Neurobiology-Informed Addiction Intervention and Treatment: Beyond PAWS

September 27, 2014 11:00-12:30pmCEUH: NAADAC approved for 1.5hoursNAADAC continuing education provider: # 549Presenter: Joe Terhaar, Ph.D. Location: Seattle

Neurobiology-Informed Addiction Intervention and Treatment: Beyond PAWS

Course Description/GoalsCourse Description: For each drug of abuse, Joe Terhaar PhD will visually and kinesthetically describe the impact on the brain, how the mechanical pattern of addiction and craving develops, toward guiding the practitioner in responding to the specific drug, increasing motivation to abstain from drug use, stay engaged in treatment, and empower recovery. The training will speak to all chemical dependency counselor levels of knowledge and skill in the neurobiology of addiction.Course Goal: To improve the effectiveness of chemical dependency counselors in motivating engagement and retention of drug users in treatment with clear and specific information about the compulsive impact of the drug on the brain and how best to respond to each drug.Participants will be able to:

Relate one salient emotion for each primary neurotransmitter of drug abuseRelate one salient neurobiological mechanism creating the compulsive trap for each drug of abuse category, sufficient to motivate behavior changeDetail at least one genetically mediated medical condition as a parallel for understanding the predetermined trap of drug addiction, and at least one genetic pattern increasing, and one decreasing, the vulnerability to drug addictionSpecific to a drug, detail from the brain neurobiology one adaptation to treatment that will increase the users motivation to abstain

Joe Terhaar, Ph.D.CAREER HIGHLIGHTS

Neurobiology-Informed responsive Addiction Treatment: One Therapists Experience. Advances in Addiction & Recovery, Summer, 2014*practicing licensed mental health counselor, marriage and family therapist, and certified chemical dependency counselor for over 30 years with experience in drug prevention, intervention, and treatment; *Full Member of the Association of Intervention Specialists, a contiguously Board Registered Interventionist-I and subsequent Certified Intervention Professional using nine strategies in helping families motivate their loved-one to enter treatment; *presenter of Neurobiology-Informed Addiction Intervention and Treatment, at the Association of Intervention Specialists Fall Conference, Palm Desert, California in October of 2013 and the NAADAC National Conference in Seattle in September, 2014*expert witness for courts litigating issues of addiction diagnosis and family intervention practices; *awarded a rare dissertation research grant to study family intervention by the National Institute on Drug Abuse (NIDA) National Institutes of Health in 2001 contributing to the science of family intervention; *state-approved marriage and family licensure supervisor since 2008; *author and former provisional patent holder of research-grounded concepts, skills, and objectives for the articulation of family intervention; *Who's Who Among Students In American Colleges and Universities, 1976-77; *author of training curricula for school teachers, social workers, and drug counselors adopted across the U.S. from Seattle to Georgia; author and manager of over $250,000 in grants and contracts

Outline of TrainingIntroOverview and Goal: Replace denial with neuro awareness Toward:Intervention: Motivate engagement in treatment with awareness of trapFinlay (1966) said concern for self, bring to focus the reasons for concernEmpower families and the addict through neurobioAdapt intervention process with awareness of neurobioInform all of the trap that will result in fatality

Counselors who briefly explain the impact of the drug on the users brainproviding the opportunity to understand what is currently driving the behaviorfree the family from acting on misguided guilt and grief, toward proactive interventions that preserve life.

Genetics To Reduce Misdirected Guilt (Refer to Video and provided handout) If confront denial alone: this risks being oppressive and negating the other aspectsBio/psycho/social: but lets look at massive impact of genetics and neuro

Neurobiology for Motivation and Treatment Stimulants and Methamphetamine Review personalities of brain neurotransmitters (Handout)(action of ntr vs location)Impact: on ntr: immediate DA (NA), 5HT (RN), NE (LC), sex,Lisa on North side: exhausted and depletedKaren on south hill: got up to eat; depleted Crave cycle: A-VTA-NA (For 2-3 months after last use, higher Fos B with lower DA in NA appears to explain 25% of the chronic cocaine-induced changes in gene expression and craving; thus a pattern of craving.)Crave: foil, glassware, etc. The paradox for the 9-repeat userMotivation: Show trapMotivate by showing the depletion and desperation; loss of pleasure (ntr)Get them while they are depressedInpatient support if unstableCut off the moneyFrom, Your in denial to You are trapped and we can help you get out

