NEUROBIOLOGY OF YOGA IN DE-ADDICTON … · NEUROBIOLOGY OF YOGA IN DE-ADDICTON Chairperson: Dr...
Transcript of NEUROBIOLOGY OF YOGA IN DE-ADDICTON … · NEUROBIOLOGY OF YOGA IN DE-ADDICTON Chairperson: Dr...
NEUROBIOLOGY OF YOGA IN DE-ADDICTON
Chairperson:
Dr Jitender Jakhar
Senior Resident
National Institute of Mental Health and Neurosciences
Presenter:
Dr Sumana V. BNYS, MD in Clinical Yoga
Research Associate
NIMHANS Integrated Centre for Yoga
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Substance abuseSubstance abuse refers to the harmful or hazardous use of psychoactive substances, including alcohol and illicit drugs.
Dependence Syndrome
Strong desire to take the
drug
Difficulties in controlling
its use
Persisting in its use despite
harmful consequences
A higher priority given to drug use
than to other activities and obligations
Increased tolerance
Sometimes a physical
withdrawal state
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Terminologies• Substance - Any Drugs, Medication, or Toxins that shares the potential of
abuse.
• Abuse - Maladaptive pattern of Substance use that impairs health in aboard sense.
• Addiction - Physiological & psychological dependence on substance ofabuse that affects the CNS in such a way that withdrawal symptoms areexperienced when the Substance is discontinued.
•Dependence Syndrome – A cluster of physiological, behavioral &cognitive phenomena induced by the repeated taking of a Substance.
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Characteristics of Dependence Syndrome• Compulsion or a strong desire to take the substance.
• Difficulties in controlling substance taking behaviour in terms of its onset, termination or levelsof use
• Physiological Withdrawal state is when a group of signs & symptoms occurs when a drug isreduced in amount or withdrawn or use of same drug with the intention of relieving or avoidingwithdrawal symptoms
• Tolerance is a state in which after repeated administration of a particular drug, effect producedby it is decreased, or requires increasing doses to produce the same effect.
• Progressive neglect of alternative pleasures or interests because of drug use and increasedamount of time spent on taking drugs or recovery from its effects.
• Persistent use of drugs despite the clear evidence or harmful consequences on health.
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Classification
Mental and behavioral disorders due to use of…
F10 – …Alcohol
F11 – …Opioids
F12 – …Cannabinoids
F13 – …Sedatives & Hypnotics
F14 – …Cocaine
F15 – …other Stimulants, including Caffeine
F16 – …Hallucinogens
F17 – …Nicotine
F18 – …Inhalants
F19 – …Psychoactive Substances
ALCOHOLTOBACCO
COCAIN
HALLUCINOGENSOPIOIDS
CAFFEINE CANNABISINHALANTS
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Aetiology
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AetiologyBIOLOGICAL FACTORS:
❖ Family history of Substance use disorders
❖ Genetic factors
ENVIRONMENTAL FACTORS:
❖ Structural factors
❖ Proximal factors
❖ Distal factors
❖ Stress
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AetiologySOCIOCULTURAL FACTORS:
❖ Cultural and ethnic background
❖Media/Advertising
❖ Childhood trauma
❖ Learning disorders
COMORBID FACTORS:
❖Antisocial personality disorder
❖Depression
❖Suicidal behaviour
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AetiologyDEVELOPMENTAL FACTORS:
❖ Adolescence vs Later age
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Aetiology
National Epidemiologic survey by the National Institute on Drug Abuse, 2003 Survey by the National Commission for Protection of Child Rights
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AetiologyPSYCHOLOGICAL FACTORS
❖General Rebelliousness
❖Sense of Inferiority or Low Self-Esteem
❖Poor Impulse Control
❖Loneliness, Unmet needs
❖Desire to escape from reality
❖Desire to experiment, a sense of Adventure, Pleasure Seeking
EASY AVAILABILITY OF DRUGS
❖Taking Drugs Prescribed by the Doctors (Eg: Benzodiazepine Dependence)
❖Taking drugs that can be bought legally without Prescription (Eg: Nicotine, Opioids)
❖Taking Drugs that can be Obtained from illicit Sources (Eg: Street Drugs)
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AetiologyBEHAVIORAL THEORIES
❖ Conditioning / Cumulative reinforcement from drug use.
❖ Drug use causes euphoric experience
❖ Stimuli & Setting associated with drug use
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Stages of AddictionDrug addiction has 2 aspects
1. Impulse control
2. compulsive disorders.
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Stages of Addiction
Binge/ Intoxication stage
Withdrawal/ Negative affect
Preoccupation/ Anticipation (craving)
Acute reinforcement/ social drinking
Recovery??
Relapse!!!
