Slide 1 Neurobiology of Addiction - SaidDent.org ; SAIDsaiddent.org/admin/images/Handout...

NeurobiologyofAddictionJoyce D Leonetti, DO, MTS, MPH

SAID Meeting October 2019

___________________________________

DisclosuresI have no competing interests in this presentation.

___________________________________

Learning Objectives

• 1. Identify the origins and current state of the opioid crisis in America.

• 2. Describe the basic elements of drive and cognition in the neurobiology of addiction.

• 3. Understand the structure and pathways associated with changes in the brain

• 4. Discuss the clinical use of psychotherapy and psychosocial interventions in the treatment of substance abuse disorders.

___________________________________

Outline

• 1. The Basic Model

• 2. Neurobiology

• 3. New Neurobiological Concepts• 4. Treatments

• 5. New Directions

• 6. Conclusions

___________________________________

TheBasicModelofAddiction

___________________________________

~ 1980How does addiction occur?

What’s involved?What are the mechanisms?

___________________________________

TheRootCauseoftheProblem

Porter & Jick,NEJM,January 10, 1980

___________________________________

TheMoneyInfluence

___________________________________

TheFalsePromise

___________________________________

1999-2009

Primarynon-heroinopioidadmissionrates(per100,000)

___________________________________

FromPillstoHeroin

Compton, New England Journal of Medicine, 2016

___________________________________

FromHerointoFentanyl

___________________________________

Neurobiology

___________________________________

EffectsofDrugsonDopamineLevels

___________________________________

AddictionChangesintheBrain

•Over Time Addiction causes changes in the brain.•Brain Structure •Prefrontal Cortex, limbic system

•Brain Pathways (neural connections)•Dopamine pathway, serotonin pathway

•Brain Chemicals•Dopamine, serotonin, endorphin, glutamate

___________________________________

•Brain Structures(prefrontal and limbic systems)

___________________________________

BrainRegions

___________________________________

BrainRegionsandtheirFunctions

___________________________________

Pleasure– RewardsPathways

___________________________________

•BrainPathways(neuralconnections)•Dopaminepathway,serotonin

pathway

___________________________________

•BrainChemicals•Dopamine,serotonin,endorphin,glutamate,andGaBA

___________________________________

Brain Chemicals

• Dopamine – a feel good chemical.• Serotonin – the happy, anti-

worry, flexibility chemical. • GaBA – an inhibitory

neurotransmitter that helps calm or relax the brain• Endorphins – the brains own

natural pleasure and pain killing chemical

• Glutamate – locks the pleasurable experience into memory

___________________________________

AComplexIllness

___________________________________

TheAddictionCycle&the4C’s• Loss of Control (damage to the prefrontal cortex; right & wrong)• Continued Use Despite Consequences - further damage to prefrontal

cortex (interferes with judgment).• Compulsion (low serotonin levels) • Craving (dopamine; brain is hard wired to crave rewards)

___________________________________

Commonmedicationsusedtotreatdrugaddictionandwithdrawal•Opioid

• Methadone • Buprenorphine • Extended-release naltrexone • Lofexidine

•Nicotine• Nicotine replacement therapies (available as a patch, inhaler, or gum) • Bupropion • Varenicline

•Alcohol• Naltrexone • Disulfiram • Acamprosate

___________________________________

•New Neurobiological Concepts

___________________________________

ThreeNovelAreas

üMotivational Circuitry

üAnti reward Pathways

üInteroception

Levounis, JournalofMedicalToxicology,2016

___________________________________

Motivation:TheStinking– ThinkingPart

___________________________________

HowtheBrainDecides

AAAAAAHHH!!!!

___________________________________

Motivation:TheStinking– ThinkingPart

___________________________________

Anti-RewardPathways

___________________________________

Rewards

“…or $12 a month

from now:”

“$10 now….?”

___________________________________

HumanNature

People avoid risks to ensure gains (even small gains)

People take risks (even big risks) to avoid definite losses

Psychology trumps probability

___________________________________

RewardandAnti-RewardSystems

Gardner, ChronicPainandAddiction, 2011

Pro Reward

Anti Reward

___________________________________

Insula is in the anterior cingulate cortex (ACC)

___________________________________

TheStop-GoModel

Volkow ND and Baler RD, Neuropharmacology, 2013

___________________________________

4Treatments

___________________________________

FirstWave:Psychoanalysis

Levounis, JournalofMedicalToxicology, 2016.

___________________________________

2ndWave:BootCamps

___________________________________

3rd Wave:TheCurrentApproach

üMedications

üCounseling and Psychotherapy

üMutual Help

Nunes, Selzer, Levounis, Davies, Substance Dependence and Co-Occurring Psychiatric Disorders, 2010.Levounis, Arnaout, and Marienfeld, Motivational Interviewing for Clinical Practice, 2017.Renner, Levounis, and LaRose, Office-Based Buprenorphine Treatment of Opioid Use Disorder, 2nd Ed., 2018.

