Understanding Addiction Implications for Practice

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Olivia Lindsey
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University Wexner Medical Center 3 Reward System The reward pathway is primarily

1 Understanding Addiction Implications for Brad Lander PhD, LICDC-CS Clinical Director / Psychologist Talbot Hall - Addiction Medicine at The Ohio State University Wexner Medical Center 3 Reward System The reward pathway is primarily involved in addiction. NIDA National Institute on Drug Addiction Brad Lander, PhD, LICDC-CS 1

Activation of The Reward Pathway Food Water Sex The natural function of the reward pathway is to release dopamine

2 NIDA National Institute on Drug Addiction Rats allowed to self-stimulate the reward pathway will do so to the exclusion of food, water and sex. The drive is so strong the rats will continue this behavior to the death. Activation of The Reward Pathway Food Water Sex The natural function of the reward pathway is to release dopamine when we do something that supports our survival, setting up a drive to repeat that behavior. Brad Lander, PhD, LICDC-CS 2

and it must be repeated The thing that drugs of abuse have in common is they stimulate the reward pathway, tricking us into thinking we did something

3 The Pleasure Principle The brain is built to repeat any behavior that stimulates this part of the brain This is the basic law of survival. It works well with animals, but not quite so well with human beings. If it feels good, it must be good for me. and it must be repeated The thing that drugs of abuse have in common is they stimulate the reward pathway, tricking us into thinking we did something important for our survival. NIDA National Institute on Drug Addiction Brain scan of someone using cocaine. The light areas show high activity, the darker areas show low activity. Brad Lander, PhD, LICDC-CS 3

4 We are born with essentially all the brain cells we will ever have. Alcohol kills brain cells and that leads to long-term cognitive issues and early-onset dementia Normal Chronic Alcoholic SPECT Scan A SPECT scan. A healthy brain shows a smooth pattern of energy. Low blood flow and poor functioning appear as holes. Healthy 7 year opiate user Brad Lander, PhD, LICDC-CS 4

Neurotransmitter Imbalances Imbalances of Results in: Serotonin Depression/Anorexia Dopamine

brain chemistry is mental illness. Alcohol and drug use causes unbalanced brain chemistry.

Introduced to a new environment, our brains adapt to make us function more effectively.

5 Neurotransmitter Imbalances Imbalances of Results in: Serotonin Depression/Anorexia Dopamine Schizophrenia Norepinephrine Anxiety/Depression Glutamate OCD/PTSD GABA Anxiety/Panic Unbalanced brain chemistry is mental illness. Alcohol and drug use causes unbalanced brain chemistry. Someone using alcohol or drugs is functioning the same as someone with a mental illness. Introduced to a new environment, our brains adapt to make us function more effectively. Nerve cells disconnect, branch out, and connect to other nerve cells making permanent changes to the brain. Brad Lander, PhD, LICDC-CS 5

6 Adaptation To Drug Consistent drug use is a new environment - adaptation occurs The reward system is re-engineered The drug takes on the properties of the activities that naturally create sensations of pleasure (food, water, sex) ASAM Definition The problem is circuitry not bad behavior. The American Society of Addiction Medicine (ASAM) - August 2011 Defines Addiction as a Chronic Brain Disease Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Must be treated, managed and monitored over a person's lifetime As a chronic disease, periods of relapse are a common feature of addiction [however] the return to drug use is not inevitable In addiction there is a significant impairment of executive functioning that manifests itself in problems with perception, learning, impulse control, compulsivity and judgment 1. Adaptive changes are permanent. No one is ever cured of addiction; it can only be put into remission. 2. The classification of chronic disease puts addiction into the same category as hypertension and diabetes. Brad Lander, PhD, LICDC-CS 6

7 Chronic Disease vs. Bad Behavior We don t call diabetics weak and we don t shame them. Focus on health vs. maintaining order Recurrence vs. relapse Handled by health system vs. court system Diabetes are not labeled carbo addicts or sugar fiends The Adolescent Brain Major growth occurs in the PFC between ages People using as an adolescent can become addicted 5x faster than if they had started at age 21 People who start using as teenagers have immature PFC s Of all the people with addiction, 96.5% started substance use before age by The National Center on Addiction and Substance Abuse at Columbia University Brad Lander, PhD, LICDC-CS 7

The key to effective treatment is matching the interventions used to the state of the

Hospitalization Intensive Outpatient Outpatient Treatment Opioid Maintenance Therapy

8 The key to effective treatment is matching the interventions used to the state of the patients functioning and circumstances. We don t call diabetics weak and we don t shame them. Treatment Options Hospital based detoxification Residential Treatment Partial Hospitalization Intensive Outpatient Outpatient Treatment Opioid Maintenance Therapy The Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5) gives behavioral criteria across six dimensions to determine level of care. Brad Lander, PhD, LICDC-CS 8

Coerced Treatment Evidence shows that people court ordered to treatment and those that seek treatment voluntarily have the same success. Coercion can come from courts, family, employers, or others.

9 Coerced Treatment Evidence shows that people court ordered to treatment and those that seek treatment voluntarily have the same success. Coercion can come from courts, family, employers, or others. Pressure to stay in treatment helpful to patients long-term success 1. The greatest problem we have working with alcoholics and addicts is our own beliefs and expectations 2. The addict is always doing the best they can Brad Lander, PhD, LICDC-CS 9

10 REMEMBER Love and acceptance go a long way Brad Lander, PhD, LICDC-CS 10

The Opiate Crisis 4/6/18. April 9, Words are important. If you want to care for something, you call it a flower.

The Opiate Crisis 4/6/18. April 9, Words are important. If you want to care for something, you call it a flower. The Opiate Crisis Presented by Dr. Anahi Ortiz Franklin County Coroner April 9, 2018 Words are important. If you want to care for something, you call it a flower. If you want to kill something, you call