Booze, Brains, and Behavior: The Psychopharmacology of Alcohol and Other Drug Use
Terrence D. Walton, MSW, CSACDirector of Treatment
Pretrial Services Agency for the District of Columbia
Any substance that is consumed in order to
alter mood, perception, and/or brain functioning
Areas of Concern
Intoxication
Damage Withdrawal
Alcohol and Drug Use and Pretrial Services
Assessing Risk and Needs Recommending Release Conditions Returning to Court Supervision Compliance Pretrial Success or Failure
Mood Altering Chemicals: An
Overview
Mood Altering Chemicals
1. Legal & Illicit 2. Street Drugs and
Prescribed Drugs3. Hard Drugs & Soft
Drugs4. Very Addictive &
Less-Addictive5. Natural and
Synthetic
1. Stimulants2. Depressants3. Opioids4. Cannabinols5. Hallucinogens/
Dissociatives6. Inhalants/
Deliriants/Other
Important Factors
Bottle to Blood to Brain Route of Administration:
Smoke Sniff Snort Shoot Swallow
The Blood Brain Barrier Neurocompatibility
Abuse Potential Factors1. Power (brain impact)
2. Popularity (acceptability)
3. Presence (accessibility)
4. Pay off (onset & intensity)
5. Persistence (length of high)
6. Patterns (of use)
7. Penalty (onset & intensity)
Two Big Questions Why do people do drugs?
Why can’t some people stop?
Use
Pleasure
Stimulation
Escape
Relief
Why Some Can’t Stop
1. Physiological Dependence
2. Psychological Dependence
Addiction
A medical condition characterized by impairment within both the brain’s reward
and executive functions centers and resulting in compulsive, repetitive, self-destructive
substance use
Exploring Physiological Dependence
Another Big Question
What’s happening in the brain and body to cause this?
The Rebound Effect
Withdrawal The brain adapts to the effects
of substance use by over-releasing chemicals that
produce the opposite effect. If the use stops abruptly, the over release of opposing chemicals continues for a period of time
causing withdrawal symptoms.
Tolerance Neuro-adaption (tolerance) occurs when neurons become less sensitive to the presence of a depressant or
opiate as a result of the brain’s attempt to return to normal. For
instance, in response to the presence of alcohol the brain may reduce the
number of receptors available to detect alcohol.
Sensitization Neuro-sensitization occurs when neurons become more sensitive to the presence of a stimulant. As a result, the neurons will only fully
activate when the current reward is expected to be greater than the
average of previous rewards (“reward prediction error”)
Exploring Psychological Dependence
To Cope with Life
A Final Big Question
What’s happening in the brain to cause
psychological dependence?
Addiction
& the Brain
Neurochemistry: The Basics
Addiction is a Brain Disease
Any use causes acute and temporary changes and
prolong use changes the brain in fundamental, destructive
and long lasting ways
How the Brain Works:Neurons &
Neurotransmitters Involved in all physical/emotional/
cognitive function Metabolism, muscle movement,
reflex Mood, reactivity, emotions Cognition, memory, etc.
Neuronal Receptor Activity
Affinity Activation
Natural Rewards
FOODWATER
SEXNURTURING
ACCOMPLISHMENT
Medial Forebrain Bundle
VentralTegmental Area
Nucleus Accumbens
Prefrontal Cortex
Brain Effects from Chronic Substance
Abuse
Un-Natural Rewards
How Drugs Work
Interact with neurochemistry
Results:Feel Good – euphoria/reward
Feel Better – reduce negative feelings
Drug-Interacting Neurotransmitters
Dopamine – excitement & reward
Serotonin – feel – “normal” Endorphin/Enkephalin –
pain relief, reward, craving GABA – lowers anxiety
ABOUTDOPAMINE
TONE
1. Amount of dopamine produced
2. Length of time dopamine is available
3. Number of dopamine receptors
Behavior Pathways Rewarding behaviors can become
routine Obsessive, preoccupation, compulsion “Subconscious” control of the
behavior Difficult to extinguish behaviors Resistant to change
Brain Command Center
DELAY DISCOUNTING
DEMAND ELASTICITY
Effective Treatment
CognitiveBehavioral Treatment
MotivationEnhance-ment
Relapse Prevention
MedicationAssisted
Treatment
Co-OccurringDisorders
Related Pretrial Release Conditions
Report to court Avoid criminal activity Maintain employment Maintain residence Stay away from person or place Report to pretrial agency in person or by
phone Drug testing Avoid alcohol and illicit drug use Participate in treatment as directed by …
THE BRAIN AND RECOVERY
Booze, Brains, and Behavior: The Psychopharmacology of Alcohol and Other Drug Use
TerrenceDwalton@ gmail.com