From Poppies to Powerlessness: an addiction...
Transcript of From Poppies to Powerlessness: an addiction...
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From Poppies to Powerlessness:an addiction materia medica
Lydia Anne M Bartholow, PMHNP
Disclosures
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Disclosures
Who the heck am I?
• PMHNP
• Doctorate in addictions (by next fall?)
• Studier of herbalism for 10+ years
• Teacher of herbalism for 3ish years
• Lived experience in addictions
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Agenda
• Understanding addiction: 101
• Conceptualizations of addiction
• Safety first: withdrawal
• Herbal materia medica for addictions
• Allopathic medications for addictions
• Understanding addiction: 101
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Tissue Dependence vs. Addiction
Tissue Dependence Addiction
Experiences withdrawals Loss of control
Experiences tolerance Shift in Mazlo’s hierarchy
Engages dopamanergicpathways
(usually) experiences withdrawals
(usually) experiences tolerance
Tissue Dependence vs. Addiction
Tissue Dependence Addiction
Experiences withdrawals Loss of control
Experiences tolerance Shift in Mazlo’s hierarchy
Engages dopamanergicpathways
(usually) experiences withdrawals
(usually) experiences tolerance
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Tissue Dependence vs. Addiction
Tissue Dependence Addiction
Experiences withdrawals Loss of control
Experiences tolerance Shift in Mazlo’s hierarchy
Engages dopaminergic pathways
(usually) experiences withdrawals
(usually) experiences tolerance
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Tissue Dependence vs. Addiction
Tissue Dependence Addiction
Experiences withdrawals Loss of control
Experiences tolerance Shift in Mazlo’s hierarchy
Engages dopamanergicpathways
(usually) experiences withdrawals
(usually) experiences tolerance
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Dopamine & the NAC
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11/12/2010 15
From Solomon RL, American Psychologist, 1980, 35: 691-712
Positive Hedonic Effects Negative Hedonic Effects
of Withdrawal
Dopamine
Opioid Peptides
Serotonin
GABA
Dopamine – “dysphoria”
Opioid peptides – pain
Serotonin – “dysphoria”
GABA – anxiety, panic attacks
Reward Transmitters Implicated in the Motivational Effects of Drugs of Abuse
Koob, CSAM Addiction Medicine Review Course, 2012
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Anti-Reward Transmitters
These are ACTIVATED in amygdala and ventral striatum
during withdrawal
Dynorphin – “dysphoria”
CRF -- stress
Norepinephrine -- stress
Anti-Reward Transmitters Implicated in the Motivation Effects of Drugs of Abuse
Koob, CSAM Addiction Medicine Review Course, 2012
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CNS Actions of Corticotropin Releasing Factor (CRF)
Koob, CSAM Addiction Medicine Review Course, 2012
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Escalation of Drug Intake
Prefrontal Cortex Abnormalities/Hypofunction
Impairment of Executive Function
Initial Intake
Neuron/oligodendrocyteDeath
Koob, CSAM Addiction Medicine Review Course, 2012
Loss of Control Over Intake – Self- Medication
• Safety first: withdrawal
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Withdrawing from…
• Opiates (Prescription & Heroin)
Withdrawing from…
• Opiates (Prescription & Heroin)
• Benzodiazapines
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Withdrawing from…
• Opiates (Prescription & Heroin)
• Benzodiazapines
• Alcohol
Withdrawing from…
• Opiates (Prescription & Heroin)
• Benzodiazapines
• Alcohol
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Withdrawing from…
• Opiates (Prescription & Heroin)
• Benzodiazapines
• Alcohol
• Stimulants
• Herbal materia medica for addictions
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• Herbal materia medica for addictions
Skullcap
• Scutteleria laterifolia
• Mint family
• Neurotrophic/Nervine
• Gabanergic
• HPA Axis “shifter”
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Passionflower
• Passiflora sp. –P. Incarnata
• Passionflower family
• Nervine
• Gabanergic
• Specific for CNS suppresantwithdrawal
Oats
• Avena sp–A. sativa
–A. fatua• Poacea // Grass
• Neurotrophic
• Addresses adrenal over-resourced
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Vitex
• Vitex agnus-castus• Lamiacea
• U-receptor agonist
• Dopaminergic
Milk Thistle
• Silybum marianum• Asteraceae
• Liver detox• Liver reconstruction• Blood sugar balancing?
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Ashwaghanda
• Withania somnifera• Solanaceae
• Adaptogen
• CNS suppressant
withdrawal
• Cravings?
California Poppy
• Eschscholzia californica
• Papaveraceae
• Gabanergic
• Nervine
• U-receptor agonist?
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Lobelia
• Lobelia inflata
• Lamiaceae
• Nicotinic agonist? Not!
• Parasympathomemetic?
Licorice
• Glycyrrhiza glabra• Fabaceae
• Support for over-resourced
adrenals
• GI Repair and rebuilding
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Medication Assisted Treatment
–Buprenorphine, methadone
–Naltrexone, Acamprosate, Antabuse
–Gabapentin, Flexeril
–Buproprion, stimulants
–N-acetylcysteine
Reward
Executive function
Inhibitory control
Memory/Learning
Motivation/Drive
Targeting Brain Circuits Involved in Addiction
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Medication Assisted Treatment
–Buprenorphine, methadone
–Naltrexone, Acamprosate, Antabuse
–Gabapentin, Flexeril
–Buproprion, stimulants
–N-acetylcysteine
Reward
Executive function
Inhibitory control
Memory/Learning
Motivation/Drive
Targeting Brain Circuits Involved in Addiction
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Medication Assisted Treatment
–Buprenorphine, methadone
–Naltrexone, Acamprosate, Antabuse
–Gabapentin, Flexeril
–Buproprion, stimulants
–N-acetylcysteine
Reward
Executive function
Inhibitory control
Memory/Learning
Motivation/Drive
Targeting Brain Circuits Involved in Addiction
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Medication Assisted Treatment
–Buprenorphine, methadone
–Naltrexone, Acamprosate, Antabuse
–Gabapentin, Flexeril
–Buproprion, stimulants
–N-acetylcysteine
Reward
Executive function
Inhibitory control
Memory/Learning
Motivation/Drive
Targeting Brain Circuits Involved in Addiction
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Medication Assisted Treatment
–Buprenorphine, methadone
–Naltrexone, Acamprosate, Antabuse
–Gabapentin, Flexeril
–Buproprion, stimulants
–N-acetylcysteine
Reward
Executive function
Inhibitory control
Memory/Learning
Motivation/Drive
Targeting Brain Circuits Involved in Addiction
Thanks!
Want references or just to say hi?
www.lydiabartholow.com