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Eighth Edition

2 Stops Remaining

Screening, Assessment, Intervention & Treatment Resources Darryl S. Inaba, PharmD., CATC-V, CADC III

Director: Clinical and Behavioral Health Services - Addictions Recovery Center

Research and Education - CNS Productions, Inc. Medford, Oregon

NIDA: Components of Comprehensive Drug

Abuse Treatment

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CNS Addiction Pathway

Survival/Reinforcement Circuit

Control Circuit

Stop Switch

Go

Switch

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Addiction is a “tug of war” between the older

Meso Cortex Survival Brain and the modern

thinking Neo Cortex Brain

Fish 500 mya

Cambrian Explosion

Reptiles 300 mya

Amphibians 315 mya

Mammals 220 mya

Primates 65 mya Hominids 5 mya

Earth 4.5 Billion Years, Life from 4 Billion Years

Neocortex: Aware Human Brain

Mesocortex, Limbic System, Basal

Ganglia: Unconscious Survival Brain

Prefrontal

Cortex

Nucleus

Accumbens

Arcuate

Nucleus Ventral

Tegmental

Area

Brain Reward Pathways

Dopamine

Opioid Peptides

Glutamate

Courtesy of Dr. John Hart, Portland, Oregon

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Limbic Area

• Role: Drive Generation (SURVIVAL)

• Intervention: Pharmacotherapy

Prefrontal Cortex

• Role: Executive Function

• Intervention: Counseling

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Sub Cortical Brain Structures

i.e. ~400 vaccines, genetic therapy, pharmaco-

genomics, and ~more medication treatments in

developments than any other medical condition

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• 2014 Study of >21,000 adults in 263 New

York Outpatient SAT Clinics

• Smokers had shorter treatment durations

and less likely to achieve treatment goals

• Smoker/Drinkers: ↑ unemployment, CJS

involvement, mental illness, other drugs of

abuse and ↓ HS diploma or GED

• < 20% US smoke (<15% ) but 67% and

61% of seeking alcohol treatment smoke

Walitzer, KS et al. (2015)

Buprenorphine (Suboxone) Ceiling Effect

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2002 2003 2004 2005 2006 2007 2008 2009

12 14 24 28 46 35 33 19

Num

ber

of

dea

ths

cause

d b

y p

resc

ription d

rug o

ver

dose

an

nual

ly

Jackson County Rx OD Deaths

Suboxone more Rxed than methadone

In 2010 U.S. Prescription Drug Deaths

(primarily opioid pain medications) were

Greater than Auto Accident Deaths!

Methadone represented 30% of these deaths

in 2010 yet only amounted to only 2% of all

pain medications prescribed

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• Operationally defined as aberrant drug-related behaviors that make patients with chronic pain look like addicts.

• These behaviors stop if opioid doses are increased and pain improves. (Weissman and Haddox, 1989)

• This indicates that the aberrant drug-related behaviors were actually a search for relief

• Little data on the subject – Only a single human report as of 2014, but evidence in rats

Pujol, J et al (2009), PLoS ONE

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Chronic Back

Pain

Complex Regional

Pain Syndrome Osteoarthritis

2011

Prefrontal Cortex to Nucleus Accumbens and amygdala Wager, Tor (2013), NEJM

Wager, Tor (2013), NEJM Wager, Tor (2013), NEJM

• • • • •

Low Stress Mild Stress Stressed Out

Annals of Internal Medicine 2015

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Uppers, Downers, All Arounders 8th Ed., in publication

Courtesy of Andrew Mendenhall M.D.

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Expanding Sciences of Pain and Recovery

CNS Productions, InCNS Productions, Inc.

Medford, Oregon

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Methamphetamine:

Neurochemistry & Recovery

Questions/Comments?

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↑

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Developing Medications: N-Acetylcysteine for Marijuana-Dependent Adolescents

Proportion of Negative Urine Cannabinoid Tests Over Time Among Cannabis-Dependent Adolescents

Gray KM et al., AJP June 15, 2012.

Courtesy of Nora Volkow (Volkow, Hitzmann, Wong, et al 1992

Courtesy of Nora Volkow, et al. Journal of Neuroscience, 21, 9414-9418, 2001

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Volkow et al. J. of Neuroscience 2001

Intoxication Sober: 30 days

Neuronutrient complex “normalization” of caudate, accumbens and

putumen regions of heroin addicts demonstrated by fMRI Scan

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Anthony JC. Prevalence of substance use among US physicians. JAMA 1992; 11:268(18):2518.

Brewster JM. Prevalence of alcohol and other drug problems among physicians. JAMA 1986; 255: 1913-1920.

Talbott GD. Prevalence of alcohol and other drug problems among physicians. JAMA 1987; 21:2927-2930.

Flaherty JA, Richman JA. Substance Use and Addiction Among Medical Students, Residents, and Physicians: Recent Advances in

Addictive Disorders. Psychiatric Clinics of North America. 1993; 16: (1), 189-195.

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Ten Film Series

Two DVD Disk Set

Marijuana: Neurochemistry & Physiology

Questions/Comments?

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Medical Consequences

of Addiction

Questions/Comments?

◆

◆ Developments in treatments of

addiction continues to improve outcomes

that improve lives and health for all.

Me at Series End

My Audience at End of the Series Eighth Edition