Transcript View PowerPoint document - New Mexico Highlands University`s

Presented by
Elizabeth Diebold, ND, MPH, CHom
• The nervous system is the body’s decision and
communication center
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Controls every part of body movement and function
Controls emotions and memory
• The central nervous system (CNS) is made up of
the brain, spinal cord, and peripheral nervous
system
• Nerves directly from the brain control movement
and function of face, senses, and life support
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Motor neurons from the brain to the body deliver
instructions about what to do or action to take
• Nerves from the brain run through the spinal
cord outward, controlling movement and function
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These nerve fibers also gather and send sensory
information back to the brain for processing
Sensory neurons to the brain deliver messages about the
environment to the brain for processing and response
• The brain is comprised of three sections:
• Forebrain
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Cerebrum
Thalamus
Hypothalamus (part of the limbic system)
• Midbrain
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Tectum
Tegmentum
• Hindbrain
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Pons
Medulla
Cerebellum
The Cerebrum is the largest part of the brain
• Lots of wrinkles means lots of surface area (and many neurons), which
makes this area very efficient
• Mostly made up of the neocortex, associated with more evolved animals and
higher information processing
• Associated with higher thought and action
• Divided into four sections (lobes):
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Frontal lobe is associated with reasoning,
planning, speech, movement, emotions,
problem solving
Parietal lobe is in charge of movement,
orientation, recognition, and perception of
environmental stimuli
Occipital lobe is associated with processing visual information
Temporal lobe rules auditory stimuli (including speech) and memory
A deep furrow divides the cerebrum in half, into left and right hemispheres
with slightly different functions
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The right is more creative, the left more concerned with logic
The two sides are connected by the corpus callosum, a bundle of nerve cell
connections
• The Cerebellum (“little brain”) is associated with regulation
and coordination of movement, posture, and balance
• While similar in structure to the cerebrum, the cerebellum is
(evolutionarily) much older
• Meaning, it is well developed in less evolved animals, who do not have the
neocortex of the cerebrum
• The Limbic system (The emotional or “reptilian brain”) is buried
deep within the cerebrum
• Evolutionarily, it is very old
• Contains:
o Thalamus, which has sensory and motor functions
Almost all sensory information enters the thalamus, where neurons send
information to the overlying cortex.
Axons from every sensory system (except smell) synapse here as the last
relay site before the cerebral cortex
o Hypothalamus is involved in homeostasis, emotion, thirst, hunger,
circadian rhythms, and control of the autonomic nervous system
Also controls the pituitary
o Amygdala is located in the temporal lobe, and involved in memory,
emotion, and fear
o Hippocampus is important for learning and memory
Especially converting short term memory to more permanent memory
Vital for recalling spatial relationships in the surrounding environment
• The Brain Stem lies beneath the limbic system, and is
responsible for basic vital life functions such as breathing,
heartbeat, and blood pressure
• This is the simplest part of the human brain, meaning it
controls only basic functions and without conscious thought
• The brains of lower animals’ brain stems look much the same
as those of more highly evolved species
• Composed of:
o Midbrain (mesencephalon), involved in vision, hearing, eye and body
movement
o Pons, which is involved in motor control and sensory analysis (e.g.,
information from the ear first enters the brain in the pons) and for level of
consciousness and sleep
Some structures within the pons are linked to the cerebellum, thus are
involved in movement and posture
o Medulla Oblongata is responsible for maintaining vital body functions,
such as breathing and heart rate
• The adult brain weighs about three pounds, and is made up of
billions of cells
• The brain controls everything
o Movements of the body
o Regulation of involuntary body functions (breathing, heartbeat,
digestion, elimination)
o Senses (touch, smell, sight, taste, hearing)
o Memory, learning, emotions
• The brain presides over those experiences we consider human
• The brain manages behavior and actions, both conscious and
unconscious
• The brain rules instinct and reflexive
actions and responses
• Various functions are controlled by very
specific areas of the brain
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The brainstem, which connects the brain and
spinal cord, coordinates basic functions such
as heart rate, breathing, digestion, and sleep
• The cerebellum coordinates skilled repetitive movements, and
maintains balance and posture
• The limbic system regulates emotions, motivation, and mood,
and is where the “reward system” is found
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The amygdala and hippocampus are part of the limbic system, and are
important for making memories
• The diencephalon is made up of the thalamus and hypothalamus
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The thalamus oversees sensory perception and regulates movement
The hypothalamus regulates the pituitary gland, which synchronizes the
release of hormones throughout the body
• The cerebral cortex is the largest part of the brain
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Contains the areas of the brain responsible for thought, reasoning, perception
Contains areas dedicated to the senses (vision, hearing, touch, smell), making
and understanding language, and movement
• Communication between brain cells is the foundation of
brain function
• The brain functions through a complex series of electric
impulses and chemical reactions
• Electrical impulses travel along nerve cells
• Chemical reactions occur in the area between nerve cells
• There are two kinds of cells in the brain:
• Neurons (nerve cells)
• The basic unit of the brain (each brain contains about 1011 of them!)
