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The  Addicted  Brain  
 
Video  1.1  
Hello.  Welcome  to  the  first  lecture  in  the  course  the  addicted  brain.  My  name  is  Dr.  Michael  
Kuhar  and  I  have  been  studying  drugs  and  the  brain  for  many  years.  One  particular  focus  of  
my  work  has  been  drug  addiction,  as  it  is  a  very  interesting  and  important  problem  with  its  
basis  in  brain  function.  
 
Today,  I'm  going  to  give  you  an  overview  of  the  entire  course.    
Obviously,  we  need  to  focus  on  the  word  “addiction.”  The  name  of  the  course  is  the  
addicted  brain—what  we  mean  by  addiction  is  critical  for  us.  
 
By  addiction  I  refer  to  a  repeated  behavior  that  results  in  distress  or  has  a  negative  impact  
in  on  life.  An  example  would  be  taking  a  drug  such  as  methamphetamine  repeatedly,  to  
where  you  feel  compelled  to  continue  to  seek  and  take  the  drug,  even  though  it  is  having  a  
negative  impact  in  your  life.  The  negative  impact  could  be  a  loss  of  a  job,  or  financial  
stresses,  or  health  problems.  In  my  view,  the  negative  impact  is  a  key  feature.    But,  it’s  
obvious  that  not  every  repetitive  activity  has  a  negative  impact  on  your  life.  For  example,  
appropriate  eating  is  a  repetitive  activity  that  we  can’t  do  without,  and  it  does  not  under  
normal  circumstances  have  a  negative  impact  on  your  life.  In  fact,  it  has  a  positive  impact  
on  your  life.  
 
There  are  some  other  things  that  occur  with  addicting  behavior.  For  example,  you  may  
have  tried  to  stop  the  behavior  many  times  and  failed.  You  may  have  had  to  increase  the  
frequency  of  the  behavior  or  the  dose  of  the  drug  that  you're  taking  to  get  the  same  effect.  
You  may  find  that  when  you  stop  the  behavior  or  drug  you  begin  to  feel  bad  and  you  go  into  
a  withdrawal  state  such  that  you  go  back  to  taking  the  drug  to  avoid  the  pain  of  withdrawal.  
 
And  while  we  are  doing  definitions,  there  are  some  other  terms  that  we  need  to  talk  about.  
We’re  also  going  to  be  using  the  word  abuse;  someone  can  be  a  drug  addict  or  a  drug  
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abuser.  The  word  addict  implies  a  more  serious  problem  than  the  word  abuser;  sometimes  
I  will  use  them  interchangeably  because  the  general  idea  is  the  same.  It's  only  a  difference  
of  degree  of  seriousness.  
 
Also,  I  will  use  the  word  drug  to  refer  to  addictive  substances,  and  the  word  medicine  to  
refer  to  curative  and  helpful  substances.    Sometimes  a  substance  can  be  both  a  drug  and  a  
medicine.  An  example  is  amphetamine,  which  can  be  used  as  a  medicine  to  treat  ADHD  and  
as  an  abused  and  addictive  substance.  
 
The  drugs  that  are  addicting  -­‐  and  we  know  what  we  mean  by  addicting  -­‐  -­‐  include:  alcohol,  
nicotine,  marijuana,  certain  prescription  drugs,  methamphetamine,  cocaine,  and  others.  In  
this  course,  we  will  talk  about  all  of  the  various  substances  that  are  abused  and  we’ll  find  
out  how  they're  different  and  how  they  are  alike.  
 
Because  drugs  are  so  dangerous,  using  animals  in  drug  abuse  and  drug  addiction  research  
is  critical.  Without  the  availability  and  proper  use  of  animals,  we  could  not  have  learned  as  
much  as  we  have  about  drugs,  nor  would  we  have  discovered  medications  for  addicts.  We  
have  been  able  to  understand  the  process  of  addiction  and  we  have  been  able  to  learn  a  
great  many  things  about  this  disorder.  
 