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Neurobiological mechanisms of the binge/intoxication stage❖ Reward circuit
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Neurobiological mechanisms of the binge/intoxication stage❖ Activation of D1 dopamine receptor
❖ Neurotransmitters that are implicated in neuroadaptations
❖ Conditioned Reinforcement and Incentive Salience
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Neurobiological mechanisms of the withdrawal/negative affect stage
The withdrawal/negative affect stage consists of chronic irritability, emotional pain, malaise,dysphoria, alexithymia, states of stress, and loss of motivation for natural rewards.
❖ Elevations in reward thresholds
❖ Neurochemical changes/ within-system neuroadaptations:
• Decreases in dopaminergic and serotonergic transmission
• Increases in μ opioid receptor, and
• Decrease in GABAergic and increases in NMDA glutamatergic transmission in the NucleusAccumbens.
❖ Decreases in reward function and increases in stress function
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Neurobiological mechanisms of the withdrawal/negative affect stage
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Neurobiological mechanisms of thepreoccupation/anticipation stage❖ Pre-frontal Cortex
❖ Go-system and Stop-system
❖ Insular functions
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Management of SubstanceAbuse/DependencePharmacological Treatment of Substance Abuse:
OPIOID
❖Methadone (Dolophine®, Methadose®),
❖ Buprenorphine (Suboxone®, Subutex®, Probuphine® , Sublocade™), and
❖ Naltrexone (Vivitrol®)
NICOTINE
❖ Nicotine replacement therapies in the form of patch, spray, gum, and lozenges.
❖ Prescription medications for nicotine addiction: Bupropion (Zyban®) and Varenicline (Chantix®)
ALCOHOL
❖ Naltrexone
❖ Acamprosate (Campral®)
❖ Disulfiram (Antabuse®)
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Management of SubstanceAbuse/DependenceDetoxification:
❖ Evaluation
❖ Stabilization and medication to coping with withdrawal symptoms by antidepressants, Clonidine
Self help groups
❖Meet others with same problem
❖Motivation
Rehabilitation programs
❖ Therapeutic communities
❖ Recovery housing
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Management of SubstanceAbuse/Dependence
Behavioural Therapy:
❖ Done by a psychologist, psychiatrist or a licensed alcohol and drug counselor
❖Behavioral therapies help patients:
• modify their attitudes and behaviors related to drug use
• increase healthy life skills
• persist with other forms of treatment, such as medication
Behavioral treatment includes:
• cognitive-behavioral therapy
• multidimensional family therapy
• motivational interviewing
• motivational incentives
Cognitive Behavioural Therapy for Relapse Prevention
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Neurobiology of Yoga in De-AddictionEmotion Regulation:
❖ Prefrontal Cortex activation (Creswell et al. 2007; Hölzel et al. 2008 , 2011a; Kang et al. 2013)
❖ Deactivation of Amygdala (Desbordes et al. 2012 ; Hölzel et al. 2010 ).
❖ Part of prefrontal cortex, in addition to the anterior cingulate cortex, the orbitofrontal cortex and parts of the insula termed as insula can be strengthened. (Creswell et al. 2007 ; Esch and Stefano 2010)
❖ Enhanced connectivity between the PFC and limbic areas (Desbordes et al. 2012 ; Hölzel et al. 2011a)
❖ Yoga meditation has been associated with greater functional connectivity between the DMN (Brewer et al., 2011; Hasenkamp et al. 2012)
Attention Regulation:
❖The prefrontal or orbitofrontal brain activates relevant dopaminergic midbrain structures and enhance the overall PFC-limbic (dopaminergic) connectivity (Esch and Stefano 2010; Kang et al. 2013)
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Neurobiology of Yoga in De-AddictionNeuromolecular Aspects of Meditation:
❖ Lower values are found for plasma NE in meditators (Infante et al. 2001).
❖ Plasma Serotonin levels are raised (Bujatti, M., and P. Riederer. 1976.)
❖Meditation increases peripheral melatonin levels and reduces cortisol levels (Liou et al. 2010, Solerberg et al 2004)
❖ Yoga increases beta-endorphine levels (Yadav et al. 2012)
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Yoga for De-addictionSl
No.
Title of the study
(Author name, Journal &
Year)
Population and
Sample size
Intervention Control
Intervention
Outcome
Measures
Results
1. Mindfulness Meditation
and Substance Use in an
Incarcerated Population
(Bowen, Sarah, et
al. Psychology of addictive
behaviors. 2006)
Users of various
substances
N=305
Vipasana
Meditation for 10
days
N=63
treatment-as-
usual aftercare
(TAU)
n=242
• The Daily Drinking
Questionnaire & the
Daily Drug-Taking
Questionnaire
• The Short Inventory of
Problems
• Drinking-Related Locus
of Control scale
• The White Bear
Suppression Inventory &
the Brief Symptom
Inventory
Collected at 0, post-
intervention, 3 & 6
months post-release.
