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  • DendritesCell body & nucleusAxonMyelin sheathAxon terminal

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  • 1. 1 Lunievicz - Neuroscience The Neuroscience of Addiction – Part 1 Joe Lunievicz, BA, RYT Director, Training Institute, NDRI
  • 2. Webinar Logistics Panel Questions Raise hand Tech Difficulties (800) 263-6317 2
  • 3. 3 Presenter: Joseph Lunievicz, Director, Training Institute, NDRI 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-K087awarded 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.
  • 4. 4 Lunievicz - Neuroscience What we’ll cover in part 1  Why Neuroscience?  Definitions  Neurochemistry lite  Impact on Drug Court Technical Difficulties: (800) 263-6317
  • 5. 5 Lunievicz - Neuroscience Question Why do our participants start using or try drugs?  Type in your answer… Technical Difficulties: (800) 263-6317
  • 6. 6 Lunievicz - Neuroscience Question Why do they, over time, continue to use drugs?  Type in your answer…
  • 7. Neuroscience Supports Addiction = Brain Disease …with biological, sociological and psychological components
  • 8. 8 What’s all the fuss about Neuroscience? Lunievicz - 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.
  • 9. 9 Disease Model Chemical Dependency Lunievicz - Neuroscience  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. Technical Difficulties: (800) 263-6317
  • 10. 10 Lunievicz - Neuroscience 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. Technical Difficulties: (800) 263-6317
  • 11. 11 Lunievicz - Neuroscience 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.
  • 12. 12 Lunievicz - Neuroscience Abuse vs. Addiction Carlton Erickson, Ph.D. University of Texas 2009  Abuse is a problem to solve caused by bad choices, selfanesthetization, 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
  • 13. 13 Lunievicz - Neuroscience Three key components in dependency…  Drug use or exposure to a drug  Genetic influence or vulnerability  Environmental influences
  • 14. 14 Lunievicz - Neuroscience Drug Exposure Who 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%
  • 15. 15 Genetic Vulnerability for Dependence Lunievicz - Neuroscience  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 variable  Mild to severe range Technical Difficulties: (800) 263-6317
  • 16. 16 Lunievicz - Neuroscience Environmental Factors - Utah Addiction Center at the University of Utah, Dr. Kelly Lundberg, 2012  Community Domain  Peer Domain  Family Domain  School/Work Domain Technical Difficulties: (800) 263-6317
  • 17. 17 Behavior… (including addiction) is related to… Lunievicz - Neuroscience  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
  • 18. 18 Lunievicz - Neuroscience 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 Technical Difficulties: (800) 263-6317 dendrite where neurotransmitters flow…
  • 19. 19 Lunievicz - Neuroscience Synapse Technical Difficulties: (800) 263-6317
  • 20. 20 Lunievicz - Neuroscience Synapse Neurotransmitters…
  • 21. 21 Lunievicz - Neuroscience 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 DopamineTechnical Difficulties: (800) 263-6317
  • 22. Pathway for Understanding Addictive Effects of Drugs on the Brain & Behavior Reward Pathway
  • 23. 23 Key parts of the brain – Reward Centers Lunievicz - Neuroscience  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… Technical Difficulties: (800) 263-6317
  • 24. Brain changed • Drug users have far less dopamine activity (right), as in PET Scans 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
  • 25. 25 Lunievicz - Neuroscience Physiological Response  Tolerance  Withdrawal  Decision making capabilities diminished Technical Difficulties: (800) 263-6317
  • 26. Behavioral Responses  Loss of control  Continued compulsive use despite harmful consequences  Multiple relapses preceding stable recovery Technical Difficulties: (800) 263-6317
  • 27. Why is Continued Treatment Critical? Normal Control Meth user (1 month abstinent) Meth user (36 months abstinent) Partial Recovery of Dopamine Transporters After Prolonged Abstinence
  • 28. 28 Lunievicz - Neuroscience Poll Which works better?  Jail  Drug Treatment Technical Difficulties: (800) 263-6317
  • 29. Re-Addiction Following Prison Rawson 2010 • Vaillant • 447 opiate addicts • Maddux & Desmond • 594 opiate addicts • Nurco & Hanlon • 355 opiate addicts • Hanlon & Nurco • 237 mixed addicts 91% 98% 88% 70% Treatment Research Institute
  • 30. Long-term Outcome Studies Rawson, 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. Technical Difficulties: (800) 263-6317
  • 31. 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 Technical Difficulties: (800) 263-6317
  • 32. Neuroscience Supports Addiction = Brain Disease …with biological, sociological and psychological components
  • 33. 33 Lunievicz - Neuroscience 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
  • 34. A Chronic Care Model Detox Duration Determined by Performance Criteria Rehab Duration Determined by Performance Criteria Continuing Care Recovering Patient
  • 35. 35 Lunievicz - Neuroscience Lessons Learned from Chronic Care  Behavior change is necessary for sustained benefit  Treatment effects do not last very long after treatment stops  Patients not in some form of treatment or monitoring are at greater risk for relapse  Retention is critical  Monitoring is essential Technical Difficulties: (800) 263-6317
  • 36. References 36 Lunievicz - Neuroscience  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
  • 37. 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 Brain Part 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
  • 38. 38 Presenter: Joseph Lunievicz, Director, Training Institute, NDRI 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-K087awarded 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.
  • 39. Thank You for Participating 39 Don’t Forget – Please complete the survey for today’s webinar Presenter: Joe Lunievicz, Director of Training, NDRI Organizer - Clyde Frederick – Senior Administrative Technologist Sponsored by The BJA Drug Court Technical Assistance Project at American University, in collaboration with the National Development & Research Institute s