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DISCUSSION POST 5

• What part of the brain is involved in addiction?

• The neural circuit responsible for the acute rewarding and reinforcing effects of recreational drugs.

• Anatomical pathways contained within this circuit include the mesolimbic and mesocortical dopamine (DA) pathways that originate in the ventral tegmental area (VTA) of the midbrain and terminate in the nucleus accumbens (Nacc), amygdala (AMG) and frontal cortex (FC) (Meyer et al., 2023).

NEUROTRANSMITTERS.

• What neurotransmitters are involved in addiction?

• There are several neurotransmitters that are involved in addiction including dopamine and gamma-aminobutyric (GABA).

• Cocaine and amphetamine, two psychostimulants, directly release DA from dopaminergic terminals to provide their rewarding effects.

• A mix of DA-dependent and DA-independent pathways mediate opioid reward.

• Alcohol increases GABA and GABA receptor activity, which increases the release of DA in the NAcc and opioid peptides in the VTA, NAcc, and AMG.

• By acting locally and within the VTA, nicotine and tetrahydrocannabinol (THC) derived from marijuana promote DA release in the NAcc.

DIFFERENCE BETWEEN DEPENDENCE AND

ABUSE.

 Drug abuse and drug dependency are two different physiological conditions.

When a person feels they must use drugs in order to act or engage regularly in daily life, that person is said to be abusing drugs .

When a prescription drug is misused, it will be taken against the doctor's or pharmacist's advice.

 Drug dependence happens when a person needs the drug to feel normal on a physiological level.

 Drug dependence is a medical condition in which a person becomes physically or mentally reliant on a substance to the point where doing so would result in physical or mental sickness.

DIFFERENCE BETWEEN WITHDRAWAL AND ADDICTION.

 Drug addiction is a medical condition that alters behavior and has an impact on the brain.

 According to the National Institute on Drug Abuse (NIDA), addiction is a potentially chronic condition characterized by abnormal behavior in the brain's reward and motivational circuits in relation to a particular addictive substance.

 Drug withdrawal is a physiological reaction to a drug's effective reduced concentration in a subject who has grown tolerant to it (National Institute on Drug Abuse, 2021).

 Over time, the abused substance has caused structures in the brain and body of the addicted person to grow dependent on it; when the substance is taken out of circulation, these structures are deprived of their normal chemical environment, and their host suffers as a result.

DUAL DIAGNOSIS

• An individual with both a mental health illness and a drug use issue is said to have a dual diagnosis (Snell-Rood et al., 2021).

• These can include illnesses including bipolar disorder, anxiety, and depression.

DESCRIBE WHAT IS MEDICATIO N-

ASS ISTED TREATMENT

(MAT)? WHAT MEDICATI O NS ARE

USED IN MAT?

• Medication-Assisted Treatment (MAT) is a treatment approach for substance use disorders that combines behavioral therapy and medications to help individuals overcome addiction. MAT involves the use of FDA- approved medications, along with counseling and support, to help individuals reduce their cravings and dependence on drugs or alcohol, manage withdrawal symptoms, and ultimately achieve long-term recovery. • For opioid addiction, medications such as methadone, buprenorphine,

and naltrexone are commonly used. • Methadone and buprenorphine are opioid agonists, which means they

activate the same receptors in the brain as opioids but with less euphoria and a slower onset of action. Naltrexone is an opioid antagonist, which blocks the effects of opioids in the brain and reduces cravings.

• For alcohol use disorder, medications such as acamprosate, naltrexone, and disulfiram are commonly used. Acamprosate helps reduce cravings and withdrawal symptoms, while naltrexone reduces the rewarding effects of alcohol and can help prevent relapse. Disulfiram works by causing unpleasant symptoms when alcohol is consumed, which can help deter individuals from drinking.

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D IF FE R EN TI AT E M E DI C AT IO N S US E D IN T H E M AN A G E M E NT O F C R AV IN G ( H I NT: LO O K UP N A LT R EXO NE ( R EV IA ) , A C A M P R O S AT E ( C A M P R A L ) ,

O N DA N SE T R O N ( ZO F R A N ) , A ND B U P R E NO R P H I NE ( B UP R EN E X) ?