At 3 months, compared to Controls,
Meditation reduced (p<0.05) alcohol
[ES 0.6], cocaine [ES 0.35] and
marijuana [ES 0.5] use, and alcohol-
related consequences [ES 0.35], and
improved psychiatric symptoms,
drinking-related locus of control and
optimism; the changes were related
to the VM participation;
2. A randomized trial of yoga
for stress and substance use
among people living with
HIV in re-entry
(Alexandra S, et al. Journal
of Substance Abuse
Treatment, 2018)
Subjects having
HIV with
substance use
disorder
N=73
Hatha yoga
practice for 12-
session, weekly
90-minute
N=37
Treatment as
usual
N=36
• Perceived Stress Scale
(PSS)
• The Timeline Follow-
back (TLFB)
• Measured at baseline,
4th session, 8th session,
post yoga, 1st, 2nd and
3rd month follow-up
At 3-months, yoga participants
reported less stress than
participants in treatment as usual [F
(1,59) = 9.24, p < .05]. Yoga
participants reported less substance
use than participants in treatment
as usual at 1-month, 2-months, and
3-months [p < .001]. 25
Sl
No.
Title of the study
(Author name, Journal &
Year)
Population
and Sample
size
Intervention Control
Intervention
Outcome
Measures
Results
3. Antidepressant efficacy and
hormonal effects of
Sudarshana Kriya
Yoga (SKY) in alcohol
dependent individuals
(A. Vedamurthachar et al.
Journal of Affective
Disorders, 2006)
Inpatients of
alcohol
dependence
N=60
SKY therapy for 2
weeks
N=30
Continued
inpatient care
only
n=30
• Beck Depression Inventory
(BDI)
• Morning plasma cortisol,
ACTH and prolactin
Measured before and at the
end of two weeks.
In both groups reductions in BDI
scores occurred but significantly
more so in SKY group. Likewise, in
both groups
plasma cortisol as well as ACTH fell
after two weeks but significantly
more so in SKY group. Reduction in
BDI scores correlated with that in
cortisol in SKY but not in control
group.
4. Yoga as an adjunct
treatment for alcohol
dependence: A pilot study
(Mats Hallgren, et al.,
Complementary Therapies in
Medicine, 2014)
Alcohol
dependent
patients
N=18
Treatment as
usual + Yoga for
10 weeks
Only treatment
as usual
• Alcohol consumption (timeline
follow-back method, DSM-IV
criteria for alcohol dependence,
and the Short Alcohol
Dependence Data
questionnaire)
• Affective symptoms (the
Hospital Anxiety and
Depression Scale)
• Quality of life (Sheehan
Disability Scale) and
• Stress (the Perceived Stress
Scale and saliva cortisol)
Assessments were taken at
baseline and sixth month
followup.
Alcohol consumption reduced more
in the treatment as usual plus yoga
group (from 6.32 to 3.36 drinks per
day) compared to the treatment as
usual only group (from 3.42 to 3.08
drinks per day).
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Sl No. Title of the study
(Author name, Journal &
Year)
Population
and Sample
size
Intervention Control
Intervention
Outcome
Measures
Results
5. The effect of a yoga
intervention on alcohol and
drug abuse risk in veteran and
civilian women with
posttraumatic stress disorder.
(Reddy S, Dick AM, Gerber
MR, Mitchell K. J Altern
Complement Med. 2014)
Women with
PTSD having
alcohol and
drug abuse
behaviours
N=38
Kripalu-based
Hatha yoga for 12
sessions of 75
minutes each
N=20
Waitlist control
N=18
• Alcohol use disorder
identification test (AUDIT)
• Drug Use Disorders Identification
Test (DUDIT)
Administered at baseline, post
intervention and 1st month follow-
up
The mean AUDIT and DUDIT scores
decreased in the yoga group; in the
control group, mean AUDIT
score increased while mean DUDIT
score remained stable. Most yoga
group participants reported a
reduction in symptoms and improved
symptom management.
6. Yoga as an Adjunctive
Intervention to Medication-
Assisted Treatment with
Buprenorphine+Naloxone
(Lander, Laura, et al. Journal
of addiction research &
therapy, 2018)
Opioid addicts
N=26
Adjunctive yoga
intervention
while remaining
in treatment as
usual for 12
weeks
N=13
Treatment as
usual
N=13
• Perceived stress scale
• Opioid craving scale
• Sleep scale from the medical
outcomes study
• Beck Anxiety Inventory (BAI)
Done at baseline, 45 days and 90
days
The treatment by follow-up time
interaction effect was significant for
perceived stress (p=0.026) indicating
that the yoga intervention had a larger
effect than TAU. Changes in perceived
stress decreased significantly over time
in both the yoga intervention group
and the TAU matched control group.
