Addiction A Match Between Lived Experience - PowerPoint Presentation

1. AddictionA Match Between Lived ExperienceAndNeuroscience

2. AddictionWhat does neuroscience tell us?There are three areas implicated in addictionThe Basal Ganglia: involved in Binge/IntoxicationThe Extended Amygdala: involved in Withdrawal/Negative AffectThe Prefrontal Cortex: involved in Preoccupation/AnticipationFrom: Finding Addiction in America: The Surgeon General’s Report on Alcohol Drugs and Health U.S. Department of Health and Human Services 2016

3. The Addicted Brain

4. The Basal GangliaBinge/Intoxication1) Initial use may begin with a moment of impulsivity, the person tries the substance2) Continued use depends on the effect of the substance on the personThe experience is pleasurable and so the use is positively reinforcedThe experience removes something dis-pleasurable and so the use is negatively reinforced

5. Positive ReinforcementCould come directly from the effects of the drug:The drug experience is enjoyableCould come from other consequences of the drug use such as:acceptance from a peer groupBeing with others

6. Negative ReinforcementCould come directly from the effects of the drugRelief from painful emotional experiences such as Stress, Anxiety, or DepressionCould come from other consequences of drug use such as:Relief from social isolationRelief from feelings of being different

7. Addiction Hijacks the Brain’s Reward SystemThe Brain’s reward system rewards eating and sex which ensures the survival of the species through the release of Dopamine which provides us with a sense of pleasureAll drugs of abuse effect this system by prompting the release of DopamineThe brain then equates these drugs with survival

8. The Reward SystemDrugs and alcohol activate this systemStimuli associated with drugs or alcohol use also activate this systemThese stimuli become triggers or cues to use and promote substance seeking and substance useThe triggers themselves cause a release of Dopamine which increases the desire to seek the drug

9. Habit Formation and CompulsivityThe release of Dopamine is reduced in people taking drugs or alcoholThe desire for the release of dopamine causes habit formation, because the habit of using is reinforced by the release of dopamineThe habit eventually leads to compulsion to avoid the negative consequences of not using which is the reduced release of dopamine

10. The Extended AmygdalaWithdrawal/Negative AffectThe Brain’s Stress SystemWhen activated it produces:Corticotrophin Releasing Factor (CRF)NorepinephrineDynorphinThese produce:DepressionAnxietyIrritability

11. Tolerance and WithdrawalTolerance: Drug and alcohol use effects on dopamine diminish over time and more is required to achieve the same effectWhen drugs or alcohol are not taken there is little release of dopamine and the person experiences Anxiety, Depression and Irritability because the stress system is activated

12. The TrapNegative feelings that accompany withdrawal strongly motivate continued substance useTaking substances relieves the negative feelings of withdrawalWithdrawal symptoms increase over time

13. The Prefrontal CortexPreoccupation /AnticipationControls our Executive FunctioningThe ability to organize thoughts and activitiesPrioritize tasks, manage time, make decisionsRegulate one’s actions, emotions and impulses

14. The Go System/The Stop SystemThe Go System: is often used to engage in behaviors that help us achieve goalsActivity here increases the urge to repeat the behaviors that are pleasurableIncreases dramatically in the presence of substance related triggers or cuesIncreases the habit response system so that behaviors become automatic and subconscious

15. The Go System/The Stop SystemThe Stop System: Inhibits the activity of the Go SystemControls habit responsesReduces the ability of triggers or cues to produce relapseControls the brain’s stress and emotional system

16. The ProblemPeople with substance abuse disorders have impairments in executive functioningThey have increased activity in the Go SystemThey have decreased activity in the Stop SystemPeople with substance abuse disorders and people with PTSD have smaller volume in the Prefrontal Cortex

17. Factors that contribute to and affect the development of addictionGeneticsMental HealthTrauma History (ACE Studies)PersonalitySocial SupportSense of SelfConnection to OthersResiliencyAge of use, length of use, poly-drug useAttachment historyPrevious head injury or a compromised brain

18. Other IssuesAdolescents have greater risks associated with use because they have an undeveloped prefrontal cortexHeavy use can affect the development of their brainsThose who have more severe long term use may have had pre-existing differences in the volume of their prefrontal cortexCo-Occurring mental health issues are common in people with Substance abuse disorders particularly PTSD

19. The ACE Studies Vincent J Felitti 200317,000 people participatedAdverse Events:1. recurrent physical abuse2. recurrent emotional abuse3. contact sexual abuse4. alcohol and/or drug abuse in household5. incarcerated household member6. family member chronically depressed, mentally ill or suicidal7. mother treated violently8. one or no parents9. physical neglect10. emotional neglect

20. ACE Studies Conclusions: Resulting Health Risks1. Cardiovascular disease2. Cancer3. Heart Attacks4. High Blood Pressure5. Stroke6. Diabetes7. Weight Gain8. Exhaustion9. Reduced Growth Hormone Levels10. Compromised Immune Function11. Bone Loss12. Addiction13. Mental illness

21. The Importance of The Ace StudyUnhealthy ways of coping with childhood adversity

22. The ACE Trajectory

23. ACE Scores and Addiction

24. The Alberta Family Wellness InitiativeThe Brain Story:1. The brain’s early development is affected by experience2. Good Mothering buffers the effects of stress3. Excessive early life stress affects the brain’s development4. Long exposure to stress damages the brain and increases risk of a range of physical and mental disorders5. Early life stress is associated with reduction in volume of hippocampus and the prefrontal cortex6. Both of these are involved in managing the stress response7. When the stress response stays on, stress hormones cause damage8. Unhealthy behaviors are engaged in as a response to long term Stress9. Acute stress has direct effects on the body

25. The Brain Core StoryBrain ArchitectureThe experiences we have in the first years of our lives affect the physical architecture of the developing brainBecause brains are built in stages with more complex structures built on simpler structures the early years are importantGood Brain Development is facilitated by exposing children to positive nurturing interactions at a young age

26. The Brain Core StoryServe and ReturnServe and return interactions with children build a solid brain foundationThis is done through the various forms of communication that pass back and forth between parents and their childrenThese interactions are the bricks that build a healthy foundation for all future developmentThey are crucial for a young person’s developing years

27. The Brain Core StoryToxic StressStress is one factor that shapes Brain Architecture in the developing childTraumatic events experienced without supportive caregivers subject children to toxic stressExamples of toxic stress include abuse, neglect, parental addiction, violence or chaotic environmentsEarly exposure disrupts brain development and leaves children at risk for physical and mental health issues

28. The Brain Core StoryAir Traffic ControlExecutive Functions such as integrated cognitive, social and emotional skills require strong brain architectureThe child’s brain acts like a control tower allowing them to pay attention, plan ahead, deal with conflicts and follow rulesStrong skills in this area help children regulate the flow of information, prioritize, and find ways to manage stress

29. The Brain Core StoryResilienceThis is the ability to stay healthy in the presence of severe stressIt requires a strong foundation built into the brain architecture and through air traffic control skillsWhen toxic stress experiences outweigh positive supports, negative life outcomes can resultResilience can be built at any stage of life but it is easiest to build in early childhood

30. Effects of Acute Stress Increased Blood Glucose > Excessive insulin secretion, Type 11 DiabetesIncreased Blood Pressure > Hypertension, coronary heart diseaseModulation of immune system> Vulnerability to inflammatory diseases, Asthma, ArthritisReduced Motivation for rewarding stimuli > loss of interest, depressionVigilance and arousal > Hyperarousal and anxiety disordersConsolidation of aversive memories > Preponderance of aversive memories, PTSD