• Interactions between neurons cause things to happen
• Dendrites receive signals from other nerves, axons transmit signals to other nerves
• The axon ends in branches with swellings called presynaptic terminals
• Axons are located near the dendrite of another neuron
• Junction is called the synapse
• Space between cells is where chemical messages occur
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Glial cells (glia)
• There are 10-50 times more glia than there are neurons in the central
nervous system
• Act as support elements (structure, myelin,
blood-brain barrier) and scavenger cells to
remove cellular trash
• Help regulate ion concentrations, remove
neurotransmitters from intracellular space,
guide neuron growth and migration
• A neurotransmitter is a chemical substance released at
the end of a nerve fiber by the arrival of a nerve impulse
• By diffusing across the synapse (aka, the junction), a
neurotransmitter causes the cell to transfer an impulse
to another nerve fiber, muscle fiber, or some other
structure
• Essential for proper brain (and so body) functions
Major Neurotransmitters in the Body
Neurotransmitter
Acetylcholine
Dopamine
GABA (gammaaminobutyric acid)
Role in the body
Used by spinal cord motor neurons to cause muscle contraction and by many
neurons in the brain to regulate memory.
In most instances, acetylcholine is excitatory.
Produces feelings of pleasure when released by the brain reward system.
Dopamine has multiple functions depending on where in the brain it acts. It is
usually inhibitory.
The major inhibitory neurotransmitter in the brain.
Important in producing sleep, reducing anxiety, and forming memories.
Glutamate
The most common excitatory neurotransmitter in the brain.
Important in learning and memory.
Glycine
Used mainly by neurons in the spinal cord.
It probably always acts as an inhibitory neurotransmitter.
Norepinephrine
Acts as a neurotransmitter and a hormone.
In the peripheral nervous system, it is part of the fight-or-flight response.
In the brain, it acts as a neurotransmitter regulating blood pressure and
calmness.
Norepinephrine is usually excitatory, but it is inhibitory in a few brain areas.
Serotonin
Involved in many functions including mood, appetite, and sensory perception.
In the spinal cord, serotonin is inhibitory in pain pathways.
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Drug abuse/addiction carries consequences for individuals and a high
cost to society
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Estimates of the total overall costs of substance abuse in the United States add up to
more than $600 billion every year
This includes loss of productivity, impacted health and increased health care costs, and
costs related to the crime which surrounds drug use and addiction
Nearly $200 billion of this figure is spent on the drugs themselves
Another $200 billion goes to the purchase of tobacco, and nearly $250 billion to
alcohol; these are often used concurrently, with or without the use of other drugs.
Costs less measurable include the impact on public safety, as well as job loss and
unemployment, educational failure, and the degeneration of families, domestic
violence, and child abuse
Drug addiction is a complex disease, and quitting takes more than
good intentions and willpower
Drugs change the brain in ways that foster compulsive drug use,
making quitting difficult
Let’s review … what is addiction?