___________________________________

CounselingandPsychotherapy

1.Cognitive- Behavior Therapy• Functional analysis

• Skills Training to identify, avoid & cope with thoughts & cravings

2. The Kitchen Sink approach• Family Therapy

• Relapse Prevention• 12 Step Faciliation (AA)

• Primary Care• Mental Health Services

• Aftercare

___________________________________

MutualHelp

MotivationalInterviewing

MI is about arranging conversations so people talk themselves into change, based on their values and their interests.

___________________________________

Alcoholics/NarcoticsAnonymous

• AlcoholicsAnonymous (AA) is an international mutual aid fellowship with the stated purpose of enabling its members to "stay sober and help other alcoholics achieve sobriety.”

• AA is nonprofessional, self-supporting, and apolitical. Its only membership requirement is a desire to stop drinking.

• The AA program of recovery is set forth in the Twelve Steps.

• Narcotics Anonymous uses the same principles.

___________________________________

4th WaveMindfulness

___________________________________

Psychodynamics

Atherapythathelpspeoplegaininsighttotheirlivesandproblemsby:

• Recognizing recurring patterns to avoid distress & develop coping mechanisms in an effort to produce change in these patterns or habits.

• Evaluating life factors of thoughts, emotions, early life experiences and beliefs.

• Developed as a simpler, goal oriented, less lengthy alternative to psychoanalysis.

___________________________________

ThankYou

___________________________________

Slide 1 Neurobiology of Addiction - SaidDent.org ; SAIDsaiddent.org/admin/images/Handout...

Documents

Transcript of Slide 1 Neurobiology of Addiction - SaidDent.org ; SAIDsaiddent.org/admin/images/Handout...

Sexual Addiction Chapter from Neurobiology of …...The Neurobiology of Behavioral Addictions Sexual Addiction DONALD L. HILTON JR., STEFANIE CARNES, AND TODD L. LOVE Introduction

Neurobiology of Addiction presentation [Autosaved]€¦ · Addiction and the brain: The neurobiology of compulsion and its persisitence. Nature Reviews/ Neuroscience 2: 695-703. •

NEUROBIOLOGY OF ADDICTION

Neurobiology of Nicotine Addiction

Neurobiology of Nicotine Addiction - Mayo

Neurobiology of Addiction presentation [Autosaved] · PDF file• Relieve boredom • Rebel ... • Genetic Factors ... Microsoft PowerPoint - Neurobiology of Addiction presentation

The Neurobiology of Addiction - Hazelden -- Addiction Treatment Center

NEUROBIOLOGY OF OPIOID ADDICTION - DiVA portalhis.diva-portal.org/smash/get/diva2:1221508/FULLTEXT01.pdf · 2018-06-20 · NEUROBIOLOGY OF OPIOID ADDICTION 5 agonists NOP agonists

Introduction to the Neurobiology of Addiction · 2019-07-29 · Introduction to the Neurobiology of Addiction Lisa Lindquist, MD Psychiatry Inpatient Consult Service Medical Director.

Chemical Dependency, Neurobiology, and Addiction ARCO 502 … · 2019-08-20 · Chemical Dependency, Neurobiology, and Addiction 9 Light University Online F. Relapse – The recurrence

Neurobiology of Addiction - ACMT · The Neurobiology of Addiction 2. Psychosocial Treatments 3. Pharmacological Treatments 4. Conclusions Outline 1 Neurobiology of Addiction 3 . 2

2.Neurobiology of Drug Addiction

NEUROBIOLOGY OF ADDICTION - Rutgers New …njms.rutgers.edu/departments/psychiatry/documents/...NEUROBIOLOGY OF ADDICTION 2 1. Neurobiology of Addiction 2. Psychotherapy of Addiction

Neurobiology of George F. Koob, Ph.D. Addiction · Neurobiology of George F. Koob, Ph.D. Addiction CONCEPTUAL FRAMEWORK, ... Arkeo Pharmaceuticals, Case Palmera, Embera Neuro Therapeutics,

Neurobiology of Opioid Addiction & Physical Health … of Opioid Addiction & Physical Health Impacts ... hallucinogens • pcp 16 . Definition ... Neurobiology of Opioid Addiction

Neurobiology of Addiction - University of Utah · 2019-08-19 · Neurobiology of Addiction. Tiffany Love, Ph.D. Department of Psychiatry. The University of Utah. What is Addiction?

The Neurobiology of Addiction · 2020-05-04 · The Neurobiology of Addiction • Joseph Garbely, D.O., FASAM • Medical Director • VP of Medical Services • Addiction Medicine

Neurobiology of Addiction€¦ · Web viewThe Neurobiology of Addiction James D. Stoehr, Ph.D. Professor, Midwestern University, Glendale, AZ 623-572-3624 jstoehr@midwestern.edu Signs

Neurobiology of Addiction – GABBAgabba.up.pt/.../440914-Neurobiology-of-Addiction-2014.pdfNeurobiology+of+Addiction+–June+23627+! Organizer:TeresaSummavielle,+Addiction+Biology+Group+

The Neurobiology of Addiction