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Brain Injury and Opioids
Brain Injury and Opioids – Part 1Acquired Brain Injury and the Toxic Brain
Monica VaccaroBrain Injury Association of Pennsylvania
Director of [email protected]
Funded by TBI State Implementation Partnership Grant SAP# 4100081563 from the U.S. Department of Health and Human Services, Administration
for Community Living (ACL). Contents are the responsibility of the authors and do not necessarily represent the official
view of ACL.
The Numbers
• 2.5 million Americans are addicted to opioids and heroin• After one week of regular opioid use, all persons
become dependent (Sutherland and Fessenden, 2018)• It is estimated that 33% of pain killer users don’t know
they are taking an opioid (reference??)
The Opioid Crisis and Relation to Acquired Brain Injury
• 67% of people in brain injury rehab have a history ofsubstance abuse prior to their injury
• 20% of people who did not have substance abuse problemsbefore their injury develop them after brain injury
• 50% of people in substance use disorder rehab have evidenceof an acquired brain injury
• People who survive an opioid overdose may suffer ananoxic brain injury
American Society of Addiction Medicine
• Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry
• Drug addiction manifests as a compulsive drive to take the drug without regard to severe adverse consequences (Volkow and Li, 2005)
• There is an interaction between the brain's opioid and dopamine (DA) systems in the reinforcing and addictive effects of substances of abuse (Volkow, 2011)
Roads to Recovery: Overdose and Brain Injury
Documentary produced by PBS New Hampshire
• Looks at the lesser-known effects of overdose - anoxic brain injury
• Tells the story of what happens to the brain during and after an event
• How it can affect treatment and recovery.
https://video.nhpbs.org/video/overdose-and-brain-injury-rbcycv/
Opioids and the Brain
• Drug addiction is a chronic and relapsing disorder • Considered a brain disorder because it involves
“functional changes to brain circuits involved in reward, stress, self-control (Goldstein and Volkow, 2011)
• Addiction is a behavior that originates from our brains• Brain circuits involved in reward, stress, self-control in the limbic system
and prefrontal cortex• Interferes with the way neurons send, receive and process signals via
neurotransmitters
How Do Opioids Act on the Brain
● Opioids - are depressants, downers
○ slow down body functions, such as heart rate and breathing
○ can lead to loss of consciousness, coma, or death
○ significant risk of an overdose is lack of oxygen to the brain
The Toxic Brain - A New Kind of Brain Injury...
● Toxic Brain Injury - occurs from prolonged substance misuse
and nonfatal overdose
○ Hypoxic Brain Injury - occurs when the brain does not
receive enough oxygen
○ Anoxic Brain Injury occurs when the brain does not receive
any oxygen
The Toxic Brain - A New Kind of Brain Injury
● Toxic brain damage is caused by:
○ disruption of nutrients needed by brain tissue
○ direct damage, injury, and death of brain cells, including
neurotransmitter receptors
○ alterations to brain chemical concentrations, including
neurotransmitters and hormones
○ deprivation of oxygen to brain tissue
Opioids and the Brain.
• Our brains are wired to increase the odds that we will repeat pleasurable activities- dopamine is central to learning this• Reward circuit is signaled by a burst of dopamine that something
important is happening and needs to be remembered.• This is how we make a habit
• Neural connectivity is altered making it easier and easier to repeat the activity without thinking
• These surges of dopamine teach the brain to seek the drug at the expense of other goals
Opioids and the Brain..
• In response to drug-related dopamine dumps• Our brains produce fewer neurotransmitters in the
reward circuit and there is reduced pleasure from naturally occurring and rewarding activities• People appear flat, unmotivated, and depressed• This is a cortical depression
• In order to experience pleasure• Increased dosages• Increased risk
Opioids and the Brain...
• Addiction is characterized by a loss of behavior• “Continued use, in apparent awareness of
associated adverse consequences, suggest that addicted behavior may involve deficits in inhibitory control, decision making, and regulation of affect” (Yucci, Lubman, neuropsychology of drug abuse)
Impact of Brain Injury on Success in Programming
Brain injury impacts an individual’s ability to use the treatment they are provided.
How can we adapt SUD treatment to facilitate success for those with brain injury?
3 Reasons for Negative Outcomes in SUD Treatment due to ABI
• Neurobehavioral consequences of injury undermine the ability to participate in “conventional” treatment
• There is a greater likelihood of co-occurring behavioral issues in this population
• Less ability to sustain improvements from treatment without continued structure and support
Ways Cognitive Impairment Interferes with Treatment
• Ability to attend for a certain period of time
• Ability to remember what was discussed in last meeting
• Ability to abstract - to understand how what is being
talked about applies to me
Ways Cognitive Impairment Interferes with Treatment...
• Sleep and its impact on attention and endurance
• Ability to prospectively remember the appointment
• Ability to plan to get to the appointment• Leaving in enough time to arrive on time
• Planning their travel to the appointment
Individual Sessions
• The person:• May not accurately report “how they are doing”• May not follow through as agreed
upon• May have difficulty developing
insight• May not recognize their need
for treatment• May not remember from session
to session
Treatment Groups/Counseling
• May have trouble understanding the content or processing the info quickly enough
• May have limited ability to recognize content’s applicability to self
• May over or under-contribute
• May repeat self
• May not be able to initiate or complete homework tasks
• May come to group/session unprepared
Selected References
• New Hampshire Public Broadcasting (NHPBS) (2019). Roads To Recovery - Overdose and Brain injury
• Parry-Jones BL, Vaughan FL, Miles Cox W. Traumatic brain injury and substance misuse: a systematic review of prevalence and outcome s research (1994–2004) Neuropsychological rehabilitation. 2006;16:537–560.
• Sutherland and Fessender (2018) Center for Behavioral Health Statistics and Quality. (2016). Key substance use and mental health indicators in the United States: Results from the 2015 National Survey on Drug Use and Health (HHS Publication No. SMA 16-4984, NSDUH Series H-51). Retrieved from http://www.samhsa.gov/data/.
• Volkow ND, Fowler JS, Wang GJ, Goldstein RZ. (2005) Role of dopamine, the frontal cortex and memory circuits in drug addiction: insight from imaging studies. Neurobiology of Learning and Memory. 78: 610-24. PMID 12559839 DOI: 10.1006/nlme.2002.4099
For further information
www.biapa.org www.health.pa.govToll Free Brain Injury Resource Line
1-800-444-6443PA Department of Health
1-717-772-2763