Cynthia L Whitaker, PsyD, MLADC

10/05/2017

Identify the effects of substance use on the brain

Increase in understanding of the role of the brain on the severity and chronicity of addiction

To increase knowledge of the connections between the brain, substance use disorders, and other behavioral health disorders

...in order to continue to decrease stigma and have informed discussions on prevention, treatment, & recovery

“Addiction is a primary, chronic disease of brain reward, motivation, memory and

related circuitry. Dysfunction in these

circuits leads to characteristic biological, psychological, social and spiritual manifestations…addiction often involves cycles of relapse and remission”

Parts of the Brain

◦Cortex

◦ Limbic System

◦ Brain Stem

Communication within the Brain

◦Neuron to Neuron

◦Neurotransmitters

◦ Receivers

◦ Transporters

Drugs interfere with the way the parts of the brain communicate

3 factors impact the brain

1. Biology/Genes

DNA makeup, predisposition

2. Environment

Stress response, amygdala

3. Drugs

Toxins

Genetics◦Genetic Vulnerability ◦Familial Patterns of Addiction

Gender Differences Mental Disorders ◦Overlap of risk factors ◦ “Self- medication” ◦ Increased risk for mental illness brought on by drug use, especially in those with genetic or other vulnerabilities

Chaotic home and abuse

Parents’ use and attitudes

Peer Influences

Community Attitudes

Poor School Achievement

Most studied & strongest predictability…

Aversive Childhood Experiences

Child physical abuse

Child sexual abuse

Child emotional abuse

Neglect

Mentally ill, depressed or suicidal person in the home

Drug addicted or alcoholic family member

Witnessing domestic violence against the mother

Loss of a parent to death or abandonment, including abandonment by divorce

Incarceration of any family member

Cognitive, Social and Mental Health symptoms due to impact on brain

Health outcomes & healthcare costs

Special education needs

Rates of school failure

Intergenerational patterns of high-cost social problems

0

0.5

1

1.5

2

2.5

3

3.5

4

Intravenous Drug Use

ACE Score

% R

ep

ort

ing

IV

Dru

g U

se

1

2

3

4+

Attempted Suicide

0

5

10

15

20

25

12

3

4+

ACE Score

% E

ver

Att

em

pti

ng

Su

icid

e

330

Report No ACEs

510

Report 1-3 ACES

160

Report 4-8 ACEs

WITH 0 ACEs

1 in 16 smokes

1 in 69 are alcoholic

1 in 14 has heart

disease

1 in 96 attempts suicide

1 in 480 uses IV drugs

WITH 3 ACEs

1 in 9 smokes

1 in 9 are alcoholic

1 in 7 has heart disease

1 in 10 attempts

suicide

1 in 43 uses IV drugs

WITH 7+ ACEs

1 in 6 smokes

1 in 6 are alcoholic

1 in 6 has heart disease

1 in 5 attempts suicide

1 in 30 use IV drugs

PROBABILITY OF SAMPLE OUTCOMES

GIVEN 1,000 AMERICAN ADULTS

Route of administration

Effect of drug itself

Early use

Availability

Cost

Interferes with the way the parts of the brain communicate

Some drugs activate neurons by mimicking neurotransmitters

Other drugs cause neurons to release abnormally large amounts of neurotransmitters or prevent recycling

Dopamine is found in regions of the brain that regulate movement, emotion, motivation, and feelings of pleasure

Drugs overstimulating the system ◦ euphoric effects

◦ strongly reinforce the behavior of drug use—teaching the user to repeat it.

Repeated exposure to drugs alters brain function and behavior

Prolonged drug use changes the brain in fundamental ways that reinforce drug taking and lead to addiction

Changes occur to both the structure of the brain and its functioning

Changes are difficult to un-do and may last a long time

Other pathways and other neurotransmitters are also involved in addiction

NOT just wanting or liking something◦ “I’m craving a Starbucks Chai Tea Latte about now”

A MIDBRAIN (limbic system) process involving both memory and emotion

Similar to hunger and thirst

Previously neutral stimuli take on drug related significance

Nature Video Cocaine Video

Front of Brain

Back of Brain

Amygdala

not lit up Amygdala

activated

Photo courtesy of Anna Rose Childress, Ph.D.

Early intervention is key—before brain changes take hold and drug use becomes compulsive

The effects of brain changes can include impaired mental and motor functions, such as memory deficits and slowed motor reactions

Extended abstinence is predictive of sustained recovery

Treatment works and brings about reductions not just in drug use, but also in criminal recidivism

It takes time, but the brain can recover

How does knowing the role of the brain in addiction impact the way you view those who are struggling to overcome addiction?

What are some “ah-ha” moments or “takeaways” that are most impactful for you?

What is one thing you will share with a colleague or supervisor tomorrow?

Other?

Cynthia L Whitaker, PsyD, MLADC

Chief of Services

Greater Nashua Mental Health Center

603-889-6147

whitakerc@gnmhc.org