7. Mindfulness-based therapy
modulates default-mode
network connectivity in
patients with opioid
dependence
(Fahmy R, Wasfi M, et al.
European
Neuropsychopharmacology.
2019)
opiate
dependent
patients
N=32
Mindfulness
based therapy for
4 weeks
N=16
Treatment as
usual
N=16
• Resting-state functional MRI
used to investigate distinct
(anterior vs. posterior) DMN
subsystems
Within the anterior DMN, decreased
right inferior frontal cortical
connectivity was detected in patients
who received MBT compared to TAU.
In addition, within the MBT-group
decreased right superior frontal cortex
connectivity was detected after
treatment. Inferior frontal cortex
function was significantly associated
with mindfulness measures.27
Sl
No.
Title of the study
(Author name, Journal &
Year)
Population
and Sample
size
Intervention Control
Intervention
Outcome
Measures
Results
8. Effectiveness of yogic
breathing intervention on
quality of life of opioid
dependent users
(Dhawan A, et al., Int J Yoga.
2015)
Opioid
Dependent
individuals
N=84
12 hours
Sudarshan Kriya
Yoga for 3 days
along with long
term standard
pharmacothera
py
N=55
Standard
treatment
alone
N=29
• World Health Organization
QOL-brief scale
• Urine drug screening
Assessment done at baseline,
3rd and 6th month
Overtime within study group, all
four QOL domain scores were
significantly higher at 6 months.
Between group comparison
showed significant increase in
physical (P < 0.05); psychological
(P < 0.001) and environment
domains (P < 0.001) for study
group while control group showed
significant changes in social
relationship domain only. Urine
screening results were negative for
study group indicating no drug use
at 6 months.
9. A Pilot Feasibility and
Acceptability Study of
Yoga/Meditation on the
Quality of Life and Markers
of Stress in Persons Living
with HIV Who Also Use
Crack Cocaine
(Agarwal RP, et al. J Altern
Complement Med, 2015)
Users of
crack
cocaine
who is also
having HIV
N=24
Yoga/Meditatio
n for 1hour
twice a week
for two months
N=12
No
intervention.
Contacted only
for assessments
N=12
• Short Form-36
• Perceived Stress Scale [PSS]
• Impact of Events Scale
[IES])
• Salivary cortisol and
• dehydroepiandrosterone
sulfate (DHEA-S)
YM participants showed modest
improvements on QOL. The PSS
total score and the IES intrusion
score improved significantly 2
months after the intervention, but
cortisol and DHEA-S did not
change.
28
Sl
No.
Title of the study
(Author name, Journal &
Year)
Population
and Sample
size
Intervention Control
Intervention
Outcome
Measures
Results
10. Mindfulness training for
smoking cessation: Results
from a randomized
controlled trial
(Judson A. Brewer, Sarah
Mallik, et al. Drug and
Alcohol Dependence, 2011)
Nicotine-
dependent
adults
N=88
Mindfulness
training for
weekly twice for
four weeks
N=41
Freedom from
smoking (FFS)
treatment
N=47
• Self-reported smoking via the
timeline follow back (TLFB)
method
• Exhaled carbon monoxide
(CO) measurement
Assessed weekly twice, end of 4
weeks and follow-up at week 17
Compared to those randomized to
the FFS intervention, individuals who
received MT showed a greater rate of
reduction in cigarette use during
treatment and maintained these
gains during follow-up (F = 11.11, p =
.001). They also exhibited a trend
toward greater point prevalence
abstinence rate at the end of
treatment (36% vs. 15%, p = .063),
which was significant at the 17-week
follow-up (31% vs. 6%, p = .012).
11. Yoga as a complementary
treatment for smoking
cessation in women. (Bock
BC, et al,. Journal of
Women's Health. 2012)
Women with
smoking
addiction
N=55
Group-based CBT
for smoking
cessation + yoga
program (yoga)
for twice a week
for 8 weeks
N=32
CBT for smoking
cessation plus a
group-based
wellness
program
N=23
• 7-day point prevalence
abstinence (7PPA), verified by
saliva cotinine level less than
57 nmol/L (15 ng/mL) done
after the treatment
• Smoking history and nicotine
dependence (FTND),
measures of anxiety (STAIT),
depressive symptoms (CESD-
10), short-form Health
Survey: SF-36
Assessed at 3rd and 6th week
follow-up
Women in the yoga group had a
greater 7-day point-prevalence
abstinence rate than controls (odds
ratio [OR], 4.56; 95% CI, 1.1–18.6).
Abstinence remained higher among
yoga participants through the 6th
month assessment (OR, 1.54; 95% CI,
0.34–6.92), but not statistically
significant.
Women participating in the yoga
program also showed reduced
anxiety and improvements in
perceived health and well-being
when compared with controls.29
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THANK YOU!
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