understanding drug abuse and addictionnadcpconference.org/wp-content/uploads/2017/07/cg-20.pdf ·...
TRANSCRIPT
![Page 1: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/1.jpg)
Understanding Drug Abuse and Addiction
Steve Hanson - Associate Commissioner
NYS OASAS
![Page 2: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/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 Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/3.jpg)
Realities
1. People like Drugs.
2. We all like things faster and easier.
![Page 4: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/4.jpg)
Drive to Get High
Some people will seek any means to alter their state of consciousness
![Page 5: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/5.jpg)
Bio-psycho-social model
BIO PSYCHO
SOCIALInteraction
![Page 6: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/6.jpg)
Neurotransmitter Action
ReuptakeRelease of NT
Receptor
![Page 7: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/7.jpg)
How Drugs Work
• Interact with neurochemistry
•Results:•Feel Good – Euphoria/reward•Feel Better – reduce negative feelings
![Page 8: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/8.jpg)
Addiction is a Brain Disease
Prolonged Use Changes
the brain in Fundamental
and Long Lasting Ways
![Page 9: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/9.jpg)
![Page 10: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/10.jpg)
Brain Changes
![Page 11: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/11.jpg)
methamphetaminemarijuanaecstasyopiumetc.
![Page 12: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/12.jpg)
Food
0
50
100
150
200
0 60 120 180
Time (min)
% o
f B
asal
DA
Ou
tpu
t
NAc shell
Empty
Box Feeding
Source: Di Chiara et al.
FOOD
![Page 13: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/13.jpg)
Sex
100
150
200
DA
Co
nce
ntr
atio
n (
% B
ase
line
)
MountsIntromissionsEjaculations
15
0
5
10
Co
pu
lation
Frequ
ency
SampleNumber
1 2 3 4 5 6 7 8 9 101112131415 1617
ScrScrBasFemale 1 Present
ScrFemale 2 Present
Scr
Source: Fiorino and Phillips
SEX
![Page 14: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/14.jpg)
Nicotine
0
100
150
200
250
0 1 2 3 hr
Time After Nicotine
% o
f B
asal
Rel
ease Accumbens
Caudate
NICOTINE
![Page 15: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/15.jpg)
Alcohol
100
150
200
250
0 1 2 3 4hr
Time After Ethanol
% o
f B
asal
Rel
ease
0.250.51
2.5
Accumbens
0
Dose (g/kg ip)
Alcohol
![Page 16: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/16.jpg)
0
100
200
300
400
0 1 2 3 4 5 hrTime After Cocaine
% o
f B
as
al R
ele
as
e
DADOPACHVA
AccumbensCOCAINE
Cocaine
![Page 17: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/17.jpg)
0
100
150
200
250
0 1 2 3 4 5hr
Time After Morphine
% o
f B
as
al R
ele
as
e
Accumbens
0.5
1.0
2.5
10
Dose (mg/kg)
MORPHINE
Source: Di Chiara and Imperato
Heroin
Morphine
![Page 18: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/18.jpg)
Source: Di Chiara and Imperato
0
100
200
300
400
500
600
700
800
900
1000
1100
0 1 2 3 4 5 hr
Time After Amphetamine
% o
f B
as
al R
ele
as
e DA
DOPAC
HVA
AccumbensMETHAMPHETAMINE
Methamphetamine
![Page 19: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/19.jpg)
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
![Page 20: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/20.jpg)
Circuits Involved In Drug Abuse and Addiction
GOSTOP
![Page 21: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/21.jpg)
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.
![Page 22: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/22.jpg)
Nature Video Cocaine Video
Front of Brain
Back of Brain
Amygdala
not lit upAmygdala
activated
Craving and the Male Brain
![Page 23: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/23.jpg)
AMYGDALAR CONNECTIVITY
during brief .5 sec Cocaine Cues
Drug 2
amyg
conx (n=7)
Placebo
Baclofen
Source: Childress, et al,
Baclofen blunts AMYGDALAR CONNECTIVITY
![Page 24: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/24.jpg)
Chemical Dependency
•Chronic Disease Prone to Relapse
•Requires significant behavior changes
•Similar to Heart Disease, Diabetes, Asthma, Gingivitis,etc.
•Similar treatment “success”
![Page 25: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/25.jpg)
Drug Types
• Stimulants: Cocaine, Caffeine, Methamphetamine
• Depressants: Alcohol, Barbiturates, Anti-Anxietals
• Pain Relief: Opioids, Aspirin, Ibuprofen
• Hallucinogens: LSD, Ecstasy, Bath Salts
• Cannibinoids: Marijuana, Synthetics
![Page 26: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/26.jpg)
Cocaine
•Natural Stimulant from South America
•Main Effects:• Euphoria
• Fight/Flight
• Snorted, Smoked, Injected, Other Mucosal Absorption
![Page 27: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/27.jpg)
Snorted - onset 2 mins.
Smoked - onset 5-12 seconds30-40 mins
1 hour15 mins
5 mins
![Page 28: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/28.jpg)
Dose Response
DOSE
EFFE
CTS
Euphoria
Psychosis
Paranoia
AnxietyEnergized
MetabolicCrisis
![Page 29: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/29.jpg)
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.
