1. 1The Neuroscience of Addiction Part 2 Joe Lunievicz, BA, RYT Director, Training Institute, NDRI

2. 2Webinar Logistics Panel Questions Raise hand Tech Difficulties (800) 263-6317 3. 3Presenter: Joseph Lunievicz, Director, Training Institute, NDRI This webinar was conducted under the auspices of the Bureau of Justice Assistance (BJA) Drug Courts Technical Assistance Project at American University, Washington, D.C. This project was supported by Grant No. 2010 DC-BX-K087awarded to American University by the Bureau of Justice Assistance. The Bureau of Justice Assistance is a component of the Office of Justice Programs, which also includes the Bureau of Justice Statistics, the National Institute of Justice, the Office of Juvenile Justice and Delinquency Prevention, and the Office for Victims of Crime. Points of view or opinions in this document are those of the authors and do not represent the official position or policies of the U.S. Department of Justice.Technical Difficulties: (800) 263-6317 4. What well cover in part 2 Bio-Psycho-SocialSpiritual Model Developmental Model of Recovery Impact on Drug CourtTechnical Difficulties: (800) 263-63174 5. Neuroscience Supports Addiction = Brain Disease5with biological, sociologic al and psychological components 6. Pathway for Understanding Addictive Effects of Drugs on the Brain & Behavior PET Scans Drug users have far less dopamine activityThe Reward Pathway6 7. Is Damage Permanent? No. Yes. Increasing evidence of brain recovery Long term heavy alcohol use results in some permanent damage to CNS (methamphetamine also) However, much can be either restored or the brain develops compensations for damaged areas This can be done biologically, psychologically, socially, and spiritually. Note: fundamental neurochemical imbalances that were there before the addiction may still need attentionTechnical Difficulties: (800) 263-63177 8. Why is Continued Treatment Critical?Normal ControlMeth user (1 month abstinent)Meth user (36 months abstinent)Partial Recovery of Dopamine Transporters After Prolonged Abstinence 9. Disease Model Chemical Dependency Disease of the brain. Chronic condition that requires life-long management. Compared to: Type 2 Diabetes, Chronic hypertensive disease, Asthma, Obesity All have a complex of physiological and behavioral health components No one treatment episode will resolve illness. Course of dependency is multiple episodes of treatment, recovery activities, relapse periods.Technical Difficulties: (800) 263-63179 10. Bio-Psycho-Social-Spiritual Model10 Reasons for starting drug use Reasons for continued drug use over time Drug Genetics Environment Treatment approaches addressing eachBiologicalSocialPsychoSpiritualTechnical Difficulties: (800) 263-6317 11. 11Questions What are examples of:Biological Biological Treatments? PsychoSocialSpiritual Psychological Treatments? Social Treatments? Spiritual Treatments?Technical Difficulties: (800) 263-6317 12. 12Definition: Recovery On-Going Process of Improving Ones Level of Functioning: Biologically Psychologically Socially Spiritually While maintaining abstinence 13. 13Developmental Model of Recovery Terrence Gorski, http://www.stoprxdrugabuse.org/html/gorski.html, 2008 Transition Stabilization 0 6 months Early Recovery 6 months - 2 years Middle Recovery 2-3 years Late Recovery 3-5 years Maintenance 14. 14Transition Develop motivating problems Attempt normal problem solving Attempts at controlled use Accept the need for abstinence Accept the need for helpTechnical Difficulties: (800) 263-6317 15. 15Assessment of Tx Need: Ex: ASAM Criteria 6 dimensions Acute intoxication or withdrawal potential Biomedical conditions Emotional/behavioral conditions Treatment acceptance Relapse potential Recovery/living environmentTechnical Difficulties: (800) 263-6317 16. 16Stabilization 0-6 months Recovery from Withdrawal (Acute and Post Acute) Interrupting Addictive Preoccupation Short Term Social Stabilization Learning Non-chemical Stress Management/coping Developing hope and motivation 17. Post Acute Withdrawal Criminal Justice Population SAMHSA TAP 19Biological Poly-drug use Regular drug use before age 15 Abusive use for a period of 15+ years History of head trauma (TBI) Parental use of drugs during pregnancy Personal or family history of diabetes, hypoglycemia, addiction, malnutrition (personal) Physical illness or chronic pain17 18. 18Post Acute Withdrawal continued Psychological and Social Childhood or adult history of psychological trauma (sexual and or physical abuse) Mental illness or severe personality disorder High stress lifestyle or personality High stress social environmentTechnical Difficulties: (800) 263-6317 19. 19Addictive Preoccupation Obsessive thought patterns Compulsive behaviors Physical cravings Activated by high-risk situations and stress People Places ThingsTechnical Difficulties: (800) 263-6317 20. 20Early Recovery 6-24 months Understanding Addiction Recognizing Addiction Identifying & Interrupting Addictive Thoughts, Feelings, and Actions Learning Non-chemical Coping Skills Developing a Sobriety Centered Value System 21. 21Middle Recovery 2-3 years Repair lifestyle damage (work, social, family, intimates relationships, balanced health promoting lifestyle) Resolving the Demoralization Crisis Repairing Addiction Caused Social Damage Building a Balanced Lifestyle 22. 22Late Recovery 3-5 years Deal with unfinished business from childhood Recognition that Childhood issues are affecting the Quality of Recovery Learning about family of origin issues Conscious examination of childhood Identification of self-defeating patterns Application to adult living Lifestyle change 23. 