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

Technical Difficulties: (800) 263-6317


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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


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…


• 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


Behavioral Responses Loss of control

Continued compulsive

use despite harmful

consequences

Multiple relapses

preceding stable

recovery


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


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.


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


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

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Neuroscience of Addiction (Part 1)

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Transcript of Neuroscience of Addiction (Part 1)