![Page 30: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/30.jpg)
Stopping Cocaine Use
•Anhedonia - Dopamine depletion
•Craving - intense craving for drug
![Page 31: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/31.jpg)
Methamphetamine
• Synthetic stimulant – Amphetamine family
• Main Effects 8-12 hours from single dose:• Euphoria
• Energy
• Snorted, smoked, injected
![Page 32: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/32.jpg)
Methamphetamine
DOPAMINE DOPAMINE
![Page 33: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/33.jpg)
Meth - Signs of Abuse
•Rapid weight loss•Nervous energy•No “need” for sleep•Aggressive• Excited talk• “Meth mouth”
![Page 34: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/34.jpg)
![Page 35: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/35.jpg)
Meth - Signs of Withdrawal
• long crash•apathy•depression• fatigue
•anxiety•suicidal ideation•cravings
![Page 36: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/36.jpg)
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 37: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/37.jpg)
Action
•Dopamine – excitement & reward
•Serotonin – feel – “normal”
•GABA – lowers anxiety
•Endorphins – pain relief, reward, craving
![Page 38: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/38.jpg)
Benzodiazepine Family
• Anti-Anxiety: Valium, Xanax
• Sleeping Aids: Ambien, Lunesta
• Can produce dependency
• Long withdrawal periods.
![Page 39: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/39.jpg)
Opioids
![Page 40: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/40.jpg)
Source: CDC
![Page 41: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/41.jpg)
Drug Poisoning Deaths Involving Opioids: USA, 2000-2013
Source: CDC
![Page 42: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/42.jpg)
Opioids
Natural Opiates
Derived from raw opium
• Morphine
• Codeine
Semi-synthetics
Modified Natural
• Heroin
• Vicodin
Synthetics
• Fentanyl
• Demerol
• Methadone
![Page 43: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/43.jpg)
![Page 44: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/44.jpg)
Heroin
•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
![Page 45: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/45.jpg)
“Take the best orgasmyou’ve ever had…Multiply it by a thousand.And you’re still nowherenear it.
![Page 46: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/46.jpg)
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
![Page 47: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/47.jpg)
Addiction/Dependency
• Opioids trigger reward system – euphoria – leads to continued use –addiction
• Withdrawal symptoms are significant – regular use to avoid withdrawal - dependence
![Page 48: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/48.jpg)
Addiction vs. Dependency
![Page 49: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/49.jpg)
Addiction vs. Dependency
Addicted not Dependent Dependent not Addicted
![Page 50: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/50.jpg)
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)
![Page 51: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/51.jpg)
Prescription Opiates
•OxyContin
•Vicodin
•Hysingla ER
![Page 52: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/52.jpg)
Overdose Reversal Kits
• Kits can save lives
• Over 90,000 trained in NY
• 2,900 known reversals
• Available Over the Counter at pharmacies
![Page 53: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/53.jpg)
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 54: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/54.jpg)
Then vs. Now
![Page 55: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/55.jpg)
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.
![Page 56: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/56.jpg)
Butane Hash Oil• Newest trend – aka
“Dabs”
• THC extracted from MJ with butane
• 30-80% THC
• Dangerous
![Page 57: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/57.jpg)
Spice/K2 and Synthetic Cannabinoids
![Page 58: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/58.jpg)
Preparation of the “Incense”:
Botanicals are sprayed with liquid preparations of:
• HU-210
• HU-211
• CP 47,497
• JWH-018
• JWH-073
![Page 59: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/59.jpg)
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
![Page 60: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/60.jpg)
![Page 61: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/61.jpg)
Similar to THC, but…
•Psychotic episodes
•Herbal incense blends are harsher to inhale
• Increased restlessness & aggressive behavior
•Doesn’t mix well with alcohol (hangovers)
![Page 62: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/62.jpg)
Bath Salts:
• Ivory Wave
• Ivory Pure
• Ivory Coast
• Purple Wave
• Vanilla Sky
![Page 63: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/63.jpg)
What’s in Bath Salts?:
• Methylenedioxypyrovalerone (MDPV) is a psychoactive drug with stimulant properties
• MDPV has four times the potency of Ritalin
• MDPV - no history of FDA approved medical use
![Page 64: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/64.jpg)
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
![Page 65: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/65.jpg)
Molly/MDMA/Ecstasy
![Page 66: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/66.jpg)
![Page 67: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/67.jpg)
Whatismolly.com
![Page 68: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/68.jpg)
MDMA/Molly/XTC
• Club drugs – produce feelings of belongingness, warmth and affection
• Intense euphoric high
• Provide energy for dancing – raves
• Less hallucinogenic
• Dangers – teeth grinding (pacifiers)
• Hyperthermia/dehydration
• Hyponatremia (low salt) water intoxication – can be lethal
![Page 69: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/69.jpg)
Effects of MDMA on Brain Function
![Page 70: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/70.jpg)
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)
• Dogs live in the moment…no planning
A dog with a bone
![Page 71: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/71.jpg)
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 72: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/72.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
![Page 73: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/73.jpg)
Early Recovery Issues
• Loss of lifestyle
• Loss of Coping Strategy
•Withdrawal
•Cognitive deficits related to early abstinence
![Page 74: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/74.jpg)
Cognitive Deficits
• Memory problems - short term loss
• Difficulty with abstractions
• Difficulty with impulse control
• Similar performance to those with brain damage -Improves.
![Page 75: Understanding Drug Abuse and Addictionnadcpconference.org/wp-content/uploads/2017/07/CG-20.pdf · Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS](https://reader030.vdocuments.us/reader030/viewer/2022040906/5e7b1f6175dea540cd6a8b86/html5/thumbnails/75.jpg)
The EndThanks