I'll  be  talking  about  how  drugs  affect  the  brain;  this  includes  the  process  of  the  brain  
adapting  to  the  repeated  battering  of  the  brain  by  drugs.  Yes—I  use  the  word  battering  
because  the  brain  is  truly  assaulted  by  these  substances,  and  I'll  explain  how  and  why  that  
happens.  I'm  also  going  to  talk  about  what  happens  at  the  cellular  level  in  the  brain,  and  
what  happens  to  the  individual  nerve  cells  during  the  process  of  addiction.  You  will  be  
hearing  the  word  neuroplasticity  that  basically  is  a  change  in  a  neural  pathway,  which  is  
the  basis  of  a  change  in  some  behavior.  Learning  is  an  example  of  neuroplasticity.  
 
We  all  know  that  addiction  is  long-­‐lasting.  It  can  take  people  a  long  time  to  wean  
themselves  away  from  this  behavior.  We’re  going  to  be  looking  at  the  long-­‐lasting  effects  of  
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drugs  by  brain  imaging  and  by  behavioral  studies.  An  awareness  of  the  fact  that  addiction  is  
long-­‐lasting  is  very  critical  to  how  we  consider  treating  drug  addiction.  
 
Another  factor  will  be  vulnerability.  This  addresses:  Who  will  be  an  addict?  Will  I  be  an  
addict?  Would  you  be  an  addict?  How  do  we  figure  that  out?  If  you  look  at  a  large  
population  of  addicts  and  compare  them  to  a  large  population  of  normal  people  you  can  see  
that  the  addicts  have  some  personality  and  environmental  factors  that  are  different.  We'll  
talk  about  these.  Of  course,  if  you  are  having  trouble  with  drugs  or  other  addictions  you  
need  to  go  into  treatment.  While  some  people  can  walk  away  from  drugs  very  easily,  others  
can't.  We  don't  know  why.  Some  people  need  treatment  to  become  abstinent  or  to  stay  
away  from  drugs.  And  the  important  thing  to  know  is  that  treatment  does  work.  You  get  the  
right  treatment  and  it's  going  to  help  you.  
 
Finally,  were  going  to  be  talking  about  government  policies  and  the  law  and  how  it  affects  
drug  users.  This  is  a  most  interesting  issue  and  its  role  in  society  is  not  minor.  
 
In  summary,  this  course  is  very  broad.  We’re  going  to  go  from  the  molecules  themselves  all  
the  way  to  government  policy,  and  I  know  that  you're  going  to  enjoy  this  and  learn  a  good  
deal.  I  look  forward  to  working  with  you.  
 
 
 
Video  1.2  
Hello  again.  In  this  lecture  I’m  going  to  outline  what  we  will  discuss  for  the  rest  of  the  week.  
 
One  of  the  topics  we’ll  touch  upon  is  the  history  of  drug  abuse  and  addiction,  and  this  is  
particularly  illuminating  because  it  implies  something  about  our  brains  and  our  culture.  
You'll  see  what  I  mean.  Drug  abuse  has  been  around  for  a  long  time  and  that  suggests  
something  about  our  native,  inborn,  vulnerability  to  using  drugs  
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Another  topic  is  how  serious  the  drug  use  problem  is.  We  all  know  that  it's  serious,  but  I'll  
be  going  into  some  of  the  details  that  describe  not  only  the  financial  costs  but  also  the  
misery  that  this  problem  produces.  I’ll  be  talking  about  the  various  individual  drugs  that  
fall  into  about  10  classes,  and  it's  interesting  that  some  of  the  drugs  in  these  classes  have  
actions  that  are  quite  different  from  drugs  in  some  of  the  other  classes,  but  yet  they  all  
produce  addiction.  What  a  fascinating  and  amazing  thing  to  consider  and  figure  out.  
 
Now,  let’s  go  into  further  detail  about  the  definition  of  drug  abuse/addiction.  As  I  had  
mentioned  earlier,  drug  abuse  or  addiction  is  seeking  and  taking  drugs  in  spite  of  distress  
and  harmful  consequences.  The  word  addiction  denotes  a  more  serious  and  harmful  state  
than  the  word  abuse.  I  will  often  use  these  interchangeably  except  when  I  really  need  to  
emphasize  the  difference.    
 
