BEHS 364 Broward Community College Brain Disease Model of Addiction Discussion

BEHS 364 Broward Community College Brain Disease Model of Addiction Discussion BEHS 364 Broward Community College Brain Disease Model of Addiction Discussion ORDER NOW FOR CUSTOMIZED AND ORIGINAL NURSING PAPERS Unformatted Attachment Preview Treatment and Prevention Addiction as “Brain Disease” The HBO Addiction Project Earlier in the course, we focused on the “medicalization” of alcohol- and drug-related deviance as a central concern of the social constructionist perspective on alcohol and drug problems. Examples of constructionist research on medicalization include Schneider’s (1978) historical analysis of how the founders of Alcoholics Anonymous popularized the disease conception of “alcoholism” during the 1930s and Conrad and Potter’s (2000) more recent study of the expansion of the medical diagnosis of ADHD to the troublesome behavior of adults as well as children. Other constructionist researchers have examined how the pharmaceutical industry has “discovered” and promoted a variety of medicalized conditions, such as “restless leg syndrome,” to create new markets for prescription drugs. However, there may be no better example of how claimsmaking by powerful groups in government, the media, and private enterprise has advanced the process of medicalization than the HBO Addiction Project. This unique effort to document and promote a conception of addiction as a “brain disease” involved an unprecedented collaboration between the cable network giant, HBO, one of the wealthiest philanthropic organizations in the U.S., the Robert Wood Johnson Foundation, and the major federal agencies dealing with substance use problems, the National Institute on Drug Abuse (NIDA) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA). The producers at HBO assembled a large team of filmmakers, medical professionals, and government scientists who participated in the construction of a fourteen-part television documentary “aimed at educating America about addiction as a brain disease and its treatment as such” (HBO Introduction to Addiction DVD). Various segments of this documentary present authentic and painful stories of people struggling with dependency on drugs or alcohol and its tragic consequences. A question running through these stories—”why can’t they just stop?”— sends a clear message that addiction is not a matter of personal choice but a disease that is beyond the control of the substance abuser. When it first aired in March 2007, this documentary attracted an audience of over 13 million viewers and received two Emmy awards (NIDA press release, Sept. 16, 2007). The entire documentary can be viewed online at the project website, HBO: Addiction, which also contains a wealth of material and resources on the nature, diagnosis, and treatment of this “chronic relapsing brain disease.” Advocate for the Disease Model of Addiction: Dr. Nora Volkow If one could speak of a “star” of this documentary, it would be Dr. Nora Volkow, Director of NIDA, who is prominently featured in several episodes of Addiction. The Resources link for this unit will take you directlyto a video in which Dr. Volkow presents a detailed account of her views about the neurochemical foundations of the brain disease of addiction. BEHS 364 Broward Community College Brain Disease Model of Addiction Discussion Prior to taking the top position at NIDA, Volkow had a distinguished career as a neuroscientist specializing in the use of brain imaging to examine the mechanisms of drug arousal and addiction. In her appearances in Addiction, she stresses themes like those in the following statement she prepared for a NIDA publication titled, “The Science of Addiction.” Note the sharply contrasting images of a “healthy” brain and the brain of a drug user that were included in Volkow’s statement—here, you can literally see the damage done by “brain disease”: How Science Has Revolutionized the Understanding of Drug Addiction Throughout much of the last century, scientists studying drug abuse labored in the shadows of powerful myths and misconceptions about the nature of addiction. When science began to study addictive behavior in the 1930s, people addicted to drugs were thought to be morally flawed and lacking in willpower. Those views shaped society’s responses to drug abuse, treating it as a moral failing rather than a health problem, which led to an emphasis on punitive rather than preventative and therapeutic actions. Today, thanks to science, our views and our responses to drug abuse have changed dramatically. Groundbreaking discoveries about the brain have revolutionized our understanding of drug addiction, enabling us to respond effectively to the problem. As a result of scientific research, we know that addiction is a disease that affects both brain and behavior. We have identified many of the biological and environmental factors and are beginning to search for the genetic variations that contribute to the development and progression of the disease. Scientists use this knowledge to develop effective prevention and treatment