Neuroimaging: Interpreting Addiction
The following monograph is included as a resource for information purposes only.
The rapid expansion of modern molecular imaging* methods since the time of their initial conception in the 1970s has given rise to numerous discoveries of molecular mechanisms that underlie brain function in health and disease.1 Early functional imaging studies of patients with Parkinson’s disease and schizophrenia produced unexpected correlative findings which inspired researchers to image other conditions (ie, addiction, chronic pain), conditions once perceived as voluntarily induced or imagined.
Researchers using results from functional molecular imaging and genetic testing have recently probed the physiologic basis of addiction, redefining it as a neurologic, genetic, environmental, and behavioral disease process. These findings are in stark contrast to beliefs of addiction as a psychological disorder arising from a lack of willpower or compromised moral affect.2
Memory, drug-related cues, neuromodulators, neurotransmitters, and the immense power of the brain’s reward pathway are now implicated as direct contributors to the origination and progression of addiction.3 Findings such as these are changing the strategic approach to treating addiction from one of a punitive nature to one that is medically sound and evidence based. The future of therapeutics formulated or designed to treat addiction is a novel and exciting one. Substantial commonalities exist among drugs of abuse, and the knowledge of these common mechanisms together with the continued elucidation of the neurobiological underpinnings of withdrawal symptoms, drug intake, craving, relapse, and comorbid psychiatric associations are critically important for the development of new therapeutic strategies.4 Preventive agents (vaccines) and therapies for addiction will no longer adhere to the traditional and typical pharmacologic formulation, but rather transit to novel, personalized, and targeted designs that will include use of proteomics, genetics, molecular intervention, and nanotechnology.3 The clinician’s approach to an addicted patient or to a patient at high risk of addiction and their subsequent treatment is on a trajectory of change. Learning how new data will influence the clinical environment is timely and essential to providing optimal patient care while containing risk.
*Molecular imaging techniques directly or indirectly monitor and record the spatio-temporal distribution of molecular or cellular processes for biochemical, biological, diagnostic or therapeutic applications. Radiologic Society of North America and Society of Nuclear Medicine. Molecular Imaging Summit. Oak Brook, IL. 2005. Accessed October 9, 2007 at: http://www.rsna.org/publications/rsnanews/jul05/misummit.html
This activity is designed for physicians, pharmacists, physician assistants, and nurses who have an interest in enhancing their knowledge and understanding of pain management and addiction medicine
Upon completion of this activity, participants should be able to:
- Define addiction and recognize the scope and negative impact of addiction on the lives of the addicted patient and the American public
- Outline how the perception of addiction has changed with the advent of medical neuroimaging technologies; differentiate the five types of medical imaging modalities used to image the brain
- Identify dopamine as the common feature to all addictive agents and state the role of dopamine relative to the rewards pathway
- Summarize how recent discoveries made via molecular imaging of the brain may influence future therapies and patient management of addiction
A tenured senior scientist within Brookhaven National Laboratory’s Medical Department, David Schlyer, PhD, is also an adjunct professor of biomedical engineering at Stony Brook University. He was awarded a bachelor of science degree in chemistry from the University of California at Riverside in 1971 and a PhD in chemistry from the University of California at San Diego in 1976. Dr. Schlyer joined Brookhaven National Laboratory’s Chemistry Department as a postdoctoral fellow to research the development of radioisotope tracers for diagnostic medical imaging. From 1981 to 1985, Dr. Schlyer worked as a corporate research chemist and then as chairman of a hospital research department. He returned to Brookhaven Lab in 1985 and continued his work on radioisotope production and to develop new detector and scanning technologies for medical imaging. He also serves as a consultant for the International Atomic Energy Agency.
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Faculty Financial Disclosure
The presenting faculty reported the following: Dr. David Schlyer has disclosed that he has no significant relationships with the grantor Cephalon, Inc. or any other commercial company whose products and services may be related to his presentation.
Planner and Provider Financial Disclosure
The individual listed below from MediCom Worldwide, Inc. reported the following for this activity: Joan Meyer, executive director and Alan Vogenberg, RPh, FASCP, clinical advisor have nothing to disclose.
Jeffrey Gudin, MD was the clinical reviewer for this activity and has nothing to disclose. Ruth Widmer, medical writer of Corona Productions has nothing to disclose.
Conflict of Interest Resolution
To identify and resolve conflicts of interest the educational content was fully peer reviewed by a member of the MediCom Worldwide, Inc. Clinical Content Review Committee who has nothing to disclose. The resulting activity was found to provide educational content that is current, evidence based, and commercially balanced.
In accordance with MediCom Worldwide, Inc. policy, the audience is advised of the following disclosures regarding unlabeled or unapproved uses of drugs or devices: Dr. Schlyer indicated that his presentation will include the discussion of bupropion, varenicline, disulfiram, vanoxerine, aripiprazole, modafinil, topiramate tiagabine, baclofen, and valproic acid for the treatment of cocaine addiction; none of these products are approved for this use in the United States. Dr. Schlyer has also indicated that is presentation will include discussion of BP-897; this product is not approved for any use in the United States.
This activity is supported by an independent educational grant from
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