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Sylvia L. RiversCommunity Outreach CoordinatorCenter for Drug and Alcohol Programs

How Drugs and Alcohol Affect the Brain

1Thank you all for inviting me to share with you some things that I think are really fascinating.

I work with a team of scientists at MUSC who are involved in cutting edge research to better understand the effects of drugs and alcohol on the brain

One of my roles is to share the knowledge they discover with our community so that people understand the biological effects or the science behind developing addiction so people with make better and healthier choices

There are many reasons why people start using drugs and alcohol, but we want people to know that with their very first use, chemical changes occur in the brain that may lead to addiction

There are lots of reasons not to do drugs.moral/ethical; legal; monetary; health reasons. Im only an expert on the latter, so Ill be talking about that with you today.

In your parents day, the anti-drug talk was based mostly on fear tacticsif you do drugs, youll die, or jump out of a window, etcthis made it sound like doing drugs was like poking yourself in the eye with a sharp stick. Like only stupid people would ever do drugs. We were not told why people would ever do drugsMUSC Center for Drug & Alcohol Programs

to combat alcohol and drug addiction through research, education, patient care and outreach

Mission team of neuroscientists, clinicians, residents, research associates, working every day to find better treatments and cureswe are part of COM, a division of the IOP, research, education, patient care and outreach33,000 square feet of space dedicated to bring the latest research findings from bench to bedside

We want to share the latest research findings - the science to help people understand how alcohol consumption might affect their health2

Addiction affects all walks of life!If you have a brain, you can develop an addiction! Crosses all walks of life (rich/poor/male/female/african american/caucasian)About 25 mill Americans have a problem with alcohol and drugsAbout 1 in 4 families affected in some way3Part I

How the brain works4First you need to know a little bit about how the brain works

Brain is one of the most important organs in our bodies it sits at the center of all human activity and makes us who we are

Weighs about 3 pounds, little bigger than a softball

It regulates our basic bodily functions, U need it to breathe, drive a car, cook dinner, read,

its pretty amazing because you need it to interpret and respond to everything

5We know that certain parts of our brain govern certain functions and these areas communicate with each other to help us hear, feel, see, make decisions, drive a car.Sensory cortex extends like a headband over the top of your brain it receives information from all over your body

Point out movement, sensory, vision ask what would happen if our vision part got damaged? We would not be able to see

Drugs and alcohol affect these two areas right here explain the prefrontal cortex (judgment, decision-making, self control, moral behaviors area) and how it makes us different from all other animals

Explain that this pathway is activated when a person receives positive reinforcement for certain behaviors ("reward"). Indicate that you will explain how this happens when a person takes an addictive drug. As another example, point to the thalamus (magenta). This structure receives information about pain coming from the body (magenta line within the spinal cord), and passes the information up to the cortex. Tell the audience that you can look at this in more detail.

6Slide 2: The brain and spinal cordThe central nervous system is composed of both the brain and the spinal cord. Describe the brain as a functional unit; it is made up of billions of nerve cells (neurons) that communicate with each other using electrical and chemical signals.

7Slide 7: Anatomy of a Neuron drawing we borrowed from NIDA

Neurons are designed to communicate with each other main diff between a neuron and other cells in body is that they talk to each other

They use special chemicals called neurotransmitters to communicate and tell our bodies what to do

Now that the students know that there are specific regions of the brain affected by Ecstasy, you will need to describe how it works. First, indicate that the different regions of the brain are connected by nerve cells or neurons via pathways. These pathways of neurons send and integrate information (electrical and chemical). Describe the neuron using the schematic in this slide. The cell body, which contains the nucleus, is the center of activity. Dendrites receive chemical information from other neurons that is converted to electrical signals which travel toward the cell body. When the cell body receives enough electrical signals to excite it, a large electrical impulse is generated and it travels down the axon toward the terminal. In the terminal area, chemicals called neurotransmitters are released from the neuron in response to the arrival of an electrical signal. Tell the students that you will explain this in more detail, using the neurochemical serotonin as an example.They use chemicals called neurotransmittersOne cell gives its neurotransmitters to another cell to tell it what to doThis process is called neurotransmissionBrain cells (neurons) talk to each other8Brain contains over 100 billion neurons.Trillions of synaptic connectionsNeurotransmission occurs at 220 mphBasic Wiring of the Brain

9Slide 7: Summary of neuronal transmissionUse the example with 2 neurons making contact to summarize neuronal transmission. Point to the cell on the top and indicate that electrical impulses flow in the direction toward the terminal. Remind the students what happens when impulses reach the terminal; neurotransmitters are released, they bind to their receptors, and new impulses are generated in the cell on the bottom. Explain that this is how information travels from neuron to neuron.

