Addiction is a relapsing brain disease, which can have a progressive disease course, characterized by the development of tolerance over time. This slide deck discusses in detail the course, natural history and prognosis of Substance Use Disorders (SUD) and other addictions, with illustrations.

This slide deck has been developed by Professor David Nutt, Imperial College London, in collaboration with Cambridge Medical – A prime Global agency.

Index for
slide deck

Introduction

Course, natural history and prognosis
Course, natural history and prognosis
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Addiction as a relapsing brain disease
Addiction as a relapsing brain disease

Addiction is a chronic brain disease, with potential outcomes ranging from relapse (a return to substance use) to remission (regaining health and social function).[1] Moreover, addiction is a widespread condition across the globe; healthcare providers, policymakers, and l…

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The progression of addictive disorders over time
The progression of addictive disorders over time

The degree to which tolerance to a substance can develop over time differs between individuals, and between different substances.[5] It is difficult to determine whether and to what degree tolerance to a substance may have occurred.[5] However, laboratory tests can be hel…

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Stages of addiction

Stages of addiction
Stages of addiction
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The stages of addiction
The stages of addiction

Addiction is a chronic brain disease.[2] It is increasingly recognized that a person with addiction undergoes brain changes as they move through the addiction cycle of binge and intoxication, withdrawal and negative affect, and finally preoccupation and anticipation.[1,2]…

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The stages of addiction: 1. Binge and intoxication
The stages of addiction: 1. Binge and intoxication

Although the situation and the reasons vary, substance dependence and addiction involve a transition from casual, impulsive drug use to compulsive drug use.[1] Compulsion is characterized by repetition of a behaviour despite the adverse consequences of that behaviour.[2,3…

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The stages of addiction: 2. Withdrawal and negative affect
The stages of addiction: 2. Withdrawal and negative affect

Brain changes occur as the addiction cycle progresses.[3] Changes occur in the forebrain, including in the extended amygdala, involving many different neurotransmitter systems, that result in increased vulnerability to cravings and preoccupations in order to counter the n…

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The stages of addiction: 3. Preoccupation and anticipation
The stages of addiction: 3. Preoccupation and anticipation

During the preoccupation and anticipation stage, environmental cues associated with the addictive substance elicit a strong dopamine response from the dysregulated reward and motivation circuitry within the brain.[3] Furthermore, in the case of many individuals with addic…

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Neurocircuitry of the addiction cycle
Neurocircuitry of the addiction cycle

The diagram on the slide illustrates the interaction between neurocircuitry and behaviour of addiction, divided into binge/intoxication, withdrawal/negative affect, and preoccupation/anticipation, each of which is associated with the activation of certain neurological pat…

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Progression of addiction and substance use disorders

Progression of addiction and substance use disorders
Progression of addiction and substance use disorders
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The gateway theory
The gateway theory

The possibility that cigarette smoking acts as a priming agent for substance use later in life,[3,4,2] or that there are common liabilities to nicotine and other addictions,[6,7] gains greater salience with the advent of e-cigarettes.[7,9] There is a debate about whether …

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The gateway theory and cigarette smoking
The gateway theory and cigarette smoking

As outlined on the slide, some researchers have used Mendelian randomization techniques to study the gateway hypothesis, particularly relating to cigarettes and e-cigarette smoking.[1,2] In the study on the slide, a two-sample Mendelian randomization technique was applied…

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The molecular basis of nicotine as a gateway substance
The molecular basis of nicotine as a gateway substance

The slide summarises some of the pioneering work done into the possible molecular and genetic factors underlying the potential role of nicotine (and therefore cigarette smoking) as a agent that may lower the threshold for addiction to other agents.[1] Further research int…

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Alcohol-free drinks and e-cigarettes
Alcohol-free drinks and e-cigarettes

Across the world, the approach to regulation of e-cigarettes varies from a total focus on health protection (meaning policies to prevent the harms of e-cigarettes), to a focus on the benefits of e-cigarettes on harm prevention (meaning policies to promote e-cigarettes as …

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The ‘common underlying liability’ model
The ‘common underlying liability’ model

The gateway hypothesis and the idea of common underlying liability represent two competing models to explain the relationship that is observed between different addictions and addictive behaviours.[1] Within the former model, initial substance use acts as a gateway to the…

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The ‘common underlying liability’ model and e-cigarettes
The ‘common underlying liability’ model and e-cigarettes

The study on the slide calculated polygenic risk scores (PRS) from a large UK dataset, and used logistic regression analysis to assess whether the association between self-reported smoking initiation and e-cigarette use could be explained by the PRS for smoking initiation…

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