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Substance Abuse: Testing HIV, Meth and Other Issues

Substance Abuse: Testing HIV, Meth and Other Issues. Thomas E. Freese, Ph.D. Director, Pacific Southwest Addiction Technology Transfer Center Director of Training, UCLA Integrated Substance Abuse Programs. Management of TB, STDs, HIV, Hepatitis C and Substance Abuse at the Border

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Substance Abuse: Testing HIV, Meth and Other Issues

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  1. Substance Abuse: Testing HIV, Meth and Other Issues Thomas E. Freese, Ph.D. Director, Pacific Southwest Addiction Technology Transfer Center Director of Training, UCLA Integrated Substance Abuse Programs Management of TB, STDs, HIV, Hepatitis C and Substance Abuse at the Border Holtville, CA June 1-2, 2007

  2. Overview of Presentation • Drug testing • Biology of addiction • Methamphetamine and the Brain • Tips for HIV Clinicians • Indicators of Successful Treatment

  3. Testing for Drugs of Abuse

  4. Length of Detection • The amount of time that someone will test positive depends on • What they were taking • How much they took • With that in mind, let’s look at some specifics

  5. Alcohol • Bodies eliminate alcohol at the constant rate of about one drink an hour (.015% BAC per hour.) • If a person’s intoxication level is about .02%, about one hour later their alcohol level would be zero. • On the other hand, if a person had an alcohol level of .20%, twice the legal limit for drunk driving in most states, it would take over 13 hours for their alcohol level to reach zero after they stopped drinking.

  6. Drug Testing

  7. What have we learned about addiction?

  8. Why do people take drugs? To feel better To lessen: Anxiety Worries Fears Depression Hopelessness Withdrawal Tofeelgood To have novel: Feelings Sensations Experiences AND To share them

  9. A Major Reason People Take a Drug is They Like What it Does to Their Brains

  10. FOOD SEX 200 200 NAc shell 150 150 DA Concentration (% Baseline) 100 100 15 % of Basal DA Output 10 Empty Copulation Frequency 50 Box Feeding 5 0 0 Scr Scr Scr Scr 0 60 120 180 Bas Female 1 Present Female 2 Present Mounts Time (min) Sample Number 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 Intromissions Ejaculations Source: Di Chiara et al. Source: Fiorino and Phillips Natural Rewards Elevate Dopamine Levels

  11. Effects of Drugs on Dopamine Release COCAINE AMPHETAMINE Accumbens 1100 Accumbens 400 1000 900 DA 800 DA 300 DOPAC 700 DOPAC % of Basal Release HVA HVA 600 % of Basal Release 500 200 400 300 100 200 100 0 0 0 1 2 3 4 5 hr Time After Amphetamine Time After Cocaine MORPHINE NICOTINE 250 Accumbens 250 Dose (mg/kg) 200 Accumbens 0.5 200 Caudate 1.0 2.5 % of Basal Release 150 % of Basal Release 10 150 100 0 1 2 3 hr 100 0 1 2 3 4 5 hr 0 0 0 1 2 3 4 5hr Time After Nicotine Time After Morphine Source: Di Chiara and Imperato

  12. Prolonged Drug Use Changes The Brain In Fundamental and Long-Lasting Ways

  13. AND… We Have Evidence That These Changes Can Be Both Structural and Functional

  14. Normal Cocaine Abuser (10 Days) Cocaine Abuser (100 Days) Sources: Volkow, et al., Synapse, 11:184-190, 1992 & Volkow, et al., Synapse, 14:169-177, 1993

  15. Dopamine D2 Receptors are Lower in Addiction DA DA Cocaine DA DA DA DA DA DA DA DA DA DA Meth Reward Circuits Non-Drug Abuser DA D2 Receptor Availability DA Alcohol DA DA DA DA DA Heroin Reward Circuits Drug Abuser control addicted

  16. Chronic cocaine increases density of dendritic spines andneuronal branching in the nucleus accumbens 11 60 55 10 Branches COC 9 50 CTL 45 8 CTL COC CTL COC CTL COC Robinson, T.E. & Kolb, B. Eur. J. of Neuro. 1999. Ferrario, C.R. et al. Biol. Psychiatry, 2005.

  17. Methamphetamine

  18. 1992 < 5 47-107 220 or more 5-46 108-219 Incomplete Data Primary Amphetamine/Methamphetamine TEDS Admission Rates:(per 100,000 aged 12 and over) SOURCE: SAMHSA Treatment Episode Data Set (TEDS).

  19. 1995 1996 1998 1997 < 5 < 5 < 5 < 5 47-107 47-107 47-107 47-107 220 or more 220 or more 220 or more 220 or more 5-46 5-46 5-46 5-46 108-219 108-219 108-219 108-219 Incomplete Data Incomplete Data Incomplete Data Incomplete Data Primary Amphetamine/Methamphetamine TEDS Admission Rates: (per 100,000 aged 12 and over) SOURCE: SAMHSA Treatment Episode Data Set (TEDS).

  20. 2000 1999 2001 < 5 < 5 < 5 47-107 47-107 47-107 220 or more 220 or more 220 or more 5-46 5-46 5-46 108-219 108-219 108-219 Incomplete Data Incomplete Data Incomplete Data Primary Amphetamine/Methamphetamine TEDS Admission Rates:(per 100,000 aged 12 and over) SOURCE: SAMHSA Treatment Episode Data Set (TEDS).