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Addiction is a chronic, often relapsing brain disease that causes
compulsive drug seeking and use, despite harmful consequences to the
individual and to those around him/her
Although the initial decision to take drugs is voluntary, the brain
changes that occur over time challenge an addicted person’s self
control and impede his/her ability to resist impulses to take drugs
Similar to other chronic, relapsing diseases, such as diabetes, asthma,
or heart disease, drug addiction can be managed successfully
• Much like other chronic diseases, it is common for
a person to relapse and use drugs again
• Reassurance and support are important,
as relapse does not signal failure
• Rather, it indicates that treatment should
be reinstated or adjusted, and that alternative
treatments and tools are needed to help the
individual regain control and be able to
sustain recovery
• Drugs work by replacing natural brain chemicals with artificial
ones that are more stimulating and longer acting, or by
blocking natural brain chemicals to achieve a different effect
• The reward system (part of the limbic system) regulates feelings
of pleasure
 This region is fully activated by drugs of abuse, which is what makes
them so addictive
• Drugs of abuse alter the communication between neurons that is
mediated by the neurotransmitter dopamine in a number of ways
• Examples:
 Increase the amount of neurotransmitter released
 Alcohol, heroin, and nicotine indirectly excite dopamine-containing
neurons so that they produce more action potentials, which
increases the amount of dopamine released
 Meth, crystal, crack, and other amphetamines cause the release of
dopamine from storage areas independent of action potentials,
which produces a quick and prolonged rise of dopamine levels
• Some drugs activate chemical receptors in synaptic
transmission, others block them
• THC and morphine activate specific receptors, which blocks a
person from experiencing pain
• Caffeine prevents the neurotransmitter adenosine (which has
sedative properties), causing stimulation and arousal
• LSD stimulates some serotonin receptors while blocking
others, impacting mental function in a very complex (and not
fully understood) way
• Although the influence of drugs on the brain’s reward
pathways and alterations of dopamine neurotransmission are
central to continued use, there are other equally important
factors at work:
• Genetics impact a person’s drug sensitivity, how drugs are
metabolized, and their tendency toward addiction
• Environmental factors, such as stress, trauma, and (especially in
teens) unhappiness can impact an individual’s willingness to
experiment with drug use or give in to continued use
• Dose and route of administration are critical factors
• A dose can be anywhere from low (no effect) to toxic (overdose)
• Not everyone responds to the same dose in the same way, or the
same way every time to a particular dose
• Responses can be influenced by age, gender, genetics, emotional
state, and past experience with drugs (including prescription drugs)
• Routes of administration have a huge impact
• Drugs enter the brain by different routes, and the route of
administration can make a dramatic difference to onset,
intensity, and duration of action for a drug
• A drug which is inhaled reaches the brain very quickly, as it will
go directly from the lungs to the heart to the brain
• Effect may be less intense because some of the drug will be exhaled and some
may not pass through the blood-brain barrier in sufficient amounts
• A drug injected intravenously travels quickly and intact, causing a
rapid onset and high risk of overdose
• Snorting or snuffing a drug brings a less intense action because it
takes longer to get the drug to the brain; the same is true of oral
ingestion, as both must be metabolized in the body first
In 1994, Mickey Mantle checked into The Betty Ford Clinic after being
told by doctors that his liver was on its last leg. His wife and sons had
already completed treatment for their own alcoholism and drug
addiction, and they urged him to go.
This man -- this legend – who had survived osteomyelitis in his youth
and gone on to set world records in baseball, was here getting sober
with his family.
A family which consisted of
two alcoholic parents and
their four children.
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Studies of identical twins suggest that up to half of an individual's risk
of becoming addicted to nicotine, alcohol, or other drugs depends on
his or her genes
Genes provide information that directs the body’s basic cellular
activities
 Research on the human genome has shown that the DNA sequences of any
two individuals are 99.9% identical
 That 0.1% variation is profoundly important, contributing to visible individual
differences, like height and hair color, and to invisible differences, such as
increased risk or protection from heart attack, stroke, diabetes, and addiction
 Some diseases are caused by an error in a single gene (e.g., sickle cell anemia,
cystic fibrosis, Huntington’s disease)
 Other diseases – including addiction – are more complicated, and variations in
many different genes lead to increased risk or resistance to a particular
disorder
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Research shows that individual health is the result of dynamic
interactions between genes, familial customs, and environmental
conditions
In other words,
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In many cases, genetic effects persist throughout a person's life
 Think about risk for high blood pressure, heart disease, or diabetes, or even
sunburn, obesity, all of which can be managed or alleviated through personal
choices and a healthy lifestyle
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Research suggests that genes can also influence how a person
responds to his or her environment, placing some individuals at
higher risk than others even under the best of circumstances if they
are not very careful
 This means that they must be educated!