Furry!Pet Kitty!Purrr!10Slide 4: Pathway for sensation of pain and reaction to painThis is a long pathway, in which neurons make connections in both the brain and the spinal cord. Explain what happens when one slams a door on one's finger. First, nerve endings in the finger sense the injury to the finger (sensory neurons) and they send impulses along axons to the spinal cord (magenta pathway). Point to each part of the pathway as you explain the flow of information. The incoming axons form a synapse with neurons that project up to the brain. The neurons that travel up the spinal cord then form synapses with neurons in the thalamus, which is a part of the midbrain (magenta circle). The thalamus organizes this information and sends it to the sensory cortex (blue), which interprets the information as pain and directs the nearby motor cortex (orange) to send information back to the thalamus (green pathway). Again, the thalamus organizes this incoming information and sends signals down the spinal cord, which direct motor neurons to the finger and other parts of the body to react to the pain (e.g., shaking the finger or screaming "ouch!").Summary1. Our brain controls how we feel, think and act2. Brain cells are called neurons3. Neurons communicate with each other with chemicals called neurotransmittersThis process is called neurotransmission

11So we have a perfect communication system natural communication systemPart IIHow Alcohol & Drugs Affect the Brain

12Drugs and alcohol are chemicals

Drugs work by changing the way our brain normally works

They interfere with the way nerve cells normally send receive and process info

With very first use, chemical changes occur in the brain that may lead to addiction

Drugs today are much more potent than they were 30 years ago and can cause long lasting or even permanent brain damageTrue of all drugs of abuse including alcohol and marijuana

REWARDFrontal Cortex

STOP13Slide 11: The reward pathway certain are of the brain that makes us feel pelasure/reward when it is activatedU have something you like, the reward area of the brain lights up, becomes activatedThis is the part of your brain that says GO teaches you this is a good thing, want moreFrontal cortext judgment area part that says stop brakesThese two areas work together to help us survive pleasure to eat, drink, sleep sex, shelter, warmthTell your audience that this is a view of the brain cut down the middle. An important part of the reward pathway is shown and the major structures are highlighted: the ventral tegmental area (VTA), the nucleus accumbens and the prefrontal cortex. The VTA is connected to both the nucleus accumbens and the prefrontal cortex via this pathway and it sends information to these structures via its neurons. The neurons of the VTA contain the neurotransmitter dopamine which is released in the nucleus accumbens and in the prefrontal cortex (point to each of these structures). Reiterate that this pathway is activated by a rewarding stimulus. [Note: the pathway shown here is not the only pathway activated by rewards, other structures are involved too, but only this part of the pathway is shown for simplicity.]Feeling Pleasure and Reward: the Dopamine Way!

REWARD

14Slide 7: Summary of neuronal transmission (Dopamine more you get more pleasure you feel)Use the example with 2 neurons making contact to summarize neuronal transmission. Point to the cell on the top and indicate that electrical impulses flow in the direction toward the terminal. Remind the students what happens when impulses reach the terminal; neurotransmitters are released, they bind to their receptors, and new impulses are generated in the cell on the bottom. Explain that this is how information travels from neuron to neuron.The Reward SystemFood, water, warmth (natural reinforcers) cause dopamine release in the nucleus accumbensAll drugs of abuse artificially cause neurotransmission in the nucleus accumbens to an extreme degree15When someone does cocaine, go from normal amount of dopamine to extreme amounts super hyper mode of GO!!!Overstimulation of the reward system produces euphoric effects-sought by people who abuse drugs and teaches people to repeat the behaviorSo much for pleasurable it is hard to stop!DRUG EFFECTS: TOO MUCH OF A GOOD THING!

