Using GoToWebinar. Healing the Addicted Brain: Cutting-Edge Science and Brain Neurochemistry

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1 Healing the Addicted Brain: Cutting-Edge Science and Brain Neurochemistry Presented by: Harold C. Urschel III MD, MMA Chief Medical Strategist - Enterhealth Using GoToWebinar ü Control Panel ü Asking Questions ü PowerPoint Slides ü Audio (phone preferred) Presented By: ü webinars ü webinars Obtaining CE Credit The education delivered in this webinar is FREE to all professionals. 1 CE is FREE to NAADAC members and AccuCare subscribers who attend this webinar. Non-members of NAADAC or non-subscribers of AccuCare receive 1 CE for $15. If you wish to receive CE credit, you MUST complete and pass the CE Quiz that is located at: (simply look for the name of the webinar) A CE certificate will be ed to you within 21 days of submitting the quiz and payment (if applicable). Successfully passing the CE Quiz is the ONLY way to receive a CE certificate. Healing the Addicted Brain: Cutting-Edge Science and Brain Neurochemistry Harold C. Urschel III MD, MMA Chief Medical Strategist - Enterhealth Credentials Nationally recognized expert on the disease of addiction and the latest science-based treatment options Author of The New York Times best seller, Healing the Addicted Brain Board certified in addiction and general psychiatry by the American Board of Medical Specialties Published work in the areas of opiate dependence, alcohol dependence, cocaine dependence and anti-addiction medications Education: Cum Laude with a Bachelor of Arts in Neuropsychology from Princeton University Doctorate of Medicine degree from the University of Texas Southwestern Medical School Clinical research fellowship at the University of Pennsylvania/ Veteran's Administration Medical Center Masters of Management Administration degree from Stanford University Graduate School of Business 7 Enterhealth Overview Enterhealth is a premier addiction disease management company in Dallas, TX. Operates Residential and Outpatient treatment facilities Board Certified doctors, psychiatrists and therapists specializing in addiction treatments are on-site 24 hours-a-day Round-the-clock, specially trained nurses Withdrawal Stabilization (detox) capabilities Neurological testing and treatments Anti-addiction medications Dual diagnosis Mission: To deliver a Continuum of Care using the latest scientific protocols and medical breakthroughs to block the effects of alcohol and drugs, lessen the affects of withdrawal, and decrease cravings so that the brain s neurological pathways have a chance to heal. Agenda Brain science of addiction Pharmacotherapy for addiction: Alcohol Dependence Marijuana Dependence Opiate Dependence Comprehensive, science-based approach to treating addiction Addiction is a Chronic Brain Disease 8 1

2 The Brain Cell (Neuron) Reference Na5onal Ins5tute of Drug Abuse. Drugs, brains, and behavior. The science of addic5on. Na5onal Ins5tutes of Health. NIH Pub No Available at: hip:// Last updated August Synapse: Where the Action Is Alcohol use creates profound changes in brain metabolism. Alcohol Dependence - Neuroscience fmri images of brain s reward system Social drinkers Neutral cues vs Alcohol cues Alcohol dependent (non-treatment seeking) Social drinkers Alcohol Dependent Individuals Normal brain Underside surface Front on surface Right side surface Reference Na5onal Ins5tute of Drug Abuse. Drugs, brains, and behavior. The science of addic5on. Na5onal Ins5tutes of Health. NIH Pub No Available at: hip:// Last updated August year old male with 17 years of heavy weekend alcohol use marked overall decreased activity. SPECT images courtesy of D.G. Amen, MD. Myrick, Anton, Li et al., Archives of General Psychiatry, April 2008 Comprehensive Treatment Approach Addiction is a medically proven brain disease that requires a multi-dimensional approach to help sustain long-term sobriety. Role: Cortex Decision Making Thinking Reasoning Rationalizing Talking based Therapies Individual Therapy 12-step Fellowships Faith-based support Nutrition and Wellness Limbic Region Role: Drive generation Medication based Therapies Anti-addiction medication Vivitrol, Campral Dual disorder medication (as needed) Why is Alcoholism a Chronic Medical Disease? Think of alcoholism like cancer It is deadly if you get it and you don t get treated If you get the right treatment, it still could come back at anytime in the future It is similar to other chronic medical diseases: Asthma Diabetes High Blood Pressure (Hypertension) Implications of the Chronic Disease Model for Alcohol/Drug Addiction Treatment DOES work, when delivered correctly! Model for Alcoholism and Drug Addiction: Treatment should be expected to improve symptoms, only while the treatment is being administered Evaluating treatment after it has been discontinued may not be appropriate Continuing care approach - Need for ongoing monitoring/care 2

