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Fes neuro

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  • 1. Addiction & the Brain
  • 2. Communication in the Brain  Human behaviour and emotions are controlled by neurotransmitters that act as “keys” between neurons.  The amount of any given neurotransmitter in the brain’s circuits is precisely controlled by feedback mechanisms – like the way that a thermostat controls temperature.
  • 3.  Drugs are substances that disturb this delicate balance, because they have “passkeys” (chemicals) that let them open certain “locks” (receptors) located between the neurons.  The brain automatically adjusts to these substances from outside the body by producing fewer of its own natural “keys”.
  • 4.  It thereby achieves a new state of ‘balance’ that is maintained until the body starts to miss the external substance.  At that point, the person experiences a craving that will persist until the neurons that stopped producing get back to work.  There are over 100 identified neurotransmitters, and evidence suggests there are substantially more.
  • 5. We know that despite their many differences, most abused substances affect the dopamine and serotonin pathways
  • 6.  This reward circuit that is overstimulated by drugs uses a particular neurotransmitter called dopamine.  It is not surprising then to discover that practically all of the drugs that cause dependencies affect the amount of dopamine in the reward circuit.
  • 7. Circuits Involved in Addiction
  • 8. 04/09/20139
  • 9. 04/09/201310
  • 10. How do drugs affect the brain?  Some substances imitate natural neurotransmitters and take their place on their receptors.  Morphine, for example, binds to the receptors for endorphin (a natural "morphine" produced by the brain).
  • 11.  Other substances increase the secretion of natural neurotransmitters. Cocaine, for example, mainly increases the amount of dopamine in the synapses, while ecstasy mainly increases the amount of serotonin.  Still other substances block a natural neurotransmitter. Alcohol, for example, blocks the NMDA receptors.
  • 12.  Dopamine is involved in many functions that are essential for survival such as attentiveness, motivation, learning, and memorization.  Most of all, dopamine is a key element in identifying natural rewards. Natural stimuli such as food and water cause us to engage in certain behaviours.  Unconscious memorization of signs associated with reward.  Not all drugs affect dopamine levels in the same way.
  • 13.  Serotonin plays an important part in the regulation of learning, mood, sleep, appetite and constriction of blood vessels  Low serotonin is connected to such psychological problems as depression, anxiety, seasonal affective disorder, and obsessive-compulsive disorder  Not all drugs affect serotonin levels in the same way.
  • 14.  Drugs and alcohol have an enormous effect on the brain.  Often misdiagnosed whilst in active addiction, and prescribed medication incorrectly as a result.  Only once drugs and alcohol are out of the system can accurate observation and diagnosis (if any) be made. Medical Intervention
  • 15.  If misdiagnosis is suspected medication will be altered, reduced, or stopped to evaluate the person. Through this process it will become evident as to whether or not medication is necessary.  In the initial phase of treatment it may be necessary to use medication in order to stabilise brain function. Once this stability has been achieved and maintained for a period of time the medication will be reviewed and where necessary altered, reduced or stopped.
  • 16.  It is vital that this is done in consultation with a doctor, preferably a psychiatrist.  Psychiatric medication cannot be stopped at once, altogether – this is very dangerous.  The necessity for, amount, and period of use of medication is dependent on the damage caused to the brain, and on any underlying factors that may be present (depression, bi-polar, etc.)
  • 17.  Anti-depressants  Fluoxetine (Prozac; Nuzak; Lilly Fluoxetine)  Sertraline (Zoloft; Serdep; Serlife)  Venlafaxine (Efexor; Venlor)  Citalopram (Cipramil; Cipralex; Lexamil)  Aimed at stabilising Serotonin levels.
  • 18.  Anti-psychotics  Risperidone (Risperdal)  Quetiapine (Seroquel; Serez)  Olanzapine (Zyprexa)  Aimed at stabilising Dopamine levels. Quetiapine has a sedative effect, and has been found to further help with anxiety.
  • 19.  Mood stabilisers  Lamotragine (Epitech; Lamictin)  Valproate (Epilim; Depakote)  Carbamazepine (Tegretol)  Topiramate (Topamax)  Aimed at stabilising fluctuating mood. Often used in conjunction with anti-depressant.
  • 20.  Anxiolytics  Benzodiazepines (Aimed at short-term relief of severe and disabling anxiety). Highly addictive.  Diazepam (Valium)  Clonazepam (Rivotril)  Lorazepam (Ativan)  Clobazam (Urbanol)
  • 21. Dual diagnoses/Co-morbidity  Addiction and coexisting psychiatric illness.  E.g. Alcoholism and depression.  Includes amongst others, depression, mood disorders, social phobias, personality disorders.  Addiction – primary; psychiatric illness – secondary  Psychiatric illness – primary; addiction secondary
  • 22.  Coexisting psychiatric illness must be treated alongside addiction – it cannot be treated before or after addiction treatment, and addiction cannot be treated before or after the coexisting illness.  Symptoms of one problem may mask or worsen the symptoms of the other.  If dealt with separately, and not concurrently, one problem will inevitably trigger the other.
  • 23.  Denial and acceptance  Motivation for change  Adherence to treatment and post-treatment plans  Lifestyle, psychological and emotional health, social abilities and interactions, spiritual life  Compliance with medication

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