• Opioid cravings: • Methadone: an opioid agonist medication that can help reduce withdrawal symptoms and cravings for opioids. • Buprenorphine: a partial opioid agonist medication that can also help reduce withdrawal symptoms and cravings,

but with a lower risk of overdose and abuse compared to methadone. • Naltrexone: an opioid antagonist medication that blocks the effects of opioids in the brain and can help reduce

cravings. • Alcohol cravings: • Naltrexone: also used for opioid addiction, it can help reduce cravings and the rewarding effects of alcohol. • Acamprosate: a medication that helps stabilize the chemical balance in the brain and can reduce cravings and

withdrawal symptoms. • Nicotine cravings: • Nicotine replacement therapies (NRT): such as nicotine gum, patches, lozenges, or inhalers, can help reduce

nicotine cravings and withdrawal symptoms. • Varenicline: a medication that helps reduce nicotine cravings by blocking the effects of nicotine on the brain.

WHAT MEDICATIONS ARE USED IN

THE MANAGEMENT OF SOBRIETY?

• Disulfiram: a medication that can help maintain sobriety in individuals with alcohol use disorder by causing unpleasant symptoms, such as nausea and vomiting, when alcohol is consumed.

• Acamprosate: as mentioned earlier, acamprosate can help reduce cravings and withdrawal symptoms, but it can also be used to support long-term sobriety in individuals with alcohol use disorder.

• Topiramate: an anticonvulsant medication that has shown promising results in reducing alcohol cravings and supporting sobriety

HOW DO YOU PLAN ON BECOMING A WAIVER X PROVIDER? SHARE RESOURCES THAT OFFER THIS CLASS

• I plan to become a Waiver X provider, by completing the necessary training and meet the qualifications set by the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Drug Enforcement Administration (DEA). The X means being able to prescribed buprenorphine which is in treatment of opioid use disorder.

• I will also do the required training that is needed to become a waiver X provider, which is provided either online or in person once it is been authorized by the SAMSHA. Some places that offer this training are: • American Society of Addiction Medicine (ASAM) • Providers Clinical Support System (PCSS) • The Addiction Technology Transfer Center (ATTC) Network • The National Council for Behavioral Health (NCBH) • The American Academy of Addiction Psychiatry (AAAP)

• That being said a new bill was passed section 1262 that states that providers are no longer required to have waiver in order to prescribe buprenorphine for the used of opioid use disorder. The effective date is June 2023

HOW DO YOU PLAN ON BECOMING A CARN PROVIDER? SHARE RESOURCES THAT OFFER

THIS CLASS.

• I plan to become a CARN by meet the qualifications set by the Addictions Nursing Certification Board (ANCB), which administers the CARN certification. Required training is also necessary along with requirements form the ANCB. 2 years as a RN in addiction, 45 hours of Continuing education and passing the CARN certification exam.

• Some resources that help with the CARN are: • International Nurses Society on

Addictions (IntNSA) • National Council for Behavioral

Health (NCBH) • International Association of

Forensic Nurses (IAFN) • American Nurses Credentialing

Center (ANCC)

REFERENCES

 Meyer, S.M., Farrar, M. A., Yates, R. J., & Biezonski, D. (2023). Psychopharmacology Drugs, the Brain, and Behavior. (4th ed.). Oxford University Press.

 Snell-Rood, C., Pollini, R. A., & Willging, C. (2021). Barriers to integrated medication-assisted treatment for rural patients with co-occurring disorders: The gap in managing addiction. Psychiatric Services, 72(8), 935-942.

 National Institute on Drug Abuse. (2021, January 28). Medications to treat opioid use disorder. Retrieved from https://www.drugabuse.gov/publications/research-reports/medications-to- treat- opioid-addiction/overview

 Medications for substance use disorders. SAMHSA. (n.d.). Retrieved April 2, 2023, from https://www.samhsa.gov/medications-substance-use-disorders

 Examination. Addictions Nursing Certification Board. (n.d.). Retrieved April 2, 2023, from https://ancbonline.org/Examination

THANK YOU!!

Group 2

• Waweru, Mary • Williams, Kurvin

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