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Scientists of pharmacogenomics are currently using genomic
information to improve treatments for a number of diseases, including
some very interesting work in addiction therapy
Clinicians have found substantial variability in how individual patients
respond to treatment, particularly drug treatment
 Part of that variability is due to genetics: Genes influence the numbers
and types of receptors in the brain, how quickly the body metabolizes
drugs, and the response an individual has to different medications
 This can have huge implications on how likely it is that an individual
becomes addicted, and how they are subsequently treated
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Two dangers in this approach:
1. The trial and error phase can be long, tedious, and deadly
2. Substituting one substance (or behavior) for another
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There is a distinct interaction of factors that leads to an addictionprone individual becoming an addict
• When drug use is present, brain neurotransmitters are
impacted
• When neurotransmitters are impacted, behavior and
physicality are changed
• Cravings are exacerbated by imbalances in the brain’s
neurotransmitter chemicals, which can be caused by the
use of psychotropic drugs of any kind
• Re-balancing brain chemistry and neurotransmitters will
allow the patient to manage mood disturbances and
cravings
The consequence of drug abuse are vast and varied, and
affect people of all ages and socioeconomic areas.
What we are doing, and how we do it, matters.
• From the National Institute on Drug Abuse, the
following trends are seen in NM (as of 2012):
• Drug overdose deaths rates for Bernalillo County (Albuquerque)
and New Mexico increased in 2011
• There was a dramatic increase in methocarbamol (Robaxin, a
muscle relaxant) poison control center cases from 2011
• Synthetic cannabinoids increased substantially in numbers of
poison control center cases and in numbers of reports identified
from drug items seized and analyzed
• A large increase occurred in reported naloxone overdose
reversals in Bernalillo County over the previous year
• Drug overdose deaths continue to increase throughout NM
• In 2010, New Mexico had the second highest drug overdose death rate in the
Nation, a rate which increased by 66% in 2011 (nearly 40% in ABQ), which
represents nearly 30 deaths per 100,000 people
• While drug overdose as the primary diagnosis decreased in 2011, drug overdose
death rates increased as a secondary diagnosis, as well as deaths involving
prescription opioids. Overdose death rates were stable for
methamphetamines/amphetamines.
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• In Albuquerque, 2012:
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21.2%
20.6%
18.7%
16.3%
of drug seizures in Albuquerque were for heroin
involved methamphetamines
involved marijuana seizures
involved cocaine
• According to the Youth Risk and Resiliency Survey, drug use
among youth in NM remains high, although it has declined in
recent years for all substances
• Approximately 26.5% of high school students reported using marijuana during
the past 30 days
• 10.2% reported having used painkillers to get high
• 6.1% were reported as current users of inhalants
• According to the National Survey of Drug Use and Health, 11.4% age 12 and
older reported current marijuana use, and 5.76% reported current nonmedical
use of prescription pain relievers
• Overall, sales of prescription opioids have increased only slightly
(<1% in ABQ, 5.8% in NM), with the highest volume being of
oxycodone
• As of 2013:
• High levels of heroin and methamphetamine/amphetamine
continue to be seized in ABQ and Bernalillo County
• Heroin and prescription opioids/opiates other than heroin were
overtaken in primary treatment admissions data by
methamphetamine/amphetamines and marijuana
• The proportion of primary methamphetamine/amphetamine
treatment admissions increased from 2010 to 2012
• Percentages of marijuana/cannabis seizures increased, but remain
lower than national data
• Treatment admissions in which marijuana was the primary drug of
choice increased in 2012 from 2010
• The proportion of drug reports for cocaine in the ABQ area were
lower than the national data, and decreased in the first half of
2013
• Primary cocaine treatment admissions declined from 2010 to 2012
From the Trust for America’s Health
• New Mexico has the Second Highest Drug Overdose
Mortality Rate in the United States
• New Mexico Scored 10 out of 10 on New Policy Report
Card of Promising Strategies to Help Curb Prescription
Drug Abuse
• What NM is doing right:
• Educate the public to understand the risks of prescription drug use
to avoid misuse in the first place;
• Ensure responsible prescribing practices, including increasing
education of healthcare providers and prescribers to better
understand how medications can be misused and to identify
patients in need of treatment
(cont…)
• Increase understanding about safe storage of medication and
proper disposal of unused medications, such as through "take
back" programs
• Make sure patients do receive the pain and other medications they
