Understanding Drug Abuse and Addiction Steve Hanson.
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![Page 1: Understanding Drug Abuse and Addiction Steve Hanson.](https://reader035.fdocuments.in/reader035/viewer/2022062713/56649cb95503460f949804f8/html5/thumbnails/1.jpg)
Understanding Drug Abuse and Addiction
Steve Hanson
![Page 2: Understanding Drug Abuse and Addiction Steve Hanson.](https://reader035.fdocuments.in/reader035/viewer/2022062713/56649cb95503460f949804f8/html5/thumbnails/2.jpg)
Basic Questions
• Why do people do drugs?
• Why can’t/ won’t some people stop?
![Page 3: Understanding Drug Abuse and Addiction Steve Hanson.](https://reader035.fdocuments.in/reader035/viewer/2022062713/56649cb95503460f949804f8/html5/thumbnails/3.jpg)
Realities
People like Drugs.
We all like things faster and easier.
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How Drugs Work
• Interact with neurochemistry• Results:
–Feel Good – Euphoria/reward–Feel Better – reduce negative
feelings
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CompulsiveDrug Use
(Addiction)
VoluntaryDrug Use
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Addiction is a Brain Disease
Prolonged Use Changes the brain in Fundamental
and Long Lasting Ways
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Brain Changes
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Neurotransmitter Action
Release of NT
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Neurotransmitters
• Acetylcholine – Memory• Dopamine – Reward/Euphoria• Norepinephrine – Metabolic Rate• Serotonin – Mood, Sleep Regulation
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Natural Rewards
FoodWater
SexNurturing
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methamphetaminemarijuanaecstasyopiumetc.
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Food
00
5050
100100
150150
200200
00 6060 120120 180180
Time (min)Time (min)
% o
f B
asal
DA
Ou
tpu
t%
of
Bas
al D
A O
utp
ut
NAc shellNAc shell
EmptyEmpty
BoxBox FeedingFeeding
Source: Di Chiara et al.Source: Di Chiara et al.
FOODFOOD
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Sex
100100
150150
200200
DA
Co
nce
ntr
ati
on
(%
Bas
elin
e)
DA
Co
nce
ntr
ati
on
(%
Bas
elin
e)
MountsMountsIntromissionsIntromissionsEjaculationsEjaculations
1515
00
55
1010
Co
pu
latio
n F
req
ue
nc
yC
op
ula
tion
Fre
qu
en
cy
SampleNumberSampleNumber
11 22 33 44 55 66 77 88 99 1010 1111 12121313 1414 1515 16161717
ScrScrScrScrBasBasFemale 1 PresentFemale 1 Present
ScrScrFemale 2 PresentFemale 2 Present
ScrScr
Source: Fiorino and PhillipsSource: Fiorino and Phillips
SEXSEX
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Nicotine
00
100100
150150
200200
250250
00 11 22 3 hr3 hr
Time After NicotineTime After Nicotine%
of
Ba
sa
l R
ele
as
e%
of
Ba
sa
l R
ele
as
e
AccumbensAccumbensCaudateCaudate
NICOTINENICOTINE
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Alcohol
100
150
200
250
0 1 2 3 4hr
Time After Ethanol
% o
f B
as
al
Re
lea
se 0.25
0.512.5
Accumbens
0
Dose (g/kg ip)
Alcohol
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00
100100
200200
300300
400400
00 11 22 33 44 5 hr5 hrTime After CocaineTime After Cocaine
% o
f B
as
al
Re
lea
se
% o
f B
as
al
Re
lea
se
DADADOPACDOPACHVAHVA
AccumbensAccumbensCOCAINECOCAINE
00
100100
150150
200200
250250
00 11 22 33 44 5hr5hrTime After MorphineTime After Morphine
% o
f B
as
al
Re
lea
se
% o
f B
as
al
Re
lea
se
AccumbensAccumbens
0.50.51.01.02.52.5
1010
Dose (mg/kg)Dose (mg/kg)
MORPHINEMORPHINE
Source: Di Chiara and Imperato
Effects of Drugs on Dopamine Levels
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Source: Di Chiara and Imperato
00
100100
200200
300300
400400
500500
600600
700700
800800
900900
10001000
11001100
00 11 22 33 44 5 hr5 hr
Time After AmphetamineTime After Amphetamine
% o
f B
as
al
Re
lea
se
% o
f B
as
al
Re
lea
se
DADA
DOPACDOPAC
HVAHVA
AccumbensAccumbens METHAMPHETAMINEMETHAMPHETAMINE
Methamphetamine
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Behavior Pathways
• Rewarding behaviors can become routine• “Subconscious” control of the behavior• Difficult to extinguish behaviors because
people are not always aware when they are initiated.