approaches that reduce the toll drug abuse takes on individuals, families, and communities. “Drug addiction is a brain disease that can be treated.” Nora D. Volkow, M.D. Director National Institute on Drug Abuse Despite these advances, many people today do not understand why individuals become addicted to drugs or how drugs change the brain to foster compulsive drug abuse…. At the National Institute on Drug Abuse (NIDA), we believe that increased understanding of the basics of addiction will empower people to make informed choices in their own lives, adopt science-based policies and programs that reduce drug abuse and addiction in their communities, and support scientific research that improves the Nation’s well-being. Nora D. Volkow, M.D. By virtue of her powerful position in government, her impressive scientific credentials, and her persuasive use of imaging technology to picture the addicted brain, Volkow has become an influential claimsmaker on behalf of the disease model of drug problems. Whereas Conrad and Potter (2000) characterized opiate addiction as only “partially medicalized” just a decade ago, Volkow and other advocates of the brain disease conception appear to be making rapid progress toward a more thoroughly medicalized understanding of addiction to drugs, alcohol, and other “pathological” habits. The medicalized conception of brain disease has important political implications as well as potentially far-ranging consequences for the way we define and control alcohol and drug problems.BEHS 364 Broward Community College Brain Disease Model of Addiction Discussion This all-encompassing model of addiction has served as a scientific justification for merging NIDA and NIAAA. As Volkow stated in an interview with the New York Times (June 13, 2001), the current separation of NIDA and NIAAA is “artificial” because alcohol and drug “(a)ddictions tend to move together…sharing many triggers and a great deal of biology.” However, critics such as the psychiatrist Sally Satel (The Human Factor, 2007; Medical Misnomer, 2007) have challenged this political initiative by raising serious questions about the validity and the therapeutic usefulness of the brain disease model of addiction. It still remains to be seen whether Volkow’s highly medicalized conception of individual deviance will eventually replace more traditional moral, social, and psychological views of alcohol and drug dependence. The Human Factor By Sally Satel Tuesday, July 10, 2007 Filed under: Big Ideas, Health & Medicine Drug abuse causes hundreds of billions of dollars in economic losses and untold personal heartache. How to limit the damage? SALLY SATEL suggests we start by ditching the ‘brain disease’ model that’s popular with scientists and focus on treating addicts as people with the power to reshape their own lives. Despite its own prejudices, an HBO series transmits just this message of responsibility and optimism. For nearly a century, the United States government has been waging one unsuccessful anti-drug crusade after another. Today, more than 20 million Americans abuse drugs and alcohol[1]. And while the users themselves pay a high price in stunted lives and heartache, the social and economic costs are staggering. The direct effects of addiction— homelessness, unemployment, and disease—and the costs of interdiction and incarceration are estimated at over $200 billion annually[2]. The annual burden in lost productivity in the workplace, mainly from absenteeism and accidents, is another $129 billion, and employees’ drug- and alcoholrelated healthcare costs add $16 billion[3]. In all, that’s about 3 percent of our gross domestic product. Addicts and their families—and the rest of us who help pick up the pieces—have it hard enough. The last thing we need is a confusing public health message about the nature of addiction. Yet that is exactly what was purveyed earlier in the year by an ambitious television series on HBO about substance abuse. While much of the series preached an ultra-medicalized philosophy of addiction—one I find woefully misleading—the broader message, paradoxically, was powerful and accurate: namely, that addicts are endowed with the ability to change their own lives. Traditionally, efforts to cut drug abuse have been divided into two parts. Supply reduction tries to limit the availability of drugs. So far, despite enormous outlays of tax dollars and increased criminal penalties, results have been dismal. Meanwhile, demand reduction both tries to stop people from using drugs (prevention) and, if they start, tries to get them to stop (treatment). That’s where I come in. I am a psychiatrist in a methadone clinic in Northeast Washington, D.C. My job is to help addicts quit heroin and not go back to it in the future. If this is a challenge for the clinician, it’s a monumental effort for the addict. Every so often a patient will ask me if I can “hypnotize” him out of his habit. One patient told me he wished there were an anti-addiction pill, “something to make me not want.” Indeed, that is the timeless quest of troubled addicts everywhere: not to want. It comes as no news to them, however, that recovery is very much a project of the heart and mind. Nor is it news that recovery is attainable. This is why I chafe at the conventional scientific wisdom about addiction: namely, that it is “a chronic and relapsing brain disease.”