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CHANGING YOUR MINDRevised 3-26-2012 VRHS Adaptation

An introduction to Chemical Dependency and Substance Use Disorders

Robert Carini

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Goals of Training

Examine the concept of addictions as mental disorder caused by chronic exposure to mood altering drugs.

Discuss the prevalence of Substance Use Disorders and their impact on personal health and society.

To enable each student to make a more informed decision with regard to a personal policy around mind altering drugs.

Life Lessons ‘We can deny the truth, but we will not be

able to avoid the consequences of the truth.’ People can only hear what they are ready to

hear. We only get to write one story with our lives. Decisions have consequences. You can’t get true joy out of a false life.

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“A disease of young people”

“…the brain [executive function/ prefrontal cortex] is under construction in the teen years…[allowing for] characteristic adolescent behavior…risk taking and the attraction to potentially dangerous situations, including drug and alcohol experimentation.”pg. 87 HBO Addiction, Hoffman and Froemke

“[Adolescents are] Not protected in the same way as an adult brain is by more matured consequential reasoning and brain development”. Ibid

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Substance Abuse in America (regional/ changes over time)-opiates-valium-’crack’ cocaine-methamphetamine-opioids

“We’re 4% of the world’s population but consume more than ½ of the worlds mood altering and pain killing pharmaceuticals and 2/3’s of the world’s illegal drugs.” personal-familial-societal-national-global implications; Califano, High Society pg 9

On any given day 100 million Americans are taking some stimulant, antidepressant, tranquillizer or painkiller; smoking; inhaling from aerosol cans or glue bottles; or self medicating with alcohol or illegal substances like marijuana, cocaine, heroin, methamphetamines, hallucinogens, Ecstasy, and other designer drugs.” Califano, High Society, page 1

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ADDICTION IS BIG BUSINESS: Youth are the target “Before graduating high school every American child will be offered the opportunity

to smoke, drink, get drunk, and get high on inhalants, marijuana, or other illegal of prescription drugs. Most…will get such offers many times, from classmates, friends, or older siblings, usually beginning in middle school. The choice these kids make may be the most important decision of their lives.

Why? Because a child who gets through age twenty-one without smoking, using illegal drugs, or abusing alcohol is virtually certain never to do so.”

(Why parents are so fearful during this time.)

All the drug pushers- from illegal street dealers and Columbian cartel bosses…tobacco and alcohol industry executives know this. They’ve known for decades how important it is to persuade kids to try their stuff” HIGH SOCIETY pg 37-8 (This is their window of opportunity.)

…2/3 of patients entering treatment were abusing illegal drugs in their teens…9 out of 10 smokers hooked before 21…Teen drinking is the number one feeder of adult alcoholism, and children who start to drink before age fifteen are four times likelier than those who don’t drink before age 21.—abuse of controlled prescription drugs tripled…etc. etc. etc . etc.

The Decision- Choosing your personal policy around drug use

The decision to use or not use a drug on a regular basis is one of the most important and life defining decisions a person will ever make, and it is frequently made in youth, or without any real consideration or conception of the possible consequences.

(This single decision for countless thousands of people translates over time into future lung cancer, divorce, criminality , mental illness, addiction/ psychological/ developmental problems with children, or death, depending on the drug(s) and circumstances.Each drug carries it’s own constellation of consequences.) legal? Illegal/ addiction potential/ physical effects on body and mental health/ side effects /route of administration? etc.

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Why factual Information and ‘Just say no’ doesn’t work with youth

Social/ Personal Influences off-set/out weigh logical/consequential decision making and factual information when choosing to use drugs. (Notional assent- but not acted on)

No sense of immediacy- a sense of exclusion-invulnerability-illusion of control

Adolescence; a time of exploration/ discovery ; secretly exploring drugs/sex/self/etc

Individuation (projecting a persona)-risk taking. Desire for maturity/ sophistication/ independence

Experimenting with mood altering substances/ adult vices is seen as natural part of the maturation process. Can be catastrophic/ fatal.

Peer influence/ Desire for Social inclusion/popularity/ Desirability-relationships- intimacy (many women introduced to drugs by

males in relationships)

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The Addicted Life is:

The wasted life The frustrated life The disoriented life The tragic life

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Definitions

Drug (medicinal use)Therapeutic chemical designed to have maximal benefit with minimal risk of

side effects or toxicity. For person prescribed, in doses, intervals as described. ANY OTHER USE IS SA

Drug Use (recreational) Any substance with psychoactive properties that is taken to artificially change feelings and mood, ( i.e. nicotine, caffeine, alcohol, narcotics,, designer drugs, abused prescribed drugs, etc.) ABUSE/ADDICTION can result from either type of use.

