OPIOID ADDICTION AND THE BRAIN MICHAEL NERNEY AND ASSOCIATES P.O. BOX 93 LONG LAKE, NY 12847-0093 518-624-5351 MCNERNEYLL@FRONTIERNET.NET
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
A DISEASE OF THE BRAIN WHO IS AT RISK? Genetics Environment Exposure
GENDER DIFFERENCES
WHY IS THIS BRAIN AT RISK? Depression Serotonin Synthesis
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
BRAIN IMAGING SYSTEMS CAT PET MRI/fMRI
BRAIN IMAGING SYSTEMS TDI DTI DSI SEM
BRAIN IMAGING SYSTEMS EEG MEG SQUID
SYSTEMS INVESTIGATED Structural Gray Matter White Matter
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
OPIOID FAMILY American Pain Foundation Pain as the 5 th vital sign JCAHCO 10 point scale
PAIN RELIEF PRESCRIPTIONS 1999 109 Million Rx 2012 259 Million Rx
OPIOID EFFECTS
FATALITIES
HEROIN: PHARMACOLOGY Source
HEROIN Pain Medication Street Drug
HEROIN IN THE BRAIN
HEROIN IN THE BRAIN Spinal Cord Midbrain Hippocampus Cerebral Cortex
HEROIN IN THE BRAIN Reward Dopamine release Pain Relief Endorphin receptors Anxiety Limbic system Hippocampus Diminished neurogenesis
Potency HEROIN
Cuts HEROIN
ON THE STREET Price As low as $12
ROUTE OF ADMINISTRATION Routes of Administration Snorting Smoking Injecting IV, SC
RISK FACTORS Addiction Infection Overdose
ROUTE OF ADMINISTRATION
HEROIN AND PAIN PILLS Rx Meds Opioids
HEROIN AND ALCOHOL Robo-shots Dextromethorphan Opioid cough suppressant Plus alcohol Rapid and powerful intoxication Motor control Impulse control Delusional
DRUG COMBINATIONS Enhance Primary Drug Effect Boost the initial drug Slow metabolism Grapefruit juice
DRUG COMBINATIONS Reduce Negative Side Effects Minimize unpleasant effects
DRUG COMBINATIONS Alleviate Withdrawal Mask the withdrawal symptoms Two separate systems One system suppression
HEROIN AND ADDICTION Tolerance Withdrawal Loss of Control Continued Abuse in Spite of Consequences
CONCERNS BRAIN CHANGES: Reward System Shutdown Too much DA CREB Gene code Synthesize Dynorphin Nothing but the drug
CONCERNS New Research on the Brain Embedded Memory Too much DA DeltaFosB Chemical Changes Protein shift PKMzeta Stores the high
LONG TERM Negative Feedback Loop Methadone Immune system
INCREASED POTENTIAL Childhood Neglect Abuse Sexual Abuse Foster Care, Health Care
INCREASED POTENTIAL Adolescence Sexual Abuse Runaways Drug and Alcohol Abuse Foster Care, Juvenile Detention
INCREASED POTENTIAL, CONT. SEXUAL ABUSE FAMILY ROLE DYSFUNCTIONALITY ROLE MODELS
PHYSICAL ABUSE Fatalities Assaults
PHYSICAL ABUSE Side Stream Vapors Cooking Smoking
PHYSICAL NEGLECT Absence of Food Absence of Clothing Absence of Furniture
PHYSICAL NEGLECT, CONT. Failure to Thrive
SEXUAL ABUSE Cocaine and Methamphetamine Disinhibitors Alcohol Heroin Prostitution Law Enforcement Health Care
FAMILY DYSFUNCTIONALITY Stealing Dealing
ROLE MODELS Drug involved lifestyle Early onset of drug use/abuse
WHY IS THIS BRAIN AT RISK? CONT. Emotional Intensity 2 to 4 Times More Frequent Change Male/Female Legitimate/Normal
TEENS AND CONFLICT Migration and Activation Cell Migration L1 Benchmarks I Know! Open Conflict Don t Take It Personally
RISK FACTORS, CONT. Males Older male siblings Females Early puberty
WHY IS THIS BRAIN AT RISK? CONT. Risk Taking New Sites of Activity Influence of Peers Male/Female
STRATEGIES FOR FAMILY MEMBERS WITH CHEMICAL DEPENDENCY Therapeutic Alliance Promoting Alliance: Express empathy and acceptance De-emphasis on labels Promote change, not confrontation
EDUCATION Public Schools Parents Workplace Hospitals Drug seeking
SIGNS Sedation Pinned pupils CNS depression
PREVENTION Public Health Model Gordon s Categories Universal Selective Indicated
TREATMENT APPROACHES Philosophical Beliefs Abstinent based TC Residential Outpatient
TREATMENT APPROACHES Medical Model Antagonist Replacement Maintenance
CURRENT AND EXPERIMENTAL MEDICATIONS AS TREATMENT ADJUNCTS For Opioid Dependency: Trexan Vivitrol Buphenex
RECOVERY IN THE BRAIN Ventricles White Matter Chemical Cerebellar choline Pre-Frontal
RECOVERY
THE PRACTICE OF RECOVERY The Clinical Connection Access to Qualified Treatment Providers Therapeutic Alliance Multiple Models Access to Support 12 Step Programs
KEY ASPECTS Fluid Intelligence Monitoring Performance Managing Emotions
EMOTIONAL COMPETENCIES Self Awareness Verbal Access Emotional Regulation Empathic Response Passionate Interest
KEY CONCEPTS FOR PARENTS Validate Emotions Social Bonding Risk-Taking Opportunities Crisis Support Early Intervention
5 ARTICLES OF PARENTING Aware Alert Awake Authoritative Affirmative
THE PRACTICE OF RECOVERY Practice and Repetition Learn from Failure