3 References: 1. Oscar-Berman M, et al. Alcohol Res Health. 2003;27: Bagnardi V, et al. Alcohol Res Health. 2001;25: Mukamal KJ, et al. Alcohol Res Health. 2001;25: National Institute on Aging. AgePage: alcohol use and abuse. Available at: Accessed April 4, Turner RT. Alcohol Clin Exp Res. 2000;24: Psychiatric Comorbidities Treatment for a Complex Disorder Depression (50 75% of alcoholics) Anxiety Disorders Major cause of Cravings and Relapse Bipolar Disorders Schizophrenia Substance Abuse Nutri'onal deficits should be treated with dietary improvements and supplementa'on Neurobiological dysregula'on should be treated with pharmacotherapy Substance Dependence Dysfunc'onal behavior should be addressed with psychosocial interven'ons Alcohol Little known Statistics Alcoholism is the third leading disease causing death in the USA behind Cancer and Heart Disease Over 100,000 Americans a year die from Alcoholism (compared to 5000 over six years in the second Iraq war) Alcohol and Drug problems are the second most common mental disorder (6-7% of all adults) Most hospital healthcare systems do not have treatment programs for Alcohol and Drug addiction Defining the Standard Drink A standard drink = 14 g ethanol 12 oz of regular beer or cooler (5% alcohol) 5 oz of table wine (12% alcohol) 1.5 oz of hard liquor (40% alcohol, 80 proof) The average person metabolizes about 1 standard drink per hour 12 oz 8-9 oz 5 oz 3-4 oz 2-3 oz 1.5 oz 1.5 oz beer / malt liquor table wine fortified wine cordial, brandy spirits cooler 8.5 oz shown in a (such as sherry liqueur, (a single jigger) (a single jigger 12 oz glass that, or port) or aperitif of 80-proof gin, if full, would hold 3.5 oz shown vodka, whiskey, etc.) about 1.5 standard 2.5 oz shown shown straight and in drinks of malt liquor a highball glass with ice to show level before adding mixer Brain Activity During Alcohol Intoxication 12 oz 8.5 oz 5 oz 3.5 oz 2.5 oz 1.5 oz 1.5 oz Source: National Institute on Alcohol Abuse and Alcoholism. Bethesda, MD: NIAAA; NIH Publication No Alcohol drinking markedly reduces brain metabolism. Source: National Institute on Alcohol Abuse and Alcoholism. Dec Audience Polling Question #1 Do you think that alcohol is a toxic substance? Addiction Backpacking in Colorado adventure Alcohol injures every major organ system in your body mouth, digestive system, liver, bones, immune system, heart, pancreas, kidneys, and BRAIN. Heath Impact of Chronic Alcohol Use Altered brain cell function 1 Reduced brain size 1 Short-term memory loss 4 Increased cancer risk, Immune system disorders 4 especially cancer of the oral cavity, pharynx, esophagus, Cardiovascular disease 3 and larynx 2 Liver cirrhosis 4 Altered blood sugar levels 4 Weakness and breakdown of Reduced pain perception 4 muscle 3 Bones predisposed to fracture

