How Drugs Affect the Brain And Medication‐Assisted Treatment Presented by Carl M. Dawson, M.S., MAC, LPC, Q‐SAP Learning Objectives After completing this section, participants will be able to: • Understand the scientific modalities neuroscientists use when studying addictions (Bio‐Psycho‐Social model of addictions, genetics and neuroplasticity) • Explore basic facts regarding the development and function of the human brain • Identify three “Feel Good” chemicals released by the brain (dopamine, serotonin, norepinephrine) • Discuss how addictive behaviors and drugs routinely “hijack” the human brain How Neuroscientists Study Addiction • All addictions (alcohol, drugs, gambling, porn, video games, food) activate the same neurological pleasure (reward) routes (pathways) in the brain • Addictionology uses the “Bio‐Psycho‐Social” model when studying addictions • Research has identified a strong genetic basis for all addiction behaviors (There is no single “addiction” gene, there are approx. 90 genes associated with addictions) How Neuroscientists Study Addiction • Remember: “Our genetics load the gun, but the environment pulls the trigger” • Addictions aren't only hijacking the brain’s activities but they have the ability to modify the neurological structures and activities of the brain (neuroplasticity) Neuroplasticity: is a term used in the field of neuroscience that defines the brain's ability to adapt, adjust and change based upon the strength and reward of the experience ‐ “Neurons that Fire Together, Wire Together” Donald O. Hebb (1904‐1985) Basic Facts and Regions of the Human Brain The average human brain weighs approximately three (3 lbs.) pounds, consisting of 60% protein (fat), possessing approximately 85 to 110 billion neurons and produces 15 watts of electricity, traveling at a speed of one‐half to 250 miles per hour Approximate Ages of the Human Brain 7,000 7,000 480,000 6 to 10 mil. Addiction occurs in the portion of the brain that is 480,000 years old ‐ REMEMBER: “Age Trumps Youth” The “Reward” routes (pathways) Limbic area The “Feel Good” Chemicals in the Brain We possess approximately sixty (60) neurotransmitters in the human brain and nervous system Here are the Big Three (3): Dopamine (DA): Involved in learning, self‐control, seeking‐searching‐wanting behaviours, cravings, euphoria, pleasure and at extreme levels, symptoms of psychosis Serotonin (5ht): Affects feelings of well‐being, anti‐ anxiety, anti‐depression Norepinephrine (NE): Stimulates the brain’s four “Fs” The frontal cortex tells our primitive brain to “STOP” remember our past, predict the future and consider the consequences Important take‐away points • Addiction is a very complex process that is a combination of our biological (genetics), psychological (learning) and social (environmental) influences • Our brains are designed to adapt and change based upon the strength of the experiences we encounter (neuroplasticity) • Our brains consist of sixty (60%) percent protein (fat). Drugs that are attracted to high concentrations of fat will easily hijack the brain and hold it hostage until it is eliminated by the body (opioids, marijuana) • All addictions following the same neurological route (pathway) in the brain and cause a greater than normal release of the pleasure seeking brain chemical, dopamine (DA) Medication‐Assisted Treatment (MAT) in Opioid Use How drug’s “Hijack” and “Turn‐On” the brain Action Potential: The electrical stimulation of a neuron Propagation: To send forth or spread Affinity: The degree of attraction or desirability “Key into a Lock” Model The key either turns “On” or turns “Off” the receptor Receptor Drug FULL NEUROTRANSMITTERS AGONIST ACTION POTENTIAL RECEPTORS “Full” Agonists • Full agonists will occupy all of the receptors • Full agonists create a Receptor stronger potential than partial agonists • Full agonists act like an “On‐Off” light switch • Full agonists, do not have a ceiling threshold which may result in single drug overdose PARTIAL NEUROTRANSMITTERS AGONIST ACTION POTENTIAL RECEPTORS “Partial” Agonist • Partial agonists are designed to only stimulate a portion of the receptor producing a weaker potential Receptor • Partial agonists act like a light “dimmer” rather than an “On‐Off” switch • Partial agonists produce a “ceiling” limit and won’t permit single drug overdosing Antagonists • Antagonists are designed to block all chemicals (full‐partial agonist) from entering the receptor Receptor • When an antagonist enters into the nervous system they will dislodge and remove any chemical on a receptor site resulting in spontaneous (immediate) drug withdrawal Medication‐Assisted Treatment (MAT) In Opioid Treatment Learning Objectives At the end of this session, participants will be able to: • Understand what makes opioid drugs so desirable • Understand Medication‐Assisted Treatment’s (MAT) three (3) main objectives • Know when Medication‐Assisted Treatment (MAT) is indicated • Explore the four (4) most currently prescribed Medication‐Assisted medications (methadone, buprenorphine, naloxone and naltrexone ) What Makes Opioid Drugs Desirable? • Opioid substances are lipophilic (fat‐ loving), meaning that they infiltrate high protein regions of the body quickly (heroin vs. codeine) • Opioid addicts become addicted to the “RUSH” of pleasure produced by the drug What Makes Opioid Drugs Desirable? • Opioid drugs that produce “LESS OF A RUSH“ are less fat‐loving and are more effective in treating opioid dependence (methadone and buprenorphine) • Opioid overdose can be lethal, either when used alone or with other CNS depressant drugs (1 + 1 = 3) effect • The most common cause of opioid related death is due to respiratory arrest Medication‐Assisted Treatment (MAT) Medication‐Assisted Treatment (MAT), combines the use of medications (methadone, buprenorphine) and behavioral therapy (Cognitive‐Behavioral) to treat substance use disorders The most frequently asked question: “Isn’t Medication‐Assisted Treatment just switching one drug for another?” Three (3) Main Objectives of Medication‐Assisted Treatment (MAT) • First (1ST) Objective: STOP the use of illicit drugs! • Second (2ND) Objective: To help abstain from the use of all mood altering substances including alcohol • Third (3RD) Objective: To eliminate the obstacles that lead to relapse The Benefits of Medication‐ Assisted Treatment • MAT has significantly improved opioid treatment admission and retention rates in the criminal justice population • MAT has been found to have significantly reduced rearrests and reincarceration rates, for probationary and paroled individuals The Benefits of Medication‐ Assisted Treatment • Research shows that the use of methadone and buprenorphine has been highly effective at reducing unauthorized and continuous opioid use • Individuals participating in a MAT protocol can be closely monitored by health care professionals for treatment compliance • Currently, buprenorphine can be dispensed through a physician’s office (OBOT) Medication‐Assisted Treatment Tapering: Progressively reducing the dosage or strength of a drug until the body no longer requires that drug in order to maintain normal functioning Maintenance: Providing a medically supervised alternative substance, for chronically drug dependent individuals who are unable or unwilling to stop using Harm Reduction: Providing a medically supervised alternative substance, aimed at reducing the harmful consequences associated with drug use Methadone “Full‐Opioid Agonists” • Methadone, like all full agonists will occupy the entire opioid receptor, producing a greater Opioid action potential and death from a single drug overdose Receptor • Duration of action is 24 to 72 hours • Dosages between 30 to 40 mg will block withdrawal, not cravings • Dosages of 80 to 100 mg are more effective at reducing opioid use Buprenorphine (Subutex) • Partial agonists are designed to only stimulate a portion of the opioid receptor, producing a lesser action potential and less opportunity for a single drug overdose • Subutex is straight Opioid buprenorphine Receptor • Subutex is less lipophilic than morphine • Dosages range from 8‐32 mg • Duration of action is 24 to 36 hours • Buprenorphine has a “Ceiling” limit at 35 mg Buprenorphine (Suboxone) • Suboxone is buprenorphine and naloxone combined • The addition of naloxone to the buprenorphine will insure that any additional Opioid use of an opioid drug or any attempt to divert the Receptor drug will result in an immediate removal of all opioid substances, including buprenorphine, causing spontaneous drug withdrawal • Dosages from 2mg‐0.5mg, 8mg‐2mg Naloxone (Narcan), Naltrexone (Vivitrol) • Naloxone‐Naltrexone are considered opioid and alcohol antagonists • They are designed to block all opioid and ethanol Opioid chemicals (full‐partial Receptor agonist) from entering the opioid receptor • They will remove any opioid or ethanol chemical occupying an opioid receptor • Naloxone lasts for only 30 to 90 minutes • Naltrexone lasts for 1 day by tablet or 30 days via injection Presentation Review In today’s presentation we covered the following topics: • Reviewed various modalities applied to the science of addiction studies • Explored various regions of the human brain that contribute to addictions • Examined three (3) primary “feel good” chemicals released by the brain Presentation Review In today’s presentation we covered the following topics: • Discussed how all drugs including opioids “hijack” the functions of the brain • Reviewed the three (3) main objectives of Medication‐Assisted Treatment (MAT) • Examined the four (4) MAT drugs currently being used in opioid treatment (methadone, buprenorphine, naloxone, naltrexone) Contact Information: CARL M. DAWSON, M.S., MAC, LPC, Q‐SAP 1320 EAST KINGSLEY SUITE “A” SPRINGFIELD, MISSOURI 65804 E‐mail: ([email protected]).