Addiction Treatment in the New Millennium: From Jail Cells to Brain Cells

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1 Addiction Treatment in the New Millennium: From Jail Cells to Brain Cells Mark Menestrina, MD, FASAM, DABAM NASCSA Scottsdale, AZ 10/23/15

3 We live in a magical thinking, medication seeking society USA is 4.7% of the world s population But we consume over 50% of the world s drugs and most of the world s pain medication -National Institute on Drug Abuse Media, TV and radio flood us with messages..we are taught not to tolerate any discomfort without taking something to feel better

4 ADDICTION IS A BRAIN CHEMISTRY DISEASE Involved the Meso-Limbic System (primitive) Neurotransmitter mediated (not conscious) Denial is a Hallmark feature Emotional, physical, psychological Chronic, Progressive, Potentially fatal Affects family, community, society and schools About 10% are susceptible to addiction Addiction is a treatable disease different than abuse anyone can abuse drugs/alcohol a preventable behavior

8 1956 AMA designates Alcoholism as a disease, Drug Addiction as a disease followed But you have a choice Like depression 30 years ago, or oncology 40 years ago Compare to other chronic diseases When we do treat Addiction, we do so acutely, and wonder why we have poor results

9 Can you spot the future alcoholic?

12 10 LEADING CAUSES OF DEATH BY AGE GROUP IN THE UNITED STATES Unintentional Injury Unintentional Injury Unintentional Injury Suicides Suicide Malignant Neoplasms Homicides Homicide Heart Disease Malignant Neoplasms Malignant Neoplasms Suicide Heart Disease Heart Disease Homicide Congenital Anomalies Diabetes Mellitus Liver Disease Influenza & Pneumonia Liver Disease Diabetes Mellitus Diabetes Mellitus HIV Cerebro-Vascular Complicated Pregnancy Cerebro-vascular HIV Respiratory Disease Influenza & Pneumonia Influenza & Pneumonia OBTAINED FROM THE CENTER OF DISEASE CONTROL & PREVENTION

16 ADDICTION VS. ABUSE ALCOHOLISM, DRUG ADDICTION, CHEMICAL DEPENDENCE DRUG ABUSE, ALCOHOL ABUSE A TREATABLE DISEASE A PREVENTABLE BEHAVIOR

18 TEENS & DRUGS & ALCOHOL USE SUDs affect all of society, but young people are especially at risk Pre-Frontal Cortex isn t fully myelinated until the 20s Teen Substance use results in tremendous mortality and morbidity It s not A War on Drugs, rather A Defense of Our Brains (B Madras)

19 A TEEN WHO FIRST USES ALCOHOL OR DRUGS AT THE AGE OF 15 IS 5 TIMES MORE LIKELY TO DEVELOP A SUD AS ONE WHO WAITS UNTIL THEY ARE 21 National Council on Alcoholism and Drug Dependence, INC

20 Age of 1 st use of alcohol <14 years old (vs. 21 yo) 4.5 times more likely to develop a SUD 7 times more likely to be in a MVA 12 times more likely to be in a physical fight 3 times more likely to attempt suicide Strong Predictor of Rx Drug Misuse (Hermos, 2008) When develop a SUD, it s more severe and develops much faster

21 What substances are teens using? Obtained from: National Institute on Drug Abuse

23 Robotripping is not something R2D2 did on Star Wars Pharm Parties are not rural entertainment involving John Deere Tractors Designers are not just expensive jeans

24 Just say no Kids tend to overestimate drug use among peers Parents tent to underestimate drug use (Pape, 2015)

25 University of Michigan National Study of Adolescent Drug Use Illicit Drugs in last year Illicit drugs besides MJ 8 th Grade 14.6% 6.4% 10 th Grade 29.9% 11.2% 12 th Grade 38.7% 15.9%

26 Risk factors for adolescent SUDs (Thatcher, National Institute on Alcohol Abuse and Alcoholism) Parent with SUD Mood Disorder Learning Disorder/Poor Performance Low Self Esteem Early Sexual Activity Dysfunctinal Family Drug/Alcohol Using Peers Easy availability of substances in community Early use of substances (first initiation age)

27 Protective factors for adolescent SUDs (Thatcher, National Institute on Alcohol Abuse and Alcoholism) Strong family bonds Parental encouragement Clear expectations and consequences Strong Pro-social bonds Conventional norms about drugs and alcohol Delayed onset of first use Religious/spiritual affiliation Good reading skills in 3 rd grade

