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Addiction is a Chronic Illness PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Addiction is a Chronic Illness" by By R. Jeffrey Goldsmith MD, DLFAPA, DFASAM, to learn how addiction can be considered a chronic illness due to its persistent and long-lasting nature. Like other chronic illnesses, addiction is characterized by a cycle of relapse and remission, and it often requires ongoing treatment and management to maintain recovery. Addiction is a brain disease that affects the reward, motivation, and memory centers of the brain. It involves changes in the brain chemistry that lead to compulsive drug or alcohol use, despite the negative consequences it may cause. These changes can last long after the individual has stopped using the substance, making addiction a chronic condition.

Tags : Addiction, Chronic Illness, drug, alcohol

Published on : Mar 14, 2023 | Views : 830 | Downloads : 2

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Slide 1-

Addiction is a Chronic Illness By R. Jeffrey Goldsmith MD, DLFAPA, DFASAM ASAM Immediate Past President
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Disclosure No commercial disclosures STR-TA Consultant, New England, TAPJ 1 Funding for this initiative was made possible (in part) by grant no. 1H79TI080816-01 from SAMHSA. The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.
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Working with communities to address the opioid crisis. SAMHSA’s State Targeted Response Technical Assistance (STR-TA) Consortium assists STR grantees and other organizations, by providing the resources and technical assistance needed to address the opioid crisis. Technical assistance is available to support the evidence-based prevention, treatment, and recovery of opioid use disorders. 3 Funding for this initiative was made possible (in part) by grant no. 1H79TI080816-01 from SAMHSA. The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.
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Contact the STR-TA Consortium To ask questions or submit a technical assistance request: Visit www.getSTR-TA.org Email str-ta@aaap.org Call 401-270-5900 4 Funding for this initiative was made possible (in part) by grant no. 1H79TI080816-01 from SAMHSA. The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.
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Disease Definition: “An interruption or cessation or disorder of bodily functions, system or organ illness A morbid entity characterized by at least two criteria: a recognizable agent an identifiable group of signs or symptoms, or consistent anatomical alterations” 5 * Steadman’s Medical Dictionary
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Comparative Concepts 6 AT McLellan, Addiction, 97, 249–252, 2002
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Relapse Rate for Addiction Similar to Other Chronic Conditions 7 McLellan, et al., JAMA, 284 (13):1689-95, 2000
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Importance of Language 8 National Council for Behavioral Health, Recovery Month 2015
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Substance Use, Recovery, and Linguistics: The Impact of Word Choice on Explicit & Implicit Bias* Implicit bias testing shows commonly used terms elicit strong negative bias Terms to describe substance use also revealed significant elicited explicit bias *Ashford, R, Brown, A, Curtis B. (2018) Drug and Alcohol Depend. 189(8): 131-38
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What if We Treated Diabetes Like Addiction? Would we… Imply (or say) that your poor lifestyle choices have caused this disease? Say your elevated blood glucose makes your blood “dirty”? Plan to treat you with insulin for only 2 years, then insist that you change your lifestyle enough so that we can taper you off it? Or… decline to treat you at all? Insist that you go to diabetes education classes in order to continue treating you? Discharge you from treatment if you choose to eat poorly, don’t lose weight, and/or have a persistently high blood sugar? 10
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Defining Addiction “A chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences Considered brain disease because drugs change the brain… structure and how it works… that can be long lasting and lead to many harmful, self-destructive behaviors”* 11 *NIH, National Institute of Drug Abuse, 2014
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Substance Use Disorder (DSM 5): Problematic pattern of substance use leading to clinically significant impairment or distress as manifested by at least 2 of following occurring in 12 mos: Use in lgr amounts than intended - Great deal of time using Unsuccessful efforts to cut down - Cont’d use despite prob’s Cravings or strong urges to use - Fail obligations Sacrifice activities because of use - Use in hazardous sit’ns SUD categorized by severity: Mild: 2-3 criteria Moderate: 4-5 criteria Severe: 6 or more criteria 12
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Does Everyone Get Addicted? No! Varies with substance & individuals factors Predisposing factors: Genetics Family history Early exposure to substance (<21 yo) Mental health disorders Trauma Trauma Trauma 13
