Recovery Enhancing Meds-Press Ready

RECOVERY-ENHANCING MEDICATIONS IN ADDICTION TREATMENT CHRISTOPHER COOK, B.A., CADC, SAP Founder-Executive Director SperanzaHealth Clinical Partners Project Manager HOPE PROGRAM @ Cove Forge 724-614-6669 [email protected]

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INTRODUCTIONS INTRO’s Everyone Loves Introductions…

OBJECTIVES

! Addiction is a BIO-PSYCH-SOCIAL DISEASE

! To understand the medications, we must pay close attention to the BIOLOGY

! Medication-Assisted Therapy (Maintenance) vs. Recovery-Enhancing Medications: Is there a difference?

! Research and Practice…

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What’s all the fuss about Neuroscience?

!  Neuroscience – definition from dictionary.com - the field ofstudy encompassing the various scientific disciplines dealingwith the structure, development, function, chemistry,pharmacology, and pathology of the nervous system thateffect the brain.

!   Every thought, sensation, emotion, physical movement isaccounted for in terms of brain structures and chemistry.

!   In other words… nothing happens in human behaviorexcept by the mechanisms of the brain.

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Is it really a Disease?

!   Disease of the brain.!   >33% of Public believes it is simply willpower…HOW

ABOUT CLINICIANS?

!   Compared to:!   Type 2 Diabetes, Chronic hypertensive disease, Asthma,

Obesity

!   No one treatment episode will resolve illness…hence 12Steps, Other social supports

!   Course of dependency is multiple episodes of treatment,recovery activities, relapse periods.

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Does this matter to what you do?

THERAPY…

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Application “The longer you’re in treatment…” !   Research has shown unequivocally that good outcomes

are contingent on adequate treatment length.

!   Generally, for residential or outpatient treatment,participation for less than 90 days is of limitedeffectiveness, and treatment lasting significantly longeris recommended for maintaining positive outcomes.

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Therefore…

! Understanding how thebrain functions duringand after drug use,encourages practitionersto correlate appropriatestrategies to the stage ofrecovery andconsequently impact onprogram retention.

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Biology of Addiction Neurotransmitters and drugs of abuse

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Neurotransmitters

!   Several Involved in Addiction !   Serotonin

!   Dopamine

!   Endorphins

!   GABA1

!   Glutamate (NMDA)

!   Norepinephrine (Adrenaline)

!   Cannabinoids

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Neurotransmitters…what do they do?

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The importance of dopamine…

Dopamine

!   D2 receptor changes associated with addiction in people and animals

!   Drugs of Abuse cause 5x to 10x increase…

!   Chronic exposure to stimulants, opioids or alcohol leads to decreased dopamine activity !   Decreased sensitivity to everyday rewards

!   How does this affect psychotherapy?

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The importance of Glutamate

!   Memory Formation

!   New pharmacological + psychological therapy?

!   Glutamate + Dopamine Directly influence the formation of new memories… !   How does this affect the addict?

Biology of Addiction MICRO-VIEW

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The synapse up close…

The Action of Opioids (Morphine)

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Opioids…

The Action of Cocaine

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Ways Chemicals “Act” in the Brain

Drugs of Abuse act…

!   Increasing Presence of Neurotransmitters by reducing uptake or forcing release (Cocaine, SSRI’s/SNRI’s, Amphetamines…)

!   Mimicking Neurotransmitters (Opioids, Cannabinoids…)

Differences…

!   Agonists (opioids)

!   Antagonists (naltrexone, naloxone, flumazenil)

!   Partial Agonists (Buprenorphine, Talwin)

!   Efficacy

!   Affinity

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Biology of Addiction MACRO-VIEW

Why do they act that way?

Phineus Gage*

Phineus Gage

!   After the accident: Personality Change !   Rude

!   Sexually inappropriate

!   Poor impulse control

Neurotoxicity Methamphetamine

Neuroscience of Addiction Day 2

The Brain in “Recovery”

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