understanding drug abuse and addiction steve hanson director, john l. norris atc nysoasas lecturer,...
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Understanding Drug Abuse and Addiction
Steve HansonDirector, John L. Norris ATCNYSOASASLecturer, SUNY Brockport
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Basic Q uestions
• Why do people do drugs?
• Why can’t/won’t some people stop?
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Realities
People like Drugs
We all like things faster and easier
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Use Addiction
Although persons may choose whether or not to initiate the use of psychoactive substances and / or alcohol, drug dependence is an involuntary result.
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Addiction is a Brain Disease
Prolonged Use Changes
the brain in Fundamental
and Long Lasting Ways
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Simple Brain Structure
• Frontal Lobe ( Cortex )–Judgement and reason
• Mid brain ( Limbic )–Emotions and reward sites
• Hind brain ( Stem ) –Bodily functions
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Neurotransmitter Action
ReuptakeRelease of NT
Receptor
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Neurotransmitters
• Acetylcholine – Memory
• Dopamine – Reward/Euphoria
• Norepinephrine – Metabolic Rate
• Serotonin – Mood, Sleep Regulation
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Rebound
Alert
Asleep
Coma
Death
SeizureDeath Alert & Cheerful
Tired & Grumpy
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Awake, Powerful, Euphoric, Sexy
Depressed, Powerless
Crash
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The Reward Pathwayand
Addiction
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Natural RewardsFoodWaterSex
Nurturing
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Reward Pathways
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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
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Chemical Dependency
• Chronic Disease Prone to Relapse
• Requires significant behavior changes
• Similar to Heart Disease, Diabetes, Asthma, Gingivitis,etc.
• Similar treatment “success”
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Relapse Happens
• Poor Craving Management
• The Relapse Process – Gorski
• Get the train back on the tracks
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Cocaine
• Natural Stimulant - South America
• Crack is a purer form that is smoked
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Cocaine Effects - Euphoria
• Blocks Reuptake of DA and NE – increases activity
• Central Nervous System - Euphoria
• Peripheral NS - NEFight/Flight HR, BP, Temp, bronchodilation,
dilates pupils
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Alert, Awake, Powerful, Confident
Drowsy, Powerless, Low Self esteem, Depression
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Snorted - onset 2 mins.
Smoked - onset 5-12 seconds30-40 mins
1 hour15 mins
5 mins
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Dose Response
Metabolic Crisis Psychosis
Repetitive Behavior
Paranoia
Restless Aggressive
Energetic Confident/ Euphoric
NE DA
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Duration
Dose Interval Effect
5 hours X 30 mins Normal Routine
10 hours 3X 15 mins Eating, Drinking 4 wks 90% Die
23 hours
3X
Unlimited
Dead in 5 days
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Stopping Cocaine Use
• Anhedonia - Dopamine depletion
• Craving - intense craving for drug
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The Memory of DrugsThe Memory of Drugs
Nature VideoNature Video Cocaine VideoCocaine Video
Front of BrainFront of Brain
Back of BrainBack of Brain
AmygdalaAmygdalanot lit upnot lit up
AmygdalaAmygdalaactivatedactivated
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Methamphetamine
• Popular in 1960’s - Hell’s Angels
• Crystal / Crank - snortable - 1980’s
• Ice - smokeable form -1990’s
• Started in Hawaii - California - Midwest
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Meth - Signs of Abuse
–rapid weight loss
–nervous energy
–no “need” for sleep
–aggressive
–mean temperment
–compulsive
–excited talk
–“Meth mouth”
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Meth - Signs of Withdrawal
–long crash
–apathy
–depression
–fatigue
–anxiety
–suicidal ideation
–cravings
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Methamphetamine Cocaine
• Synthetic
• Smoking High 8-24 hours
• No Medical Use
• Neurotoxic
• “Natural”
• Smoking High 10 - 30 minutes
• Local anesthetic
• Non-neurotoxic
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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
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Action
• Dopamine – excitement & reward
• Serotonin – feel – “normal”
• GABA – lowers anxiety
• Endorphins – pain relief, reward, craving
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Endorphins
Drink
Endorphins
RewardStop Drinking
Endorphins
Craving
Block Endorphins with Naltrexone – Break Reward Cycle
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Opiates
• Dates to 4,000 BC• Mimics endorphin activity• Natural - Opium, morphine, codeine• Semi-synthetic- Heroin, Dilaudid,
Oxycontin• Synthetics - Darvon, Demerol,
Fentanyl,
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Opiates
• Heroin more potent -60-80% - <10% in ‘70’s
• Younger age group - High School • Users start with snorting - IV within 12
months• Withdrawal painful - not deadly• Lots of Relapse
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Prescription Opiates
• OxyContin-an oral, controlled release form of the drug- Much abuse – crush the tablet – heroin-like high
• Darvon
• Vicodin
• Dilaudid
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Ecstasy – “E”
• 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
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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.
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Main Effects
• Decreased Anxiety - Euphoria
• Increase focus of concentration – eliminates boredom.
• Impaired Short Term Memory
• Perceptual changes – time
• Analgesia
• Increased Appetite
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LSD
• Extremely powerful drug• Doses in micrograms – 1/1000mg• Dose is 30-50g –Effects last 10-
12 hours• Illusions – pseudohallucinations• Increase in sensory signal strength –
intense emotional experiences
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Club Drugs
• Phencyclidine – PCP – Angel Dust
• Ketamine – “K”, Special K, Super K
• Dextromethorphan – DXM, Robitussin, Coricidin
• GHB – Gamma Hydroxy-butyrate – “liquid X” – Also GBL – Blue Nitrol
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Early Recovery Issues
• Loss of lifestyle
• Loss of Coping Strategy
• Withdrawal
• Cognitive deficits related to early abstinence
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Cognitive Deficits
• Memory problems- short term loss
• Difficulty with abstractions
• Difficulty with impulse control
• Similar performance to those with brain damage - improves.
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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)
• Sometimes the dog takes you for a walk.
A dog with a bone
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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
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PET Scan Images
• http://www.nida.nih.gov/pubs/Teaching/