1. U.P. Health Strategies
May 8, 2018

2. Medication Assisted Treatment - Where are we?
John L. Lehtinen, MD
Addiction Medicine

5. The views expressed in this presentation are those of John L
The views expressed in this presentation are those of John L. Lehtinen, MD an Addiction Medicine Physician

6. Financial: None No conflicts to report
DISCLOSURES
Financial: None
No conflicts to report

7. Drug/Product Off-Label use disclosure:
Off-Label use of a drug(s) and/or product will be addressed in this presentation

8. WHAT IS ADDICTION?
But what is addiction? We now know that while the initial decision to use drugs is voluntary, drug addiction is a disease of the brain that compels a person to continue taking drugs despite their many adverse health and life consequences.

9. The 5 C’s & a “D” Chronicity Compulsive use
Inability to Control use
Continued use despite consequences
Cravings
Chronicity
Denial

10. Addiction is a Chronic Brain Disease
Not a lack of will power or poor judgment or bad behavior or bad choices
Impaired control - caused by brain chemistry malfunction
DRUG USE PRODUCES BRAIN DAMAGE!

11. Neurotransmitter Mediated
(Not under conscious control)
CHRONIC, PROGRESSIVE, POTENTIALLY FATAL DISORDER

15. “SPECT” IMAGING SINGLE PHOTON EMISSION COMPUTED TOMOGRAPHY
NUCLEAR MEDICINE SCAN
EVALUATES CEREBRAL BLOOD FLOW & BRAIN METABOLIC ACTIVITY

16. 39 year old heroin user

17. 25 Year old methadone user

18. 33 Year old Meth user

19. 38 Year old alcoholic

20. Daily THC use years

21. DURING SUBSTANCE USE

23. A YEAR DRUG & SUBSTANCE FREE

26. WHICH BRAIN DO YOU WANT?

27. in Fundamental and Lasting Ways
Addiction is a Brain Disease
Prolonged Use Changes
the Brain
in Fundamental and Lasting Ways
FACULTY NOTE: (from NIDA teaching instructions – you may use this narrative text as a guide, but it does not need to be repeated word for word)
Positron emission tomography (PET) scan of a person on cocaine Cocaine has other actions in the brain in addition to activating reward. Scientists can now see how cocaine actually affects brain function in people. The PET scan allows us to see how the brain uses glucose; glucose provides energy to each neuron so it can perform work. The scans show where the cocaine interferes with the brain's use of glucose - or its metabolic activity. The left scan is taken from a normal, awake person. The red color shows the highest level of glucose utilization (yellow represents less utilization and blue shows the least). The right scan is taken from a cocaine abuser on cocaine. It shows that the brain cannot use glucose nearly as effectively – point out the loss of red compared to the left scan. There are many areas of the brain that have reduced metabolic activity. The continued reduction in the neurons' ability to use glucose (energy) results in disruption of many brain functions.
Image Source: National Institute on Drug Abuse (NIDA) Teaching Packet No. 5: “Bringing the Power of Science to Bear on Drug Abuse and Addiction”
Slide Source: Steve Hanson, MSEd Director, John L. Norris ATC New York State Office of Alcoholism and Substance Abuse Services
Instructions Source: National Institute on Drug Abuse (NIDA) Teaching Packet No. 2: “The Brain & the Actions of Cocaine, Opiates, and Marijuana”
“Healthy” Brain
“Addicted” Brain

28. The Neurobiology of Addiction

29. “FEEL GOOD” NEUROTRANSMITTERS
Endorphins
Nor-epinephrine
Phenylethylmine
Dopamine

30. PHENYLETHYLMINE
FEELINGS OF BLISS
FEELINGS OF INFATUATION
CHOCOLATES

31. INHIBITORY NEUROTRANSMITTERS
ENKEPHALINS
GABA (Gamma Amino Butyric Acid)

32. GABA Gamma Amino Butyric Acid ANTI-STRESS ANTI-ANXIETY ANTI-PANIC
ANTI-PAIN
FEEL CALM
MAINTAIN CONTROL
FOCUS

33. GABA = Calming
“THE BRAKES”
Primary brain inhibitor necessary to feel calm & relaxed

34. GLUTAMATE Brains primary excitatory neurotransmitter
Important in memory

35. HORMONAL NEUROTRANSMITTERS

36. SEROTONIN
Neurotransmitter responsible for regulating moods and emotions
A lack of serotonin can lead to depression and /or obsessive, compulsive behaviors