HARI NUGROHO, MDUPT TERAPI & REHABILITASI BADAN NARKOTIKA NASIONAL

Permasalahan Penyalahgunaan NarkobaIndonesia pasar potensial peredaran gelap narkobaJumlah penyalahguna semakin meningkatAdiksi merupakan masalah Public HealthAdiksi adalah Brain Disease

HomelessnessCrimeViolenceNeurotoxicityAIDS, CancerMental illness, HepatitisHealth careProductivityAccidents

Estimated Economic Cost to Society Due to Substance Abuse and Addiction:

Illegal drugs: $181 billion/year Alcohol: $185 billion/year Tobacco: $158 billion/year Total: $524 billion/year

Surgeon Generals Report, 2004; ONDCP, 2004; Harwood, 2000.

Why Do People Take Drugs in The First Place?To Feel GoodTo have novel:feelingssensationsexperiencesANDto share them To Feel BetterTo lessen:anxietyworriesfearsdepressionhopelessness

Your Brain on Drugs in the 1980s

Your Brain on Drugs TodayYELLOW shows places in brain where cocaine binds (e.g., striatum)Fowler et al., Synapse, 1989.

Addiction is Like Other DiseasesIt is preventableIt is treatableIt changes biologyIf untreated, it can last a lifetime Healthy BrainDiseased HeartDecreased Heart Metabolism in Heart Disease Patient

Drugs can be Imposters of Brain Messages

AddictionReward & well-beingMotivationMovementDopamine

dopamine transporters

But Dopamine is only Part of the StoryScientific research has shown that other neurotransmitter systems are also affected:SerotoninRegulates mood, sleep, etc.GlutamateRegulates learning and memory, etc.

ControlAddictedDopamine D2 Receptors are Decreased by AddictionFunctionally DA D2 Receptor AvailabilityCocaineAlcoholHeroinMeth

Konsekuensi dari perubahan di otak

Gangguan mental dan perilaku

DAT Recoverywith prolongedabstinence frommethamphetamine [C-11]d-threo-methylphenidate Volkow et al., J. Neuroscience, 2001.lowhigh Normal ControlMethamphetamine Abuser(1 month abstinent) Methamphetamine Abuser (14 months abstinent)

Pengaruh Terhadap HatiHepatitis BHepatitis CSirrosis hati

Kanker hati

HIV / AIDSTerutama IDUInfeksi OportunistikButuh dukungan keluargaRutin terapi ARV

4 dari 10 kematian AIDS berhubungan dengan Drug Abuse

Wajah drugs abuser

We Need to Keep Our Eye on the Real Targets!AbstinenceFunctionality inFamily, Workand CommunityIn Treating Addiction

TERIMA KASIH

***The effects of drug abuse are wide ranging and affect people of all ages. Besides addiction, drug abuse is linked to a variety of health problems, including HIV/AIDS, cancer, heart disease, and many more. It is also linked to homelessness, crime, and violence. Thus, addiction is costly to both individuals and society.

*Drug abuse costs the United States economy hundreds of billions of dollars in increased health care costs, crime, and lost productivity. The total costs of drug abuse and addiction due to use of tobacco, alcohol and illegal drugs are estimated at $524 billion a year. Illicit drug use alone accounts for $181 billion in health care, productivity loss, crime, incarceration and drug enforcement. *Why would anyone abuse drugs? Research has shown that people generally take drugs to either feel good (i.e., sensation seekers or anyone wanting to experiment with feeling high or different) or to feel better (i.e., self-medicators or individuals who take drugs in an attempt to cope with difficult problems or situations, including stress, trauma, and symptoms of mental disorders).

