Brain Chemistry of Addiction Carol Ackley River Ridge

Brain Chemistry of Addiction Carol Ackley River Ridge Treatment Center Burnsville & Minnetonka, MN Children’s Justice Initiative Alcohol and Other Drug (CJI-AOD) Project 1

Overview of Presentation • Addiction: What is it? • Meth and Other Stimulants: Relapse and Recovery • Drug Testing and Lab Reports: What to Look For • Compatibility of the Recovery and Child Development Timelines • What You Can Do to Help Parents and Their Children 2

Addiction: What is it? 3

AMA stated alcoholism was a disease in 1956 • Equal opportunity disease • No one is immune • Some people are much more vulnerable 4

Drug and Alcohol use interfere with primary survival pathways in the brain • Automatic • Semi – automatic • Voluntary 5

Neural Pathways in the Brain 6

Neurotransmission 7

Molecular Structure 8

Neurotransmission 9

NEUROTRANSMITTERS • • • Endorphins/ Enkephalins Serotonin Norepinephrine Dopamine Acetylcholine 10

Neurotransmission 11

Neurotransmission cocaine 0 12

Neurotransmission 13

Neurotransmission 14

Neurotransmission 15

ADDICTIVE DISEASE • Progressive • Chronic • Fatal 16

ADDICTIVE DISEASE • Full Remission • Harm Reduction • Prevention 17

RESTABILIZE BRAIN CHEMISTRY • Abstinence • Nutrition • Stress Prevention 18

VULNERABILITY to ADDICTIVE DISEASE 40% - 50% GENETIC 50% - 60% ENVIRONMENTAL Early Onset Chemical Environment Poor Nutrition Increased Stress Poor Coping Mechanisms Chronic Illness Grief & Loss 19

QUESTIONS SO FAR? 20

Meth and Other Stimulants: Relapse and Recovery 21

100 90 80 40 30 20 50 to 70% 50 30 to 50% 60 50 to 70% 70 40 to 60% Percent of Patients Who Relapse Rates are Similar for Drug Dependence and Other Chronic Illnesses 10 0 Drug Type I Hypertension Asthma Dependence Diabetes Source: Mc. Lellan, A. T. et al. , JAMA, Vol 284(13), October 4, 2000. 22

Myth “Only 6% of meth addicts get and stay sober. ” 2003 HBO Documentary “Crank: Made in America. ” 23

Treatment Works • In the State of Colorado during 2003, 80 percent of meth users were abstinent at discharge from treatment. • In the State of Iowa, a 2003 study found that 71. 2 percent of meth users were abstinent six months after treatment. • A 2002 -2003 study done by the Tennessee Bureau of Alcohol and Drug Abuse found that 65 percent of meth clients were abstinent six months after discharge from treatment. • The Texas Department of State Health Services examined outcome data for publicly-funded services from 2001 -2004 and found that approximately 88 percent of meth clients were abstinent 60 days after discharge. • Utah’s Division of Substance Abuse and Mental Health reported that in State Fiscal Year 2004, 60. 8 percent of 24 meth clients were abstinent at discharge.

Treatment Admissions by Primary Substance 25 Source: Treatment Episode Data Set (TEDS) – Highlights 2004

“Meth has more long-term, serious effects on the brain than cocaine, ” said Dr. Nora Volkow, senior scientist at Brookhaven National Laboratories in Upton, N. Y. , who has studied the effects of both cocaine and methamphetamine of the brain for 15 years. 26 Beating an addiction to meth: Researchers zero in on brain effects, treatment approaches. By Julia Sommerfeld, MSNBC, 2004

Effects of Drugs on Dopamine Levels Neurotoxic Amphetamine Basalar release (%) Cocaine Nicotine Time after ingestion (hour) Di Chiara and Imperato 27

METH: Not Just Any Speed • Meth is an powerfully addictive Central Nervous System Stimulant, chemically similar to Amphetamine. • But Meth does it better: – injected (10 -20 min, C / 4 -6 hrs, M) – smoked (5 -20 min, crack / 8 -12 hrs, ice) – excretion (50%, 1 hr. , C / 50%, 12 hrs, M) • Meth lasts in the body and brain longer, and at higher levels than CA or AMP. Special thanks to Rick Moldenhauer, MS, LADC, LPC 28

Stages of Meth Recovery Withdrawal Stage (Day 0 -15) During withdrawal, clients are disoriented, depressed, and very fatigued. They feel out of control and do not understand what is happening to them. Very explicit direction is required during this period. 29

Stages of Meth Recovery Honeymoon Stage (Day 16 -45) During this period, cravings are reduced, mood improves, energy increases, and confidence and optimism return. Frequently, clients feel that the problem is over and their activity becomes scattered, inefficient, and frenetic. Seeing no obvious need for continuous treatment, many clients may return to alcohol and secondary drug use and discontinue treatment activities at this stage. 30

Stages of Meth Recovery The Wall (Day 46 -120) This period is viewed as the major hurdle in meth recovery. Relapse vulnerability increases as clients experience a return of low energy, little pleasure in life, difficulty concentrating, irritability, loss of sex drive and insomnia. Clients often assume that these conditions will persist indefinitely. The Wall has also been 31 referred to as protracted withdrawal.