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Dependence vs. Addiction Physical Dependence: Most people taking opioids for extended period develop some level of physical dependence Does NOT mean they are “addicted” Withdrawal symptoms can be minimized or managed with slow taper of medication Addiction: Most people addicted to opioids are also physically dependent and will experience withdrawal sx on stopping Other substances can be strongly addictive (e.g. cocaine), but have withdrawal symptoms different from alc/opioids 14
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Neurobiology of Addiction Stages of addiction: Use/ binge  intoxication, dopamine release (“reward system”) Withdrawal  negative effect Preoccupation / anticipation  pursuit Addiction changes brain, resets brain’s reward system Over time, drug consumption triggers less dopamine, more reactivity to stress, negative emotions 15
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Brain Anatomy SAMHSA, 2016, The Three Stages of the Addiction Cycle and the Brain Regions Associated with Them
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Systems for SUD Care & Recovery 17 Recovery Supports & Social Health Needs Medications to Treat Addiction MH/SUD Counseling Support Trauma
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FDA-Approved Medications for OUD Methadone Opioid agonist, FDA-approved since 1971 Can only be administered by federally-recognized “Opioid Treatment Program” (OTP/methadone clinic) Buprenorphine Partial opioid agonist, FDA-approved in 2002 Can be administered in office-based treatment programs by prescribers with DEA X-waiver or OTP Can be prescribed X3 doses by any DEA licensed physician Naltrexone Opioid antagonist/blocker, FDA-approved in 1984 (tabs), 2010 (IM) Can be administered by any prescribing clinician Available as IM, tablet (poor adherence, not widely used)
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Treatment duration (days) Remaining in treatment (nr) 0 5 10 15 20 0 50 100 150 200 250 300 350 Maintenance: 75% Abstinent at 1 year 0% mortality HR = 58.7, p .0001 Kakko, Lancet 2003 No meds (“Detox”): 0% Abstinent at 1 year 20% mortality! “Abstinence” vs. Buprenorphine
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Medications for Addiction Treatment (MAT) Works, AND Still Greatly Underused 20 Strong evidence for effectiveness of Medications for Addiction Treatment for SUD/OUD i.e. methadone, buprenorphine, naltrexone Saves lives, decreases OD deaths Reduces harm from illicit drug use Reduces craving, allowing more focus on recovery Decreases risk of relapse, increases rates of recovery Strong evidence that MAT still widely under-utilized – in Maine & nationally
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Access to OUD Medications Remains Key Barrier to Reducing OD Deaths Williams, Bisaga. Health Affairs, 2017.
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Goals of Medication for OUD Reduce mortality! All cause and drug-related Reduce OUD-associated diseases Transmission of blood-borne viruses (HIV, Hep C) Infectious complications from IV drug use Reduce and/or discontinue opioid use Increase retention in addiction treatment Improve general health and well-being Reduce drug-related crime Volkow, et al, NEJM. 2016
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Suboxone = Buprenorphine + Naloxone
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Subutex: Buprenorphine Only
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Effects of Buprenorphine Blocks cravings Alleviates opiate withdrawal symptoms Partial agonist  does not produce ‘high’ Blocks effects of misused opioids Increases treatment retention Less physical dependence than methadone, withdrawal less challenging 26
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Other Buprenorphine Formulations Probuphine 6 month implant 4 matchstick sized rods in upper arm Sublocade Subcutaneous (abdominal), for treatment of moderate to severe OUD Must start on sublingual formulation to stable dose first Buprenex IV form, for treatment of moderate to severe pain Not approved for OUD treatment Butrans 7-day transdermal patch, used for severe pain Not approved for OUD treatment
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Buprenorphine Prescribing Requirements & Limits Per Drug Addiction Treatment Act (DATA) 2000, DEA requires “X-waiver” to DEA license (DEA-X) Must apply through DEA & SAMHSA Requires physicians to take 8 hours of training on addiction treatment PAs, NPs must complete 24 hours of training Once X-waiver obtained, most prescribers are initially limited to treating 30 patients at time After 1 year, provider can complete (simple) online application to increase to treat up to 100 patients 28
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More Information on Medication Treatments for OUD 29 https://store.samhsa.gov/home Substance Abuse and Mental Health Services Administration. Medications for Opioid Use Disorder. Treatment Improvement Protocol (TIP) Series 63, Executive Summary. HHS Publication No. (SMA) 18-5063EXSUMM. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2018.
