Research Agenda,” Psychiatric Services 58, no. 10 (2007): 1262–1264.CrossRefGoogle Scholar
Roman, P. M. and Blum, T. C., “Alcohol: A Review of the Impact of Worksite Interventions on Health and Behavioral Outcomes,” American Journal of Health Promotion 11, no. 2 (1996): 136–149.CrossRefGoogle Scholar
ONDCP Drug Policy Information Clearinghouse and Schmidt, G., Drug Treatment in the Criminal Justice System - March 2001 Fact Sheet (Rockville, MD: White House Office of National Drug Control Policy, 2001).Google Scholar
See Leshner, , supra note 1; id.; Center for Substance Abuse Treatment, Substance Abuse Treatment for Adults in the Criminal Justice System, Treatment Improvement Protocol (Tip) Series 44, DHHS Publication No. Sma 05–4056 (Rockville, MD: Substance Abuse and Mental Health Services Administration, 2005).Google Scholar
Hser, Y.-I. et al., “Predictors of Short-Term Treatment Outcomes among California's Proposition 36 Participants,” Evaluation and Program Planning 30, no. 2 (2007): 187–196.CrossRefGoogle Scholar