1 brain chemistry of addiction carol ackley river ridge treatment center burnsville &...

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Brain Chemistry of Addiction

Carol Ackley

River Ridge Treatment Center

Burnsville & Minnetonka, MN

Children’s Justice Initiative

Alcohol and Other Drug (CJI-AOD) Project

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Overview of Presentation• Addiction: What is it?

• Meth and Other Stimulants: Relapse and Recovery

• Drug Testing and Lab Reports: What to Look For

• Compatibility of the Recovery and Child Development Timelines

• What You Can Do to Help Parents and Their Children

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Addiction: What is it?

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AMA stated alcoholism was a disease in 1956

• Equal opportunity disease

• No one is immune

• Some people are much more vulnerable

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Drug and Alcohol use interfere with primary survival pathways in the brain

• Automatic

• Semi – automatic

• Voluntary

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Neural Pathways in the Brain

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Neurotransmission

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Molecular Structure

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Neurotransmission

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NEUROTRANSMITTERS

• Endorphins/ Enkephalins

• Serotonin

• Norepinephrine

• Dopamine

• Acetylcholine

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Neurotransmission

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Neurotransmission

cocaine

0

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Neurotransmission

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Neurotransmission

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NeurotransmissionNeurotransmission

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ADDICTIVE DISEASE

• Progressive

• Chronic

• Fatal

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ADDICTIVE DISEASE

• Full Remission

• Harm Reduction

• Prevention

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• Abstinence

• Nutrition

• Stress Prevention

RESTABILIZE BRAIN CHEMISTRY

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VULNERABILITY to

ADDICTIVE DISEASE

40% - 50% GENETIC

50% - 60% ENVIRONMENTAL

Early OnsetChemical Environment

Poor NutritionIncreased Stress

Poor Coping MechanismsChronic IllnessGrief & Loss

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QUESTIONS SO FAR?

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Meth and Other Stimulants: Relapse and Recovery

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Relapse Rates are Similar forDrug Dependence and

Other Chronic Illnesses

00

1010

2020

3030

4040

5050

6060

7070

8080

9090

100100

Drug Dependence

Type I Diabetes

Hypertension Asthma

40 t

o 60

%40

to

60%

30 t

o 50

%30

to

50% 50

to

70%

50 t

o 70

%

50 t

o 70

%50

to

70%

Source: McLellan, A.T. et al., JAMA, Vol 284(13), October 4, 2000.

Per

cen

t of

Pat

ien

ts W

ho

Rel

apse

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Myth

“Only 6% of meth addicts get and stay sober.”

2003 HBO Documentary “Crank: Made in America.”

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Treatment Works• In the State of Colorado during 2003, 80 percent of meth

users were abstinent at discharge from treatment.• In the State of Iowa, a 2003 study found that 71.2 percent of

meth users were abstinent six months after treatment.• A 2002-2003 study done by the Tennessee Bureau of

Alcohol and Drug Abuse found that 65 percent of meth clients were abstinent six months after discharge from treatment.

• The Texas Department of State Health Services examined outcome data for publicly-funded services from 2001-2004 and found that approximately 88 percent of meth clients were abstinent 60 days after discharge.

• Utah’s Division of Substance Abuse and Mental Health reported that in State Fiscal Year 2004, 60.8 percent of meth clients were abstinent at discharge.

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Treatment Admissions byPrimary Substance

0

200,000

400,000

600,000

800,000

1,000,000

1,200,000

1,400,000

1,600,000

1,800,000

2,000,000

1992 1994 1996 1998 2000 2002 2004

Alcohol Opiates Cocaine

Marijuana/hashish Methamphetamine Source: Treatment Episode Data Set (TEDS) – Highlights 2004

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“Meth has more long-term, serious effects on the brain than cocaine,” said Dr. Nora Volkow, senior scientist at Brookhaven National Laboratories in Upton, N.Y., who has studied the effects of both cocaine and methamphetamine of the brain for 15 years.

Beating an addiction to meth: Researchers zero in on brain effects, treatment approaches. By Julia Sommerfeld, MSNBC, 2004

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AmphetamineAmphetamine

CocaineCocaine

NicotineNicotine0

100

200300

400500

600700

800900

1,0001,100

0 1 2 3 4 5

Di Chiara and ImperatoDi Chiara and Imperato

Basalarrelease

(%)

Basalarrelease

(%)

Time after ingestion (hour)Time after ingestion (hour)

NeurotoxicNeurotoxic

Effects of Drugs on Dopamine Levels

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METH: Not Just Any Speed• Meth is an powerfully addictive Central

Nervous System Stimulant, chemically similar to Amphetamine.

