Brain Damage & Recovery: The Resilience of the Brain, Addiction Impact & Therapeutic Repair. Michael Fishman, MD Director of Young Adult Program

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1 Brain Damage & Recovery: The Resilience of the Brain, Addiction Impact & Therapeutic Repair Michael Fishman, MD Director of Young Adult Program

2 How Addiction Takes Hold Large & rapid upsurges in dopamine Rewarding effects Stimulates feelings of pleasure & motivation Dopamine rush

3 How Addiction Takes Hold Dopamine Rush Mimics but greatly exceeds in intensity and duration feelings occurring in response to pleasurable stimuli such as sight, smell, or food

4 How Addiction Takes Hold Dopamine Rush Repeated exposure to dopamine surges Blunts response of dopamine system to everyday stimuli Down Regulated dopamine receptors

5 How Addiction Takes Hold The addict s normal hierarchy of needs and desires are disturbed Priorities to procure and use drugs Instinct Food, family, friends lose value

6 How Addiction Takes Hold Loss of control over the drug Disrupts brain circuits involved in memory and control over behavior

7 How Addiction Takes Hold Memories of drug experience can trigger cravings People, places, things associated with former drug use Stress

8 How Addiction Takes Hold Control over behavior is compromised Brain regions (frontal lobes) controlling behavior are compromised Compromises inhibitory control over desires and emotions

9 How Addiction Takes Hold Addiction = Brain Disease The addict s reward circuitry is increasingly dulled by drugs Reward circuitry is desensitized by drugs

10 How Addiction Takes Hold Drug loses ability to reward (tolerance) Compromised brain leads addicts to pursue anyway Avoid withdrawal Try to feel normal

11 Reward-Related Processes Subcortical structures Dopaminergic projections to medial and orbital regions of frontal cortex Ventral striatum (including nucleus accumbens) Medial prefrontal cortex tracks rewarding outcomes

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15 How Addiction Takes Hold Many drugs are rewarding when injected into the nucleus accumbens Amphetamine releases dopamine Cocaine dopamine uptake inhibitor

16 How Addiction Takes Hold Opiates strongest rewarding effects thru mesolimbic dopamine system Alcohol produces Beta Endorphins Damages limbic system and frontal cerebral cortex

17 How Addiction Takes Hold Cannabinoid increases firing of the mesolimbic dopamine system Nicotine nicotine receptors in mesolimbic system increase dopamine release

18 Brain Damage Direct and indirect Liver ammonia build-up, bleeding, HTN Withdrawal syndromes (depressants) Drug related trauma

19 Brain Damage Malnutrition Down regulation opiate receptors Elevation of glucocorticoids, norepinephrine, glutamate Depletion of dopamine, serotonin, GABA, opioid peptides

20 Repair & Recovery Must address complexity of the disease With prolonged abstinence, our brains can recovery at least some of their former functioning 12-Step recovery, religion, aversive Must take personal responsibility

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22 Repair & Recovery Most focus on the nucleus accumbens and its dopaminergic input from the ventral tegmental area of the mid brain Block drug from getting to its target Cocaine vaccine, naltrexone

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24 Repair & Recovery Opiates Naltrexone / Vivitrol Up-regulates receptors Helps restore hormonal balance Pharmacotherapy with individual therapy (behavioral)

25 Repair & Recovery Avoid damage Detox Maintenance vs. binge drinking Kindling effect

26 Repair & Recovery Alleviating cravings may allow the brain to slowly recover Methadone, Buprenorphine, nicotine, Naltrexone Acamprosate

27 Repair & Recovery Ongoing research on dopamine receptor antagonists and agonists in the treatment of addiction

28 Repair & Recovery Nutrition (? Supplements) Exercise Stress reduction Acupuncture

29 Repair & Recovery Cognitive exercises Thiamine and glucose SSRI s

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32 Michael Fishman, MD Director of Young Adult Program (678) (800)

33 FURTHER INFORMATION To contact one of Talbott Recovery s Intake Specialists Please call: OR Visit our website at: talbottrecovery.com

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