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TIP 63 Part 1: Key Messages
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TIP 63 Part 2: Key Messages
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TIP 63 Part 3: Key Messages
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TIP 63 Part 4: Key Messages
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TIP 63 Part 5: Key Messages
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Factors of overdose Factors contributing to overdoses Southern Ohio pill mills were shut down More strict prescribing guidelines went out to providers Increased availability of heroin in Ohio Heroin became a cheaper Resulted in a higher death rate among younger Ohioans Risk Factor's for overdose Overusing what is prescribed Misusing what is prescribed Mixing opioids with ETOH, Benzos, Sedatives, Sleeping pills, Cocaine Using alone Poor health (especially Lung, Liver problems) Getting a new drug New dealer New dosage Dosage’s >50mg morphine equivalent = higher risk Persons at highest risk for overdose Young males aged 18-25 Men are 59% more likely than women to die of an overdose Highest rate of overdose by age group: 45 - 49 years Patients discharged from emergency medical care following opioid intoxication or poisoning Persons with tolerance level reset either from admission to hospital, jail, rehab etc. Risks increase as the dose increases for pt on >50mg Morphine equivalent
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Naloxone/Narcan Used by EMS for >40 years Reverses the effects of opioids on the brain. Blocks the effects of opioids at receptor sites Quickly restores breathing Harmless if given to someone not overdosing Will NOT reverse overdose caused by non-opioids: ETOH, BZ(valium, xanax), cocaine Effects last only 30 - 60 minutes Buys you time to get medical attention
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Examples of Naloxone dosing materials Naloxone Vials Naloxone vials with a syringe to dose IM Narcan Naloxone Carpuject IM dosing option Naloxone Nasal Atomizer Intranasal dosing option
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Resources Ashford, R.D., Brown, A.M., Curtis, B. (2018). Substance Use, Recovery, and Linguistics: The Impact of Word Choice on Explicit and Implicit Bias. Drug and Alcohol Dependence, 189, 131-138. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing McLellan, A.T. (2002). Have we evaluated addiction treatment correctly? Implications from a chronic care perspective. Addiction, 97(3):249-52. McLellan, A.T., Lewis, D.C., O’Brien, C.P., & Kebler, H.D. (2000). Drug dependence, a chronic medical illness: implications for treatment, insurance, and outcomes evaluation. JAMA, 284(13):1689-95. National Council for Behavioral Health, 2015, Language Matters National Institute on Drug Abuse (2014). Drugs, Brains, and Behavior: The Science of Addiction, NIH Pub No 14-5605. https://www.drugabuse.gov/sites/default/files/soa_2014.pdf Stedman, T. L. (2005). Stedman's medical dictionary for the health professions and nursing. Philadelphia: Lippincott Williams & Wilkins. Substance Abuse and Mental Health Services Administration. Medications for Opioid Use Disorder. Treatment Improvement Protocol (TIP) Series 63, Executive Summary. HHS Publication No. (SMA) 18-5063EXSUMM. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2018. Substance Abuse and Mental Health Services Administration (US); Office of the Surgeon General (US). Facing Addiction in America: The Surgeon General's Report on Alcohol, Drugs, and Health [Internet]. Washington (DC): US Department of Health and Human Services; 2016 Nov. Figure 2.3, The Three Stages of the Addiction Cycle and the Brain Regions Associated with Them. Available from: https://www.ncbi.nlm.nih.gov/books/NBK424849/figure/ch2.f3/ U.S. Department of Health and Human Services (HHS), Office of the Surgeon General, Facing Addiction in America: The Surgeon General’s Spotlight on Opioids. Washington, DC: HHS, September 2018. https://addiction.surgeongeneral.gov/sites/default/files/Spotlight-on-Opioids_09192018.pdf