Addiction Treatment in the New Millennium: From Jail Cells to Brain Cells Mark Menestrina, MD, FASAM, DABAM mark.menestrina@gmail.com NASCSA Scottsdale, AZ 10/23/15
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
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
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
Can you spot the future alcoholic?
10 LEADING CAUSES OF DEATH BY AGE GROUP IN THE UNITED STATES-2013 15-24 25-34 35-44 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
ADDICTION VS. ABUSE ALCOHOLISM, DRUG ADDICTION, CHEMICAL DEPENDENCE DRUG ABUSE, ALCOHOL ABUSE A TREATABLE DISEASE A PREVENTABLE BEHAVIOR
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)
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
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
What substances are teens using? Obtained from: National Institute on Drug Abuse
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
Just say no Kids tend to overestimate drug use among peers Parents tent to underestimate drug use (Pape, 2015)
University of Michigan National Study of Adolescent Drug Use 2014 www.monitoringthefuture.org 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%
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)
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
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)
Alcohol Related problems College Students 2008 (Hingson et. Al. 2009) Deaths 1,825 Injury 599,000 Assaults 696,000 Sexual Abuse 97,000
Passive Drinking And Driving
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
THE NEW GATEWAY FOR MANY YOUNG PEOPLE
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
Protecting our kids continued We check our smoke detectors twice a year, right? In Livonia in 2006 1 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
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.
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