1 / 68

ADDICTION

ADDICTION. What is and what isn’t. Leo Lanoie, MD, ASAM Cert. Addiction is not:. Tolerance Physiological Dependence Excessive use Stupid use Intoxication. Tolerance. Occurs with many drugs Means larger dose required to reach the desired effect Larger doses needed reach toxic effect

peggy
Download Presentation

ADDICTION

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. ADDICTION What is and what isn’t Leo Lanoie, MD, ASAMCert

  2. Addiction is not: • Tolerance • Physiological Dependence • Excessive use • Stupid use • Intoxication

  3. Tolerance • Occurs with many drugs • Means larger dose required to reach the desired effect • Larger doses needed reach toxic effect • If often seen in addiction but can occur without addiction

  4. Physiological Dependence • Occurs with many drugs • Patient experiences withdrawal if drug is discontinued abruptly • Occurs in addiction but can occur in many non addicted patients.

  5. Withdrawal • Occurs only in physiologically dependent persons • Occurs when drug stopped abruptly • Symptoms usually the opposite of drug effect • May be life threatening

  6. Life Threatening withdrawal occurs with 2 groups of addictive drugs. • Alcohol • Benzodiazepines

  7. ADDICTION The Three C’s • COMPULSION - Differs from craving in that it is subconscious • Loss of CONTROL • Continued use despite negative CONSEQUENCES

  8. ADDICTION The American Society of Addiction Medicine states that, “Addiction is a chronic relapsing disease.”

  9. Why do Alcoholics drink?Why do Addict drug? To feel normal

  10. Pathophysiology of Addiction • Anhedonia • Neuro-adaptation • Plasticity

  11. Pleasure Pathway

  12. What it takes to become addicted Biology Psychology Environment Addiction

  13. Early signs that child is at Risk

  14. The Pickle Line Once a pickle, you can never again be a cucumber

  15. The Pickle Line Amount Abuse Dependence Time

  16. PSEUDOADDICTION • Drug seeking behavior in person with inadequately treated severe (usually chronic) pain. • Falsely labeled addicts. • Treatment is adequate pain management. • Cause: Opiophobia among physicians

  17. Always Look at the Arms

  18. Amphetamine vs Methamphetamine CH3 CH3 2

  19. Stimulant Like: • Cocaine • Amphetamine • Methylphenidate • Ephedrine • Phenylephrine • Adrenaline (fight or flight reaction)

  20. Drug Tmax (H) T1/2 (H) pKa Amphetamine 2-4 7-34* 9.9 Cocaine 1 .75-1.5 Methamphetamine 1-3 6-15* 9.9 Methylphenidate 1-3 2.4-4.2 8.8 * urine pH dependent: the lower the pH the shorter the half life Pharmacokinetics of Oral Stimulants

  21. Intoxication = High • Caused by presynaptic release of catecholamines (Dopamine, noradrenalin, adrenalin) • Fight or flight = vasoconstriction, tachycardia, lower seizure threshold, dilated pupils, sweating, lots of energy, no appetite. • Behavioral and psychological effects: Euphoria, decreased fatigue, paranoia, hallucinations, delusional thinking

  22. Intoxication • Visual, auditory, somatosensory hallucinations occur but formication is typical of stimulant psychosis. • Psychosis should resolve in a few days. • Psychotic flashbacks reported up to two years after cessation of methamphetamine use • Severe intoxication can result in organic brain syndrome • Serotonin syndrome (Triad of behavioral & cognitive changes; autonomic instability; neuromuscular changes)

  23. Sensitization & Tolerance • Sensitization – (kindling) once exposed to a low dose of drug the effect is reached with an even lower dose of drug. • Tolerance – chronic use of high doses = more and more drug needed to produce same effect.

  24. Withdrawal - Crash • Depression, fatigue, anhedonia, anxiety, difficulty concentrated, intense drug craving, increased appetite and hypersomnolence. • Most symptoms resolve spontaneously in a few weeks • Craving may persist • No physical withdrawal in the opioid or alcohol sense

  25. Persistent Abstinence Syndrome • Anhedonia (depression) that can last up to two years after stopping drug use. • Thought to be due to dopamine depletion • Newer antidepressants such as Effexor may be helpful • Tryptophan supplementation recommended by some psychiatrists.

  26. Methamphamphtamineand Immunity • Methamphetamine interferes with normal cellular immune response. • In HIV positive patients, viral load will increase five fold when they use Methamphetamine and return to normal when they stop.

  27. Crystal Meth and Sex • Methamphetamine use is associated with hypersexuality. • Dopamine release in Nucleus accumbens is what produces sexual pleasure. The more dopamine, the greater the pleasure. • Dopamine release is far greater with cocaine.

  28. Pleasure Pathway

  29. Crystal Meth and Sex • Methampethamine causes ED. • Viagra • Burgeoning HIV epidemic in certain populations

  30. Treatment of Addiction What works and What doesn’t

  31. Assess Readiness to Change • Precontemplative • Contemplative • Preparation • Action • Maintenance Prochaska and Diclementi Relapse

  32. Non Pharmacological • Motivational Interviewing and Motivational Enhancement • Cognitive Behavioural Therapy • Insight based Psychotherapy not recommended until patient in stable recovery. • Twelve step programs very effective in motivated patients

  33. Abstinence vs Harm Reduction Paradigm shift from: Recovery = Total abstinence to Recovery = full return of function

  34. METHADONE ASSISTED RECOVERY Prince Albert Community Methadone Treatment Program

  35. Methadone MaintenanceNot a new idea • Dr Marie Nyswander and Dr. Vincent Dole New York in 1967 • That program is still going though a number of the original patients have since died of cigarette related illness

  36. METHADONE • Synthetic opioid • Physiological dependence risk high in that it exhibits: - Tolerance - Physical dependence (Withdrawal) • Slow onset of action - 30 minutes

  37. METHADONE (Continued) • Long half-life -24 to 36 hours • No euphoria • Blocks (Mu) receptors if dosage adequate: - Brain becomes unresponsive to euphoric effect of other opioids - receptors may be involved in alcohol effect.

  38. Receptor the surface of a brain cell Receptor

  39. Receptor the surface of a brain cell Agonist eg heroine or methadone

  40. Opiate Blockade Naloxone Opiate Receptor Methadone Dr. Ray Baker – used with permission

  41. METHADONE (Continued) • Painkiller - effect lasts 6 to 8 hours • Overdoses lethal in non- tolerant persons • Long term use is safe • Safe in pregnancy

  42. METHADONE (Continued) • Takes 4-6 weeks to reach steady state (stabilize) • Patients prone to “drug sickness” during this period. • Usual dose 60-120mg but may be much higher

  43. Methadone 24 Hour Dose Response Heroin Normal Range Dose Response Subjective w/d Objective w/d Time 0 hrs. 24 hrs. Slide courtesy of Dr. J. Thomas Payte

More Related