Neuroscience of Addiction (Part 1)
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Transcript of Neuroscience of Addiction (Part 1)
1Lunievicz - Neuroscience
The Neuroscience of Addiction – Part 1Joe Lunievicz, BA, RYT
Director, Training Institute, NDRI
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Webinar LogisticsPanel QuestionsRaise handTech Difficulties
(800) 263-6317
This webinar was conducted under the auspices of the Bureau of Justice Assistance (BJA) Drug Courts Technical Assistance Project at American University, Washington, D.C. This project was supported by Grant No. 2010 DC-BX-K087-awarded to American University by the Bureau of Justice Assistance. The Bureau of Justice Assistance is a component of the Office of Justice Programs, which also includes the Bureau of Justice Statistics, the National Institute of Justice, the Office of Juvenile Justice and Delinquency Prevention, and the Office for Victims of Crime. Points of view or opinions in this document are those of the authors and do not represent the official position or policies of the U.S. Department of Justice.
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Presenter: Joseph Lunievicz, Director, Training Institute, NDRI
Lunievicz - Neuroscience
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What we’ll cover in part 1
Why Neuroscience? Definitions Neurochemistry lite Impact on Drug Court
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Question
Why do our participants start using or try drugs?
Type in your answer…
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QuestionWhy do they, over time, continue to use drugs?
Type in your answer…
Neuroscience SupportsAddiction = Brain Disease
…with biological, sociological and
psychological components
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What’s all the fuss about Neuroscience? Neuroscience – definition from dictionary.com - the field of study
encompassing the various scientific disciplines dealing with the structure, development, function, chemistry, pharmacology, and pathology of the nervous system that effect the brain.
Every thought, sensation, emotion, physical movement is accounted for in terms of brain structures and chemistry.
In other words… nothing happens in human behavior except by the mechanisms of the brain.
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Disease Model Chemical Dependency Disease of the brain. Chronic condition that requires life-long management. Compared to:
Type 2 Diabetes, Chronic hypertensive disease, Asthma, Obesity All have a complex of physiological and behavioral health components
No one treatment episode will resolve illness. Course of dependency is multiple episodes of treatment,
recovery activities, relapse periods.
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Application“The longer you’re in treatment…”
Research has shown unequivocally that good outcomes are contingent on adequate treatment length.
Why? Then… how long…
Generally, for residential or outpatient treatment, participation for less than 90 days is of limited effectiveness, and treatment lasting significantly longer is recommended for maintaining positive outcomes.
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Therefore… Understanding how the
brain functions during and after drug use, encourages practitioners to correlate appropriate strategies to the stage of recovery and consequently impact on program retention.
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Abuse vs. AddictionCarlton Erickson, Ph.D. University of Texas 2009
Abuse is a problem to solve caused by bad choices, self-anesthetization, celebration, or just wanting to get high Reduce through treatment such as education, positive reinforcement of
alternate behaviors, coercion, environmental change, maturation, pressure to stop, life events
Chemical dependence is a brain disease caused by genetic vulnerability, drug use, and environmental influence Reduce through “treatment” to positively affect abnormal brain function to
reduce need for drug – Evidence Based Practices
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Three key components in dependency…Drug use or exposure to a drugGenetic influence or vulnerabilityEnvironmental influences
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Drug ExposureWho Becomes Dependent?Estimated lifetime prevalence of risk…
Nicotine – 32% Heroin - 23% Crack - 20% Cocaine - 17% Alcohol – 15% Stimulants other than cocaine – 11%
US epidemiological Estimates, 1992-98
Anthony et al,. 1994
Chen & Anthony, 2004
Hughes et al,. 2006
Cannabis – 9% Sedatives – 9% Analgesic opioids – 9% Psychedelics – 5% Inhalants – 4%
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Genetic Vulnerability for Dependence
Abnormal genes Problems in the pleasure pathway Impaired control over drug use
Addicting drugs seem to “match” the need in the chemical system that is not normal
Onset time is variableMild to severe rangeTechnical Difficulties: (800) 263-6317
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Environmental Factors- Utah Addiction Center at the University of Utah, Dr. Kelly Lundberg, 2012
Community DomainPeer DomainFamily DomainSchool/Work Domain
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Behavior… (including addiction) is related to…
Characteristics of brain regions
The functions of neurons, including their connectivity into pathways or circuits
The neurochemistry that exists between neurons that allows them to interact
External stimuli
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The Players of the Brain Neurons - the cells of the brain
100 billion Dendrites, Axons, Cell body with Nucleus
Neurotransmitters - chemicals that communicate information throughout our brain and body 50+
Synapse The space between the axon terminal and the receptor dendrite where neurotransmitters
flow… 10,000 per neuron
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Synapse
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SynapseNeurotransmitters…
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What Drives Addiction?Neurotransmitters
Similarity between drug molecules and neurotransmitter molecules
Most drugs activate the reward pathway or pleasure centers of the brain through neurotransmitters such as Dopamine
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Pathway for Understanding Addictive Effects of Drugs on the Brain & Behavior
Reward Pathway
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Key parts of the brain – Reward Centers
Pre-frontal Cortex Voluntary control of skeletal muscle Personality Higher intellectual processes (prefrontal cortex takes up the
majority of the frontal lobe – executive suite) Concentration, planning, decision making
“On second thought… ” Matures last (ages 25-26 for full maturity) Modulated by Dopamine…
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• Drug users have far less dopamine activity (right), as is indicated by the depletion (dark red shows disruption), compared to the controls (left)
Studies show that this difference contributes to dependence and a diseased brain
Brain changed in PET Scans
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Physiological ResponseToleranceWithdrawalDecision making
capabilities diminished
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Behavioral Responses Loss of control
Continued compulsive
use despite harmful
consequences
Multiple relapses
preceding stable
recovery
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Partial Recovery of Dopamine Transporters After Prolonged Abstinence
Normal Control Meth user(1 month abstinent)
Meth user(36 months abstinent)
Why is Continued Treatment Critical?
