Addiction is a Brain Disease

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