SUBSTANCE USE DISORDERS-AN OVERVIEW

RICHARD JONES MA, MBA, LCAS, CCS, SAP, CEAPEXECUTIVE DIRECTOR: FAVOR GREENVILLE

WWW.FAVORGREENVILLE.ORG

AOD INFORMATION…NATION’S NUMBER ONE HEALTH PROBLEM

• ACCORDING TO FEDERAL GOVERNMENT (SAMHSA) 23.5 MILLION PEOPLE AGE 12 OR OLDER NEEDED TREATMENT FOR AN ILLICIT DRUG OR ALCOHOL USE DISORDER. OF THESE, ONLY 2.6 MILLION (11.2%), RECEIVED TREATMENT…

• COSTS TO SOCIETY: ALCOHOL--$235 BILLION A YEAR; ILLICIT DRUGS $193 BILLION A YEAR…

• 1 IN 4 FAMILIES ARE DIRECTLY IMPACTED BY AN ALCOHOL OR OTHER DRUG USE DISORDER…

• THE IMPACT IS TRULY IMMEASURABLE… (RELATED HEALTH ISSUES FOR FAMILY MEMBERS, LOST PRODUCTIVITY, “A RIPPLE EFFECT OF DESTRUCTION”)…

HOW ABOUT ON A LOCAL LEVEL…

• NATIONAL HOUSEHOLD SURVEY ON DRUG USE AND HEALTH (2010): BETWEEN 7.13% AND 8.21% (32,890 TO 37,872 PEOPLE) OF ADULTS IN GREENVILLE COUNTY SUFFER FROM ALCOHOL OR OTHER DRUG USE DISORDER.

• SOUTH CAROLINA IS “AVERAGE” IN TERMS OF ITS ADDICTION PROBLEM… “MOST ADDICTED”: DISTRICT OF COLUMBIA AND RHODE ISLAND (WHAT?)

USE TO DEPENDENCE (ANTHONY ET AL., NATIONAL COMORBIDITY STUDY 1994/1997)

Drug Type Have Used Drug DependenceTobacco 75% 32%Alcohol 91% 15%All drugs 51% 18%Cannabis 46% 9%Cocaine 16% 17%Speed 15% 11%Anxiolytics 13% 9%Heroin 1.5% 23%

DIFFERENCE: USING & ADDICTION

HEAVY USE, “PARTYING”, “HAD A BAD NIGHT”

Genetic factors

Reward potential

Age onset, frequency,

Drug specific

CROSSING “LINE” INTO ADDICTION

• USE DESPITE CLEAR CONSEQUENCES• TOLERANCE• WITHDRAWAL• CRAVING/PRE-OCCUPATION• CAN’T CONTROL• CAN’T CUT BACK• INTERPERSONAL ISSUES• AVOID NON-USING ACTIVITIES• GREAT DEAL OF TIME SPENT ON USING

DISEASE:ORGAN – DEFECT – SYMPTOMS

DIABETES• ORGAN= PANCREAS

• DEFECT= CANNOT PRODUCE INSULIN

• SYMPTOMS= BLURRED VISION, WOUNDS THAT WON’T HEAL, NUMBNESS

DRUG OR ALCOHOL ADDICTION

• ORGAN=MID BRAIN

• DEFECT= DYSREGULATION OF DOPAMINE (HEDONIC) SYSTEM

• SYMPTOMS= DRUG SEEKING, CRAVING, LOSS OF CONTROL, USE DESPITE CONSEQUENCES

A BRAIN DISEASE

THE DOPAMINE FEEDBACK LOOP

• IN A HEALTHY BRAIN DOPAMINE PRODUCTION IS CLOSELY REGULATED• DOPAMINE EQUALS GOOD STUFF (FOOD, SEX, PLEASURE) • TOO MUCH DOPAMINE THE BRAIN ADDS MORE RECEPTORS OR RECYCLES

