Behavioral Approaches to Cessation of Risky Substances (Jois)

Introduction to Behavioral Approaches in Substance Use

• Welcome and overview of the topic by Dr. Joyce.

• Importance of understanding substance use disorders (SUD) across all medical specialties.

Understanding Substance Use Disorders

• Need to mitigate and manage substance-related health issues encountered in practice.

• Personal experiences of substance use consequences in emergency medicine.

Key Components of the Lecture

• Review of prevalence rates of risky substance usage in the U.S.

• Definition of addiction and its relevance.

• Discussion of behavioral strategies to reduce substance misuse.

• Introduction of interventional techniques applicable in medical practice.

The Evolution of Addiction Perception

• Historical view of addiction as a moral failing; treatment focused on punishment.

• Shift towards viewing addiction as a medical disorder through scientific discoveries.

• Recognition of addiction's impact on brain chemistry and behavior.

Definition of Addiction

• Chronic relapsing disorder characterized by compulsive drug seeking and use despite adverse consequences.

• Functional brain changes associated with addiction: reward, stress, and self-control circuits.

Brain Imaging and Addiction

• PET scan comparisons: Cocaine users vs. non-users.

• Lower levels of D2 dopamine receptors in cocaine users.

• Recovery changes: gradual return of dopamine receptors post-abstinence.

Motivations for Substance Use

• Feeling Good: Intense pleasure experiences.

  • Stimulants (e.g., cocaine): Euphoria, self-confidence, increased energy.

  • Opioids (e.g., heroin): Relaxation and satisfaction.

• Feeling Better: Use as a coping mechanism for anxiety and depression.

  • Stress plays a significant role in initiation and continuation of use.

• Enhancement of Performance: Pressure to improve focus academically or athletically.

• Curiosity and Social Pressure: Particularly significant during adolescence.

Biological and Environmental Risk Factors

• Variability in addiction susceptibility among individuals:

  • Genetic Factors: Account for 40-60% of risk, including epigenetic influences.

  • Mental Disorders: Higher risk for individuals with underlying mental health issues.

• Environmental Factors: Influence of family, peers, and community.

• Importance of recognizing multiple risk and protective factors affecting addiction probability.

Protective Factors Against Addiction

• Positive family influences and support systems.

• Healthy peer relationships and social skills.

• Early educational engagement and success in schools.

Neuroscience of Addiction

• Substances alter brain function, increasing dopamine release.

• Problematic substance use categorized into three stages:

  • Binge Intoxication: Initial consumption and pleasure response (Basal Ganglia).

  • Withdrawal/Negative Effect: Emotional distress when the substance is absent (Extended Amygdala).

  • Preoccupation/Anticipation: Craving for the substance post-abstinence (Prefrontal Cortex).

Socio-Environmental Factors

• Impact of trauma on substance use:

  • Types of Trauma: Acute, chronic, and complex trauma.

  • Connection between trauma experiences and substance misuse.

• Adverse Childhood Experiences (ACE): Correlation to long-term health consequences and risks of developing SUD.

Early Substance Use and Long-Term Impact

• Evidence suggests early drug use leads to a higher likelihood of developing addiction issues.

• Importance of early prevention strategies and intervention.

Introduction to Behavioral Approaches in Substance Use

• Welcome and overview of the topic by Dr. Joyce.

• Importance of understanding substance use disorders (SUD) across all medical specialties.

Understanding Substance Use Disorders

• Need to mitigate and manage substance-related health issues encountered in practice.

• Personal experiences of substance use consequences in emergency medicine.

Key Components of the Lecture

• Review of prevalence rates of risky substance usage in the U.S.

• Definition of addiction and its relevance.

• Discussion of behavioral strategies to reduce substance misuse.

• Introduction of interventional techniques applicable in medical practice.

The Evolution of Addiction Perception

• Historical view of addiction as a moral failing; treatment focused on punishment.

• Shift towards viewing addiction as a medical disorder through scientific discoveries.

• Recognition of addiction's impact on brain chemistry and behavior.

Definition of Addiction

• Chronic relapsing disorder characterized by compulsive drug seeking and use despite adverse consequences.

• Functional brain changes associated with addiction: reward, stress, and self-control circuits.

Brain Imaging and Addiction

• PET scan comparisons: Cocaine users vs. non-users.

• Lower levels of D2 dopamine receptors in cocaine users.

• Recovery changes: gradual return of dopamine receptors post-abstinence.

Motivations for Substance Use

• Feeling Good: Intense pleasure experiences.

  • Stimulants (e.g., cocaine): Euphoria, self-confidence, increased energy.

  • Opioids (e.g., heroin): Relaxation and satisfaction.

• Feeling Better: Use as a coping mechanism for anxiety and depression.

• Enhancement of Performance: Pressure to improve focus academically or athletically.

• Curiosity and Social Pressure: Particularly significant during adolescence.

Biological and Environmental Risk Factors

• Variability in addiction susceptibility among individuals:

  • Genetic Factors: Account for 40-60% of risk, including epigenetic influences.

  • Mental Disorders: Higher risk for individuals with underlying mental health issues.

  • Environmental Factors: Influence of family, peers, and community.

• Importance of recognizing multiple risk and protective factors affecting addiction probability.

Protective Factors Against Addiction

• Positive family influences and support systems.

• Healthy peer relationships and social skills.

• Early educational engagement and success in schools.

Neuroscience of Addiction

• Substances alter brain function, increasing dopamine release.

• Problematic substance use categorized into three stages:

  • Binge Intoxication: Initial consumption and pleasure response (Basal Ganglia).

  • Withdrawal/Negative Effect: Emotional distress when the substance is absent (Extended Amygdala).

  • Preoccupation/Anticipation: Craving for the substance post-abstinence (Prefrontal Cortex).

Socio-Environmental Factors

• Impact of trauma on substance use:

  • Types of Trauma: Acute, chronic, and complex trauma.

  • Connection between trauma experiences and substance misuse.

  • Adverse Childhood Experiences (ACE): Correlation to long-term health consequences and risks of developing SUD.

Early Substance Use and Long-Term Impact

• Evidence suggests early drug use leads to a higher likelihood of developing addiction issues.

• Importance of early prevention strategies and intervention.