Stages of Meth Recovery Adjustment Stage (Day 121 -180) A great feeling of accomplishment often occurs after making it past the Wall. This can result in a sense that everything should return to the way it was before. Clients who successfully deal with this stage begin to adjust to lifestyle and relationship changes, which began in previous stages, as the new definitions of “normal. ” 32

Stages of Meth Recovery Resolution Stage (Day 181 -Open) Completion of the six-month sobriety period signals a shift from learning new skills to monitoring for relapse signs, maintaining a balanced lifestyle, and developing new areas of interest. For some, individual or relationship issues may emerge that require additional 33 attention.

New Research from NIDA • • • Calcium-channel blockers Zofran - the anti-nausea drug Tyrosine Several antidepressants Selegiline Vitamin E 34 Beating an addiction to meth: Researchers zero in on brain effects, treatment approaches. By Julia Sommerfeld, MSNBC, 2004

In addition, NIDA is funding research on the development of an antidote for methamphetamine that would be used in overdose situations. The hope is that a compound could leach meth out of the tissues, decreasing concentrations of the drug in the body. Theoretically, this would reduce the duration of the high and some of the adverse effects. However, such a treatment is years away from being tested in people, according to NIDA. 35 Beating an addiction to meth: Researchers zero in on brain effects, treatment approaches. By Julia Sommerfeld, MSNBC, 2004

Drug Testing and Lab Reports: What to Look For 36

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RSI Laboratories 1931 West Broadway Street Minneapolis, MN 55411 Phone: 612 -287 -1660 Fax: 612 -287 -1666 Lab Director: Steve Kastner, MT (ASCP) CLIA ID: 24 D 0882916 CAP ID: 4004701 -01 Positive results HAVE NOT been confirmed by GC/MS. 38

RSI Laboratories 1931 West Broadway Street Minneapolis, MN 55411 Phone: 612 -287 -1660 Fax: 612 -287 -1666 Lab Director: Steve Kastner, MT (ASCP) CLIA ID: 24 D 0882916 CAP ID: 4004701 -01 Positive results HAVE NOT been confirmed by GC/MS. 39

Compatibility of the Recovery and Child Development Timelines 40

The Five Clocks • • • MFIP Child welfare system Recovery process Child development Agency and staff timelines 41

The addiction recovery timeline is compatible with the 12 -month permanency timeline if there is: – Early, comprehensive assessment – Early engagement – Early, appropriate and adequate service delivery 42

Measurable Indicators of Recovery • Verbalize an awareness that AOD addiction is a disease • Verbalize an awareness of specific negative consequences in all life areas • Verbalize an awareness of stress as trigger for cravings and relapse • Verbalize an awareness of impact on children • Mental health stabilized 43

Measurable Indicators of Recovery • A concrete, specific relapse prevention plan that includes: – Identification of personal warning signs and triggers of relapse – Daily plan for healthy living • (ie: nutrition, sleep, hygiene, exercise, spiritual care, personal time, sober support, recreation) – Stress management and prevention plan – Specific identification of sober support network: who, what, where, when 44

What You Can Do to Help Parents and Their Children 45

Support You Can Provide • • Drug screens for accountability Transportation Child Care Employment/ Economic Opportunity Safety Case Management Parenting support/ training Access to ancillary services (“No 46 wrong door”)

QUESTIONS? 47

Brain Chemistry of Addiction • Addiction is a disease, not a choice • Progressive, Chronic and Fatal • Young brains at risk due to unique stage of development • Very treatable • Prevention important • Early interventions, assessment and treatment are the keys to success 48

Crisis=Danger & Opportunity 49

Additional Resources • Carole Johnson, CJI-AOD Project Specialist, State Court Administrator’s Office, 651 -296 -2269 or carole. johnson@courts. state. mn. us • Dan Griffin, Court Operations Analyst, State Court Administrators Office 651 -215 -9468 or dan. griffin@courts. state. mn. us • Deborah Moses, Operations Manager, DHS-Chemical Health Division, 651 -431 -3251 or deborah. moses@state. mn. us • Jackie Crow Shoe, Social Service Program Consultant, DHS-Child Safety and Permanency Division, 651 -4314676 or jackie. crowshoe@state. mn. us 50