Addiction is a Brain Disease



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Addiction is a Brain Disease

  • Addiction is a Brain Disease

    • Understand the Structure and Pathways Associated with changes in the brain.
  • Prevention and Early Intervention for Substance Misuse/Abuse /Addiction

    • SBIRT as an Evidence Based Model
    • Motivational Interviewing Skills


A person addicted to drugs / alcohol is

  • A person addicted to drugs / alcohol is

    • Bad, crazy, simply stupid
    • Lacking willpower
    • Hopeless
    • Must be punished as a means to force them to change
    • Must reach bottom before they can get help






Over Time Addiction causes changes in the brain.

  • Over Time Addiction causes changes in the brain.

    • Brain Structure
      • Prefrontal Cortex, limbic system
    • Brain Pathways (neural connections)
      • Dopamine pathway, seratonin pathway
    • Brain Chemicals
      • Dopamine, seratonin,endorphin, glutamate




  • Dopamine – a feel good chemical.

  • Seratonin – the happy, anti-worry, flexibility chemical.

  • GaBA – an inhibitory neurotransmitter that helps calm or relax the brain

  • Endorphins – the brains own natural pleasure and pain killing chemical

  • Glutamate – locks the pleasureable experience into memory



Craving (dopamine; brain is hard wired to crave rewards)

  • Craving (dopamine; brain is hard wired to crave rewards)

  • Compulsion (low seratonin levels)

  • Loss of Control (damage to the prefrontal cortex; right & wrong)

  • Continued Use Despite Consequences – further damage to prefrontal

  • cortex (interferes with judgement).



Genetics / Environment

  • Genetics / Environment





Only about 100 years old

  • Only about 100 years old

  • Emerged from Germ Theory

  • Organ >>>> Defect >>>> Symptoms

    • Femur > Fracture > Pain/Deformity
    • Pancreas > Insulin Secretion > Symptoms of Diabetes
  • Doctors go after the Defect to cure the disease.



Disease is a departure from health.

  • Disease is a departure from health.

  • Disease –” a disordered or incorrectly functioning organ, part, structure or system of the body.



Cravings

  • Cravings

  • Compulsion

  • Loss of Control

  • Continued use Despite Consequences



Substance use

    • Substance use
    • Substance Abuse (Risky Use)
    • Substance Dependence / Addiction
  • DSM IV makes a clear distinction between substance abuse / addiction; the pattern of compulsive use is the distinguishing factor.





General Risk Factors

    • General Risk Factors
    • Psychological
    • Behavioral
    • 3. Social
    • 4. Demographic
    • 5. Family
    • 6. Genetics




1. Paradigm shift from traditional view of substance abuse interventions 2. Views Substance Abuse as a public health issue and focus on risk reduction as well as abstinence 3. Focus on identifying “misuse” early and providing brief interventions 4. Is comprehensive in it’s approach

  • 1. Paradigm shift from traditional view of substance abuse interventions 2. Views Substance Abuse as a public health issue and focus on risk reduction as well as abstinence 3. Focus on identifying “misuse” early and providing brief interventions 4. Is comprehensive in it’s approach





  • Low Intensity, Short Duration

  • Range from Brief Advice to several

  • Intended to provide early intervention



Multiple physical health, emotional, and interpersonal problems are associated with illicit drug use.

  • Multiple physical health, emotional, and interpersonal problems are associated with illicit drug use.

  • Financial difficulties and legal, work, and family problems can all result from or be exacerbated by drug abuse.



10-15 minute interventions

  • 10-15 minute interventions

  • 4 Components:

    • Raise the Subject
    • Provide Feedback
    • Enhance Motivation
    • Develop a Plan


Elicit values and goals

  • Elicit values and goals

  • Explore discrepancies between current behavior and future aspirations

  • Tailor feedback and advice to address concerns and needs

  • Use reflections and summaries to respond to the person’s reasons for considering change target behavior.





What is Motivational Interviewing?

  • What is Motivational Interviewing?

    • a semi-directive, client
    • centered conversation for eliciting behavior change by helping people to explore and
    • resolve ambivalence about change.


Empowers people to take ownership of their own

  • Empowers people to take ownership of their own

  • health management by:

    • Providing information respectfully
    • Partnering
    • Supporting sense of self-efficacy
    • Places patient is role as the expert regarding how to change their behavior


Motivation is a state of readiness to change that fluctuates with time and situations.

  • Motivation is a state of readiness to change that fluctuates with time and situations.

  • Motivation can be increased through interaction.

  • The process of making a change often includes mixed feelings*

  • *Ambivalence is a normal part of the change process.



The task of the practitioner is to:

  • The task of the practitioner is to:

    • Tap into the person’s potential for change
    • Guide the natural change process already within the individual
    • Impart hope, belief in, and confidence that the person can make desired changes.


avoid direct persuasion

  • avoid direct persuasion

  • avoid unsolicited advice

  • respect the status quo



O.A.R.S.

  • O.A.R.S.

    • Open-Ended Questions
    • Affirmations
    • Reflections
    • Summarizations
    • importance X confidence = readiness


Identifying Ambivalence and Finding the Potential for Change…

  • Identifying Ambivalence and Finding the Potential for Change…

  • “I know I should probably not drink so much. I often feel a bit fuzzy the next day, and sometimes I forget things that I need to do. But drinking helps me relax at the end of the day, and it helps me forget my pain.”



How important would you say it is to cut back or quit using?

  • How important would you say it is to cut back or quit using?

  • Why did you pick a ___ and not a (lower number)?

  • What concerns do you have about your use?





Questions

  • Questions

  • Comments

  • Discussion



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