OPIOID ADDICTION AND THE BRAIN MICHAEL NERNEY AND ASSOCIATES P.O. BOX 93 LONG LAKE, NY

Transcription

1 OPIOID ADDICTION AND THE BRAIN MICHAEL NERNEY AND ASSOCIATES P.O. BOX 93 LONG LAKE, NY

2 A DISEASE OF THE BRAIN ASAM Primary chronic disease of the brain reward, motivation, memory, and related circuitry. Clarify and de-stigmatize Public Perception Percentage change 38% to 47% but no change in stigma

3 A DISEASE OF THE BRAIN WHO IS AT RISK? Genetics Environment Exposure

4 GENDER DIFFERENCES

5 WHY IS THIS BRAIN AT RISK? Depression Serotonin Synthesis

6 BRAIN DISEASE Just the Facts Relapse ranges from 50%-90% Multiple factors Definition Drug of Addiction Gender, Age, Length of Use Length of Treatment Reliability of Instrument

7 BRAIN IMAGING SYSTEMS CAT PET MRI/fMRI

8 BRAIN IMAGING SYSTEMS TDI DTI DSI SEM

9 BRAIN IMAGING SYSTEMS EEG MEG SQUID

10 SYSTEMS INVESTIGATED Structural Gray Matter White Matter

11 MOTIVATION FOR DRUG USE Seek drugs for: Create positive effect in brain chemistry Dopamine release in reward sites Suppress negative emotions Activation in specific sites

12 OPIOID FAMILY American Pain Foundation Pain as the 5 th vital sign JCAHCO 10 point scale

13 PAIN RELIEF PRESCRIPTIONS Million Rx Million Rx

14 OPIOID EFFECTS

15 FATALITIES

16 HEROIN: PHARMACOLOGY Source

17 HEROIN Pain Medication Street Drug

18 HEROIN IN THE BRAIN

19 HEROIN IN THE BRAIN Spinal Cord Midbrain Hippocampus Cerebral Cortex

20 HEROIN IN THE BRAIN Reward Dopamine release Pain Relief Endorphin receptors Anxiety Limbic system Hippocampus Diminished neurogenesis

21 Potency HEROIN

22 Cuts HEROIN

23 ON THE STREET Price As low as $12

24 ROUTE OF ADMINISTRATION Routes of Administration Snorting Smoking Injecting IV, SC

25 RISK FACTORS Addiction Infection Overdose

26 ROUTE OF ADMINISTRATION

27 HEROIN AND PAIN PILLS Rx Meds Opioids

28 HEROIN AND ALCOHOL Robo-shots Dextromethorphan Opioid cough suppressant Plus alcohol Rapid and powerful intoxication Motor control Impulse control Delusional

29 DRUG COMBINATIONS Enhance Primary Drug Effect Boost the initial drug Slow metabolism Grapefruit juice

30 DRUG COMBINATIONS Reduce Negative Side Effects Minimize unpleasant effects

31 DRUG COMBINATIONS Alleviate Withdrawal Mask the withdrawal symptoms Two separate systems One system suppression

32 HEROIN AND ADDICTION Tolerance Withdrawal Loss of Control Continued Abuse in Spite of Consequences

33 CONCERNS BRAIN CHANGES: Reward System Shutdown Too much DA CREB Gene code Synthesize Dynorphin Nothing but the drug

34 CONCERNS New Research on the Brain Embedded Memory Too much DA DeltaFosB Chemical Changes Protein shift PKMzeta Stores the high

35 LONG TERM Negative Feedback Loop Methadone Immune system

36 INCREASED POTENTIAL Childhood Neglect Abuse Sexual Abuse Foster Care, Health Care

37 INCREASED POTENTIAL Adolescence Sexual Abuse Runaways Drug and Alcohol Abuse Foster Care, Juvenile Detention

38 INCREASED POTENTIAL, CONT. SEXUAL ABUSE FAMILY ROLE DYSFUNCTIONALITY ROLE MODELS

39 PHYSICAL ABUSE Fatalities Assaults

40 PHYSICAL ABUSE Side Stream Vapors Cooking Smoking

41 PHYSICAL NEGLECT Absence of Food Absence of Clothing Absence of Furniture

42 PHYSICAL NEGLECT, CONT. Failure to Thrive

43 SEXUAL ABUSE Cocaine and Methamphetamine Disinhibitors Alcohol Heroin Prostitution Law Enforcement Health Care

44 FAMILY DYSFUNCTIONALITY Stealing Dealing

45 ROLE MODELS Drug involved lifestyle Early onset of drug use/abuse

46 WHY IS THIS BRAIN AT RISK? CONT. Emotional Intensity 2 to 4 Times More Frequent Change Male/Female Legitimate/Normal

47 TEENS AND CONFLICT Migration and Activation Cell Migration L1 Benchmarks I Know! Open Conflict Don t Take It Personally

48 RISK FACTORS, CONT. Males Older male siblings Females Early puberty

49 WHY IS THIS BRAIN AT RISK? CONT. Risk Taking New Sites of Activity Influence of Peers Male/Female

50 STRATEGIES FOR FAMILY MEMBERS WITH CHEMICAL DEPENDENCY Therapeutic Alliance Promoting Alliance: Express empathy and acceptance De-emphasis on labels Promote change, not confrontation

51 EDUCATION Public Schools Parents Workplace Hospitals Drug seeking

52 SIGNS Sedation Pinned pupils CNS depression

53 PREVENTION Public Health Model Gordon s Categories Universal Selective Indicated

54 TREATMENT APPROACHES Philosophical Beliefs Abstinent based TC Residential Outpatient

55 TREATMENT APPROACHES Medical Model Antagonist Replacement Maintenance

56 CURRENT AND EXPERIMENTAL MEDICATIONS AS TREATMENT ADJUNCTS For Opioid Dependency: Trexan Vivitrol Buphenex

57 RECOVERY IN THE BRAIN Ventricles White Matter Chemical Cerebellar choline Pre-Frontal

58 RECOVERY

59 THE PRACTICE OF RECOVERY The Clinical Connection Access to Qualified Treatment Providers Therapeutic Alliance Multiple Models Access to Support 12 Step Programs

60 KEY ASPECTS Fluid Intelligence Monitoring Performance Managing Emotions

61 EMOTIONAL COMPETENCIES Self Awareness Verbal Access Emotional Regulation Empathic Response Passionate Interest

62 KEY CONCEPTS FOR PARENTS Validate Emotions Social Bonding Risk-Taking Opportunities Crisis Support Early Intervention

63 5 ARTICLES OF PARENTING Aware Alert Awake Authoritative Affirmative

64 THE PRACTICE OF RECOVERY Practice and Repetition Learn from Failure