Terrence D. Walton, MSW, CSAC Pretrial Services Agency for the Booze, Brains, and Behavior: The Psychopharmacology of Alcohol and Other Drug Use Terrence D. Walton, MSW, CSAC Director of Treatment Pretrial Services Agency for the District of Columbia Terrencewalton@aol.com Psychopharmacology is the study of the effects of drugs on behavior. There are two points I hope will be repeated through out this presentation and I would like you to keep them in mind during the course of the presentation.

Any substance that is consumed in order to alter mood, perception, and/or brain functioning

Areas of Concern Intoxication Damage Withdrawal

Alcohol and Drug Use and Pretrial Services Assessing Risk and Needs Recommending Release Conditions Returning to Court Supervision Compliance Pretrial Success or Failure

Mood Altering Chemicals: An Overview

Mood Altering Chemicals Legal & Illicit Street Drugs and Prescribed Drugs Hard Drugs & Soft Drugs Very Addictive & Less-Addictive Natural and Synthetic Stimulants Depressants Opioids Cannabinols Hallucinogens/ Dissociatives Inhalants/ Deliriants/Other The most useless part of any food label “all natural”

Important Factors Bottle to Blood to Brain Route of Administration: Smoke Sniff Snort Shoot Swallow The Blood Brain Barrier Neurocompatibility

Abuse Potential Factors Power (brain impact) Popularity (acceptability) Presence (accessibility) Pay off (onset & intensity) Persistence (length of high) Patterns (of use) Penalty (onset & intensity) If you’re already hooked before the penalties kick in, then the addiction potential is greater.

Two Big Questions Why do people do drugs? Why can’t some people stop?

Use Pleasure Stimulation Escape Relief

Why Some Can’t Stop Physiological Dependence Psychological Dependence

Addiction A medical condition characterized by impairment within both the brain’s reward and executive functions centers and resulting in compulsive, repetitive, self-destructive substance use

Exploring Physiological Dependence Withdrawal Tolerance

Another Big Question What’s happening in the brain and body to cause this?

The Rebound Effect

Withdrawal The brain adapts to the effects of substance use by over-releasing chemicals that produce the opposite effect. If the use stops abruptly, the over release of opposing chemicals continues for a period of time causing withdrawal symptoms.

Tolerance Neuro-adaption (tolerance) occurs when neurons become less sensitive to the presence of a depressant or opiate as a result of the brain’s attempt to return to normal. For instance, in response to the presence of alcohol the brain may reduce the number of receptors available to detect alcohol.

Sensitization Neuro-sensitization occurs when neurons become more sensitive to the presence of a stimulant. As a result, the neurons will only fully activate when the current reward is expected to be greater than the average of previous rewards (“reward prediction error”)

Exploring Psychological Dependence To Cope with Life To Feel Normal

What’s happening in the brain to cause psychological dependence? A Final Big Question What’s happening in the brain to cause psychological dependence?

Addiction & the Brain

Neurochemistry: The Basics

Addiction is a Brain Disease Any use causes acute and temporary changes and prolong use changes the brain in fundamental, destructive and long lasting ways

How the Brain Works: Neurons & Neurotransmitters Involved in all physical/emotional/ cognitive function Metabolism, muscle movement, reflex Mood, reactivity, emotions Cognition, memory, etc.

Neuronal Receptor Activity Affinity Activation

Natural Rewards FOOD WATER SEX NURTURING ACCOMPLISHMENT

Medial Forebrain Bundle Prefrontal Cortex Ventral Tegmental Area Nucleus Accumbens

Brain Effects from Chronic Substance Abuse

The Reward Pathway and MACs

Un-Natural Rewards Alcohol and Other Drug Use

How Drugs Work Interact with neurochemistry Results: Feel Good – euphoria/reward Feel Better – reduce negative feelings

Drug-Interacting Neurotransmitters Dopamine – excitement & reward Serotonin – feel – “normal” Endorphin/Enkephalin – pain relief, reward, craving GABA – lowers anxiety

About Dopamine Tone

Amount of dopamine produced Length of time dopamine is available Number of dopamine receptors

Behavior Pathways Rewarding behaviors can become routine Obsessive, preoccupation, compulsion “Subconscious” control of the behavior Difficult to extinguish behaviors Resistant to change

Delay Discounting Demand Elasticity Brain Command Center Delay Discounting Demand Elasticity

Effective Treatment Co-Occurring Disorders Cognitive Behavioral Motivation Enhance-ment Relapse Prevention Medication Assisted Treatment Co-Occurring Disorders

Related Pretrial Release Conditions Report to court Avoid criminal activity Maintain employment Maintain residence Stay away from person or place Report to pretrial agency in person or by phone Drug testing Avoid alcohol and illicit drug use Participate in treatment as directed by …

The Brain and Recovery

TerrenceDwalton@ gmail.com Booze, Brains, and Behavior: The Psychopharmacology of Alcohol and Other Drug Use TerrenceDwalton@ gmail.com Psychopharmacology is the study of the effects of drugs on behavior. There are two points I hope will be repeated through out this presentation and I would like you to keep them in mind during the course of the presentation.