THE ADDICTED BRAIN: WHAT S GOING ON IN THERE? 3 CE hours Sandra Morgenthal, PCC-S, CCFC, RN Copyright 2016 Sandra Morgenthal All rights Reserved You can contact this author at sandymorgenthal@yahoo.com For technical assistance with this home study contact: jheisel@heiselandassoc.com
Introduction and Overview Substance Use and Abuse There are all kinds of addictions, drugs and Heroin specifically, have reached almost epidemic proportions in America. Then there is alcohol, which has been with us since time began. More recently, however, compulsive behaviors such as overeating, gambling, and sexual compulsions have come under study with regards to addictions. The various types of addiction currently under study by scientists and medical researchers will be presented, as well as the variables involved in addictions. This presentation will strive to improve and enhance understanding of the complex and multi-faceted nature of addiction, its causes, its impact, its treatment, and relapse-prevention. The role of genetics and other biological factors such as specific neurotransmitters and receptor sites and hormone secreting glands, environmental exposures and variables, family dynamics, history of trauma, abuse or neglect, social stressors, individual resiliency, beliefs about health, wellness, and suffering, and the individual s mental health status prior to exposure all impact the development of addiction and it s outcome. The problem addiction presents in our culture has increased to alarming proportions. The cost is incalculable for individuals, families, and their communities. Understanding of the causes contributing to the various types of addictions will be examined. Functions of the brain that contribute to addiction will be presented. Case study examples will provide meaningful insight into the impact of addiction on individuals, families, and communities. Each type of addiction has this in common; an individual's life is changed dramatically by addiction. Sometimes it is lost altogether. Families are disrupted or destroyed. Communities suffer in many ways through the loss of productivity and the cost of healthcare for the affected person. This is widely recognized in the mental health community and addressed in the DSM-5. There are two types of substance-related diagnoses in DSM-5: The Substance Use Disorders, which describe a pattern of problematic substance use (i.e., Substance Dependence and Substance Abuse); and the Substance-Induced Disorders, which describe behavioral syndromes that are caused by a direct effect of the substance on the central nervous system (CNS) (i.e., intoxication, withdrawal and substance-induced delirium, dementia, amnesic syndrome, psychotic disorder, mood disorder, anxiety disorder, sleep disorder, and sexual dysfunction).
Although the DSM-5 distinguishes between Substance Use and Substance- Induced Disorders, it should be noted that more often than not, Substance- Induced Disorders occur in the context of an accompanying Substance Use Disorder. When this occurs both should be diagnosed (e.g., Alcohol Withdrawal and Alcohol Dependence). Twelve classes of substances are recognized in the DSM-5 1. alcohol 2. amphetamine and related substances 3. caffeine 4. cannabis 5. cocaine 6. hallucinogens 7. inhalants 8. nicotine 9. opioids 10. phencyclidine (PCP) and related substances 11. sedatives, hypnotics, or anxiolytics 12. other substances (over-the-counter OTC meds or toxins) Dependence or abuse are most often connected with 1-11 however, other medications with psychoactive effects (e.g., steroids, anti-cholinergics) may occasionally become drugs of abuse. The much more commonly encountered problem is that many medications have side effects that are occasionally severe enough to be considered a clinically significant behavioral syndrome (e.g., hallucinations, severe depression, etc., panic attacks). The problem comes from the fact that not every class of substance causes each and every type of Substance-Related Disorder. Some variable are: 1. Route: intravenous, smoking, oral, etc. 2. Speed of action: immediate versus delayed 3. Duration of effects: short versus long-acting 4. Equal and opposite reaction 1 It is important to recognize that cultural differences in what is considered acceptable and expectable substance use may complicate the diagnosis of Substance Use Disorder. Some religious cultures require absolute abstinence. There can be strict social sanctions that could lead to feeling outcast. In other cultures, where considerable substance use is part of the daily norm (e.g. Mediterranean wine drinking) some may develop physiological dependence without having a pattern of compulsive use that would warrant a diagnosis of Substance Dependence. The last word is a substance use can mimic virtually every psychiatric presentation known to mankind. Therefore, a substance-use etiology should always be at the top of your list of possible suspects in tracking down a differential diagnosis. In younger individuals, the most likely culprits are drugs of abuse. In older individuals, medication side effects are frequent offenders, particularly because these people may have a reduced ability to clear the drugs.