need, and that patients have access to safe and effective drugs
• Improve, modernize and fully-fund Prescription Drug Monitoring
Programs, so they are real-time, interstate and incorporated into
Electronic Health Records, to quickly identify patients in need of
treatment and connect them with appropriate care and identify
doctor shoppers and problem prescribers
• Make rescue medications more widely available by increasing
access for at-risk individuals to naloxone and provide immunity for
individuals and others seeking help
• Expand access to and availability of effective treatment options as
a key component of any strategy to combat prescription drug
abuse
• UNM: Center on Alcoholism, Substance Abuse, and
Addictions (CASAA)
• Studies in the areas of behavior, pharmacological, and integrated
behavioral and pharmacological treatment interventions
• Studies across a broad range of treatment settings and diversified
patient populations
• Eastern NM University
• Research and training in biological, social, and psychological
aspects of addiction, and in efficacy of various counseling
techniques
• Special studies of “special populations,” including women,
minorities, youth, and persons with concomitant physical and
mental disabilities/disorders
• Pacific Coast Research Center
• Multidisciplinary study in the areas of criminal justice, drug abuse,
and implementation, partnering with other states and agencies
and focusing on organizational and system processes
• Planning
• Studies in behavior change show that taking the time and effort to
make a plan is a powerful motivator in changing one’s actions
• Use a calendar, chart, or daily list, and include details of the plan
• Formulate a long-term plan to maintain sight of the “Big Picture,”
then set aside time each week to make a detailed weekly plan
• Be sure to note down-time and rewards to keep you motivated
• Include a few minutes every day to re-play how the day went
• Offers feedback, and allows for adjustments to behavior
• Allows us to feel more in control and confident, and thus more
prepared for the next move, the next day
• Visualizing
• Five minutes a day will do the trick!
• Envision yourself in brilliant detail acting as you want to, carrying
out the behaviors you aspire to, and being the person you want to
be/become
• Meditation
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The simplest form of meditation is one sitting quietly and concentrating on the
breath
Once mastered, meditation can be used for stress control and to ease
cravings (be they drugs, food, or behavior)
Five minutes in the morning and before bed, and just a minute or two
whenever a “time out” is needed
• Journaling
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Journaling serves to get the spiraling thoughts out of your head and into a
place where they can be dealt with and put to rest
The journal can be as simple (a spiral notebook or computer document) or as
fancy as you like.
Make certain that the journal, in whatever form, is completely private
• Rewards
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Ever go to Disneyland? Participate in a group event?
Rewards, big or small, and powerful motivators
Small rewards, such as stickers, charms, or chips should come regularly, and
for even the smallest victories
Large rewards, such as a trip, new bicycle, or day at the spa can come with
larger goals reached – such as time clean
• Review progress daily
• Ask yourself …
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3.
4.
Did you have the day you planned to have?
Name one thing, large or small, that you are proud of today
What challenges did you face today? How did you do? Why?
How can what happened today help me tomorrow? What can I change? How can I
better be prepared?
• Feedback, not failure!
• Use what is learned in these exercises to change behaviors, adjust the
plan, and re-commit to goals
• Forgive and move on
• There are bound to be slips and slides; make a note
of them and then forgive yourself so you can move on
• Look forward, not back
• Whatever today looked like, look forward to a better tomorrow
• Use the “coin analogy”
• One coin does not make one rich – but that is where it begins
• Adding one coin at a time does not make one rich – but is how wealth is built
• Many coins, collected over time, leads to riches, just as many small steps leads
to goals met, behaviors changed
For more information or answers to questions,
Call Dr Diebold at 505-410-2840
or email [email protected]
Kurt Cobain
• The lead singer of the world’s biggest rock band of the 1990s was a lifelong
heroin addict, a problem that only worsened as fame grew. Unable to handle
the pressures that accompany success, Cobain secluded himself in his sprawling
Washington estate, overdosed on heroin, then committed suicide via a selfinflicted gunshot wound.
River Phoenix
• River Phoenix enjoyed a meteoric rise to stardom during his short life, and
participated in habitual cocaine and heroin use from his early teens. Phoenix
would succumb to a drug overdose from a speedball (cocaine and heroin
mixture) outside of the famous Viper Room nightclub on the Sunset Strip in LA.
