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Addiction –a brain disease
1. Addiction –a brain disease
An overview for the
Cupcake Girls
• Nalini Velayudhan D.O.
• Board Certified Family
Practice
• Board Certified
Addiction Medicine
• June 2012
2. The Nervous System
• Made up of two parts:
– Central Nervous System
• Brain, nerve cells (neurons)
– Peripheral Nervous System
• Spinal Cord, and nerve cells
3. Neurons
• 100 billions nerve cells
• Send and receive
messages
• Nerve cells use
chemicals to
communicate with each
other.
4. Neurotransmitters
• Brain’s chemical
messengers
• Chemicals made in the
neuron, released in the
synapse and attach to
nearby neuron.
5. Brain
• Command center of
the body
• Weighs 3 lbs
• Drugs affect
different areas of
the brain:
– Brain stem
– Limbic system
– Cerebral Cortex
7. Brain Areas involved in
• Brainstem: the ventral tegmental area
(VTA) at the top of the brainstem
contain nerve cells that use the
neurotransmitter DOPAMINE to relay
messages.
• Limbic System: the nucleus accumbens
receive the messages from dopamine-
containing neurons in the VTA.
• Cerebral Cortex: receive messages
from other parts of the brain to make
9. Brain
• Limbic System: located on top of the
brainstem and buried under the cortex
• More primitive brain structures
(amygdala, hippocampus)
• Involved in emotions and motivations,
particularly those related to survival~
fear, anger, and sexual behavior
• Also related to feeling of pleasure that
are related to survival such as eating,
11. Brain
Hijacked
• Drugs of abuse act directly on this
primitive area of the brainstem and
limbic system hijacking the higher
functioning cerebral cortex’s ability to
stay in control.
• Drugs override the cortex and there is
loss of reasoning and control.
12. Effects of Drugs of Abuse on the
Brain
• Drugs of abuse produce a pleasurable
event or “reward.”
• The brain is wired to repeat behaviors
that are rewarding.
• Drugs of abuse are mistakenly believed
to be essential to survival (like eating
and drinking water) in an addicted
brain.
• Drugs of abuse are many more times
14. Effects of drugs of abuse on the
brain
• Almost all drugs change the way the
brain works by altering chemical
neurotransmission.
– Dopamine *
– GABA
– NMDA
– Glutamate
15. Effects of drugs of abuse on the
• Nicotine: activate the nicotinic Ach
receptors.
• Alcohol: alters the balance between
neurotransmitters like GABA and
NMDA.
• Opiates (heroin, pain pills): mimic
effects of natural neurotransmitters at
mu receptors
18. Effects of drugs of abuse on the
brain
• PCP: blocks receptors and prevents
neuronal messages from getting
through.
• Methamphetamines: act by causing
neurotransmitters to be released in
greater amounts than normal into
synaptic cleft.
• Cocaine: interferes with the molecules
20. Effects of drugs of abuse on the
brain
• Prolonged drug use changes the brain
in fundamental and long-lasting ways.
• Drugs of abuse interfere with the way
nerve cells normally send, receive, and
process information.
• Drugs of abuse “hijack” the brain’s
ability to make the right decision
21. Addiction is a chronic disease
• Drug addiction is a chronic disorder
like diabetes, high blood pressure or
asthma.
• Treatment is essential- sometimes
repeated treatment and prolonged
treatment is needed.
• Treatment is behavior-based and
medical based.
22. How to catch a problem
• 1. Have you ever ridden in a car driven by
someone who had been using alcohol or
drugs?
• 2. Do you ever use alcohol or drugs to
relax, to feel better about yourself, or to
fit in?
• 3. Do you ever use alcohol or drugs when
you are alone?
• 4.Do you ever forget things you did while
using alcohol or drugs?
• 5. Do family or friends ever tell you to cut
down on your use of alcohol or drugs?