Treatment: do not do grief work*Structure/support and over GriefEthanolThe critical roles of DA & glutamate, B-endorphin & naltrexone (less reward from drinking), serotoninGABA and anxiety in LC(about motivating family and drug users, not psychopharm class)

Motivation: Show trap especially of 5HTMotivate from his/her loss of contentment (low 5HT): SLC6A4; they are afraid to act, reassure of contentment (Bill in hot July; Norm: loss of contentment)Get them while they are depressed, but caution of anxiety (LC-GABA)Concern for self: Physical deterioration and need for physical examRisk of seizures with abstinence: benzo for travel: family talk to doc

Treatment: Craving and Physical rehabStructure & Grief: Cuing system is strong, must interrupt crave cycle, other family alcoholics keeping family norms of us* Orange Julius gal: triggered by my orange juice

Physical rehab: diet supplements: beCalm'd, Neu-be calm'd); good nutrition due to malnutrition Medications: Vivitrol/ReVia, Check other medsCase study: RLS: Mirapex (Pramipexole) is a Dopamine3 agonist and rebalances the balance reducing sx of RLS; but also triggers compulsive gambling, sex, stereotypy, and overeating in 14% of individuals, likely from triggering striatum; Joey: was it only DA3 behavior or addiction exacerbated by D3 trigger?

CNS depressantsThe critical role of Benzo: suppress locus coeruleus and reduce anx until withdrawalWithdrawal risks GABAA and Cl-, massive anxietyGABA anxiety without coping capacityGo to treatment so you do not have to be so anxiousThe critical role of Benzo weakens regulatory capacity of the VTA and permits excess DA (pleasure)

Motivation: Show trap especially of GABAConcern for self: anxiety without coping capacity (student Amanda)Kid unable to pee due to anx; Northern nurse (tritrate)Anxiety vs no motivation Risk of anxiety and seizures with abstinence: benzo for travelWithdrawal varies due to length of use: 40-45% who use more than 4 months have physical dependence; 80 to 85 % if more than 2 years.

Treatment: Craving and Physical rehabStructure & Grief: Cuing system is strong, must interrupt crave cycle Support small reward pattern for forward movement; structure reward system for action and specific tasks Support later grief of lost aspirations, once stable in abstinenceOpioidsMimics natural endorphins that reduce transmission of substance P to dull the perception of stress from pain via the locus coeruleus; strong stimulation of mu to increase dopamine activity, strong anticholinergia from suppression of NE in the locus coeruleus (suppressing alertness and capacity to express adrenaline) causing somnolence; opioids stimulate glutamate receptors enhancing the pleasure of DA.

Phils hand: 20/80% b. craving cycle A-VTA-NA c. Tramadol itself does not trigger -opioid receptor, but is metabolized to O-desmethyltramadol, a significantly more potent -opioid agonist, creating euphoria and craving

Motivation: Show trap of running from painConcern for self: always trying to outrun the pain (Annie to LVRC; Asian Tom for suboxone)Comfort of pleasure, fear of pain Ease withdrawal with buprenorphineLoss of comfort and contentment: cannot appreciate the sunTreatment: Craving and Physical rehabStructure & Grief: Cuing system is strong; interrupt crave cycle Support dealing with natural pain of daily lifeSupport later grief of lost aspirations, once stable in abstinence

Pain For some, short acting opioids inflame glial cells in the spinal column amplifying and perhaps initiating neuropathic pain. Motivation: Reflect the loss of pleasure to avoid pain and regain happiness by effective pain treatment. Validate pain as real (with or without primary injury); explain pain mechanism and relief of better pain treatment (Ashley; Bill from north county with st hernia)Treatment: 10 non-opioid pain management strategies integrated into daily life at Las Vegas Recovery Center

Buprenorphine Suboxone, Subutex: dysphoria in last stage of stepdown: glutamate, serotonin, dopamineIntervention: detox from buprenorphineTreatment: Apt substitute for short acting opioid for pain patients in recovery or chronic pain patients

Inhalants Disrupt DA in VTA and NA, (pleasure) and GABA (anxiety) De-myelination of the neuronal sheath resulting in dementia. Likely has connection to NMDA and DA thus psychosis and euphoria.