• Resistant to change
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Circuits Involved In Drug Abuse and Addiction
All of these must be considered in developing strategies to effectively treat addiction
GOSTOP
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Go & Stop
• Craving elicits Go!! • Powerful • Activity in limbic system not frontal cortex • Feeling/reacting vs. thinking/planning• Thinking initiates Stop!!• Addicts have “bad brakes” – Stop! • Hard to stop this fast moving car.
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Fred Flintstone Brakes
21
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Craving
Trigger
Memory
Stimulation of NucleusAccumbens & Amygdala
Focus on Drug Anxiety Increases
ImpairedJudgement
Relapse
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AMYGDALAR CONNECTIVITY during brief .5 sec Cocaine Cues
Drug 2 amyg conx (n=7)
Placebo
Baclofen
Source: Childress, et al, unpublished
Baclofen blunts AMYGDALAR CONNECTIVITY
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MyelinationWhy it’s hard to change
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Myelination = Stronger & FasterLike Paving a Dirt Road
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Chemical Dependency
• Chronic Disease Prone to Relapse• Requires significant behavior
changes• Similar to Heart Disease, Diabetes,
Asthma, Gingivitis,etc.• Similar treatment “success”
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Relapse Happens
• Poor Craving Management• The Relapse Process – Gorski• Get the train back on the tracks
![Page 28: Understanding Drug Abuse and Addiction Steve Hanson.](https://reader035.fdocuments.in/reader035/viewer/2022062713/56649cb95503460f949804f8/html5/thumbnails/28.jpg)
Cocaine Effects
• Blocks Reuptake of DA and NE – increases activity
• Central Nervous System - Euphoria• Peripheral NS - NEFight/Flight
–HR, BP, Temp, bronchodilation, dilates pupils
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Snorted - onset 2 mins.
Smoked - onset 5-12 seconds30-40 mins
1 hour15 mins
5 mins
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Dose Response
DOSE
EF
FE
CT
S
Euphoria
Psychosis
Paranoia
AnxietyEnergized
MetabolicCrisis
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Animal Studies
• Primates will ignore food and water in order to get cocaine – to the point of death by starvation/dehydration
• Given unlimited access to cocaine, animals will quickly die from cocaine related deaths.