Psychoactive Drug Chemical that changes mood, cognition, behavior or emotions by changing the functioning of the brain. (All substances of abuse are psychoactive, capable of ‘spiking reward’ in the brain)

ToleranceThe need to use more of a drug over time to produce the same effects. This

occurs as a result of neuro-adaptation in the brain due to it’s repeated/ chronic exposure to the drug. A change in brain sensitivity to the drug.

The Goal is the “High” All drugs of abuse do one thing and one thing

only. They artificially (endogenous) ‘spike’ reward neurotransmitters in the brain.

They force the brain to feel good when nothing good is happening.(exogenous) Disrupts the stasis in the brain.

Can produce life altering side effects. Accidents, overdose, SUD development, “rewiring the brain for drug presence as new normality” Mental Health problems. “Chasing the Dragon,” 11

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An old saying…….

“First the Man takes a drink. free choice

Then the drink takes a drink. drug effected

Then the drink takes the man.sud

Father Martin in ‘Chalk Talk’

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FOOLING AROUND

GETTING HOOKED(Bio behavioral change)

HITTING BOTTOM(pain of continued use begins to outweigh the compulsion to continue / consequences) names from the Dishonest Brain, Dupont

Freedom of Choice—Non-attachment

1. NON-USE; ABSTINENCE

2. EXPERIMENTATIONCuriosity?

Peer Pressure?Cultural Norm?

3. USE – Occasional / FrequentCan be a life changing decision –The unseen turning point in a person’s life.

4. ABUSE – Behavioral Problemresponds to coercion, education and decreased availability.real or potential negative consequencesunder-functioning as a result of userisk takingcan stop with enough external leverage

5. ADDICTION- use becomes involuntarytolerance buildsformation of denial systemdishonesty/ development of ‘secret’life’lies and evasions to continue usesubconscious liesobsessional / entrapping thoughts of usingincurable (but treatable)mental disorderbio-behavioral changealteration to identityseizure of motivational hierarchy in service of the drugit is now the person’s nature to usebrain has altered to a new normality- the presence of the drugbrain change increases as use continuesAddiction/Compulsive

Use

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Factors in addiction Formation

The Drug (drugs) Used(1.Mechanism of action on brain. 2.Sites of action in brain – dictate degree of neurotoxicity and structural change, level of reward dopamine projection from VTA to nucleus accumbens, ‘high’ varies from drug to drug)

The Route of Administration (inhaled, oral, intravenous, transdermal, smoked, suppository, sub-cutaneous injection, etc.)

Age use began. (strongly impacts human development and engagement with world/ can result in developmental deficits)

How long it has been used. (Brain change continues until use stops. (may have long term/ permanent effects)

Idiosyncratic factors, neuro-biologic, bio-genetic, mental health issues, social-behavioral, resiliency, etc.

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NeurotransmittersAll FEELINGS, EMOTIONS, thoughts, moods, memories ARE

MEDIATED BY MEANS OF NEURTOTRANSMITTERS. (Biochemical substrate of emotions- imbalances cause many mental disorders, including SUD)

Of the many neuro-transmitters identified, a small number have been linked to the endogenous REWARD system (allow positive feelings or emotions, any pleasurable activity the arts, exercise, intimacy, learning, accomplishment, nature, friendship, etc. etc.). DOPAMINE/ SEROTONIN are released

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“Crossing the Line” Drug ‘spikes’ reward neurotransmitters. Action potential is increased.

Drug induced ‘High’ is followed by Dysphoria (‘crash’- symptoms opposite of high) BRAIN DOES NOT RETURN TO NORMAL, but feels a ‘let down’. Sets up increased desire for another ‘high’- Cyclic high/crash pattern reinforces use.

The exogenous neuro-transmitters resemble the person’s own endogenous neurotransmitters but they are different and come in massive amounts. REWARD CASCADE EXPERIENCE CAN BE well OVER 5X NATURALLY OCURRING ENDOGENOUS REWARD.

The imbalance is neuro-toxic; triggers brain adaptation. Causes inhibition of endogenous neurotransmitter production (less of the natural ‘feel

good’ chemicals) and multiplication of receptor sites to remove the toxic amount of reward neuro transmitters.

Tolerance builds. Long term effects develop Brain attempts to return to stasis under CHEMICAL ATTACK . Is OVERWHELMED.

A line is crossed. USE BECOMES INVOLUNTARY Addiction develops. A new normality. The brain has adapted to the presence of the drug. It is now the persons nature to use. No return to normal use.

