Saturday, November 30th, 2013
Alcoholics Annoymous (AA) was founded in the 1930s, as the method of treatment for alcoholism. For the majority of the century it was the sole strategy for treatment. Later in the century, persons addicted to narcotics took a page from AA’s book and founded Narcotics Anonymous (NA) based on the same 12-step process. Treatment of alcoholism and substance addictions was not without controversy: was it a medical disease? social malady? moral failing?
With advances in research on addiction, a majority of scientists support the medical model and tools have been developed to treat this disease. Recognized as a medical disease, that impacts the brain, scientists developed some biological tools to complement AA and NA.
For example, Campral was introduced in the U.S. early in the 21st century. The purpose of the drug is to reduce the physical and emotional distress of abstinence. Generally, Campral is prescribed to persons who are able to demonstrate abstinence.
In addition to Campral, Naltrexone was designed to help persons addicted to opiates and alcohol. The intended purpose of the medicine is to lessen the positive feelings gained from opiates or alcohol. It works in the brain by blocking opioid receptors thereby diminishing the positive feeling or “high.” (Naltrexone should not be given if the person has liver disease. Also, it should not be given if a person is taking methadone.)
Other supportive medicines have been tried to ameliorate addictions: Topamax, a mood stabilizer, Ativan, a class of medicines called benzodiazepines, and Antabuse, causing sickness when a person drinks alcohol.
Medicines can’t combat addictions alone. Treatment programs, lifestyle changes and positive social support are necessary to improve the lives of persons who have addictions.
Until next time: Treat yourself and others with kindness. It’s good for your brain.
Tuesday, September 24th, 2013
Alcohol and drug use have at least one primary purpose: to provide pleasure. The risks of obtaining drugs – breaking the law – or abusing alcohol – hangovers – are miniscule in comparison to pleasure. Without the component of pleasure involved, “the war on drugs, ” and the disease of alcoholism never would have been issues. So, how does the motive of pleasure lead to the tragedy of addiction?
Moral depravity? Addictive personalities? Dysfunctional families? Of course, none of these choices provide relevant answers to the explanation for addiction. Recent brain studies, brain scans of persons with chronic addictions to drugs from heroin to marijuana and alcohol lead us back to pleasure and a neurotransmitter, vital to pleasure, called dopamine. We experience a similar response when we have a cup of coffee or eat a good meal. But what happens when a “street drug” enters the brain?
For example, methamphetamine is injected intravenously or inhaled, and the chemical referred to as “meth” locates its targets or receptor sites on nerve endings in the brain. Dopamine, a neurotranmitter, is released and there’s a rush of “euphoria and ecstacy.” The rush or chemical avalanche leads to more receptors responding to dopamine, extending the high for hours, depending on the chemical. (You can substitute any drug in the example, like cocaine, marijuana, heroin; each drug has its own desired effects.)
As use continues for weeks and months, the brain responds with an adaptive trait: the dopamine receptors on the nerve cells (neurons) diminish in number, a response to overuse of “pleasure-causing drugs.” To the person experiencing an addiction, the highs or “rush” becomes more difficult to achieve with the same amount of drug. As a result, a person addicted to the drug increases his dose in an attempt to achieve the same level of pleasure that he initially obtained. As more and more receptors diminish, the addiction cycles into a downward spiral of trying to maintain a high at greater costs to brain health.
At this point, the deadly manifestation of addiction is on full display: break-up of families, legal problems, and loss of life. But what can be done to help someone who is addicted break this tragic and potentially deadly cycle? Next time: a look at treatment and beating the pleasure game.
For more information about drug abuse go to the National Institute of Drug Abuse, blog link.
Until then: treat yourself and everyone with kindness, it’s good for your brain and theirs.
Sunday, July 14th, 2013
For decades, scientists debated whether addictions were the result of failure of moral fiber or medical disease. Dr. Nora Volkow, pictured on left, ended that debate by demonstrating the relationship between addiction and the brain.
Drugs and alcohol promote pleasure, leading to a pattern of behavior that’s repeated, seeking a high. If we look more closely, it isn’t a weak will or lack of moral fiber that leads to addiction, but it is the nature of the drug and how our brain responds to specific chemicals. For example, even something as benign as chocolate tugs at our brain’s biochemistry, pushing the dopamine button, so to speak.
Dopamine is one of many neurotransmitters in the brain, but its role is primary in importance when talking about addictions. Nerves or neurons, literally billions, communicate to one another through chemical messengers. Each neurotransmitter has a specific function: in the case of dopamine it is our reward chemical.
In addition, our brain has a “reward circuit” called the limbic system. The limbic system regulates mood, eating, and motivation. And when illicit drugs are taken, like heroin or marijuana, the limbic system becomes more active, resulting in greater feelings of pleasure. Like most things that lead to pleasure, our brain wants to do it again and again. In an addict, that creates cravings!
The National Insitute of Drug Abuse has an abundance of articles and videos to promote a better understanding of the nature of drug addictions. Please go to the following link to learn more: http://www.drugabuse.gov/related-topics/addiction-science.
