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Addiction Treatment: A Strengths Perspective 4th Edition

Katherine van Wormer Diane Rae Davis

Part II BIOLOGY

Chapter 3

Substance Misuse, Dependence, and the Body

Brain Regions and Their Functions

Ecstasy and the Brain

The Brain and Addiction

Neurotransmitters affect emotions and memory

Neurotransmitters Affect Emotions and Memory

Dopamine—reuptake affected by cocaine, which blocks dopamine synapse

Depletion following cocaine use. Nicotine affects dopamine too.

Parkinson’s when too little. Dopamine-boosting drugs for Parkinson’s associated with mania and gambling behavior.

Excess of dopamine associated with schizophrenia.

Serotonin: influenced by alcohol, involved in sleep. Decreased levels linked to depression, anxiety, aggressiveness, impulsiveness, suicidal behaviors.

Depletion Following Cocaine Use.

The right scan is taken from someone who is on cocaine. The loss of red areas in the right scan compared to the left (normal) scan indicates that the brain is using less glucose and therefore is less active. This reduction in activity results in disruption of many brain functions.

Memory and Craving

Addict never gets original high—brain has changed. Addiction is a brain disease.

Cues can trigger memory…picture of alcoholic beverages activates certain areas of the brain.

Prozac reduces craving by regulating serotonin levels.

Cocaine in the Brain

Slides are from the National Institute on Drug Abuse (NIDA) (www.nida.nih.gov)

Gambling and the Brain

Persons with gambling disorders may have abnormal levels of dopamine and serotonin.

Lack of control may result.

Highs enhanced when rewards uncertain.

Near misses especially thrilling.

The Role of Genes

Study of mental hospitals, prisons, 50% who used chemical substances had mental disorders.

Cloninger—Sweden…259 male adoptees with alcoholic fathers

Type 1: late onset..75% of alcoholics, relates to harm avoidance, anxiety, guilt

Type 2: risk taker (starts about age 11), male, hyperactive, antisocial, hereditary

Ondansetron: works on serotonin, little effect on type 1

Twins: 40-60% concurrence of alcoholism. Separated at birth monkeys drank more under stress, people with low dopamine like stimulants

People with ADHD risk for drug abuse.

Medical Consequences

Wernicke Korsakoff:

Cases reported of Dr. Oliver Sacks

Peripheral neuropathy related to lack of Vitamin B

Confabulation….Dr. Sacks—Awakenings

Medical Consequences continued

Liver damage…removes toxins from blood, bile circulates in blood stream Yellow skin tone, cirrhosis, immune system breakdown. Heart – nicotine, cocaine Fetal alcohol syndrome. See photograph in text. Short nose, indistinct groove between nose and mouth, thin upper lip, small head and eyes, learning problems. Role of sperm should be considered as well as mother’s role.

Interventions Related to Biology

Schick Shadel, Seattle treatment center

Conditioning or aversion therapy—favorite drink plus emetine to induce vomiting.

Use of truth serum on alternate days.

Changing Brain Chemistry

Brain Lock (Schwartz) cognitive treatment for OCD to “rewire the brain”

Ondansetron—decreases craving

Zyban and smoking; Chantix helps person produce more dopamine.

Nicotine gum; patch.

Naltrexone, approved 1995, not a narcotic unlike methadone.

Blocks receptors for getting high.

Synthetic Prescription Drugs

Methadone (synthetic form of heroin);

Methadone maintenance

Heroin maintenance in Britain, Switzerland, Vancouver.

Buprenorphine can be prescribed by GPs, reduces likelihood of overdose

Eating disorders and dopamine

Bulimics—related to depression

Anorexia—anxiety

Luvox, Prozac, and Paxil decrease binges.

Holistic Treatments

Herbal remedies

St. John’s wort

Hypnosis

Acupuncture from China

Massage therapy

Physical exercise to reduce tension