Howdy! Neurotransmitter Balance: The Key to Understanding Addiction Jeff Sandoz, PhD Troy University Acknowledgements • Special thanks go to Dr. Fred Von Stieff for permission to use his diagram in this presentation from his book Brain In Balance. • With gratitude for Dr. Daniel Inaba and CNS Productions Inc. for the use of the information on slides courtesy of CNS Productions, Medford Oregon via their publication Uppers, Downers, All Arounders. Outline - Neurotransmitter Balance I. Book Brain In Balance II. Neurotransmitter System III. GABA vs Glutamate IV. Brain Scans & the Future Book I IV Brain Scans & the Future III VS. II Mind Map Neurotransmitter Visual Systems I. Book Rosetta Stone: Understand the 3 Factor Relationship among Drug Use, Craving & Neurotransmitters levels. About the Author •Board-certified Addictionologist •Over 20,000 successful detoxified patients [Evidence-Based Best Practice] •Medical Director three chemical dependency programs •Certified-American Board of Addiction Medicine •Certified-American Society of Addiction Medicine •Certified-California Society of Addiction Medicine •Chief Medical Review Officer-State of California Dr. Von Stieff •Legal expert in substance abuse II. Neurotransmitter Systems Goal: Learn the rules of HOW THE BRAIN WORKS, making sense of how the neurotransmitters function. Analogy: Putting together pieces of the Brain Puzzle Build a puzzle: Start on the borders & work your way in. Glutamate Acetylcholine Endocannabinoid GABA Serotonin Dopamine Premise: Brain is Seeking Balance Most healthcare professionals do not understand how addiction and detoxification affect neurochemical systems of patients. Dynamic State of Equilibrium Neurotransmitter Diagram Purpose: Understand brain imbalance related to addiction – Done by viewing neurotransmitter levels of patient. 8 Neurotransmitters Add 7 colors of the rainbow and white to enhance your memory of the location of each neurotransmitter. [ROY G BIV] 8 Basic Neurotransmitter Systems Visualizing this diagram helps to understand what is going on in the person’s brain. Specifically how neurochemical balance can be altered. Diagram: Placing the Neurotransmitters • Large circle represents patient’s brain. • 8 smaller circles represent eight neurotransmitter systems. Diagram: Placing the Neurotransmitters • Resembling the chambers of a six shooter • + one more • & one in the middle. Diagram: Placing the Neurotransmitters • Resembling the face of a clock: • Opiates in the middle. Diagram: Placing the Neurotransmitters • Resembling the face of a clock: • Serotonin at 1 o’clock Diagram: Placing the Neurotransmitters • Resembling the face of a clock: • GABA between 2 and 3 o’clock Diagram: Placing the Neurotransmitters • Resembling the face of a clock: • Glutamate between 4 and 5 o’clock Diagram: Placing the Neurotransmitters • Resembling the face of a clock: • Dopamine at 6 o’clock Diagram: Placing the Neurotransmitters • Resembling the face of a clock: • Noradrenaline between 7 and 8 o’clock Diagram: Placing the Neurotransmitters • Resembling the face of a clock: • Acetylcholine between 9 and 10 o’clock Diagram: Placing the Neurotransmitters • Resembling the face of a clock: • Endocannabinoid at 11 o’clock Visualizing the Neurotransmitter System Utilize Diagram 4 Times 1) Genetic Deficiencies Imbalance due to Mental Illness, Trauma, Stress Visualizing the Neurotransmitter System Utilize Diagram 4 Times 1) Genetic Deficiencies Imbalance/MI/Trauma 2) Effect of Self- Medicating Drugs Visualizing the Neurotransmitter System Utilize Diagram 4 Times 1) Genetic Deficiencies Imbalance/MI/Trauma 2) Effect of Self- Medicating Drugs 3) Withdrawal & Detox Visualizing the Neurotransmitter System Utilize Diagram 4 Times 1) Genetic Deficiencies Imbalance/MI/Trauma 2) Effect of Self- Medicating Drugs 3) Withdrawal & Detox 4) Stabilization:Add Meds to Correct or Balance the System Address & Analyze Patient Neurochemical Imbalance 1 Genetic Deficiencies, Predispositions in Family -Stress/Mental Illness, Trauma Sources –Psychosocial History, Genogram, Family Drinking Survey. Helpful information with regard to genetic issues – neurotransmitter deficiencies and imbalances. Diagram 1 – Showing the Genetic Ailment • Disposition –Mental status/ emotional mood • Background – Family members DSM-V Neurotransmitter X • Cravings –Past/Present Drug Use Acetylcholine • Sketch diagram/X marks Endocannabanoid neurotransmitter Serotonin • Review notes on possible GABA neurotransmitters out of balance. Glutamate Review research on pubmed.com. Dopamine Noradrenaline Opiate Diagram 1 – Showing the Genetic Ailment • Genetic Predispositions in Family Condition X Alcoholism Bipolar Anxiety Depression X Schizophrenia Drug Addiction Eating Disorders PTSD Other Diagram 1 – Showing