???STOP?2-10 times the dopamineLasts much longer than natural rewardsStrongly motivates people to seek drugs and take drugs again and againLeaves permanent mark on your brain what happened to the stop/judgement area? Deactivated.16What does this mean to your brain?It means that you try drugs you will probably like them. Because you like them, youll do it again. And then again. And then again..

Then what?17Effect is so powerful activating our reward system that the brain is motivated to do drugs again and again

Brain changes..Too much dopamine, and the body turns down the volume on its own

Body says too much dopamine, so it stops making itReceptors disappear lose ability to receive pleasureAll drugs of abuse cause overstimulation of dopamine to be releasedRepeated dopamine release causes down-regulation brain adjusts by producing less dopamine

BRAIN CHANGES-dopamines impact on the reward circuit of a drug abusers brain can become abnormally low ability to experience pleasure reduced.

18Your brain changesOver time, drugs of abuse highjack your brain: your neurons change physically--one result is that you lose the ability to feel pleasure (resets pleasure meter)You will need more and more of the drug just to feel normal--like you used to be before you took drugsYou lose the ability to take or leave the drug--you HAVE to have it, aka addiction19Drug addiction is a disease of the brain one of the reasons that people who are addicted to drugs just cant stop on their own is that this disease is so powerful that it changes the way people think and behave.

Tolerance, withdrawal, loss of control, intense cravings

Imagine if you were stranded on an island with no food or water in a few days, you wuld get intensely hungry and thirstyall you can think about is food and water.drug addiction is much like that intense cravings that dont go away with willpowerAddiction is a chronic brain diseaseRecovering addicts struggle for the rest of their lives not to use drugs or alcohol againMost recovering addicts relapseThe brain of an addicted person remains changed for a long, long time--scientists dont know if it ever returns to normal20

Brain Scanner - fMRI

22Slide 6: A positron emission tomography (PET) scanner.Now lets take a look inside your mind... One of the tools that scientists use to see the effects of drugs on the brain is called positron emission tomography or a PET [say the word pet] scan. Similar to an x-ray, but much more sophisticated, a PET scan is used to examine many different organs including the heart, liver, lungs, and bones, as well as the brain. A PET scan shows much more than the physical structure of bone and tissue. A PET scan shows how well (or how little) an organ is functioning.Using a PET scan, a doctor or a scientist can see what is actually happening in a persons brain and see the effects of drugs. The PET scan shows areas of the brain that are active and also areas that are inactive or not functioning at all. Typically, a PET scan takes 1 to 2 hours with the person lying completely still so that the PET images will be clear.Lets see the effects a drug like cocaine has on the brain.

InsulaVentral StriatumCingulateWhen people crave alcohol, there are certain changes to the brain that can be seen on MUSCs fMRI. These craving centers of the brain are being studied and new medications are being used in an attempt to reduce craving for Alcoholism-The DiseaseSocial Drinker AlcoholicWhen people crave alcohol, there are certain changes to the brain that can be seen on MUSCs fMRI. These craving centers of the brain are being studied and new medications are being used in an attempt to reduce craving for alcohol and its affect on the brain23

Brain activity is changed by drugsCocaine Abuser (10 days later)

Normal

Cocaine Abuser (100 days later)

24Slide 8: Long-term effects of drug abuse.

This PET scan shows us that once addicted to a drug like cocaine, the brain is affected for a long, long time. In other words, once addicted, the brain is literally changed. Lets see how...In this slide, the level of brain function is indicated in yellow. The top row shows a normal-functioning brain without drugs. You can see a lot of brain activity. In other words, there is a lot of yellow color.The middle row shows a cocaine addicts brain after 10 days without any cocaine use at all. What is happening here? [Pause for response.] Less yellow means less normal activity occurring in the braineven after the cocaine abuser has abstained from the drug for 10 days.The third row shows the same addicts brain after 100 days without any cocaine. We can see a little more yellow, so there is some improvement more brain activityat this point. But the addicts brain is still not back to a normal level of functioning. . . more than 3 months later. Scientists are concerned that there may be areas in the brain that never fully recover from drug abuse and addiction.Photo courtesy of Nora Volkow, Ph.D. Volkow ND, Hitzemann R, Wang C-I, Fowler IS, Wolf AP, DeweySL. Long-term frontal brain metabolic changes in cocaine abusers. Synapse 11:184-190, 1992; Volkow ND,Fowler JS, Wang G-J, Hitzemann R, Logan J, Schlyer D, Dewey 5, Wolf AP. Decreased dopamine D2receptor availability is associated with reduced frontal metabolism in cocaine abusers. Synapse 14:169-177,1993.