4 1. Antabuse full Prescribing Informa5on. Odyssey Pharmaceu5cals, Inc. 2. ReVia full Prescribing Informa5on. Duramed Pharmaceu5cals, Inc. 3. Campral full Prescribing Informa5on. Merck Santé s.a.s. 4. VIVITROL full Prescribing Informa5on. Alkermes, Inc. Medications for Alcohol Dependence Vivitrol The Role of Pharmacology in A Comprehensive Approach to Addiction Treatment Antabuse (disulfiram) 1 30 tabs/month* 1 tab/day) ReVia (naltrexone) 2 30 tabs/month* (1 tab/day) Campral (acamprosate) tabs/month* (2 tabs, 3x/day) Vivitrol (naltrexone for extendedrelease injectable suspension) 4 1/month Vivitrol (Extended Release, Injectable Naltrexone) for Alcohol Dependence Approved in June 2006 for Alcohol Dependence by FDA Benefits for Alcohol Dependence Reduces urge to use Alcohol by up to 90% Blocks euphoria (drunk feeling) Decreases severity of relapse One Injection lasts for 30 days Marijuana 32 Audience Polling Question #2 Do you think that marijuana is addictive? Marijuana Pot is addicting!!!!!!!!!! Often called pot, grass, reefer, weed, Mary Jane, or MJ Marijuana is a mixture of dried, shredded leaves, stems, seeds, and flowers of Cannabis sativa the hemp plant. There are 250 different substances in MJ smoke, THC is only one of them The THC from just one joint takes 7 days to get out of the body (42 days to get out completely if used daily) MJ withdrawal starts 3 weeks after the last dose Withdrawal side affects include: irritability, insomnia, decreased appetite, increased aggression and cravings MJ is a gateway drug! Marijuana Pot is dangerous and impairs cognitive ability! The smoke from a MJ cigarette (joint) is 4 times MORE carcinogenic than the smoke from a cigarette Heart attack risk - MJ increases heart rate by % 5-fold increase in risk within the first hour after smoking MJ s negative impact on learning can last for days or even weeks after the high and relaxation wear off MJ use impairs physical and mental health, cognitive abilities, social life and career status MJ injures your brain functioning Impaired short-term memory Difficulty with complex tasks and learning Poor decision-making, risky behavior Impaired driving 4

5 Medications to Treat MJ Dependence No specific anti-addition medications have been developed specifically for MJ Many candidates are currently in research trials Medication options that can reduce anxiety and enhance sleep (that have no addictive potential) Quetiapine (Seroquel) Trazodone (Desyrel) Hydroxyzine (Vistaril) SSRI s and SNRI s Generation Rx: The Opioid Epidemic Medications to Treat Opiate Dependence Opioids & Agonists Opioid Blockers aka Antagonists Suboxone (buprenorphine/naloxone) Subutex (buprenorphine) Vivitrol (extended-release, injectable naltrexone) Naltrexone Methadone Opioid molecule attaching to a receptor Opioids Opioid receptor Opioid Blocker or Antagonist Opioids Opioid receptor Reference Na5onal Ins5tute of Drug Abuse. Drugs, brains, and behavior. The science of addic5on. Na5onal Ins5tutes of Health. NIH Pub No Available at: hip:// Last updated August Benefits of Buprenorphine/Naloxone (Suboxone) for Opiate Addiction Treatment Removes Cravings within 3 days If you use heroin or pain pills you can t feel their effects If you take too much you are punished Safer: Less likelihood of overdose The perfect solution for Narcotic addiction when used with a comprehensive treatment program Now in a new film delivery system dissolves faster, safer (10% cheaper) Buprenorphine Binding Opioid Receptors Zubieta et al., 2000 Buprenorphine 16mg completely blocks opioid ligand binding Vivitrol (Extended-Release, Injectable Naltrexone) for Opiate Dependence Approved in October 2010 for Opiate Dependence by FDA All of the same benefits as in Alcohol Dependence Reduces urge to use Heroin/Pills Blocks euphoria Decreases severity of relapse Need to be off opiates for days before first injection 5

