Addiction: A Chronic Brain Disease PowerPoint Presentation

Addiction:  A Chronic Brain Disease PowerPoint Presentation

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Flora Sadri, DO,MPH, FAAFP. Area Medical Director, . CleanSlate. Centers. Kentucky Academy of Family Physicians. August 4, 2017. Flora Sadri, DO, MPH, FAAFP. Area Medical Director, . CleanSlate.  Centers. ID: 652320

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Presentations text content in Addiction: A Chronic Brain Disease

Slide1

Addiction: A Chronic Brain Disease

Flora Sadri, DO,MPH, FAAFP

Area Medical Director,

CleanSlate

Centers

Kentucky Academy of Family Physicians

August 4, 2017

Slide2

Flora Sadri, DO, MPH, FAAFP

Area Medical Director, 

CleanSlate

 Centers

President, Massachusetts Academy of Family Physicians

Chair, Commission on Government and Advocacy, American Academy of Family Physicians (AAFP)

Vice Chair, Legislative Advocacy Committee, American Society of Addiction Medicine (ASAM)

Slide3

ASAM’s Definition of Addiction

 

Addiction is a

primary, chronic disease of brain reward, motivation, memory and related circuitry

. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.

O reward and/or relief by substance use and other behaviors.

Slide4

Addiction: Changes in the Brain

A

chronic, relapsing brain disease

Drugs change brain structure and function

Brain changes can be long-lasting 

Slide5

Addiction is a chronic brain disease

Federal government: (Surgeon General, NIDA, SAMHSA, NIAAA)

Physician Organizations: (AMA, ASAM,

etc

)

NOTE:

not everyone with a substance use disorder has the disease of addiction

not everyone who appears drug seeking/doctor shopping has the disease of addiction

not everyone who uses illicit drugs has the disease of addiction, or a substance use disorder – how do you

kow

it when you see it?

Slide6

American Society of Addiction Medicine (ASAM) Addiction Definition, April 2011

American Society of Addiction Medicine (ASAM) Addiction Definition, April 2011

Affects neurotransmission such that addictive behaviors replace healthy self-care related behaviors

Genetics account for 50% of addiction development

Significant self-deception

Disruption of healthy supports and problems in interpersonal relationships

History of trauma or stressors that overwhelm an individual’s coping abilities

The presence of co-occurring psychiatric illness

Distortion in meaning, purpose and values that guide attitudes, thinking and behavior

The effects to the brain allow external cues to trigger craving and drug use

Persistent risk of and/or recurrence of relapse

Impaired executive function so that perception, learning, impulse control., compulsivity and judgment are impaired.

Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry

Slide7

SUBSTANCE USE DISORDER (SUD)

Symptoms are in four major categories 

Impaired control

Social impairment 

Risky use

Tolerance and withdrawal

Slide8

4 C’s of Addiction

C

ompulsive

Use

C

ontinued Use Despite Harm

Loss of

C

ontrol

C

ravings

Slide9

Risk factors for developing addiction

We can impact 2 out of 3

And lack of exposure to the substance means the brain will not develop addiction to the substance

Slide10

Slide11

Genetics Account for 50% of

Risk of Addiction

Slide12

Emotional

neglect

Abuse

Adverse

childhood

experiences

Household

dysfunction

Adverse Childhood Experiences

Emotional Neglect

Abuse

Household Dysfunction

Slide13

Risk factors for developing addiction

We can impact 2 out of 3:

Early exposure

 (community based resiliency training)

Traumatic childhood due to abuse/neglect/missing parenting

(treating adults with addiction helps prevent their kids from being addicted)

And Iatrogenic Addiction can be prevented:

Lack of any brain exposure prevents the brain's addiction to the substance

The minority of overdose deaths are under age 25. This is an epidemic impacting middle aged and older adults

Slide14

Slide15

Act First, Think Later

More Risky

Impulsive Behavior

Less than Optimal Planning

Preference for Physical Activity and Sensation Seeking

Emotions Felt Very Intensely

Strongly Influenced by Friends and Peers

Less Consideration of Negative Consequences

This is Normal Development

Slide16

Slide17

Rate of Change

Brain Development

Source:

Tapert & Schweinsburg, 2005

Slide18

Dopamine Receptors

Slide19

Slide20

Synaptic Refinement

Slide21

Slide22

Myelination

Slide23

Slide24

Slide25

Slide26

Dopamine Pathways

Serotonin Pathways

Functions

Reward (motivation)

Pleasure, euphoria

Motor function (fine tuning)

Compulsion

Perseveration

Functions

Mood

Memory processing

Sleep

Cognition

Slide27

Addiction is a Developmental Pediatric Disease

Source: NIAAA National Epidemiologic Survey on Alcohol and Related Conditions, 2003

Slide28

Slide29

How Heroin Works

Slide30

Slide31

Slide32

Slide33

Slide34

Slide35

Opioid Addiction: A Chronic Brain Disease

Goals of treating chronic conditions: 

Decrease related morbidity and mortality;

 decrease total cost of care

 increase functioning / quality of life

Slide36

Drug Dependence is a Chronic Medical Illness

Diabetes Type I – 60% Medical Adherence

HTN – Less than 40% Adherence

Asthma – Less than 40% Adherence

Drug Abuse – 40% - 60% Adherence

Slide37

Addiction as a Chronic Disease

McLellan AT, Lewis DC, O’Brien CP,

Kleber

HD. Drug dependence, a chronic medical illness: Implications for treatment, insurance, and outcomes evaluation. JAMA. 2000

oct

; 284(13): I168-95.

Addiction

Hypertension

30-60% Genetic

25-50% Genetic

40-60% Relapse

50-70% Relapse

Initial

choices: alcohol/drug

Initial choices: food, activityPotential permanent physiological changesPotential permanent physiological changesAbstinence and medications do not reverse diseaseLifestyle changes and medications do not reverse disease< 50% adhere to drug abstinence 1 year post-treatment< 40% adhere to medication, 30% adhere to lifestyle changes

Slide38

FACT OR FICTION

ADDICTION IS A CHOICE?

Slide39

FACT OR FICTION

ADDICTION IS A CHOICE

FALSE

ADDICTION IS A DISEASE

Slide40

Chronic Relapsing Brain Disease

Treat the condition like DM, HTN, CAD, CVD

Long-term abstinence without MAT

 <5%

Key elements: empathy, compassion and knowledge

We are passionate about this work because it is the right thing to do for patients and their families 

ASAM/ABAM continuing education and mentoring 

Slide41

FACT OR FICTION

PEOPLE USE BECAUSE THEY JUST WANT TO GET HIGH?

Slide42

FACT OR FICTION

PEOPLE USE BECAUSE THEY JUST WANT TO GET HIGH

FALSE

Slide43

FACT OR FICTION

TAKING SUBOXONE OR METHADONE IS JUST SUBSTITUTING ONE DRUG FOR ANOTHER

?

FALSE!

Slide44

FACT OR FICTION

FACT

Methadone or Suboxone are the primary treatments associated with decreased opioid addiction related mortality, morbidity, cost of care, and improved functioning.

Slide45

RATIONALE FOR MEDICATIONS in ADDICTION TREATMENT (MAT)

Consistent with understanding that Addiction is a Chronic Disease, Maintenance Treatment works! 

REDUCES CRAVINGS 

DECREASES WITHDRAWAL SYMPTOMS

BLOCKS EUPHORIA FROM OPIATES 

DECREASES OPIATE USE 

Detoxification is not effective

Inpatient care without ongoing medication leads to increased death risk

Long-term abstinence without MAT

 <5%

Slide46

FACT OR FICTION

ADDICTS CAN JUST STOP USING IF THEY WANT TO?

“JUST SAY NO”

Slide47

FACT OR FICTION

ADDICTS CAN JUST STOP USING IF THEY WANT TO

“JUST SAY NO”

IT’S NOT THAT EASY

Slide48

Slide49

49

Slide50

This is Addiction

Slide51


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