Brain Areas involved in• Brainstem: the ventral tegmental area (VTA) at the top of the brainstem contain nerve cells that use the neurotransmitter DOPAMINE to relay messages.• Limbic System: the nucleus accumbens receive the messages from dopamine- containing neurons in the VTA.• Cerebral Cortex: receive messages from other parts of the brain to make
Brain• Limbic System: located on top of the brainstem and buried under the cortex• More primitive brain structures (amygdala, hippocampus)• Involved in emotions and motivations, particularly those related to survival~ fear, anger, and sexual behavior• Also related to feeling of pleasure that are related to survival such as eating,
Brain Hijacked• Drugs of abuse act directly on this primitive area of the brainstem and limbic system hijacking the higher functioning cerebral cortex’s ability to stay in control.• Drugs override the cortex and there is loss of reasoning and control.
Effects of Drugs of Abuse on the Brain• Drugs of abuse produce a pleasurable event or “reward.”• The brain is wired to repeat behaviors that are rewarding.• Drugs of abuse are mistakenly believed to be essential to survival (like eating and drinking water) in an addicted brain.• Drugs of abuse are many more times
Effects of drugs of abuse on the brain• Almost all drugs change the way the brain works by altering chemical neurotransmission. – Dopamine * – GABA – NMDA – Glutamate
Effects of drugs of abuse on the• Nicotine: activate the nicotinic Ach receptors.• Alcohol: alters the balance between neurotransmitters like GABA and NMDA.• Opiates (heroin, pain pills): mimic effects of natural neurotransmitters at mu receptors
Effects of drugs of abuse on the brain• PCP: blocks receptors and prevents neuronal messages from getting through.• Methamphetamines: act by causing neurotransmitters to be released in greater amounts than normal into synaptic cleft.• Cocaine: interferes with the molecules
Effects of drugs of abuse on the brain• Prolonged drug use changes the brain in fundamental and long-lasting ways.• Drugs of abuse interfere with the way nerve cells normally send, receive, and process information.• Drugs of abuse “hijack” the brain’s ability to make the right decision
Addiction is a chronic disease• Drug addiction is a chronic disorder like diabetes, high blood pressure or asthma.• Treatment is essential- sometimes repeated treatment and prolonged treatment is needed.• Treatment is behavior-based and medical based.
How to catch a problem• 1. Have you ever ridden in a car driven by someone who had been using alcohol or drugs?• 2. Do you ever use alcohol or drugs to relax, to feel better about yourself, or to ﬁt in?• 3. Do you ever use alcohol or drugs when you are alone?• 4.Do you ever forget things you did while using alcohol or drugs?• 5. Do family or friends ever tell you to cut down on your use of alcohol or drugs?
Alcohol Withdrawal• Among patients who consume 20 standard alcoholic drinks/day symptomatic withdrawal is likely with abstinence.• Three main categories of Alcohol Withdrawal Syndrome: – 1. Central nervous system excitation: restlessness, agitation, seizures – 2. Autonomic nervous system excessive activity: nausea, vomiting, tachycardia, tremulousness, hypertension – 3. Cognitive dysfunction
Alcohol Withdrawal• Three stages of withdrawal
Alcohol Withdrawal• Stage 1: “minor withdrawal” – Begins ﬁve to eight hours after last drink – Characterized by anxiety, restlessness, agitation, mild nausea, decreased appetite, sleep disturbance, facial sweating, mild tremulousness, and ﬂuctuation tachycardia and hypertension
Alcohol Withdrawal• Stage 2: “major withdrawal” – Occurs 24 to 72 hours after last drink – Characterized by marked restlessness and agitation, moderate tremulousness with constant eye movement, diaphoresis, nausea, vomiting, anorexia and diarrhea. – Patients have marked tachycardia (>120 bpm) and elevated systolic blood pressure (>160 mm Hg) – “Alcoholic hallucinosis” may be present- can be auditory or visual – Patient may be confused but easily reoriented – Seizures- typically grand mal- may occur, usually single, last < 5mins. Status epilepticus is not associated with alcohol withdrawal and indicates another problem
Alcohol Withdrawal• Stage 3: “delirium tremens” – Can occur from 72 to 96 hours after last drink – Associated with fever, severe hypertension, tachycardia, deliriums, drenching sweats, and marked tremulousness – Causes of death include head trauma, cardiovascular complications, infections, aspiration pneumonia and ﬂuid & electrolyte abnormalities
Sedative Withdrawal• Signs of withdrawal may not be seen for 7 to 10 days after last intake of substance – This is because many benzodiazepines have long-acting metabolites – Many individuals also take more than one or more substance of abuse
Stimulant Withdrawal• Amphetamines and Cocaine are the most prevalent stimulants abused• Amphetamines: – Methamphetamine – MDMA- ecstasy• Cocaine: – Cocaine HCL – “crack”- alkaloid form of cocaine (smoked)
Stimulant Withdrawal• “Crash” drastic • Malaise reduction in mood and • Problems with memory, energy concentration• Craving the stimulant • Occasional suicidal• Craving for sleep, hyper ideation somnolence• Depressed mood • Craving can last months to years after the last• Anxiety stimulant use• Paranoia• Hyperphagia- “the
Opioid Withdrawal• Watery eyes • Generalized body aches• Sniffles / runny nose • Abdominal cramps• Yawning • Pupillary dilation• Muscle twitching • Anorexia• Diarrhea/ loose stools• Nausea and vomiting
Opioid Withdrawal• Peak withdrawal symptoms most severe with discontinuing heroin use• Longest duration of withdrawal symptoms with methadone but with lower peak severity
Withdrawal• Alcohol and Sedative withdrawal can be lethal and life threatening sometimes requiring hospitalization. – Need monitoring and medical management for withdrawal seizures, delirium tremens, falls, head injury, aspiration – Need treatment to replenish ﬂuids, vitamins, nutrients, support blood pressure, heart rate• Opioid and Stimulant withdrawal less likely to be lethal.
Long Term Recovery• Long term care involves outpatient support of medical condition• 12 Step Recovery meetings like AA or NA• Intensive Outpatient Programs• Counseling• Residential Care• Spiritual connection with family,
OutlineResources:Alcoholics Anonymous (AA): www.aa.orgNational Council on Alcoholism and DrugDependence, Inc. (NCADD): 800-622-2255or www.ncadd.orgSubstance Abuse and Mental Health ServicesAdministration (SAMHSA): 800-622-HELP orwww.samsha.gov/treatmentNational Institute on Alcohol Abuse andAlcoholism (NIAAA): 301-443-3860 orwww.niaaa.nih.gov