the brain's role in addiction and chronicity of sud
TRANSCRIPT
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Cynthia L Whitaker, PsyD, MLADC
10/05/2017
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Identify the effects of substance use on the brain
Increase in understanding of the role of the brain on the severity and chronicity of addiction
To increase knowledge of the connections between the brain, substance use disorders, and other behavioral health disorders
...in order to continue to decrease stigma and have informed discussions on prevention, treatment, & recovery
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“Addiction is a primary, chronic disease of brain reward, motivation, memory and
related circuitry. Dysfunction in these
circuits leads to characteristic biological, psychological, social and spiritual manifestations…addiction often involves cycles of relapse and remission”
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Parts of the Brain
◦Cortex
◦ Limbic System
◦ Brain Stem
Communication within the Brain
◦Neuron to Neuron
◦Neurotransmitters
◦ Receivers
◦ Transporters
Drugs interfere with the way the parts of the brain communicate
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3 factors impact the brain
1. Biology/Genes
DNA makeup, predisposition
2. Environment
Stress response, amygdala
3. Drugs
Toxins
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Genetics◦Genetic Vulnerability ◦Familial Patterns of Addiction
Gender Differences Mental Disorders ◦Overlap of risk factors ◦ “Self- medication” ◦ Increased risk for mental illness brought on by drug use, especially in those with genetic or other vulnerabilities
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Chaotic home and abuse
Parents’ use and attitudes
Peer Influences
Community Attitudes
Poor School Achievement
Most studied & strongest predictability…
Aversive Childhood Experiences
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Child physical abuse
Child sexual abuse
Child emotional abuse
Neglect
Mentally ill, depressed or suicidal person in the home
Drug addicted or alcoholic family member
Witnessing domestic violence against the mother
Loss of a parent to death or abandonment, including abandonment by divorce
Incarceration of any family member
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Cognitive, Social and Mental Health symptoms due to impact on brain
Health outcomes & healthcare costs
Special education needs
Rates of school failure
Intergenerational patterns of high-cost social problems
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0
0.5
1
1.5
2
2.5
3
3.5
4
Intravenous Drug Use
ACE Score
% R
ep
ort
ing
IV
Dru
g U
se
1
2
3
4+
Attempted Suicide
0
5
10
15
20
25
12
3
4+
ACE Score
% E
ver
Att
em
pti
ng
Su
icid
e
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330
Report No ACEs
510
Report 1-3 ACES
160
Report 4-8 ACEs
WITH 0 ACEs
1 in 16 smokes
1 in 69 are alcoholic
1 in 14 has heart
disease
1 in 96 attempts suicide
1 in 480 uses IV drugs
WITH 3 ACEs
1 in 9 smokes
1 in 9 are alcoholic
1 in 7 has heart disease
1 in 10 attempts
suicide
1 in 43 uses IV drugs
WITH 7+ ACEs
1 in 6 smokes
1 in 6 are alcoholic
1 in 6 has heart disease
1 in 5 attempts suicide
1 in 30 use IV drugs
PROBABILITY OF SAMPLE OUTCOMES
GIVEN 1,000 AMERICAN ADULTS
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Route of administration
Effect of drug itself
Early use
Availability
Cost
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Interferes with the way the parts of the brain communicate
Some drugs activate neurons by mimicking neurotransmitters
Other drugs cause neurons to release abnormally large amounts of neurotransmitters or prevent recycling
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Dopamine is found in regions of the brain that regulate movement, emotion, motivation, and feelings of pleasure
Drugs overstimulating the system ◦ euphoric effects
◦ strongly reinforce the behavior of drug use—teaching the user to repeat it.
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Repeated exposure to drugs alters brain function and behavior
Prolonged drug use changes the brain in fundamental ways that reinforce drug taking and lead to addiction
Changes occur to both the structure of the brain and its functioning
Changes are difficult to un-do and may last a long time
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Other pathways and other neurotransmitters are also involved in addiction
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NOT just wanting or liking something◦ “I’m craving a Starbucks Chai Tea Latte about now”
A MIDBRAIN (limbic system) process involving both memory and emotion
Similar to hunger and thirst
Previously neutral stimuli take on drug related significance
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Nature Video Cocaine Video
Front of Brain
Back of Brain
Amygdala
not lit up Amygdala
activated
Photo courtesy of Anna Rose Childress, Ph.D.
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Early intervention is key—before brain changes take hold and drug use becomes compulsive
The effects of brain changes can include impaired mental and motor functions, such as memory deficits and slowed motor reactions
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Extended abstinence is predictive of sustained recovery
Treatment works and brings about reductions not just in drug use, but also in criminal recidivism
It takes time, but the brain can recover
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How does knowing the role of the brain in addiction impact the way you view those who are struggling to overcome addiction?
What are some “ah-ha” moments or “takeaways” that are most impactful for you?
What is one thing you will share with a colleague or supervisor tomorrow?
Other?
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Cynthia L Whitaker, PsyD, MLADC
Chief of Services
Greater Nashua Mental Health Center
603-889-6147