Brain Change/Tolerance

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Brain Systems in Conflict

‘OLD BRAIN; Reward’

Instinctual (Hunger, thirst, craving, satiation, sexual behavior, reward, compulsion

Emotional/Impulsive

Original chart: j.a.m.a

‘NEW BRAIN;

Cognitive/ Rational appreciation of consequences/ Moral/Executive function/ Decision Making

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EXECUTIVE FUNCTION DISRUPTION

Limbic systems interrelated regulation of learning, memory, morals, and executive function is deranged. Drug related behaviors move up, all other considerations and interests move down.

Instinctual/ Primitive Brain works against survival and best interests- Brain is “on the drugs side”.

Functional Disconnect between orbitofrontal cortex ( moral values/ cultural mores, weighing of consequences- and primitive instinctual drives driving drug-seeking behaviors.

Increased Brain Sensitivity- Major cause of ‘relapse’. ‘The drug has a mind of it’s own.’

‘Triggers’: THE PRESENCE OF THE DRUG #1 Visual Cues; “People, Places and things” related to use. Can be any where, any time.

Stressors- situational/ relational Anxiety, Depression etc.

Instantly CREATES UPSURGE IN DOPAMINE RELEASE/ TRIGGERS INTENSE DESIRE TO USE, disrupted Executive function -Leads to relapse 20

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The Denial System;It is AUTOMATIC and largely SUBCONCIOUS. (Trans-

conscious, situational, modulated by Psycho-social context-Dynamic) “The brain is on the drugs’ side.”

The mental LIES and EVASIONS that the addicted mind creates continue use of the substance ONE MORE DAY. “I’ll quit Tomorrow”, “It’s no big deal.””I’m bored.” minimization/ externalization/ blaming the world, laws,circumstances etc. etc. )

A core component of addiction. Brain sensitivity/Executive function disruption combined.

It is what allows the self-destructive behavior to be carried on for so long. (Often for Decades) or until death.

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“This region of your brain has started to mistake the chemical message of survival with the message delivered by drugs.

The drive to use becomes confused with the drive to survive.

This drive overwhelms the centers of the brain where cognitive reasoning and will reside….

These are powerful drives that begin emanating from deep nonverbal drive centers of the brain and demand gratification with the same life-or-death intensity as taking a breath.”

The brain’s rational understanding is overwhelmed…You can’t stop, no matter how hard you try or who badly you want to.That’s addiction…

What we have here is a set of very powerful drives being activated beneath conscious control in a region of the brain that can’t be deactivated by reason, language, or will”.

Dr. Drew Pinsky, Cracked

Quotes on Denial

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Alcohol is 1st gateway drug

One of every 13-14 regular drinkers will develop alcoholism. (not a huge ratio, but the numbers involved are huge)

Approximately 16,000,000+ alcoholics nationally: (each has a significant negative impact on the lives of the persons that they are closest to.)

Catastrophic consequences without addiction; drug

effected behaviors: car accidents- crimes-domestic abuse/ violence- sexual acts

Virulent Toxin: Affects brain, heart, esophagus, liver, pancreas, testes, etc.

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Nicotine; ( Smoking is always substance abuse. Route of administration is Carcinogenic. The only product that kills when used as intended) Youth seen as ‘replacement smokers’ by the industry.

Nicotine addiction kills 450,000 people a year in the United States (deadlier that all other drugs combined), and millions of others seriously ill alcohol 100,000; other drugs 20,000 per year

Califano, High Society

61 million smokers in USA- 80% try to quit every year.( Only around 2%-3% succeed per year)- Overall number of smokers down sharply . Losing social acceptability in adult society.

4,500 kids try smoking 1st time daily,1,500 cross into nicotine addiction daily) Califano, High Society, pg. 15

Life expectancy -15 years shorter for (women)-13 years less (men) than for non-smokers.Califano, High Society, pg 138

Marijuana 3rd ‘gateway drug’The science is in. It is addictive.

20% of all 1st time presenters to treatment are addicted to marijuana. Can be 7X more powerful than in 70’s- more neuro toxic (brain change)- underestimated by parents.

20x more carcinogenic than tobacco. Negative impact on brain development, cognition, memory

deficits. (over time combines with natural aging) “The careless drug”; “Marijuana makes users stupid and

lazy…In the most extreme form this is called the amotivational syndrome, meaning that chronic pot smokers become listless and apathetic, not just when using the drug, but all the time.” pg. 146, The selfish brain, dr. Dupont

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