Substance Use Disorder: A Chronic & Progressive Behavioral Disorder

UCSF Osher Center for Integrative Medicine – Jeffrey DeVido, MD Assistant Professor – UCSF Department of Psychiatry – Presentation June 8, 2016

Historically treated as a moral disorder or a moral weakness, medical science now recognizes a substance use disorder as a chronic relapsing medical illness. The following are built points of Dr. DeVido's presentation. (Link at the bottom)

  • Mood disorders, depression - anxiety, addictions go together

  • An addiction enhances dopamine release or enhance the effects of dopamine in the nucleus accumbens (reward center of the brain) over time the brains ability to produce dopamine reduces and they don’t get the same high which is why a state of dependency develops

  • When they stop it feels bad, they get sick and severely depressed.

  • Tolerance builds and they don’t get the same high; using it reduces how bad they would feel otherwise. Cycle of reuse – it may not feel great, but it feels worse without it = dopamine

  • The faster it gets into the brain the greater the reinforcement for the substance #1 fastest route = lungs / inhaled (nicotine – crack cocaine)

  • Must integrate different treatments to fit the individual (It's not a one size fits all)

  • Enhance their motivation to change

  • I want / I don’t want - Ambivalence regarding substance misuse is normal. Part of them really does not want to use and part of them really does. Must tip the scale more to “I want to change”

  • Teach new resistance skills with Cognitive Behavioral Therapy (CBT) Its like learning a new language, it takes daily practice.

  • The time to intervene is when they have a negative trigger, a bad interaction with someone, or a negative event (accident, arrest, etc)

  • Group therapy does make the treatment more effective – “it takes a village”

  • The village: Family, Community is part of the treatment

  • AA is a "fellowship", not treatment; each group is a different social network and the person must find where they fit in. It becomes their community / family

  • This disease will kill, we must do all we can by combining treatment modalities

  • Wellbutrin helps with nicotine withdrawals

  • Their life priorities center around the addiction. It becomes almost impossible for them not to sustain that pattern of behavior and use.

  • This is a brain disease - Being punitive does not work

  • GABA calms the brain down – Alcohol calms the brain down. Body stops producing GABA and relies on alcohol. When stopping alcohol the body can’t adjust quickly and start making GABA on its own again. It doesn’t remember how. Person has to have something to calm the brain. Without GABA and Dopamine the brain becomes excitatory / easily angered / severe anxiety / body can’t adjust and person gets sick, anxious, angry, impulsive.

  • There are environmental, genetic, economic factors that predispose one to developing a SUD

  • Considered a chronic relapsing illness

  • Psychotherapies are more effective when combined: enhancing motivation to change, building skills, realigning priorities, fitness routines, healthy diet, group/community support, enlisting the help of the persons in their environment/social support, correcting medical issues, etc

  • Combining treatment types is critical for healing and long-term sobriety

I would like to add a few things regarding overcoming addictions. It is also imperative that the person address the trauma in their lives prior to and during the addiction phase. They must address and clear painful memories - past and present, painful events, eventually forgiving themselves and others as needed. The Insightful Change Method has been used in this area with good results as part of the whole.

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