THE PHYSIOLOGY OF ADDICTION...FL Alcohol and Drug Abuse Association December 2018 12/17/2018 1 1 THE PHYSIOLOGY OF ADDICTION Effects of Drug‐Taking Behavior on the Brain Ruth A

FL Alcohol and Drug Abuse Association December 2018

12/17/2018

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THE PHYSIOLOGY OF ADDICTION

Effects of Drug‐Taking Behavior on the Brain

Ruth A. Potee, MD, ABAM

Family Physician & Addictionologist, Valley Medical GroupMedical Director, Franklin County House of Corrections

Medical Director, Franklin Recovery CenterMedical Director, Pioneer Valley Regional School District

Chair, Department of Medicine, Baystate – Franklin Medical CenterCo‐Chair – Healthcare Solutions of the Opioid Taskforce

Thanks to Tess Jurgensen and the OTF of Franklin County and North Quabbin for organizing these forums

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Eat, Drink, Have Sex, Use Drugs

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How Cocaine Works

How Heroin Works

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‘For every action there is an equal and opposite reaction’

Sir Isaac Newton

Newton’s 3rd Law of ‘Drug Abuse’

‘

Normal

‘Newton’s Third Law of Physics

High

Tolerance

75% Normal

50% Normal

Volkow ND et al. N Engl J Med 2016;374:363-371

Neurobiologic Advances from the Brain Disease Model of AddictionNora D. Volkow, M.D., George F. Koob, Ph.D., and A. Thomas McLellan, Ph.D.N Engl J Med 2016; 374:363-371January 28, 2016

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Genetics Early Use Trauma

Poor Mental Health

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Addiction is a Developmental Pediatric Disease

0%

5%

10%

15%

20%

25%

30%

35%

5 10 15 20 25 30 35 40 45 50

Age

Age of First Alcohol Use

Age at first Nicotine Use

Age of First Cannabis Use

Per

cen

tag

e in

eac

h a

ge

gro

up

wh

o

beg

in u

sin

g a

lco

ho

l

0%

5%

10%

15%

20%

25%

30%

35%

5 10 15 20 25 30 35 40 45 50

Age

Age of First Alcohol Use

Age at first Nicotine Use

Age of First Cannabis Use

Per

cen

tag

e in

eac

h a

ge

gro

up

wh

o

beg

in u

sin

g a

lco

ho

l

Source: NIAAA National Epidemiologic Survey on Alcohol and Related Conditions, 2003

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Emotionalneglect Abuse

Adversechildhoodexperiences

Householddysfunction

Adverse Childhood ExperiencesEmotional Neglect

AbuseHousehold Dysfunction

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NYT January 19, 2016

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http://w

ww.nytim

es.com/2011/09/01/us/01drugs.htm

l?src=me&ref=us

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Thanks to Jennifer Clarke, MD, MPH Medical Director, RI‐DOC for this slide

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Thanks to Jennifer Clarke, MD, MPH Medical Director, RI‐DOC for this slide

In early December, 26-year-old Dejah Hall, from Arizona, highlighted the harrowing effects of drug addiction by sharing her

before-and-after photos on social media

Read more: http://www.dailymail.co.uk/femail/article-4069526/Former-addicts-share-amazing-photos.html#ixzz4sEPHq7REFollow us: @MailOnline on Twitter | DailyMail on Facebook

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Stable & Sober Housing

Medicine

Mental Health Treatment

Positive Relationships

Physical Movement

Having a Sense of Purpose

What It Takes To Get Better

Stable & Sober Housing Medicine Mental Health Treatment

Positive Relationships Physical Movement Having a Sense of Purpose

What It Takes To Get Better

Stable & Sober Housing Having a Sense of Purpose Medicine

Mental Health Treatment Positive Relationships Physical Movement

Working Parenting Going to 12 Step Recovery

Growing into an Adult Brain Getting Treatment for Trauma

Hope Self Love Feeling Acountable

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Thanks to Jennifer Clarke, MD, MPH Medical Director, RI‐DOC for this slideDrug Alcohol Depend. 1981 Jun;7(3):249‐56.The Swedish methadone maintenance program: a controlled study.Gunne LM, Grönbladh L

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fer Clarke, MD, MPH Medical Director, RI‐DOC for this slide1981 Jun;7(3):249‐56.one maintenance program: a controlled study.h L

Thanks to Jennifer Clarke, MD, MPH Medical Director, RI‐DOC for this slideDrug Alcohol Depend. 1981 Jun;7(3):249‐56.The Swedish methadone maintenance program: a controlled study.Gunne LM, Grönbladh L

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What actually works?

What are the costs? (OAT = Opioid Agonist Treatment)

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General guidelines

MethadoneLong history of use, high opioid tolerance, unstable life needing lots of structure and support

BuprenorphineMild‐to‐moderate dependence, greater life stability, more potential for abuse

NaltrexoneMild‐to‐moderate dependence, greater life stability, greater risk of relapse and overdose

Which treatment is best?

The One That Works!

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ruthpotee.com

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Documents

THE PHYSIOLOGY OF ADDICTION...FL Alcohol and Drug Abuse Association December 2018 12/17/2018 1 1 THE PHYSIOLOGY OF ADDICTION Effects of Drug‐Taking Behavior on the Brain Ruth A