Sunday, May 13, 2012

video of me going on about addiction. and a good look up my nose.

here's a video of a talk i gave a couple of weeks back at Addictions Rounds to an audience of clinicians/treatment providers and researchers: "Addiction Neuroimaging: What is known, and (how) can it be used?"

unfortunately the beginning got cut off.  missing slides after the jump.

First I’m going to spend some time talking about addiction and the brain, then give an overview of some of the most common neuroimaging techniques, and then discuss some skillful and unskillful uses of these techniques in the field of addiction.  After that, I would like to talk to you about some ways that this type of knowledge can be useful for practice, and give one example, which is my pitch for therapeutic patient education in addiction.  Finally, I would love to have a discussion about other ways, and hear from you what you feel is needed and how neuroimaging knowledge can be leveraged to improve clinical practice.

Starting with addiction and the brain, I would like to point a quote I once heard, that the mind is what the brain does.  Most people would agree that the two are inextricably linked, and that without the brain, there can be no mind.  As such, since addiction is thought of as a mental condition, part of our understanding of the condition has to come from understanding the brain.  The reason I am pointing out what seems obvious is that different people conceptualize addiction in different ways.  This includes the disease model, but there are some schools of thought where social, environmental, psychological, and historical variables play a bigger part.  My opinion is that these views are not necessarily incompatible, because they all somehow link back to some kind of neurobiological process that ultimately steers a person’s behaviour – although it could be that we know nothing about that process.  If you believe that there are neurobiological underpinnings to addiction, then neuroimaging is a powerful tool in helping us understand.  For one, it helps understand the human experience, rather than mice or cell cultures or test tubes, and also, it helps develop biomarkers, which are biological intermediaries between internal/ or external processes and behavioural outcomes, and as such, have the advantage of being objective.  People’s internal and external experiences, self-reports, etc are so varied that it is difficult to find commonalities, so imaging provides some standardized measures that can then be compared across people and tested for utility moving forward.

 This is one way in which addiction and the brain can be conceptualized.  The first thing you’ll notice is that it isn’t a unitary construct, but rather, made up of a number of nodes that are arranged in a cycle.  These begin with administration of the addictive agent, which produces euphoria and reinforcement, which, with repeated administrations, result in neuroadaptations underlying processes like withdrawal and tolerance.  If you now add emotional components to the mix, like drug cues or stress, the result will be drug craving, eventually leading loss of control and poor decision making, and ultimately drug seeking and administration, starting the cycle all over again.  You can see on here that each of these components is associated with certain neurobiological  correlates, and the field has made great strides in understanding those correlates, using neuroimaging.  The reason this is important is that each of the nodes can be a target for intervention, but requires a thorough understanding first.

No comments:

Post a Comment