[4] This view is much heralded by the National Institute on Drug Abuse, or NIDA, part of the National Institutes of Health.BEHS 364 Broward Community College Brain Disease Model of Addiction Discussion NIDA is funded at slightly over $1 billion a year and carries enormous authority on Capitol Hill, among grant-seeking scientists, and in medical schools. The “brain disease” idea is promoted at major rehab institutions such as the Betty Ford Center and Hazelden[5]; it is now a staple of anti-drug education in high schools and in counselor education. And, of course, lawyers play fast and loose with the brain disease rhetoric in courtrooms[6]. The brain disease concept sends a perilous public health message. First, it suggests that an addict’s condition is amenable to a medical cure (much as pneumonia is cleared with antibiotics). Second, it misappropriates language more properly used to describe conditions such as multiple sclerosis or schizophrenia—afflictions that are neither brought on by the sufferer himself nor modifiable by his desire to be well. Third, it carries a fatalistic theme, implying that users can never free themselves of their drug or alcohol problems. The brain disease rhetoric also threatens to obscure the vast role of personal agency in perpetuating the cycle of use and relapse to drugs and alcohol. It sends a mixed message that undermines the rationale for therapies and policies that depend on recognizing the addict’s potential for self-governance. Despite its worrisome implications, the scientists who forged the brain disease concept in the mid-1990s had good intentions. By placing addiction on equal footing with more conventional medical disorders, they sought to create an image of the addict as a hapless victim of his own wayward neurochemistry. They hoped this would inspire companies and politicians to allocate more funding for treatment. Also, by emphasizing dramatic scientific advances, such as brain imaging techniques, and applying them to addiction, they hoped researchers might reap more financial support for their work. Finally, promoting the idea of addiction as a brain disease would rehabilitate the addict’s public image from that of a criminal who deserves punishment into a sympathetic figure who deserves treatment. Within clinical and research circles, the brain disease narrative quickly made a powerful impression. “The majority of the biomedical community now considers addiction, in its essence, to be a brain disease,”[7] says Alan Leshner, the former director of NIDA, who now heads the American Association for the Advancement of Science. To the public, however, the notion has largely been unknown. Until now. This spring, the “chronic and relapsing brain disease” message got a big boost from HBO’s series called “Addiction,” which featured nine full-length segments plus a “supplementary series” that included interviews with medical experts and researchers about treatment and recovery. There was also a “complementary series” that comprised intimate portraits of the lives of four people, plus an impressive educational website and a book entitled Addiction: Why Can’t They Just Stop? Full-page ads with the tag line “Why can’t they just stop?” were placed in major newspapers and magazines. BEHS 364 Broward Community College Brain Disease Model of Addiction Discussion The series was produced in partnership with NIDA, the National Institute on Alcohol Abuse and Alcoholism, and the Robert Wood Johnson Foundation. Brain disease had center stage. As Nora Volkow, the neuroscientist who heads NIDA, explained in one episode, “Addiction is a disease of the brain that translates into abnormal behavior.” But what exactly does that assertion mean? It’s no abstract question. The answer determines the extent to which we can and should hold addicts responsible for their actions—a matter which, in turn, determines to a significant degree our ability to reduce the effects of drug and alcohol abuse. According to Volkow and other neuroscientists, “brain disease” refers to disruptions in the brain’s motivational and reward circuitry that result from the cumulative effect of repeated use of certain substances. As these neural pathways become “hijacked,” use that started as voluntary becomes less and less deliberate, harder and harder to control, and, in the most extreme cases, even automatic. The process unfolds through the action of a major neurotransmitter called dopamine, which, under normal circumstances, increases in the presence of any salient stimulus that is important or pleasurable, such as food, sex, or social bonding. It serves as a “learning signal.” An organism, animal or human, comes to desire, again and again, any experience that causes dopamine’s release. When drugs, as opposed to food or sex, serve as the stimulus, the dopamine release is especially intense. Thus, each