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Stopping Cocaine Use
• Anhedonia - Dopamine depletion• Craving - intense craving for drug
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Methamphetamine
DOPAMINE DOPAMINE
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Meth - Signs of Abuse
–rapid weight loss
–nervous energy–no “need” for
sleep–aggressive
–mean temperment
–compulsive–excited talk–“Meth mouth”
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Meth - Signs of Withdrawal
–long crash–apathy–depression–fatigue
–anxiety–suicidal
ideation–cravings
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Alcohol
• Most popular drug of abuse• Probably the most physically toxic of
drugs • Damages almost every organ in the body• Easy access, adults use, advertising,
relatively inexpensive.• THE DRUG for Youth
![Page 38: Understanding Drug Abuse and Addiction Steve Hanson.](https://reader035.fdocuments.in/reader035/viewer/2022062713/56649cb95503460f949804f8/html5/thumbnails/38.jpg)
Action
• Dopamine – excitement & reward• Serotonin – feel – “normal”• GABA – lowers anxiety• Endorphins – pain relief, reward,
craving
![Page 39: Understanding Drug Abuse and Addiction Steve Hanson.](https://reader035.fdocuments.in/reader035/viewer/2022062713/56649cb95503460f949804f8/html5/thumbnails/39.jpg)
Endorphins
Drink
Endorphins
RewardStop Drinking
Endorphins
Craving
Block Endorphins with Naltrexone – Break Reward Cycle
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Endorphins
Drink
Endorphins
RewardStop Drinking
Endorphins
Craving
Block Endorphins with Naltrexone – Break Reward Cycle
![Page 41: Understanding Drug Abuse and Addiction Steve Hanson.](https://reader035.fdocuments.in/reader035/viewer/2022062713/56649cb95503460f949804f8/html5/thumbnails/41.jpg)
Opiates
Natural OpiatesDerived from raw opium
• Morphine• Codeine
Semi-syntheticsModified Natural
• Heroin• Vicodin
Synthetics• Fentanyl• Demerol• Methadone
![Page 42: Understanding Drug Abuse and Addiction Steve Hanson.](https://reader035.fdocuments.in/reader035/viewer/2022062713/56649cb95503460f949804f8/html5/thumbnails/42.jpg)
Opiates
• Heroin more potent -60-80% - <10% in ‘70’s• Younger age group – 18-24 y.o. and
younger• Suburban/Rural• Users start with snorting - IV within 12
months• Withdrawal painful - not deadly• Lots of Relapse
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“Take the best orgasmyou’ve ever had…Multiply it by a thousand.And you’re still nowherenear it.
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Heroin
Effects• Analgesia - change in
pain perception• Euphoria - Intense• Sedation - “on the nod”• Respiratory Depression• Cough Suppression• Nausea/vomiting• Constipation
Withdrawal• Pain• Depression• Alert• Rapid Breathing• Coughing• Nausea/Vomiting• Diarrhea• 3-5 days
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Addiction/Dependency
• Opioids trigger reward system – euphoria – leads to continued use – addiction
• Withdrawal symptoms are significant – regular use to avoid withdrawal - dependence
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Addiction vs. Dependency
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Heroin usage patterns
• Highly addictive and dependence producing• Significant tolerance up to 35X • Increased cost• Tolerance management (Tx, jail, etc.)• Mixing with other opiates and other drugs
(speedballing/cocaine)
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Treatment
• Traditional Recovery Based/NA• Naltrexone - Antagonist/Blocker• Opiate Maintenance Tx – withdrawal
management– Methadone- daily– Buprenorphine/Suboxone– Methadone to abstinence models
![Page 49: Understanding Drug Abuse and Addiction Steve Hanson.](https://reader035.fdocuments.in/reader035/viewer/2022062713/56649cb95503460f949804f8/html5/thumbnails/49.jpg)
Prescription Opiates
• OxyContin-an oral, controlled release form of the drug- Much abuse – crush the tablet – heroin-like high
• Darvon • Vicodin• Dilaudid
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Two “Types” of Rx Drug Abusers
• The Drug Abuser who likes Rx drugs.– Frequently use other
drugs (cocaine, alcohol, heroin, other non-Rx drugs)
– Fits the “model” of a drug abuser.
– “addicted” to high
• The Patient who becomes dependent on their medication– Infrequent use of other
substances – unless can’t get Rx.
– Don’t fit “model” of drug user – age, other behaviors.
– “dependent” on the drug
![Page 51: Understanding Drug Abuse and Addiction Steve Hanson.](https://reader035.fdocuments.in/reader035/viewer/2022062713/56649cb95503460f949804f8/html5/thumbnails/51.jpg)
Why Prescription Drug Users May Believe That They Are “Different”
• “I had/have real pain, I wasn’t using these to get high like those drug addicts”
• “My doctor prescribed these for me. It wasn’t my idea”
• “I never robbed anyone or did those things that addicts do.”