29 Underage drinking: A major public health issue Drinking and Driving Suicide Sexual assault High risk sex Physical fights Injuries under the influence Non-drinkers affected passive drinking (Obtained from: The National Institute on Alcohol Abuse and Alcoholism)

30 Alcohol Related problems College Students 2008 (Hingson et. Al. 2009) Deaths 1,825 Injury 599,000 Assaults 696,000 Sexual Abuse 97,000

31 Passive Drinking And Driving

32 Non-Scientific Poll of Livonia Youth (Social Networking Site) 80% get alcohol from older friends or older siblings, 62% from home w/o parents knowing 30% from parents, 23% from friends parents Why do they think they get away with drinking? 91% because parents are clueless 8% because parents are okay with it

34 THE NEW GATEWAY FOR MANY YOUNG PEOPLE

35 We all want to protect our young people right? Abducted by a stranger: 1 in 1.5 million Equestrian Accidental Death: 1 in 297K Youth Football: 1 in 78K Lifetime MVA fatality: 1 in 228 Odds in this year alone: 1 in 17K

36 Protecting our kids continued We check our smoke detectors twice a year, right? In Livonia in person died in a house fire, (1 in 93K) lifetime 1 in 1200 Livonia in 2006, 12 young people died of fentanyl or heroin/fentanyl

37 Addiction Treatment Made Easy getting them from A to B Negative Consequences Liver Law Spouse Boss Positive Benefits of Recovery I really like this This is all we really do in treating chemically dependent patients. This may include medications, counseling support groups, treatment of co-occurring disorders, etc. and is of variable length of time.

44 Cardberry, Sean. The Two Way. Afghanistan Opium Harvest Sets New Record. (2014). Retrieved from: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS) [online] (2007) [cited 2011 Mar 4]. Available from URL: Hermos, John A., et al. "Early age-of-onset drinking predicts prescription drug misuse among teenagers and young adults: Results from a national survey." Journal of Addiction Medicine 2.1 (2008): Hingson RW, Zha W, Weitzman ER. Magnitude of and trends in alcohol-related mortality and morbidity among U.S. college students ages 18-24, Journal of Studies on Alcohol and Drugs, July(Suppl 16): 12-20, Hingson, Ralph. White, Aaron. National Institute on alcohol Abuse and Alcoholism. The Burden of Alcohol Use: Excessive Alcohol Consumption and Related Consequences Among College Students. Retrieved from:

45 Madras B, Compton W, Avula, D, Stegbauer, T, Stein, J, & Clark, H W (2009) Screening, brief intervention, referral to treatment (SBIRT) for illicit drug and alcohol use at multiple health- care sites: Comparison at intake and 6 months later Drug and Alcohol Dependence, 99 (1-3), National Council on Alcoholism and Drug Dependence, INC. (2015). Retrieved from: National Drug Threat Assessment Summary: US Department of Justice Drug Enforcement Administration. Retrieved from: -center/dir-ndta-unclass.pdf National Institute on Drug Abuse: The Science of Drug Abuse and Addiction (2014). Retrieved from:

46 Pape, Hilde. Young People s Overestimation of Peer Substance Use: An Exaggerated Phenomenon? Addiction (Abingdon, England) (2012): PMC. Web. 1 Oct Parents Opposed to Pot: Bursting the Bubble of Marijuana Hype. The War on Drugs Is Defense of Our Brains. (2015). Retrieved from: brains/ Thatcher, Dawn Ph.D., and Clark, Duncan M.D., Ph.D. National Institute on Alcohol Abuse and Alcoholism. Adolescents at Risk For Substance Use Disorders Retrieved from: US Department of Health and Human Services: Substance Abuse and Mental Health Services Administration Center for Behavioral Health Statistics and Quality. Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings. Retrieved from: Web/NSDUHresults2013.htm

47 World Drug Report: The Opium/Heroin Market. Retrieved from:

Teens, Alcohol and Drugs: Trends in the New Millennium

Teens, Alcohol and Drugs: Trends in the New Millennium Mark Menestrina, MD, FASAM Medical Director Brighton Hospital Detox Unit Mmenestrina@brightonhospital.org 15 th Annual Michigan Traffic Safety Summit