Part III Drugs/Alcohol & High School

25Drugs, Alcohol, Teenage Brain

InfantChildAdolescentAdultOlder AdultAge of first use, number of initiatesUsing drugs and alcohol during the critical time of brain development can cause addiction to become hard-wired in adult hood

Most addicts being treated at MUSC started in middle school -13 yrs.26Warning: Your Brains not done growing!

Blue represents maturing of brain areas.TOP VIEW.SIDE VIEW.IMAGES OF BRAIN DEVELOPMENT INHEALTHY CHILDREN AND TEENS (AGES 520)Age 5Age 20Frontal lobe is responsible for planning, organizing, decision-making, impulse control

It is the part of the brain that develops last (age 22-25)27

28Slide 3: Brain regions and neuronal pathwaysCertain parts of the brain govern specific functions. Point to areas such as the sensory (orange), motor (blue) and visual cortex (yellow) to highlight their specific functions. Point to the cerebellum (pink) for coordination and to the hippocampus (green) for memory. Indicate that nerve cells or neurons connect one area to another via pathways to send and integrate information. The distances that neurons extend can be short or long. For example; point to the reward pathway (orange). Explain that this pathway is activated when a person receives positive reinforcement for certain behaviors ("reward"). Indicate that you will explain how this happens when a person takes an addictive drug. As another example, point to the thalamus (magenta). This structure receives information about pain coming from the body (magenta line within the spinal cord), and passes the information up to the cortex. Tell the audience that you can look at this in more detail.

If you start early, you have a greater chance of getting hooked!

Age can have a lot to do with dev. Addiction to drugs/alcohol29Dont believe the hype:Not everyones doing it

Warning: Drugs can ruin a person, a very short time!

Meth highly toxic, some ingredients - Battery acid, antifreeze, drain cleaner, very damaging, causes people to age quickly, messes up motor skills, memory

Do you think they wanted to look like this?31SummaryThe brain does not fully developed until mid 20sThe younger you start using, the more likely youll get hookedEverybodys NOT doing itIf you drink too much, you can dieIf you use alcohol/drugs frequently over a steady period of time, they can take over your lifeLet Your Brain Fully Develop

The bottom line34Questions?www.alcoholanddrugabuse.orgwww.CDAP.musc.edu

Sylvia Rivers843-792-9531riverssy@musc.edu

35Tips for ParentsTune Into Your TeenGuide Your TeenRespect Your TeenBe a Good Role Model

36Spend time with your teen communicate with them (the common thread among teens who remain drug free is that they have a close relationship with their parentsSet expectations and rules and be Clear, better to say no than maybeIf you dont show them respect, they wont respect youDont involve your teen in your use (asking them to bring you a beer) dont drink every night - If you come home stressed out and have a drink, your kids will learn this from you - go on a walk to de-stress

Short term:Impairs vision, taste, smellSlows reaction timeImpairs attentionBlackoutsEffects of AlcoholLong term:Severe memory lossConstant states of confusionLiver damageBrain damageHeavy DrinkingThe Risks The BodyInflammation of the liver (cirrhosis, hepatitis)Increased blood pressure (hypertension)Damaged heart muscleStrokeSuppression of the immune systemPneumoniaOsteoporosisBrain atrophyPeripheral vascular diseaseMiscarriageFetal Alcohol Syndrome (FAS)Accidents and traumaSuicidePancreatitis (especially in people with high levels of triglycerides)Linked with cancers (mouth, throat, esophagus, colon, pancreas, liver, breast)Heavy drinking takes its toll:38Alcohol FactsDrinking impairs judgment, coordination, can increase feelings of depressionBinge drinking: 4 drinks for women and 5 drinks for men over a four-hour period. Less time, more risk; younger people, more risk. Alcohol poisoning is a severe, physical reaction to an overdose of alcohol. The brain, struggling to deal with the overdose of alcohol and lack of oxygen, begins to shut down the voluntary functions that regulate breathing and heart rate.A Standard Serving of Alcohol