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PollWhich works better?
JailDrug Treatment
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Re-Addiction Following PrisonRawson 2010
• Vaillant• 447 opiate addicts 91%
• Maddux & Desmond • 594 opiate addicts 98%
• Nurco & Hanlon • 355 opiate addicts 88%
• Hanlon & Nurco • 237 mixed addicts 70%
Many Other Studies Including: (Simpson, Wexler, Inciardi, Hubbard, Anglin)
Treatment Research Institute
Long-term Outcome StudiesRawson, 2010
Alcohol: Vaillant: multiple studies reporting a majority of alcoholics who enter treatment experience multiple relapses and retreatments with about 30-50% achieving stable abstinence.
Cocaine; Hser: Ten year follow-up of cocaine dependent patients in treatment indicates that fewer than 50% achieve extended periods of abstinence. Most reenter treatment multiple times.
Methamphetamine: Marinelli-Casey 3 year follow up indicates of a cohort of 600 MA dependent individuals about 50% continue to use MA at a moderate or severe level during the 3 year post treatment 36 month period.
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Public Expectations of Substance Abuse Interventions
Safe, complete detoxification Reduced use of medical services Eliminate crime Return to employment/self support Eliminate family disruption No return to drug use
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Neuroscience SupportsAddiction = Brain Disease
…with biological, sociological and
psychological components
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Impact
Addiction is a brain disease not simply a behavior
Impact on cognitive functioning What is said, heard, interpreted,
acted upon Ability to comply Ability to remain abstinent
Concept of mitigating circumstance How you view and react to relapse
A Chronic Care Model
Detox
Continuing CareRecovering Patient
RehabDurationDetermined byPerformanceCriteria Duration
Determined byPerformanceCriteria
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Lessons Learned from Chronic CareBehavior change is necessary for sustained benefitTreatment effects do not last very long after
treatment stopsPatients not in some form of treatment or
monitoring are at greater risk for relapseRetention is criticalMonitoring is essential
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References Richard Rawson, Ph.D. Professor, Semel Institute for Neuroscience
and Human Behavior, David Geffen School of Medicine, University of California at Los Angeles: Addiction is a Chronic Disease and it Matters, 2010
Carlton Erickson, Ph.D. College of Pharmacy, The University of Texas, Presentation: Neuroscience of Addiction, 2009
Robert Walker, MSW, LCSW, University of Kentucky Center on Drug and Alcohol Research, Presentation: The Neuroscience of Addiction, 2008
George F. Koob, Ph.D. Professor and chairman committee on the Neurobiology of Addictive Disorders, The Scripps Research institute, La Jolla, CA, Presentation: The Neuroscience of Addiction, 2006
NIDA, The Neurobiology of Addiction Teaching Packets, 2007 Nestler, Eric, J., Molecular Basis of Long-Term Plasticity Underlying
Addiction, Neuroscience, Volume 2, 2001
Upcoming Webinars Addiction and the Neuroscience of the Brain
Part II: Bio-Psycho-Social-Spiritual factors impacting addiction and early recovery as well as client participation in the drug court program.
September 20, 2012 3pm-4pm
Addiction and the Neuroscience of the BrainPart III: Focus will be on the three components of relapse prevention: warning
signs of relapse, identifying triggers, and reinforcement strategies.
September 27, 2012 3pm-4pm
This webinar was conducted under the auspices of the Bureau of Justice Assistance (BJA) Drug Courts Technical Assistance Project at American University, Washington, D.C. This project was supported by Grant No. 2010 DC-BX-K087-awarded to American University by the Bureau of Justice Assistance. The Bureau of Justice Assistance is a component of the Office of Justice Programs, which also includes the Bureau of Justice Statistics, the National Institute of Justice, the Office of Juvenile Justice and Delinquency Prevention, and the Office for Victims of Crime. Points of view or opinions in this document are those of the authors and do not represent the official position or policies of the U.S. Department of Justice.
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Presenter: Joseph Lunievicz, Director, Training Institute, NDRI
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Sponsored by The BJA Drug Court Technical Assistance Project at American University, in collaboration with the National Development & Research Institute s
Organizer - Clyde Frederick – Senior Administrative Technologist
Presenter: Joe Lunievicz, Director of Training, NDRI
Thank You for ParticipatingDon’t Forget – Please complete the survey for today’s webinar