Types of Addiction Addictions take many forms, most notably drugs and alcohol. Heroin addiction, which was once almost under control in America, has increased at an alarming rate. Cocaine remains a significant drug problem. Marijuana is still illegal (in most states) and its use in America is very high. Abuse of prescription medications causes many addictions. Other street drugs such as methamphetamines, benzodiazepines, inhalants and Angel Dust also have the potential to become addictive. Alcohol, which has always been a problem in causing addiction, is an ongoing issue. More recently, however, compulsive behaviors such as overeating, gambling, obsessive shopping, compulsively playing video games and sexual compulsions have come under study with regards to addictions. The Multi-faceted Nature of Addiction The various types of addiction, especially those with the greatest personal and economic impact will be explored. Some types of addiction are more likely to harm or kill the addicted person or lead to disruption in their life or the lives of those closest to them. Any addiction which is significantly associated with increased crime rates will be presented as well. The Impact of Addiction The full impact of addiction on the individual, the family, and the community at-large, including economic impact cannot be accurately measured. To the extent it can be identified, it will be discussed in this presentation. It is known that crime rate and addiction are two problems that run parallel paths and both cost the governments - federal, state and local, incalculable amounts in budget spending in planned and unplanned ways. Insurance providers feel the impact in their annual budgets. Families and individuals spend untold dollars trying to rein in the power of addiction s impact on their lives. The study of addiction has reached a point of necessity in America today since the number of new cases of addiction to Heroin has reached an all-time high. The effects on the young are of particular concern to healthcare workers, government and social agencies, and, in particular to families struggling with someone they love fighting addiction. The Process of Addiction The process of addiction as it relates to bio-psychosocial factors, and beliefs about what it is and what causes it, will be examined. Variables that contribute to, or reduce, the express state of addiction as determined by scientist experts in the field will be presented and discussed. The process of addiction in the individual, their families, and the community will be presented
through the use of examples, case studies, and reports from family and friends of addicts, as well as statements from those fighting addiction, and from clinical statistics regarding remission. Treatment Modalities "Addiction affects parts of the brain involved in reward and motivation, learning and memory, and control over behavior. Addiction is a disease that affects both the brain and behavior." National Institute on Drug Abuse. January, 2016 The state of addiction has been with us since man learned he had a pleasure center and how to appease it. Throughout history addiction has taken on many forms. Its treatment, therefore, must be equally eclectic and cover all bases from a Mind/Body/Spirit perspective. Treatment modalities, historical and current, will be discussed and their efficacy as it is determined in research will be presented. Relapse and Relapse Prevention Prevention of relapse is every health worker's goal in being therapeutic with their addicted clients. Relapse is everyone's fear, most of all the client. They are always afraid they will fail. The therapist's concern is they haven't done the right thing for the client or they haven't done enough. Relapse and relapse prevention will be presented. Addiction: Denial and Acceptance Why Some and Not Others? Why is it that some people can have a mixed drink, a glass of wine, or a beer and leave it at that, while others can t seem to stop until they are intoxicated? Why do some place a bet at an outing to the race track and, win or lose, walk away and not gamble again for some time, if ever? Even so, others become compulsive gamblers unable to stop until everything is gone; house, car, job, and family? There are those who view food as a pleasant necessity, while others reach a point of feeling strung out in their relationship with food. They report hiding food, hoarding food, thinking about what they will eat next while gorging themselves with a whole cake or a half gallon of ice cream. Unable to stop themselves from what they are doing, they report feeling lost, hopeless, and forgotten in their pain. Because it is food, and we all need food to survive, they believe no one understands they feel addicted.