23Maintenance Life-long process Maintaining a recovery program Effective day-to-day coping Continued growth and development Coping with life transitions and complicating factorsTechnical Difficulties: (800) 263-6317 24. 24ExampleStimulants in general and Methamphetamine in particularTechnical Difficulties: (800) 263-6317 25. 25Ex: STAGES OF RECOVERY STIMULANTSOVERVIEW DAYDAYDAYDAYDAY01545120180 26. 26Frequency of Impairment by Neuropsychological Domain 6060 Controls MA Users% Impaired505040403030202010100Attention/ Psychomotor SpeedLearning and MemoryWorking MemoryFluencyInhibitionExecutive Systems Function0 27. 27Defining Domains: What this Means in Executive Systems Functioning a.k.a. frontal lobe functioning. Deficits on executive tasks assoc. w/: Poor judgment. Lack of insight. Poor strategy formation. Impulsivity. Reduced capacity to determine consequences of actions.Technical Difficulties: (800) 263-6317 28. 28How this Translates intoMethamphetamine Treatment Bupropion Cognitive/Behavioral Therapy-CBT Motivational Interviewing-MI Contingency Management-CM 12-Step Facilitation Therapy Community Reinforcement ApproachCRA Matrix Model of Outpatient Treatment 29. Treatment Tailored further Clinical Strategies to Enhance Treatment Outcomes with Methamphetamine Users29Rawson, 2009Educate clients about the reality of MA addiction Employ varied adult learning formats to increase comprehension and retention of knowledge in view of cognitive deficiencies (especially verbal memory problems). Provide workbooks and learning aids on relapse prevention for clients to take with them into continuing care. Technical Difficulties: (800) 263-6317 30. Clinical Strategies to Enhance Treatment Outcomes with Methamphetamine Users Strategies to reduce anhedonia and negative mood states, episodic paranoia, sleep problems (aerobic exercise, Yoga, Tai Chi, meditation) Anger management strategies (to cope with possible serotonergic dysregulation-induced irritability). Groups to address extensive maladaptive sexual behaviors and expectations.Technical Difficulties: (800) 263-631730 31. Clinical Strategies to Enhance Treatment Outcomes with Methamphetamine Users31RawsonThe single most important factor for positive treatment outcome will be the degree to which clients are retained in post-residential treatment. Use community care organizations with a continuum of care that can decrease and increase intensity of care when clinically indicated. Create treatment plans that maximize compliance Employ positive reinforcement (vouchers-contingency management) methods to promote retention and prosocial alternative behaviors. Coordinate parole monitoring and treatment participation in community care. Make mental health care available. Involve family in community care services. 32. References32 Richard Rawson, Ph.D. Professor, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California at Los Angeles: Addiction is a Chronic Disease and it Matters, 2010 Carlton Erickson, Ph.D. College of Pharmacy, The University of Texas, Presentation: Neuroscience of Addiction, 2009 Robert Walker, MSW, LCSW, University of Kentucky Center on Drug and Alcohol Research, Presentation: The Neuroscience of Addiction, 2008 Richard Rawson, Ph.D. Professor, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California at Los Angeles: Methamphetamine: New Knowledge, Neurobiology and Clinical Issues, 2007 33. 33Cointinued George F. Koob, Ph.D. Professor and chairman committee on the Neurobiology of Addictive Disorders, The Scripps Research institute, La Jolla, CA, Presentation: The Neuroscience of Addiction, 2006 NIDA, The Neurobiology of Addiction Teaching Packets, 2007 Nestler, Eric, J., Molecular Basis of Long-Term Plasticity Underlying Addiction, Neuroscience, Volume 2, 2001 Counselors Manual for Relapse Prevention With chemically Dependent Criminal Offenders TAP Series 19b, SAMHSA Terence T. Gorski, Best Practice Principles in the Treatment of Substance Use Disorders, 2003 Terence T. Gorski, Recovery from Addiction, A Developmental ModelMay 5 2008 34. 34Upcoming Webinar Addiction and the Neuroscience of the Brain Part III: Focus will be on the three components of relapse prevention: warning signs of relapse, identifying triggers, and reinforcement strategies.September 27, 2012 3pm-4pm 35. 35Presenter: Joseph Lunievicz, Director, Training Institute, NDRI This webinar was conducted under the auspices of the Bureau of Justice Assistance (BJA) Drug Courts Technical Assistance Project at American University, Washington, D.C. This project was supported by Grant No. 2010 DC-BX-K087awarded to American University by the Bureau of Justice Assistance. The Bureau of Justice Assistance is a component of the Office of Justice Programs, which also includes the Bureau of Justice Statistics, the National Institute of Justice, the Office of Juvenile Justice and Delinquency Prevention, and the Office for Victims of Crime. Points of view or opinions in this document are those of the authors and do not represent the official position or policies of the U.S. Department of Justice. 36. Thank You for Participating 36Dont Forget Please complete the survey for todays webinarPresenter: Joe Lunievicz, Director of Training, NDRI Organizer - Clyde Frederick Senior Administrative TechnologistSponsored by The BJA Drug Court Technical Assistance Project at American University, in collaboration with the National Development & Research Institute s