THE EXCESS SIGNALING PRODUCTION TO STOP—TOO MUCH DOPAMINE=SCHIZOPHRENIA NOT ENOUGH DOPAMINE=PARKINSON’S

• DRUGS DISRUPT THIS NORMAL CYCLE BY FLOODING THE RECEPTORS WITH TOO MUCH DOPAMINE (EITHER BY EXCESSIVE RELEASE OR PREVENTING THE RECYCLING; INHIBITING THE “STOP” SIGNAL)

DOPAMINE FEEDBACK LOOP

Dopamine released

Signal to stop

Receptors fill

Excess recycled

DOPAMINE FEEDBACK LOOP• DRUGS CAUSE A GREATLY AMPLIFIED LEVEL OF DOPAMINE AND EUPHORIC HIGH

THAT KEEPS THE ADDICT COMING BACK FOR MORE.• IN COMPARISON TO NATURALLY INDUCED DOPAMINE RELEASE, DRUG INDUCED

DOPAMINE RELEASE IS MORE IMMEDIATE, LONGER LASTING, AND MORE INTENSE. AT LEASE INITIALLY.

• IN ORDER TO COMPENSATE AND “REBALANCE” IT’S DELICATE DOPAMINE FEEDBACK LOOP IN RESPONSE TO REPEATED “FLOODS” THE BRAIN RESPONDS BY DAMPENING IT’S ABILITY TO PRODUCE DOPAMINE (TURN THE WATER OFF ON THE TOILET).

• BASELINE DOPAMINE LEVELS BECOME ABNORMALLY LOW AND ABILITY TO EXPERIENCE PLEASURE IS REDUCED.

• IN THE MEANTIME, THE MIDBRAIN (SURVIVAL: DOPAMINE EQUALS FOOD, SEX ETC…) HAS BEEN PAYING CLOSE ATTENTION. MORE DOPAMINE IS GOOD SO THE DRUG IS “TAGGED” AS GOOD AT A SURVIVAL LEVEL (GLUTAMATE-TAG).

DOPAMINE FEEDBACK LOOP CONT. • SO…THE MIDBRAIN TAGS THE DRUG AS NECESSARY FOR SURVIVAL AND CRAVINGS

PROMOTE A REPEAT/RETURN TO USING THE DRUG. • IT BECOMES A MATTER OF SURVIVAL NOT PLEASURE OR CHOICE… • THE DRUG IS A FUNDAMENTAL PART OF EXISTENCE. JUST LIKE FOOD, WATER, ETC… • CRAVINGS ARE REGULATED BY GLUTAMATE THROUGH ITS IMPACT ON MEMORY AND

LEARNING. • IN TIME, TRYING TO REGAIN OPTIMAL GLUTAMATE LEVELS, THE BRAIN DEVELOPS

HABITS IN THE DEEP SEATED, NON-CONSCIOUS MEMORY SYSTEM OF THE MID-BRAIN.• AS A RESULT ENVIRONMENTAL CUES ASSOCIATED WITH THE DRUG CAN TRIGGER

MEMORIES OF USE CAUSING UNCONTROLLABLE CRAVINGS.

WHAT THE DO WE DO? • DON’T IGNORE IT AND HOPE FOR THE BEST.• THE SOONER YOU INTERVENE THE BETTER.• GET EDUCATED AND INFORMED.• EXPLORE CONCRETE OPTIONS BASED ON SPECIFICS

OF THE SITUATION:• RELATIONSHIP• AGE• DRUG(S) INVOLVED• TREATMENT HISTORY• SUPPORT AVAILABLE (PEOPLE AND $$)

OPTIONS MAY INCLUDE:• INTERVENTION• TREATMENT • CRISIS RESPONSE (EMERGENCY SITUATIONS,

LEGAL ISSUES ETC…)• SUPPORT RECOVERY• ENFORCE BOUNDARIES• FAMILY RECOVERY

MULTIPLE PATHWAYS TO RECOVER

• FACT: THERE ARE MULTIPLE PATHWAYS TO RECOVERY… IT IS NOT A ONE-SIZE FITS ALL ENDEAVOR…