Transcript The Brain Injury Definition of Addiction

William G. Zollweg, Ph.D.
Sociology Professor Emeritus
University of Wisconsin – La Crosse
Former Department of Justice
National Drug Court Institute
Program Evaluator
Contact: [email protected]
Why me?
Detroit High School
University of Northern Colorado
United States Navy
U.S. Naval School of Meteorology and Oceanography
San Diego State University
Western Michigan University
University of Wisconsin – La Crosse
National Drug Court Institute
The Evolution of Understanding Addiction
Two Fundamental Addiction Paradigms
Moral
Defect
Medical
Model
Toward A Unified Theory of Addiction

A theory that explains the range of
examples
 A theory that presents testable
hypotheses
 A theory that offers hope
But first: The Basics of Drugs and the Brain
Neurology and Chemistry
 Neurons
are nerve cells
 Neurons
send electrical/chemical impulses
Different body parts
Different cells
 Neurons
determine:
Autonomic functions
Voluntary functions
The Basics of Drugs (part 2)
Neurons release chemicals called:
 Neurotransmitters
Neurotransmitters act on specific sites called:
 Receptors
Specific Neurotransmitters fit into specific receptors
(key in lock)
The Basics of Drugs (part 3)
The relationship between transmitter and receptor is
relative, not specific!
 The
better the fit the greater the stimulation
Transmitter/Receptor Affinity
High Affinity = Strong Effect
Low Affinity = Weak Effect
The Basics of Drugs (part 4)
Psychoactive Drugs
 Cross
the blood-brain barrier
 No
blood-brain barrier crossing, no psychoactive
effect
 Different
routes of administration result in different
levels of blood-brain cross over
The Basics of Drug Pharmacology
All drugs have multiple effects
 Main effects –the intended result of a drug
 Side effects – the effects of the drug that are not
intended
Effect Dose (ED) – is the amount of a drug needed
to produce the intended effect
 ED50 – is the amount needed to produce the
effect in 50% of a population
 ED100 – the amount needed for 100% of the
population
Drug Pharmacology
Toxicity – refers to the drugs ability to kill the
organism
Cause
harm to one or more of the organs in
an organism
Lethal Dose (LD) – the amount need to kill an
organism
LD50
– kill 50% of the population
LD100
– kill 100%
Drug Pharmacology
Drug Margin of Safety
 How far apart is the ED from the LD for a given
drug?
 Barbiturates have a low margin of safety
 Marijuana has a high margin of safety
Multiple Drugs Complicate
 Additive – greater effect
 Antagonistic – cancel effect
 Synergy – multiply effect
Drug Classifications
Stimulants – amphetamines, methamphetamines, Dexedrine,
cocaine,
caffeine, Ritalin, Adderall, nicotine, et
al.
Antidepressants
– Prozac, Zoloft, Lithium
Sedatives – Barbiturates, Quaalude, Valium
Hallucinogens – LSD, mescaline, peyote, MDMA (ecstasy),
psilocybin
Analgesics – opiates (opium, morphine, heroin, codeine)
opioids
(methadone, Demerol, Darvon)
Non-narcotic - Tylenol,
ibuprofen, aspirin
Three Major Neurotransmitters:

Dopamine



Serotonin



Effects heart rate and blood pressure
Produces the euphoria of love and pleasure
Effects mood, emotions, and sleep patterns
Produces a calm serene state of mind
Norepinephrine



Effects heart rate and blood pressure
Constricts blood vessels in the lungs
Produces the “rush” of excitement
Addiction
No universally accept definition
Four common definitions in competition for dominance
1.
Physical dependence definition
2.
Quantity and frequency definition
3.
Psychological dependence definition
4.
Life problems definition
Brain Injury definition
Physical Dependence
Definition of Addiction
Clear physical withdrawal symptoms must be present
Shakes
Cramps
Problems:
 Too
restrictive to be useful
 Problem
abusers are not included
Quantity and Frequency Definition of
Addiction
Once per week
3-5 times per week
Everyday Use
Problems:
 Individual factors influence the effects based on quantity
(Habituation, age, weight, etc.)
 Binge users don’t fit into the definition
Yearly average may be low but, the pattern of use
reveals excessive amounts in short periods of time
Psychological Dependence
Definition of Addiction
Experience psychological discomfort as a withdrawal
symptom
Do you use after a bad (for a good time) time?
Do your friends use less than you?
Problems:
 Moderate users could also answer yes to many of the
questions
 Definition is very subjective
 Difference between habit and dependence?
Life-Problems
Definition of Addiction
Medical problems (e.g. liver)
Family problems (divorce, abuse)
Career problems (loss of job, no promotion)
Criminal Justice problems (arrests, convictions)
Problems:
 Sub-culture/cultural
definitions of problems
 Medical problems are not straight per dose outcomes (not
all develop a common medical problem)
Brain Injury Definition
Both neurotransmitters and receptors become damaged with
repetitive use
A repetitive use injury (carpal tunnel, tennis elbow, concussion, etc.)
Damaged so that only the active chemical will trigger the release of
dopamine (or serotonin, or norepinephrine)
Only the chemical can generate happiness
Therefore: family, children, music, chocolate, sex, and work have little
value
Thus, there is no way to scare someone out of addiction
 Similar to “if you breath I am going to hurt you.”
 What things make you really happy?
Injury Healing Time

Healing time varies based on degree of injury

Research shows that most injuries begin to heal after 8 or
9 month of abstinence
What does the Brain Injury definition
mean for us?



All people are equally susceptible to addiction injury

There is no addictive personality

There is no identifiable predisposition
Treatment can effectively be coerced

The addict does not have to “want” to be helped

What would the success rate be for voluntary treatment of a broken arm be?
The single most important variable involved in addiction recovery is LENGTH OF
TREATMENT.

Regardless of treatment type

The longer the addict stays in treatment, the greater the success of the treatment

Abstinence, or near abstinence allows the neurotransmitters and receptors to heal
References


Findings from studies using follow-up periods of up to 2 years indicate that
participation in formal treatment are consistently associated with better outcomes.

Anglin MD, Hser YI. Drug abuse treatment. In: Watson RR, editor. Drug and Alcohol
Abuse Reviews. Treatment of drug and Alcohol Abuse. Vol. 3. Human Press; Totowa,
NJ: 1992. pp. 1–36.

Fiorentine R, Hillhouse M. Drug treatment and 12-step program participation: The
additive effects of integrated recovery activities. Journal of Substance Abuse
Treatment. 2000a;18(1):65–74.[PubMed]
The main phases of substance abuse treatment are detoxification/stabilization,
rehabilitation and continuing care. The published scientific literature provides
evidence of effective treatment components with the length of stay being the
clearest predictor of beneficial effects from treatment. Treatment modalities
with longer recommended duration typically have better outcomes, as do patients
who remain engaged in treatment longer, regardless of the modality.

UNITED NATIONS INTERNATIONAL DRUG CONTROL PROGRAMME VIENNA
Investing in Drug Abuse Treatment A Discussion Paper For Policy Makers UNITED
NATIONS New York, 2003