Terrence D. Walton, MSW, CSAC Director of Treatment Pretrial Services Agency for the District of...

Booze, Brains, and Behavior: The Psychopharmacology of Alcohol and Other Drug Use

Terrence D. Walton, MSW, CSACDirector of Treatment

Pretrial Services Agency for the District of Columbia

Terrencewalton@aol.com

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

1. Legal & Illicit 2. Street Drugs and

Prescribed Drugs3. Hard Drugs & Soft

Drugs4. Very Addictive &

Less-Addictive5. Natural and

Synthetic

1. Stimulants2. Depressants3. Opioids4. Cannabinols5. Hallucinogens/

Dissociatives6. Inhalants/

Deliriants/Other

Important Factors

Bottle to Blood to Brain Route of Administration:

Smoke Sniff Snort Shoot Swallow

The Blood Brain Barrier Neurocompatibility

Abuse Potential Factors1. Power (brain impact)

2. Popularity (acceptability)

3. Presence (accessibility)

4. Pay off (onset & intensity)

5. Persistence (length of high)

6. Patterns (of use)

7. Penalty (onset & intensity)

Two Big Questions Why do people do drugs?

Why can’t some people stop?

Use

Pleasure

Stimulation

Escape

Relief

Why Some Can’t Stop

1. Physiological Dependence

2. 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

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

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

FOODWATER

SEXNURTURING

ACCOMPLISHMENT

Medial Forebrain Bundle

VentralTegmental Area

Nucleus Accumbens

Prefrontal Cortex

Brain Effects from Chronic Substance

Abuse

Un-Natural Rewards

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

ABOUTDOPAMINE

TONE

1. Amount of dopamine produced

2. Length of time dopamine is available

3. 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

Brain Command Center

DELAY DISCOUNTING

DEMAND ELASTICITY

Effective Treatment

CognitiveBehavioral Treatment

MotivationEnhance-ment

Relapse Prevention

MedicationAssisted

Treatment

Co-OccurringDisorders

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

Booze, Brains, and Behavior: The Psychopharmacology of Alcohol and Other Drug Use

TerrenceDwalton@ gmail.com