the Genetic Ailment • Example - Cocaine Addiction & Depression • Drug of Choice Cocaine. Review research on pubmed.com. • Family Conditions DSM-V Parental Alcohol Addiction X Condition Neurotransmitter Alcoholism Acetylcholine Bipolar Endocannabanoid Anxiety Serotonin 5-HT Depression X 2A Schizophrenia GABA Drug Glutamate ? Addiction Dopamine Eating Disorders Noradrenaline PTSD Other Opiate Address & Analyze Patient Neurochemical Imbalance 2 Drugs/Alcohol affect Neurotransmitter System –to chemically compensate for deficits/excess Alcohol Consumption Record, Substance Use History & Comprehensive Drinker Profile. Verify with Family Members Helpful information regarding understanding patterns of drinking/drug use – Refer to ‘Drug Index’ in book which lists of drugs and their neurochemical/ neurotransmitters agonistic and antagonistic effects. Diagram 2 – Effects of Drug Abuse Example- Cocaine Addiction, Genetically Depressed Patient • Explore findings on Neurotransmitter pubmed.com. How Acetylcholine specific drugs Endocannabanoid [stimulate/inhibit] }Serotonin production of affected neurotransmitters. GABA [slight] • Patient chooses drugs Glutamate D1, D2 Agonist that boost lacking/low Dopamine neurotransmitters. Noradrenaline Opiate Diagram 2 – Effects of Drug Abuse • Example - Cocaine Addiction on Genetically Depressed Patient • How the drug influences original genetic deficiencies • Arrows show if drug influences [stimulates/inhibits] production of affected neurotransmitter. Effect of self-medication. Neurotransmitter Condition X Alcoholism Acetylcholine Bipolar Endocannabanoid Anxiety Serotonin Depression X GABA Schizophrenia [slight] Glutamate Drug Addiction X D1, D2 Agonist Eating Disorders Dopamine PTSD Noradrenaline Other Opiate Diagram 1 & 2 Match-Up Action of Drug –Self Medication produces Desired Effect (Balance) in Diagram 2 cancels out any Deficiencies in Diagram 1. Diagram 2 Diagram 1 Neurotransmitter Acetylcholine Endocannabanoid Serotonin GABA Self-Medication [slight] ? Glutamate } Dopamine D1, D2 Agonist Noradrenaline Opiate Address & Analyze Patient Neurochemical Imbalance 3 Withdrawal/detoxification alters neurotransmitter levels. 1. Pattern parallels/surpasses initial assessment in Genetic Deficiencies. 2. More likely will rebound with Withdrawal/Detox affect. Diagram 3 – Anticipating Effect of Withdrawal on Neurotransmitter Levels • Neurochemical imbalances caused by drugs will lead to withdrawal Effect of withdrawal once cocaine is discontinued. Diagram 3 –Withdrawal • Withdrawal = Brain’s method of up-regulation. • (Returning Brain’s neurochemical balance to original genetic baseline.) • Severe agitation Could signify by negative or minus sign “-” in areas of down arrows. -- Address & Analyze Patient Neurochemical Imbalance 4 Medications balance Neurotransmitter levels. 1. Review medication to block the ‘high’. 2. to lower specific neurotransmitters 3. to raise specific neurotransmitters Diagram 4 – The Treatment Plan After viewing Diagrams 1, 2 & 3; consider how to eliminate craving once the drugs of choice are removed. • Visualize ALL corrective measures. • Show effects of Medications use to correct: 1) Genetic Deficiencies, 2) Drug Abuse, 3) Withdrawal. Diagram 4 –Treatment Diagram All Corrective Measures • Close up –Detail Medication affects to remedy depression & cocaine addiction Neurotransmitter Acetylcholine Endocannabanoid Serotonin Medication – depends on symptoms GABA Glutamate Slowly Dopamine Agonist Noradrenaline Opiate Why Use These Diagrams? • Visualization through diagrams emphasizes which neurotransmitters impact: 1) Drug Use, X 2) Mental Status & Neurotransmitter 3) Neurotransmitter Acetylcholine Endocannabanoid Inadequacies Serotonin 4) Greatly Improve GABA Quality & Outcome Glutamate of Patient TreatmentDopamine 5) Science-Based, Noradrenaline not Intuition Opiate Why Use These Diagrams? • Improve skills in gathering the right Information 1) Genetic Makeup, 2) Desired Drugs Neurotransmitter X 3) Last Use of Drug Acetylcholine 4) Current Feelings Endocannabanoid 5) Level of Craving Serotonin If uncertain, take GABA no action. Instead, Glutamate Gather more Data! Dopamine Noradrenaline Opiate Diagrams – Valuable to Field of Detoxification • Confused? Learn more of neurotransmitter systems • Practice with patients until proficient • Look at drugs in a new way: actions on neurotransmitter sites & chain reaction effects. X Neurotransmitter Acetylcholine Endocannabanoid Serotonin GABA Glutamate Dopamine Noradrenaline Diagram Synopsis 1)Genetic Baseline of Neurochemical Deficiencies – Note the Imbalance! 2)Drugs addicted to & affected Neurotransmitters 3)How Detox alter Neurotransmitter levels 4)Corrective Medications used for a) Safe Withdrawal b) Rids Cravings Neurotransmitter