Tim Allen
• During the 1990s, Tim Allen was one of the most beloved stars on television,
with his hit show Home Improvement rating number every season of its
existence. During this time, Allen overcame a very serious cocaine addiction,
one that led him to trouble with law enforcement, before enjoying mainstream
success. Tim Allen is an excellent example of a celebrity who had the strength
and support to overcome drug addiction in a setting that makes recovery very
difficult.
Stephen King
• “As the tall, thin man in his mid-40s lay unconscious on the floor of his office,
his eyes shut tight and his shirt-front soaked with blood, the silence of the night
all around him was broken only by the shrieks of the bats which haunted the
rafters of his vast Victorian mansion.” The scene was like something out of a
novel by that master of the macabre Stephen King, ironic given that the
comatose figure was none other than King himself - dead to the world after
drinking countless cans of beer and snorting so much cocaine that his ravaged
nose had become a gushing crimson fountain. An unhappy child, King learned
to medicate himself with drugs and alcohol as a college student. He finally
began recovery in 1988 – which he struggles with to this day.
Elvis Presley
• When Elvis was young, he was a polite, clean cut young man. Although many
parents saw his hip gyrations and racy and his lyrics signs of a collapse of
society, he was actually quite tame by modern standards. When Elvis went into
the US Army, he began taking amphetamines. When he returned to civilian life,
he developed a prescription drug addiction that included practically every drug
found a pharmacist’s shelf. After decades of drug dependence, Elvis died of an
overdose with a shocking fourteen different drugs in his system.
John
• “My goal in life wasn't living...it was getting high. I was falling in a downward
spiral towards a point of no return.
• Over the years, I turned to cocaine, marijuana, and alcohol under a false belief
it would allow me to escape my problems. It just made things worse.
• I had everything, a good job, money, a loving family, yet I felt so empty inside.
As if I had nothing.
• Over twenty years of using, I kept saying to myself, I’m going to stop
permanently after using this last time. It never happened. There were even
moments I had thought of giving up on life.”
Ben
• “It started with the weed, then the pills (Ecstasy) and acid, making cocktails of
all sorts of drugs, even overdosing to make the rushes last longer. I took
copious amounts of these chemicals every day for as long as two years until I
had a bad trip one night and went into toxic psychosis. I prayed and cried for
this feeling to go away, I had voices in my head, had the shakes and couldn't
leave home for six months. I became very withdrawn and thought everyone
was watching me. I couldn’t walk in public places. Man! I couldn’t even drive.
• “I ended up homeless and on the streets, living and sleeping in a cardboard
box, begging and struggling to find ways to get my next meal.
• “I asked myself if this is rock bottom, and I believe that it was. While observing
these homeless people I decided that I had had enough. Yes I wanted drugs,
but I realized that I could want life more.”
Michael
• “I have had a rough life. I don’t know my real father. The only person I have
ever even called dad died when I was nine years-old. My mom is a drug addict
and is in prison now, as she was pretty much my whole life. I only have maybe
one or two friends who I can really count on, and I have always lived with my
grandmother since birth.
• On my 13th birthday, I was at a friend’s house. Now I knew that he and his
family smoked pot, but I had never tried it and then my friend asked me if I
wanted to try it. I was hesitant, but I said sure and so started my addiction with
drugs.
• I knew I was already hooked right after the first hit. I fell in love with it, but
little did I know how much trouble it would cause me later down the road. So, I
went home the next day, and I paced back and forth for about thirty minutes. I
didn’t know what was wrong with me, then it hit me that I needed to have
more. So almost everyday after school I went over to his house just to get a
quick high.
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Mental illnesses of any kind does not define the individual– people are wholistic
beings, living in unique environments with families, friends, jobs (or not), and
lifestyle habits, with feelings, emotions, and dreams that are central to who
they are …
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It is ALL of these things that must be addressed in order for anyone – including
addicts and others with mental illnesses - to regain a healthy wholeness
Life is not predestined to be an ever downward-spiraling path, so let’s not
enable people to believe that it is in any way
Teach skills to enable addicts to live a functional life, find success and
happiness, and pursue their dreams in the real world
Vary your approach! Each person you deal with will come from a different place,
have a unique outlook, a distinctive set of genes, and need specific information
to be successful in their wellness journey
Strive for greatness – anyone can live an exemplary and fulfilling life, so never
let an individual slide by without trying!