40BAL LEVEL (legal limit .08)Hour 1150lbs125lbs100lbs6 Buds0.160.20.261 Bottle Mad Dog0.170.210.27Half Pint Jack (5 shots)0.150.180.22.08 Legal Limit Impaired balance, speech and vision.15 Gross motor impairment, judgment severely impaired.20 Feeling dazed, nausea, impaired gag reflex (choke on vomit).30 STUPOR, little comprehension where you are, pass out.40 Onset of coma, possible death due to respiratory arrest

After 2 hours of drinkingHour 2150lbs125lbs100lbs12 Buds0.330.40.512 Bottles Mad Dog0.350.420.53Pint of Jack (10 shots)0.290.350.45.08 Legal Limit Impaired balance, speech and vision.15 Gross motor impairment, judgment severely impaired.20 Feeling dazed, nausea, impaired gag reflex (choke on vomit).30 STUPOR, little comprehension where you are, pass out.40 Onset of coma, possible death due to respiratory arrest

Alcohol Poisoning

Cigarettes

Acetone: nail polish removerAmmonia: household cleanerArsenic: used in rat poisonsBenzene: used in making dyesButane: gas; used in lighter fluidCarbon monoxide: poisonous gasCadmium: used in batteriesCyanide: deadly poisonDDT: a banned insecticideHydrogen Cyanide: rat poisonLead: poisonous in high dosesMethoprene: insecticideMethyl isocyanate: its accidental release killed 2000 people in Bhopal, India in 1984Napthalene: ingredient in mothballsNicotine: a poison used to kill cockroachesPolonium: cancer-causing radioactive element 44Nicotine (Cigarettes)Nicotine is the most addictive and psychoactive chemical in tobacco

CigaretteReaches brain in 8 secondsChewing tobacco and snuffMucous membranes lining mouth and nasal passagewaysOne of 4,000 chemicals in tobacco products

Health Consequences of SmokingCancers of the larynx, oral cavity, esophagus, bladder, pancreas, and kidney (30% of all cancer deaths caused by smoking)Lung cancer (80%-90% of all deaths) and emphysema.Heart disease (people who smoke have nearly twice the risk of contracting it than nonsmokers do)4.3 million men and women worldwide die prematurely due to cigarette smoking.

MarijuanaIs marijuana addictive?What are effects of marijuana on brain and body?What is K-2 or Spice?

47Yes Long term use leads to addiction in some people that is they cannot control their urges to seek out and use marijuana, even though it negatively affects their family relationships, school performance, rec. activities can develop tolerance to its effects so need more to get same desired effects-Effects on brain and body-heavy use affects the parts of the brain that control memory, attention, and learning, and can casue changes in brain like cocaine, heroine, alcohol-scientists still learning what it does to brain. Marijuana heart rate speeds upLong term use-may play role in development of cancer, respiratory and immune system problems,

K2 or spice marketed as incense or fake weed, is a mixture of herbs and spices that is sprayed with a synthetic compound chemically similar to THC (psychoactive ingredient in marijuana) similar effects of marijuanan-paranoia, panic attacks, giddiness, increased heart rate and blood pressure, and is stored in the body for long periods of time.Is Marijuana Addictive?Many people believe that marijuana cannot cause addictionTHIS IS NOT TRUEMarijuana users CAN become addicted to marijuanaAddicted users have cravings for marijuana and show withdrawal symptoms when not usingShort-Term Effects of MarijuanaDistorted PerceptionProblems with memory and learningLoss of coordinationTrouble with thinking & problem solvingIncreased heart rateOther drugsOther drugsOpiates pain pillsBenzodiazepines benzoes, anxiety pillsDetxomethorphan (DXM, Triple Cs)

Family history of addiction

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