Motivation: Risk of volatile behavior and denial of problemConcern for self: brain damageAnxiety vs no motivation (2010) Gruber found chronic users experienced deficits in cognitive flexibility making continuing the same mistakes even when corrected. Also seen were those smoking earlier and longer experienced greater deficits. Bolla et al. (2002) found that effects last 30 days or more after use.

Treatment: Craving and Physical rehabStructure & Grief: Cuing system is strong, must interrupt crave cycle, structure to avert cravingsbrain damage risk requires special education assessment for learning support educationally.

CannabisCB-1 and anandamide:reduced ACH in hippocampus= reduced memory likely withreduced glutamate (reduced excitation) and sidestep hypothalamus (reduced anxiety) and inhibit GABA (inhibitory) in pons and amygdalaVia anandamide, increased DA in NA probably from VTA

Thus, pleasurable to have low physical response capacity while perceiving everything as pleasurable and interesting and not record anxiety not felt, thus no reason to challenge self or change:trick brain into feeling that the mundane is enjoyable and interesting, stealing motivation to plan, act, move forward or especially risk something new and challenging

Rare psychosis risk due to glutaminergic NMDA for a few. Camaraderie of cannabis: amygdala larger with larger and more complex social networks

Motivation: lack of motivationCall withdrawal what it is, if recently abstinent Drug user is not accustomed to taking initiative and moving beyond anxiety, but needs to for treatment; address lost aspirations and encourage reconsidering goals; rebound anxietySupport resuming aspirations with initiative for abstinence

Treatment: lack of motivation Concern for self: brain damage; loss of aspirationsAnxiety vs no motivation

PsychedelicsLSD1. LSD & psilocybin: serotonin agonists, reducing serotonin action at postsynapse; binds to serotonin2A sites, triggering other neurotransmitters. Also, altered action of glutamate and DA in the raphe nuclei. Mescaline has greater proportional effects on norepinephrine, and perhaps dopamine and serotonin at high doses. Some mild ACH effects. 2. Motivation: Same as cannabis and MDMA.3. Treatment: Same as cannabis and MDMA.

Anticholinergics (scopolamine, belladona, atropine, hyoscamine, plants like Mandragora officeinarum) or in Jimsonweed (Datura stramonium): Dryness creates a delirium with mild euphoria2. Motivation: Same as cannabis and MDMA.3. Treatment: Same as cannabis and MDMA.

Glutamic: PCP, K, Triggers NMDA-type glutamate receptors (of DA and NE) by blocking calcium flow with interaction between dopaminergic and glutaminergic neurons. In higher doses, may also affect 5HT2. Motivation: Same as cannabis and MDMA3. Treatment: Same as cannabis and MDMA MDMALoser doses it acts like serotonin; higher doses like amphetamine2. Motivation: Same as cannabis and MDMA3. Treatment: Same as cannabis and MDMA DXM (dextromethorphan)An opioid-like drug that binds to and acts as antagonist to the NMDA glutaminergic receptor Motivation: Same as cannabis and MDMATreatment: Same as cannabis and MDMAJoe Terhaar, Ph.D., LMFT, LMHC, AIS, CIPIntervention Specialists, LLC9203 E. Trent, #2Spokane WA 99206509-838-2111 866-788-7464www.TreatWithCare.com

To order the DVD for neuro motivation in your sessions, go online to:www.SilvertopVideo.com

And pay only $150 with the NAADAC conference discount