25. Alcohol Withdrawal
• Among patients who consume 20 standard
alcoholic drinks/day symptomatic
withdrawal is likely with abstinence.
• Three main categories of Alcohol Withdrawal
Syndrome:
– 1. Central nervous system excitation:
restlessness, agitation, seizures
– 2. Autonomic nervous system excessive activity:
nausea, vomiting, tachycardia, tremulousness,
hypertension
– 3. Cognitive dysfunction
27. Alcohol Withdrawal
• Stage 1: “minor withdrawal”
– Begins five to eight hours after last drink
– Characterized by anxiety, restlessness, agitation,
mild nausea, decreased appetite, sleep
disturbance, facial sweating, mild tremulousness,
and fluctuation tachycardia and hypertension
28. Alcohol Withdrawal
• Stage 2: “major withdrawal”
– Occurs 24 to 72 hours after last drink
– Characterized by marked restlessness and agitation,
moderate tremulousness with constant eye movement,
diaphoresis, nausea, vomiting, anorexia and diarrhea.
– Patients have marked tachycardia (>120 bpm) and elevated
systolic blood pressure (>160 mm Hg)
– “Alcoholic hallucinosis” may be present- can be auditory or
visual
– Patient may be confused but easily reoriented
– Seizures- typically grand mal- may occur, usually single,
last < 5mins. Status epilepticus is not associated with
alcohol withdrawal and indicates another problem
29. Alcohol Withdrawal
• Stage 3: “delirium tremens”
– Can occur from 72 to 96 hours after last drink
– Associated with fever, severe hypertension,
tachycardia, deliriums, drenching sweats, and
marked tremulousness
– Causes of death include head trauma,
cardiovascular complications, infections,
aspiration pneumonia and fluid & electrolyte
abnormalities
31. Sedative Withdrawal
• Signs of withdrawal may not be seen
for 7 to 10 days after last intake of
substance
– This is because many benzodiazepines
have long-acting metabolites
– Many individuals also take more than one
or more substance of abuse
32. Stimulant Withdrawal
• Amphetamines and Cocaine are the
most prevalent stimulants abused
• Amphetamines:
– Methamphetamine
– MDMA- ecstasy
• Cocaine:
– Cocaine HCL
– “crack”- alkaloid form of cocaine (smoked)
33. Stimulant Withdrawal
• “Crash” drastic • Malaise
reduction in mood and • Problems with memory,
energy concentration
• Craving the stimulant
• Occasional suicidal
• Craving for sleep, hyper ideation
somnolence
• Depressed mood • Craving can last months
to years after the last
• Anxiety
stimulant use
• Paranoia
• Hyperphagia- “the
36. Opioid Withdrawal
• Peak withdrawal symptoms most
severe with discontinuing heroin use
• Longest duration of withdrawal
symptoms with methadone but with
lower peak severity
37. Withdrawal
• Alcohol and Sedative withdrawal can be
lethal and life threatening sometimes
requiring hospitalization.
– Need monitoring and medical management
for withdrawal seizures, delirium tremens,
falls, head injury, aspiration
– Need treatment to replenish fluids, vitamins,
nutrients, support blood pressure, heart rate
• Opioid and Stimulant withdrawal less
likely to be lethal.
38. Long Term Recovery
• Long term care involves outpatient
support of medical condition
• 12 Step Recovery meetings like AA or
NA
• Intensive Outpatient Programs
• Counseling
• Residential Care
• Spiritual connection with family,
39. Outline
Resources:
Alcoholics Anonymous (AA): www.aa.org
National Council on Alcoholism and Drug
Dependence, Inc. (NCADD): 800-622-2255
or www.ncadd.org
Substance Abuse and Mental Health Services
Administration (SAMHSA): 800-622-HELP or
www.samsha.gov/treatment
National Institute on Alcohol Abuse and
Alcoholism (NIAAA): 301-443-3860 or
www.niaaa.nih.gov
