Nursing Grand Rounds: Alcohol, Drugs and Brain Science
Alcohol and Other Drugs: The Problem, The Science & Patient Assessment
Presented by:Julie Dostal, PhD Executive Director of LEAF, Inc.
Why Have This Discussion?∗ Alcohol use is the 2nd Leading Preventable Cause of all Mortality in the U.S. (Cigarettes are 1st)∗ Harmful alcohol use, other addictive behaviors, and ineffective policy are THE leading public health issues.∗ Addiction is a chronic, relapsing disease that, until now, has been treated outside the medical field.
The J-Curve of Alcohol Use:Risk for All Causes of Mortality 3 0 1-2
So, How Many People are in the Risky Drinking Categories79% ofAmericans areeither abstainersor low-riskdrinkers
Definitions of Risky Drinking:∗ HEAVY DRINKING: >14 drinks per week for men (or >4 drinks per occasion) >7 drinks per week for women (or >3 drinks per occasion)∗ HAZARDOUS DRINKING : a quantity or pattern of alcohol consumption that places individuals at risk for adverse health events∗ HARMFUL DRINKING : alcohol consumption that results in physical or psychological harm
Figure 3.1 Current, Binge, and Heavy Alcohol Use among Persons by Age
Past Month Use of Illicit Drugs Shows Significant Increase in “Baby Boomer” Adults (Nearly Doubled in Every Subset)
Past Month Illicit Drug use Among 18 to 25 Year Olds; Fairly Stagnant
What “Causes” Substance Abuse?∗ Scientists find no direct cause and effect for substance abuse or dependence.∗ HOWEVER, we do know some things about “why.” • Dependence is a biopsychosocial disease. • Abuse often has biopsychosocial roots.
BIOpsychosocial Making Decisions….Human beings make decisions for these reasons -• They work for us or they make sense to us OR• They make us FEEL goodThus…. We have a reward pathway.
Neurotransmitter Decisions/Judgment– Dopamine(Endorphin =Endogenous + Triggers dopamine releaseMorphine) Responds to stimuliHuman braindevelopmentis complete at Amygdalaabout the ageof 25.
Although not directly within the reward path, theAmygdala is the emotional command post. It iskey in both creating and rememberingemotions/feelings. Think about what you feel when you hear a song that was popular during an emotional time in your life. That is the same emotional mechanism as a craving.
Why do we even need a reward pathway?To reward us for activities consistent with our survival and that of our species! (what are they?)∗ Consuming Food∗ Drinking Water∗ Procreation∗ Child Nurturing/Rearing
Dopamine Receptors areLower in Addicts Cocaine DA D2 Receptor Availability Alcohol Heroin control addicted
Reward Pathway Gone Astray∗ I like it∗ I want it • Neuroadaptation Occurs (weight lifting)∗ I NEED IT!! The craving become a survival strategy
Addiction is a Chronic, Relapsing Disease Addicted individuals are often set up for failurebecause we tend to treat them with an acute model rather than a chronic model of care.
Assessment: The T-ACE∗ T - Tolerance: How many drinks does it take to make you feel high? (threshold – more than 2)∗ A - Have people annoyed you by criticizing your drinking?∗ C - Have you ever felt you ought to cut down on your drinking?∗ E - Eye-opener: Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover? (shows dependence)∗ Two positive answers is considered a positive screening.
What to do with a Positive Assessment∗ Find common ground. Does the patient see a problem that needs changing?∗ Remember that sometimes the answer or solution that the patient wants is not what we might think is best.∗ Explore other difficult things a person has conquered or accomplished as examples of success!∗ Offer resources.