• But Meth does it better:– injected (10-20 min, C / 4-6 hrs, M)– smoked (5-20 min, crack / 8-12 hrs, ice)– excretion (50%,1 hr., C / 50%, 12 hrs, M)

• Meth lasts in the body and brain longer, and at higher levels than CA or AMP.

Special thanks to Rick Moldenhauer, MS, LADC, LPC

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Stages of Meth Recovery

Withdrawal Stage (Day 0-15)

During withdrawal, clients are disoriented, depressed, and very fatigued. They feel out of control and do not understand what is happening to them. Very explicit direction is required during this period.

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Stages of Meth Recovery

Honeymoon Stage (Day 16-45)

During this period, cravings are reduced, mood improves, energy increases, and confidence and optimism return. Frequently, clients feel that the problem is over and their activity becomes scattered, inefficient, and frenetic. Seeing no obvious need for continuous treatment, many clients may return to alcohol and secondary drug use and discontinue treatment activities at this stage.

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Stages of Meth Recovery

The Wall (Day 46-120)

This period is viewed as the major hurdle in meth recovery. Relapse vulnerability increases as clients experience a return of low energy, little pleasure in life, difficulty concentrating, irritability, loss of sex drive and insomnia. Clients often assume that these conditions will persist indefinitely. The Wall has also been referred to as protracted withdrawal.

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Stages of Meth Recovery

Adjustment Stage (Day 121-180)

A great feeling of accomplishment often occurs after making it past the Wall. This can result in a sense that everything should return to the way it was before. Clients who successfully deal with this stage begin to adjust to lifestyle and relationship changes, which began in previous stages, as the new definitions of “normal.”

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Stages of Meth Recovery

Resolution Stage (Day 181-Open)

Completion of the six-month sobriety period signals a shift from learning new skills to monitoring for relapse signs, maintaining a balanced lifestyle, and developing new areas of interest. For some, individual or relationship issues may emerge that require additional attention.

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• Calcium-channel blockers

• Zofran - the anti-nausea drug

• Tyrosine

• Several antidepressants

• Selegiline

• Vitamin E

Beating an addiction to meth: Researchers zero in on brain effects, treatment approaches. By Julia Sommerfeld, MSNBC, 2004

New Research from NIDA

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In addition, NIDA is funding research on the development of an antidote for methamphetamine that would be used in overdose situations. The hope is that a compound could leach meth out of the tissues, decreasing concentrations of the drug in the body. Theoretically, this would reduce the duration of the high and some of the adverse effects. However, such a treatment is years away from being tested in people, according to NIDA.

Beating an addiction to meth: Researchers zero in on brain effects, treatment approaches. By Julia Sommerfeld, MSNBC, 2004

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Drug Testing and Lab Reports: What to Look For

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Controlled Substance

RSI Lab Threshold (Screening1)

Detection Time in Urine

RSI Lab Threshold (Confirmetions2)

Cannabinoid (THC)50 ng/ml

(150 ng/ml = HI)

Up to Six Weeks (Regular use)

2-3 days (Occasional use)

10 ng/ ml (THC-COOH)

Cocaine (Benzolecognine)

300 ng/ml (5000 ng/ml = HI)

2 to 4 Days 150 ng/ml

Amphetamine Methamphetamine

1000 ng/ml (5000 ng/ml = HI)

1 to 2 Days 200 ng/ml

Barbiturates200 ng/ml

(3000 ng/ml = HI)1 Day to 3 Weeks

Benzodiazepines (Librium, Valium)

200 ng/ml (5000 ng/ml = HI)

Up to 7 Days

Methadone300 ng/ml

(1000 ng/ml = HI)Up to 14 Days 200 ng/ml

Opiates300 ng/ml

(2000 ng/ml = HI)2 to 4 Days

200 ng/ml (Codeine & Morphine)

Phencylidine (PCP)25 ng/ml

(150 ng/ml = HI)Up to 10 Days 20 ng/ml

Ethanol (Alcohol)50 mg%

(300 mg% = HI)Dose Dependent (Up to 24 Hours)

20 mg%

MDMA (Ecstasy)500 ng/ml

(1000 ng/ml = HI)1 to 2 Days 100 ng/ml

1 to 3 Days 10 ng/ml

1 All screening procedures are performed on a Hitachi 911 using the Cedia immunoassay method. 2 THC, Cocaine, Amphetamines, Methadone, Heroin, Ecstasy, Opiates, and PCP confirmations are performed on a Hewlett Packard 5890 Gas Chromatograph/Mass Spectrometer (GS/MS). Ethanol confirmations are performed on a Gow-Mac Series 580 Gas Chromatograph.