  21. 2003 2004 2002 2005 < 5 < 5 < 5 < 5 47-107 47-107 47-107 47-107 220 or more 220 or more 220 or more 220 or more 5-46 5-46 5-46 5-46 108-219 108-219 108-219 108-219 Incomplete Data Incomplete Data Incomplete Data Incomplete Data Primary Amphetamine/Methamphetamine TEDS Admission Rates:(per 100,000 aged 12 and over) SOURCE: SAMHSA Treatment Episode Data Set (TEDS).

  22. Methamphetamine and HIV and the Brain

  23. Meth Abuse, HIV Infection Cause Changes in Brain Structure • Methamphetamine abuse and HIV infection cause significant alterations in the volume of brain gray matter structures and cognitive functions • In both cases the changes may be associated with impaired cognitive functions, such as difficulties in learning new information, solving problems, maintaining attention and quickly processing information. • Co-occurring methamphetamine abuse and HIV infection appears to result in greater impairment than each condition alone. SOURCE: http://www.drugabuse.gov/newsroom/05/NR8-11.html

  24. Meth Abuse, HIV Infection Cause Changes in Brain Structure • Methamphetamine abuse is associated with increases in the volume of the brain's parietal cortex (which helps people to understand and pay attention to what's going on around them) and basal ganglia (linked to motor function and motivation). • HIV infection is associated with prominent volume losses in the cerebral cortex (involved in higher thought, reasoning, and memory), basal ganglia, and hippocampus (involved in memory and learning). SOURCE: http://www.drugabuse.gov/newsroom/05/NR8-11.html

  25. Meth Abuse, HIV, and Brain Volume http://www.drugabuse.gov/NIDA_notes/NNvol20N6/Increases.html

  26. PET Scan of Long-Term Impact of Methamphetamine on the Brain

  27. 2.0 Motor Activity 1.8 1.6 1.4 (Bmax/Kd) Dopamine Transporter 1.2 1.0 7 8 9 10 11 12 13 Normal Control Time Gait (seconds) 2 Memory 1.8 1.6 1.4 Dopamine Transporter Bmax/Kd 1.2 1 16 14 12 10 8 6 4 Methamphetamine Abuser Delayed Recall p < 0.0002 (words remembered) Dopamine Transporters in Methamphetamine Abusers

  28. Differences between Stimulant and Comparison Groups on tests requiring perceptual speed

  29. Longitudinal Memory Performance number correct test

  30. Labeling of Emotion Brain scans were taken while people answered the question below looking at the following pictures What did their brains show? Which of the two bottom pictures matches the emotion shown on top?

  31. Control Subjects and Methamphetamine Abusers Activate Emotion & Face Processing Areas Control Methamphetamine • amygdala • amygdala D Payer et al., Abstr. Soc. Neurosci., 2005

  32. Control > MA 4 3 2 1 0

  33. 5 4 3 2 1 0 MA > Control

  34. How much does the brain heal?

  35. PET Scan of Long-Term Meth Brain Damage

  36. Partial Recovery of Brain Dopamine Transporters in Methamphetamine (METH) Abuser After Protracted Abstinence 3 0 ml/gm METH Abuser (1 month detox) Normal Control METH Abuser (24 months detox) Source: Volkow, ND et al., Journal of Neuroscience 21, 9414-9418, 2001.

  37. Partial Recovery of Brain Metabolism in Methamphetamine (METH) Abuserafter Protracted Abstinence 70 0 µmol/100g/min Control Subject (30 y/o, Female) METH Abuser (27 y/o, Female) 3 months detox METH Abuser (27 y/o, Female) 13 months detox Source: Wang, G-J et al., Am J Psychiatry 161:2, February 2004.

  38. Methamphetamine Use Often Leads to Bad Decision Making

  39. …Bad Decision Making When police went into Nitschmann Middle School Tuesday to arrest Principal John Acerra for allegedly selling crystal methamphetamine, sources said they found him naked while sitting at his desk watching gay pornography. He was high on methamphetamine at the time. Bethlehem, PA

  40. …More Bad Decision Making

  41. MSNBC-TV 33 year old man, high on methamphetamine admitted to emergency room complaining of severe headache in Portland Oregon.

  42. Doctors did not see anything abnormal during the initial examination… • X-rays revealed 12 nails, 1 ½ to 2 inches long, embedded in his head.

  43. The man at first claimed it was an accident, but he later admitted that it was a suicide attempt. • The nails were removed, and the man survived without any serious permanent damage. • He was eventually transferred to psychiatric care; he stayed for almost one month under court order but then left against doctors’ orders Source: Skidmore, S. (2006, April 21) Oregon Man Survives 12 Nails to the Head. TheAssociated Press.

  44. Methamphetamine Use and HIV Testing

  45. Methamphetamine Use and HIV Testing • Screening for risk may be difficult due to: • Embarrassment • Memory impairment • Slower information processing • Decisions around testing may be difficult due to: • Impaired decision making • Changes in cognitive functioning • Fear resulting from extremity of behavior • Emotional disruption • Lack of appropriate social support

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