new infusion “teaches” the brain to desire drugs. Ultimately, the urge to use heroin or cocaine overrides a person’s interest in once-enjoyable activities—let alone the basic chores of living, which now seem drab by comparison. After a while, however, many addicts report getting very little pleasure from drinking or using drugs. So why does the intense desire to consume persist? According to Volkow and her colleagues, persistent exposure to drugs and alcohol damages the parts of the brain that evaluate experiences and plan appropriate actions. Addicts’ brains, says Volkow, “have been modified by the drug in such a way that absence of the drug makes a signal to their brain that is equivalent to the signal of when you are starving…. [It is] as if the individual was in a state of deprivation, where taking the drug is indispensable for survival. It’s as powerful as that.”[8] What’s so compelling about this model is that you can literally see it in action. Scientists use an imaging technique called positron emission tomography (PET) to produce a visual record of the brain on drugs. When a person is given a drug, or merely shown pictures of paraphernalia, a PET scan image will depict the brain’s reward centers glowing red with a rush of dopamine-related metabolic activity. Such PET scans are prominently featured in the HBO series, and they seem convincing. Biology, however, is not destiny. In fact, the brain of an addict who is experiencing a drug craving but fights it off also lights up like a Christmas tree—as brightly as the brain of a person who planned to obtain drugs to quell the craving—because resistance activates additional inhibitory centers in the brain. Nor can scans permit scientists to predict reliably whether a person with a desire-activated brain will act on that desire. Indeed, researchers have noted that self-reported craving does not necessarily correlate with a greater chance of actually using cocaine.[9] In other words, scans cannot distinguish between an impulse that is irresistible and an impulse that can be resisted but is not. “You can examine pictures of brains all day,” says philosopher Daniel Shapiro of West Virginia University, “but you’d never call anyone an addict unless he acted like one.”[10] We tend to think of the cocaine addict in the throes of a days-long binge. He frantically gouges himself with needles, jams a new rock into his pipe every 15 minutes, or hungrily snorts lines of powder. Or we think of the heroin junkie either nodding off or doubled over in misery from withdrawal, so desperate for the next hit that he’ll get the money any way he can. In the grip of such forces, an addict cannot be expected blithely to get up and walk away. These tumultuous states—with neuronal function severely disrupted—are the closest drug use comes to being beyond the user’s restraint. Yet addicts rarely spend all of their time in conditions of such intense neurochemical siege. In the days between binges, for example, cocaine addicts make many decisions that have nothing to do with drugseeking. Should they clean the apartment? Try to find a different job? Kick that freeloading cousin off their couch for good? Heroin-dependent individuals often function quite well as long as they have regular access to some form of opiate drug in order to prevent withdrawal symptoms[11]. Most of my own patients even hold jobs while pursuing their heroin habits, which typically entail use about every six to eight hours. In other words, there is room for other choices. These addicts could go to a Narcotics Anonymous meeting, for example, or enter treatment if they have private insurance, or register at a public clinic if they don’t. And yes, they could even stop cold turkey. I’ve interviewed scores of opiate addicts who have done it. They take lots of Valium-type drugs to handle withdrawal and suffer through a few days of vomiting, diarrhea, and cramping. When Jamie Lee Curtis, who abused painkillers, appeared on a recent Larry King show that was devoted to addiction (and plugged the HBO series), guest host Maria Shriver asked her, “What made you get clean?” She responded, “Well, you know what, that turning point was a—was really a moment between me and God. I never went to treatment. I walked into the door of a 12-step program and I have not walked out since.” Apparently, Ms. Curtis never got the memo that addiction is a brain disease. It is simply a fact that many people do stop spontaneously. It is also a fact that a lot of them will start up again weeks, months, or years later. But in the interim, they have command over whether or not they do. The “chronic and relapsing” element of the brain disease narrative suggests that relapse is an inherent and virtually inevitable property of addiction. Volkow sums it up: “Just as an asthma attack can be triggered by smoke, or a person with diabetes can have a reaction if they eat too much sugar, a drug addict can be triggered to return to drug abuse.” Scientists … Purchase answer to see full attachment Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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