Another  phrase  that  you  will  probably  hear  is  drug  dependence.  This  is  associated  with  a  
state  of  physiologic  need  such  that  physiological  signs  occur  when  you  stop  taking  the  drug.  
An  example  is  the  depression  that  occurs  when  an  addict  stops  taking  cocaine,  or  the  
diarrhea  that  happens  when  an  opiate  addict  stops  taking  prescription  painkillers.  
 
I  also  want  to  mention  the  DSM-­‐5,  which  is  the  latest  official  manual  for  professionals  who  
deal  with  and  diagnose  drug  use  and  drug  disorders.  The  DSM-­‐5  is  the  fifth  edition  of  the  
diagnostic  and  statistical  manual  of  mental  disorders,  which  is  published  by  the  American  
Psychiatric  Association.  The  interesting  thing  is  that  this  manual  does  not  use  the  word  
addiction  or  dependence,  but  rather  it  refers  to  the  problematic  use  of  drugs  as  a  substance  
use  disorder  or  as  a  substance-­‐induced  disorder.  These  are  interesting  changes  that  avoid  
using  the  word  addict  or  dependence,  which  can  be  stigmatizing;  being  labeled  an  addict  in  
any  circumstance  can  prejudice  certain  people  against  you.  A  substance  use  disorder,  as  we  
described  for  drug  abuse  and  addiction,  is  a  continued  use  of  the  drug  in  spite  of  problems  
and  the  problems  include  impairment,  risks  to  your  health,  and  brain  changes.  On  the  other  
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hand,  substance  induced  disorder  refers  to  things  caused  by  the  drugs  and  these  would  
include  intoxication,  withdrawal,  or  other  side  effects.    
 
Note  that  another  behavior  besides  drug  use  is  included,  and  that  is  the  gambling  disorder.  
With  additional  scientific  studies,  other  behaviors  may  be  referred  to  as  addictions  or  
addictive-­‐like  states  and  will  be  included  in  future  editions  of  the  DSM.  
 
Now  for  something  important.  We  have  been  describing  addiction  and  abuse  in  terms  of  a  
behavior  which  is  something  you  do  in  spite  of  harmful  consequences,  but  now  I  want  to  
shift  the  focus  slightly  to  talk  about  a  brain-­‐based  description  of  drug  abuse  and  drug  
addiction.  Because  the  brain  is  the  organ  of  behavior,  and  drug  addiction  is  a  disordered  or  
problematic  behavior,  then  I  want  to  say  that  drug  abuse  or  addiction  is  a  brain  disorder.  
As  we  look  at  the  brains  of  people  who  use  drugs,  we  find  that  drug  use  is  characterized  by  
changes  in  the  chemistry  and  the  anatomy  of  the  brain,  and  some  of  these  are  quite  
dramatic.  It's  clear  that  these  changes  in  chemistry  and  anatomy  underlie  and  are  the  cause  
of  the  changes  in  behavior.    A  powerful  idea  is  that  if  we  could  reverse  some  of  these  
chemical  changes  or  anatomical  changes,  then  it  seems  likely  that  we  would  have  way  to  
treat  and  maybe  even  cure  drug  users.  
 
The  way  these  changes  occur  in  the  brain  is  by  drugs  acting  at  specific  molecular  sites  that  
we  refer  to  as  receptors.  Different  drugs  have  different  molecular  sites  and  we'll  get  into  
that  at  a  later  point.  The  important  issue  here  is  that  we  can  talk  about  drug  abuse  and  drug  
addiction  from  the  perspective  of  the  physiology  of  the  brain  in  addition  to  the  perspective  
of  behavior.  This  is  an  important  shift  in  emphasis  that  will  have  many  benefits  and  create  a  
view  of  addiction  that  will  be  helpful  to  us.  
 
As  we  conclude  this  lecture,  I  want  you  to  take  the  time  to  explore  and  answer  the  
following  questions.  When  thinking  about  drug  abuse  and  addiction  as  a  behavioral  
disorder,  what  are  the  key  behaviors  that  define  this  disorder?    
 
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