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From Poppies to Powerlessness:an addiction materia medica

Lydia Anne M Bartholow, PMHNP

Disclosures

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Disclosures

Who the heck am I?

• PMHNP

• Doctorate in addictions (by next fall?)

• Studier of herbalism for 10+ years

• Teacher of herbalism for 3ish years

• Lived experience in addictions

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Agenda

• Understanding addiction: 101

• Conceptualizations of addiction

• Safety first: withdrawal

• Herbal materia medica for addictions

• Allopathic medications for addictions

• Understanding addiction: 101

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Tissue Dependence vs. Addiction

Tissue Dependence Addiction

Experiences withdrawals Loss of control

Experiences tolerance Shift in Mazlo’s hierarchy

Engages dopamanergicpathways

(usually) experiences withdrawals

(usually) experiences tolerance

Tissue Dependence vs. Addiction

Tissue Dependence Addiction

Experiences withdrawals Loss of control

Experiences tolerance Shift in Mazlo’s hierarchy

Engages dopamanergicpathways

(usually) experiences withdrawals

(usually) experiences tolerance

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Tissue Dependence vs. Addiction

Tissue Dependence Addiction

Experiences withdrawals Loss of control

Experiences tolerance Shift in Mazlo’s hierarchy

Engages dopaminergic pathways

(usually) experiences withdrawals

(usually) experiences tolerance

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Tissue Dependence vs. Addiction

Tissue Dependence Addiction

Experiences withdrawals Loss of control

Experiences tolerance Shift in Mazlo’s hierarchy

Engages dopamanergicpathways

(usually) experiences withdrawals

(usually) experiences tolerance

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Dopamine & the NAC

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11/12/2010 15

From Solomon RL, American Psychologist, 1980, 35: 691-712

Positive Hedonic Effects Negative Hedonic Effects

of Withdrawal

Dopamine

Opioid Peptides

Serotonin

GABA

Dopamine – “dysphoria”

Opioid peptides – pain

Serotonin – “dysphoria”

GABA – anxiety, panic attacks

Reward Transmitters Implicated in the Motivational Effects of Drugs of Abuse

Koob, CSAM Addiction Medicine Review Course, 2012

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17

Anti-Reward Transmitters

These are ACTIVATED in amygdala and ventral striatum

during withdrawal

Dynorphin – “dysphoria”

CRF -- stress

Norepinephrine -- stress

Anti-Reward Transmitters Implicated in the Motivation Effects of Drugs of Abuse

Koob, CSAM Addiction Medicine Review Course, 2012

11/12/2010 18

CNS Actions of Corticotropin Releasing Factor (CRF)

Koob, CSAM Addiction Medicine Review Course, 2012

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19

Escalation of Drug Intake

Prefrontal Cortex Abnormalities/Hypofunction

Impairment of Executive Function

Initial Intake

Neuron/oligodendrocyteDeath

Koob, CSAM Addiction Medicine Review Course, 2012

Loss of Control Over Intake – Self- Medication

• Safety first: withdrawal

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Withdrawing from…

• Opiates (Prescription & Heroin)

Withdrawing from…

• Opiates (Prescription & Heroin)

• Benzodiazapines

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Withdrawing from…

• Opiates (Prescription & Heroin)

• Benzodiazapines

• Alcohol

Withdrawing from…

• Opiates (Prescription & Heroin)

• Benzodiazapines

• Alcohol

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Withdrawing from…

• Opiates (Prescription & Heroin)

• Benzodiazapines

• Alcohol

• Stimulants

• Herbal materia medica for addictions

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• Herbal materia medica for addictions

Skullcap

• Scutteleria laterifolia

• Mint family

• Neurotrophic/Nervine

• Gabanergic

• HPA Axis “shifter”

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Passionflower

• Passiflora sp. –P. Incarnata

• Passionflower family

• Nervine

• Gabanergic

• Specific for CNS suppresantwithdrawal

Oats

• Avena sp–A. sativa

–A. fatua• Poacea // Grass

• Neurotrophic

• Addresses adrenal over-resourced

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Vitex

• Vitex agnus-castus• Lamiacea

• U-receptor agonist

• Dopaminergic

Milk Thistle

• Silybum marianum• Asteraceae

• Liver detox• Liver reconstruction• Blood sugar balancing?

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Ashwaghanda

• Withania somnifera• Solanaceae

• Adaptogen

• CNS suppressant

withdrawal

• Cravings?

California Poppy

• Eschscholzia californica

• Papaveraceae

• Gabanergic

• Nervine

• U-receptor agonist?

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Lobelia

• Lobelia inflata

• Lamiaceae

• Nicotinic agonist? Not!

• Parasympathomemetic?

Licorice

• Glycyrrhiza glabra• Fabaceae

• Support for over-resourced

adrenals

• GI Repair and rebuilding

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37

Medication Assisted Treatment

–Buprenorphine, methadone

–Naltrexone, Acamprosate, Antabuse

–Gabapentin, Flexeril

–Buproprion, stimulants

–N-acetylcysteine

Reward

Executive function

Inhibitory control

Memory/Learning

Motivation/Drive

Targeting Brain Circuits Involved in Addiction

38

Medication Assisted Treatment

–Buprenorphine, methadone

–Naltrexone, Acamprosate, Antabuse

–Gabapentin, Flexeril

–Buproprion, stimulants

–N-acetylcysteine

Reward

Executive function

Inhibitory control

Memory/Learning

Motivation/Drive

Targeting Brain Circuits Involved in Addiction

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39

Medication Assisted Treatment

–Buprenorphine, methadone

–Naltrexone, Acamprosate, Antabuse

–Gabapentin, Flexeril

–Buproprion, stimulants

–N-acetylcysteine

Reward

Executive function

Inhibitory control

Memory/Learning

Motivation/Drive

Targeting Brain Circuits Involved in Addiction

40

Medication Assisted Treatment

–Buprenorphine, methadone

–Naltrexone, Acamprosate, Antabuse

–Gabapentin, Flexeril

–Buproprion, stimulants

–N-acetylcysteine

Reward

Executive function

Inhibitory control

Memory/Learning

Motivation/Drive

Targeting Brain Circuits Involved in Addiction

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41

Medication Assisted Treatment

–Buprenorphine, methadone

–Naltrexone, Acamprosate, Antabuse

–Gabapentin, Flexeril

–Buproprion, stimulants

–N-acetylcysteine

Reward

Executive function

Inhibitory control

Memory/Learning

Motivation/Drive

Targeting Brain Circuits Involved in Addiction

Thanks!

Want references or just to say hi?

www.lydiabartholow.com