• “I have to take something for this pain!”
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What the Rx Drug User Might Have Trouble Relating To
• “Hitting Bottom”• Changing People, Places & Things• Change your “Lifestyle”• You must be completely abstinent from
everything else – alcohol included• Going to meetings all of the time.
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Marijuana
• Used since 2,700 BC• More potent today (5-10X) than ‘70’s• Kids starting younger• Eliminates boredom, focus
concentration, lowered anxiety, euphoric, increased appetite.
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Spice/K2 and Synthetic Cannabinoids
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Preparation of the “incense”:
• botanicals are sprayed with liquid preparations of:– HU-210– HU-211– CP 47,497– JWH-018– JWH-073
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Origins of Synthetic Cannabinoids
• HU-210 & HU-211 - synthesized at Hebrew University, Israel in 1988. HU-210 is an anti-inflammatory; HU-211 as an anesthetic
• CP 47,497 - developed by Pfizer in 1980 as an analgesic• JWH-018 & JWH-073 - synthesize by a researcher at
Clemson (1995) for use in THC receptor research - John W. Huffman
• more than 100 different synthetic cannabinoids have been created
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Some Effects of Synthetic Cannabinoids are Similar to THC
• increase heart rate & blood pressure• altered state of consciousness • mild euphoria and relaxation • perceptual alterations (time distortion)• intensification of sensory experiences• pronounced cognitive effects• impaired short-term memory • reduction in motor skill acuity• increase in reaction times
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Some Effects of Synthetic Cannabinoids are Different to THC
• production inconsistencies• herbal incense blends are harsher to inhale • increased restlessness & aggressive behavior • herbal incense produces a shorter “high”
(perceptual alterations & sensory effects are limited)
• doesn’t mix well with alcohol (hangovers)• incense costs more than marijuana
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Bath Salts:
• Ivory Wave• Ivory Pure• Ivory Coast• Purple Wave• Vanilla Sky
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What’s in Bath Salts?:
• Methylenedioxypyrovalerone (MDPV) is a psychoactive drug with stimulant properties which acts as both a norepinephrine-dopamine reuptake inhibitor (NDRI).
• MDPV has four times the potency of Ritalin• MDPV - no history of FDA approved medical
use• sold since 2007 as a research chemical
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Pharmacological Effects of “Bath Salts”:
• increase heart rate & blood pressure• pupil dilation • hyperactivity, arousal & over stimulation• increased energy & motivation• euphoria - agitation • dizziness• nausea• breathing difficulties• diminished perception of the requirement for
food and sleep
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Addiction is like…
• The dog does not want to let go of the bone (addiction/ denial).
• It gets excited when it thinks its going to get its bone (craving)
• It always wants more bones (loss of control)
• Sometimes the dog takes you for a walk.
A dog with a bone
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What Boomer is Thinking
What can I getaway with?They won’t test me
for another week.
Try the second-hand smoke
excuse.We can talk our way out of this.
![Page 68: Understanding Drug Abuse and Addiction Steve Hanson.](https://reader035.fdocuments.in/reader035/viewer/2022062713/56649cb95503460f949804f8/html5/thumbnails/68.jpg)
Treatment is like…
• You teach the dog’s owner to control the dog.
• You develop a variety of tools (relapse prevention) to help the dog be obedient.
• Some dogs are harder to train.
Obedience School for the Dog
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Early Recovery Issues
• Loss of lifestyle• Loss of Coping Strategy• Withdrawal• Cognitive deficits related to early
abstinence
![Page 70: Understanding Drug Abuse and Addiction Steve Hanson.](https://reader035.fdocuments.in/reader035/viewer/2022062713/56649cb95503460f949804f8/html5/thumbnails/70.jpg)
Cognitive Deficits
• Memory problems - short term loss
• Difficulty with abstractions• Difficulty with impulse
control• Similar performance to
those with brain damage - Improves.
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The End
Thanks