Images: courtesy of Vivian Felsen

*Drugs of abuse change the brain, and new technologies are showing us how. Indeed weve come a long way from this primitive depiction of a brain on drugs.*We can now measure the brains response to drugs of abuse in real time. This slide depicts images of a human brain taken at different intervals following administration of radioactive cocaine. Because the drug was radiolabeled, scientists can see precisely where cocaine binds in the brain (yellow signal) and for how long. Studies such as these teach scientists more about how cocaine exerts its devastating effects, and can illustrate to people in real time what happens to their brains on drugs.*Addiction is similar to other chronic diseases. Using imaging technology to measure metabolism (in this case, glucose uptake) in the brain and heart, one can see that both addiction and heart disease produce observable changes in organ function. In each pair of images shown above, the healthy organ shows greater activity (reds and yellows) than the diseased organ. In drug addiction, the frontal cortex, which is a part of the brain associated with judgment and decision-making, is significantly affected. Like heart disease, drug addiction can be prevented and treated successfully. If left untreated, however, its effects can last a lifetime.

*How are drugs able to affect brain chemicals? Often, the chemical structure of drugs is similar to brain chemicals or neurotransmitters. Similarity in structure allows them to be recognized by neurons and to alter normal brain messages. Illustrated in this slide is THC, the active ingredient found in marijuana. Its chemical structure is highly similar to anandamide, which is involved in a variety of functions including regulation of pain, appetite, memory, and mood.*Dopamine is a brain chemical involved in many different functions including movement, motivation, reward and addiction. Nearly all drugs of abuse directly or indirectly increase dopamine in the pleasure and motivation pathways and in so doing, alter the normal communication between neurons.*This slide and the one that follows show how neurotransmission works specifically for dopamine. What is schematically illustrated in this slide is a nerve terminal (top), the synaptic cleft or space between the neurons, and the post-synaptic or receiving portion of a dendrite on a neighboring neuron. Dopamine is contained in vesicles (round storage sites) in the nerve terminal; dopamine receptors are present on the receiving (bottom) neuron. *When a signal comes down the axon, dopamine (shown in orange) is released into the synapse. It then crosses the synaptic cleft to the second neuron, where it binds to and stimulates dopamine receptors (shown in blue), generating a signal in the second neuron. The dopamine is then released from the receptor and crosses back to the first neuron where it is picked up by dopamine transporters (reuptake molecules; shown in purple) for re-use.*Dopamine is an important brain chemical in drug abuse and addiction, but other brain systems and brain chemicals are also involved. Serotonin and glutamate neurotransmitter systems, for example, are among those affected. These neurotransmitters are important regulators of mood, sleep, learning and memory, and more.*Repeated drug exposure also changes brain function. Positron emission tomography (PET) images show similar changes in brain dopamine receptors resulting from addiction to different substances. Dopamine D2 receptors are one of five types of receptors that bind dopamine in the brain. The brain images on the left are those of controls, while those on the right are from individuals addicted to cocaine, methamphetamine, alcohol, or heroin. The striatum (which contains the reward and motor circuitry) shows up as bright red and yellow in the controls (in the left column), indicating numerous D2 receptors. Conversely, the brains of addicted individuals (in the right column) show a less intense signal, indicating lower levels of D2 receptors. This reduction likely stems from repeated over-stimulation of the dopamine receptors. Brain adaptations such as this contribute to the compulsion to abuse drugs.

*****It takes time, but the brain can recover. This slide shows images of dopamine transporter (DAT) binding in three brains: (1) a healthy control (top); (2) a methamphetamine abuser one month after discontinuing drug abuse (middle); and (3) a methamphetamine abuser after 14 months of abstinence (bottom). The control brain shows a robust concentration of dopamine transporters in the striatum (red and yellow), while the methamphetamine abuser has a dramatic drop in DAT binding, even a month after drug abuse has stopped. Sustained abstinence, however, allows a near-full return of DAT binding to normal levels. Still, some of the behavioral effects of methamphetamine do not completely return to normal (not shown). This means that it can take a long time to recover from methamphetamine abuse, but recovery is possible.

*******Among the most serious health consequences of addiction is the transmission of HIV. In addition to the well known risks associated with injection drug use (i.e., transmission through needle and other equipment sharing), are the risks stemming from drug or alcohol intoxication, which can alter a persons judgment, and increase the probability of high-risk behaviors, such as unprotected sex. *****Addiction treatment aims to help people achieve abstinence and become full participants in society. Ancillary support services, in addition to behavioral and pharmacological treatments, help to connect people to needed social, medical, and employment services, to get their lives back on track. *