6 A Revolutionary Approach to Managing the Disease of Addiction The Science-based Approach Offers Hope Addiction is very treatable Addiction should be treated comprehensively Patients need a great deal of HOPE that they can beat this devastating illness Family and loved ones need education about the illness The Key to the Approach is Science Scientists have effectively studied Addiction for the last years They have spent hundreds of millions of dollars They have found some really wonderful and effective treatments that have revolutionized the field Unfortunately, many treatment providers are not using these tools or information to treat their patients Question: What does effective addiction treatment look like in 2012? Answer: A continuum of care model that integrates the latest breakthroughs in medicine and treatment is the key to achieving long-term sobriety. Enterhealth Continuum of Care 60% of people who successfully complete traditional forms of treatment will relapse within the first year The leading cause of relapse is failure to follow the prescribed continuing care plan set up at discharge Enterhealth is meeting that challenge by developing a science-based treatment model that provides philosophically consistent touch points in the patient s recovery journey. We call it Enterhealth s Continuum of Care Enterhealth s Continuum of Care Enterhealth Ranch Residential Rehab Facility More Structured Here s how it works As the patient progresses from one phase of treatment to the next, he/she is not taken from one support system and then dropped into another, and another. The patient maintains a consistent continuum of care within the Enterhealth comprehensive treatment options. This enables Enterhealth to: Transitional Living Less Structured Intensive Outpatient Build a continuing relationship/trust with better outcomes Monitor the patient based on their unique needs/situation Build on and/or modify therapies over time as needed Maintain a consistent, comprehensive approach over the client s life Outpatient Support All of the Answers Traditional Treatment Model 12-Step AA Family Therapy Group and/or (Group) Individual Therapy Pa5ent The Enterhealth Science-Based Treatment Model Withdrawal Stabilization/ Life Care Tools Detox & Support Wellness & Nutrition Patient AA/ Spiritual support Family Therapy (Group & Group & Individual) Individual Therapy Neurological Testing & Treatments Psychiatric Dual Diagnosis Co-Occurring Medical Disease Anti-Addiction Medication Most people that drink alcohol don t get addicted to it (only about 10-12% do) Alcohol and Drug Addic5on (and possibly many others) is a chronic, medical disease of the brain. If you use most tradi5onal methods you currently have about a 30% chance of sobriety, because addic5on treatment programs are only using year old technology. If you treat it as a chronic medical brain disease, you have up to 90 % chance for staying sober/in recovery. 55 6

7 For follow-up on any of the above topics: Harold Urschel - drhurschel@enterhealth.com Or follow Dr Urschel and Enterhealth on Facebook and Twitter to stay breast of the latest developments in alcohol and drug addiction treatment. Feel free to ask questions through the Questions pane. 57 Upcoming Free Webinars Archived Webinars October 17, pm-4pm EST Integrated Cognitive Behavioral Therapy for PTSD November 14, pm-4pm EST Impacts of Addiction on the Family System and Children Medication Assisted Recovery: What Every Addiction Professional Needs to Know Building Your Business with SAP/DOT Ethics Co-occurring Disorders Test-Taking Strategies Conflict Resolution 2012 Webinar Series ü New webinar monthly! ü Education is free to all professionals. ü CE credit available for purchase. adolescents, criminal justice, trauma and many more Information and Registration at: Or Screening, Brief Intervention Clinical Supervision and Referral to Treatment (SBIRT) ASAM Placement Criteria DSM-5 Proposed Changes Billing and Claim Submission Changes Archived webinars: or CE credit still available! The clinical tools you need. The customer support you deserve. That s why Orion Healthcare Technology is the preferred software vendor of NAADAC. Obtaining CE Credit The education delivered in this webinar is FREE to all professionals. Assessments and Screening Patient Placement Discharge Summaries Insurance Billing 1 CE is FREE to NAADAC members and AccuCare subscribers who attend this webinar. Non-members of NAADAC or non-subscribers of AccuCare receive 1 CE for $15. Treatment Planning Progress Notes Reporting and Tracking Prevention Tracking For more information: Click: Call: (800) If you wish to receive CE credit, you MUST complete and pass the CE Quiz that is located at: (simply look for the name of the webinar) A CE certificate will be ed to you within 21 days of submitting the quiz and payment (if applicable). Successfully passing the CE Quiz is the ONLY way to receive a CE certificate. 7

8 Harold Urschel - drurschel@enterhealth.com Thank You for Participating! 8