RSI Laboratories Threshold Levels

6 - Acetlymorphine (Heroin)

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RSI Laboratories1931 West Broadway Street

Minneapolis, MN 55411Phone: 612-287-1660Fax: 612-287-1666

Lab Director: Steve Kastner, MT (ASCP)

CLIA ID: 24D0882916

CAP ID: 4004701-01

 Positive results HAVE NOT been confirmed by GC/MS.

* Drugs of Abuse*THC >150P 50 ng/mlCreatinine 23 20 ng/ml* Normal Creatinine is 20 mg/dl or greater

Name: ****** ******* Sample ID: ******* Agency: River Ridge Bville Client Id: ******** Collected Date: 12/15/06 Location Fax: 952-892-7722 Order Date: 12/20/06 Order Time: 10:15AM SampleID CollectionDateCollectionTime Verified Operator Test Name

*************12/15/06 09:00PM 12/20/06

AC ********

Threshold Level Units

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RSI Laboratories1931 West Broadway Street

Minneapolis, MN 55411Phone: 612-287-1660Fax: 612-287-1666

Lab Director: Steve Kastner, MT (ASCP)

CLIA ID: 24D0882916

CAP ID: 4004701-01

 Positive results HAVE NOT been confirmed by GC/MS.

* Drugs of Abuse*THC 58 P 50 ng/mlCOCAINE 1788 P 300 ng/mlCreatinine 23 20 ng/ml* Normal Creatinine is 20 mg/dl or greater

Name: ****** ******* Sample ID: ******* Agency: River Ridge Bville Client Id: ******** Collected Date: 02/08/06 Location Fax: 952-892-7722 Order Date: 02/08/06 Order Time: 05:42PM SampleID CollectionDateCollectionTime Verified Operator Test Name

*************02/08/06 05:00PM 02/10/06

AC ********

Threshold Level Units

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Compatibility of the Recovery and Child Development

Timelines

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The Five Clocks

• MFIP• Child welfare system• Recovery process• Child development• Agency and staff

timelines

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The addiction recovery timeline is compatible with the 12-month permanency timeline if there is:

– Early, comprehensive assessment

– Early engagement

– Early, appropriate and adequate service delivery

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• Verbalize an awareness that AOD addiction is a disease

• Verbalize an awareness of specific negative consequences in all life areas

• Verbalize an awareness of stress as trigger for cravings and relapse

• Verbalize an awareness of impact on children• Mental health stabilized

Measurable Indicators of Recovery

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• A concrete, specific relapse prevention plan that includes:

– Identification of personal warning signs and triggers of relapse

– Daily plan for healthy living

• (ie: nutrition, sleep, hygiene, exercise, spiritual care, personal time, sober support, recreation)

– Stress management and prevention plan

– Specific identification of sober support network: who, what, where, when

Measurable Indicators of Recovery

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What You Can Do to Help Parents and Their Children

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• Drug screens for accountability

• Transportation

• Child Care

• Employment/ Economic Opportunity

• Safety

• Case Management

• Parenting support/ training

• Access to ancillary services (“No wrong door”)

Support You Can Provide

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QUESTIONS?

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• Addiction is a disease, not a choice

• Progressive, Chronic and Fatal

• Young brains at risk due to unique stage of development

• Very treatable

• Prevention important

• Early interventions, assessment and treatment are the keys to success

Brain Chemistry of Addiction

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Crisis=Danger & Opportunity

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Additional Resources• Carole Johnson, CJI-AOD Project Specialist, State Court

Administrator’s Office, 651-296-2269 or carole.johnson@courts.state.mn.us

• Dan Griffin, Court Operations Analyst, State Court Administrators Office 651-215-9468 or dan.griffin@courts.state.mn.us

• Deborah Moses, Operations Manager, DHS-Chemical Health Division, 651-431-3251 or deborah.moses@state.mn.us

• Jackie Crow Shoe, Social Service Program Consultant, DHS-Child Safety and Permanency Division, 651-431-4676 or jackie.crowshoe@state.mn.us