Next time, I will explore how cravings go awry in addiction.
Until then, treat yourself and others with kindness, it’s good for your brain.
Tuesday, July 2nd, 2013
The wars in Iraq and Afghanistan inflicted trauma to soldiers’ brains resulting in what is called Post Traumatic Stress Disorder or PTSD. Armed Forces were unprepared to treat the mental health wounds of war, manifested in the forms of addiction, domestic violence, and suicide. In addition, some veterans found themselves incarcerated for horrible crimes, including murder.
However, treatment of PTSD is available and effective. Veterans in Minnesota can seek help by contacting their local Veterans Service Officer for resources. Willmar has a service officer located at the Kandiyohi Health and Human Services building. St. Cloud Veterans Administration has an inpatient mental health unit and mental health outpatient clinic. There is also a Veterans Administration Outpatient Clinic located in Montevideo.
Treatment begins with an assessment to determine the extent of the problems. Medicines may be prescribed to decrease or lower activity, in certain areas of the brain, that became overactive during war. In addition to medicines, group support with peers provides a safe place to share similar stories and reduce a sense of isolation.
Addiction to drugs and or alcohol, an attempt to “self-medicate” symptoms of PTSD, needs to be reduced or stopped. This may require treatment in an inpatient chemical dependency program or outpatient program depending on the severity of the addiction.
Family education and support also is a component of healing. Family members have experienced both the terrifying fear of losing a loved one in battle and now by the assault of PTSD. Family members need support and someone to listen to them. They need to know that there is hope and that their loved one can recover.
Please go to http://www.ptsd.va.gov/index.asp.
And until next time, treat others and yourself with kindness; it’s good for your brain.
Thursday, June 6th, 2013
Soldiers from the 3rd Platoon, Charlie Company, 306 Infantry, were known as the “Band of Brothers.” Their mission in Iraq was to drive the same highway, in the Sunni Triangle, patrolling for IEDs (Improvised Explosive Devices). They called their mission, “Mad Max.” On Veterans Day, 2004, a car crashed through barriers and exploded, wounding 7 soldiers of the 3rd Platoon, including Sgt. Shawn Huey.
Ryan Krebs, the platoon medic, witnessed the bloodshed. Smoke and dust were everwhere; two kids were dead. And Sgt. Huey was covered in blood. Krebs attempted to help Sgt. Huey, but shrapnel had severed a major artery. Sgt. Huey’s eyes appeared lifeless according to Krebs.
When Krebs returned home from Iraq, he experienced PTSD. He had nightmares; walking down the street he would check for snipers on buildings, felt depressed, paranoid and saw people in crowds that he knew had died in Iraq.
The other members of 3rd platoon returned to Ft. Carson, near Colorado Springs, one year after their deployment. They were asked if they were experiencing any signs of PTSD, and all of the soldiers said they were fine, for fear of bing stigmatized or thought weak.
It was during the first three years of the Iraq war that there was a rise in failed drug tests. David Nash, age 19, became a cocaine addict. Nash said he felt paranoid and unsafe; cocaine helped him feel calm. He didn’t care about anything else. Cocaine helped shut off his mind from the bad memories.
Ft. Carson experienced an increase in suicides and homicides: 36 suicides and 17 convicted or charged with murder, attempted murder or manslaughter. The leadership at Ft. Carson was unprepared for the problems that followed the soldiers home from war. Since 2002, the diagnosis of PTSD, at Ft. Carson, has gone from 26 cases to 1,120.
Information for this post comes from “The Wounded Platoon,” broadcast in May, 2010, on PBS.
For complete coverage: http://www.pbs.org/wgbh/pages/frontline/woundedplatoon/
Until next time, treat youself and others with kindness; it’s good for your brain.
Monday, May 20th, 2013
Post-traumatic stress disorder may be caused by trauma from war, sexual assault or catastrophic disasters. Veterans of the wars in Afghanastan and Iraq have witnessed unspeakable horrors. As a result of these experiences, soldiers returning home to their communities, homes and families carry emotional scars that will extend far beyond the end of the war. Some of the soldiers’ emotional scars will manifest in the form of nightmares, flashbacks and hyperarousal: the cluster of symptoms fall under the disorder of post-traumatic stress disorder or PTSD. http://www.ptsd.va.gov/public/pages/symptoms_of_ptsd.asp
As a result of the symptoms, it may become extremely difficult to engage in intimate social contacts with a partner, complete tasks at work or participate in community activities, like church or clubs. Flashbacks may be triggered by noises, arousing fear and vivid images of the battlefield or traumatic event. Trust is diminished and intimate relationships become stressed. And events or situations that remind the person of past trauma are avoided. All of these manifestations of PTSD result in a terribly chaotic life to the person and to the person’s family and friends.
A closer look at the brain reveals a disturbance to an area called the basal ganglia. Under normal circumstances, the basal ganglia helps regulate or set an acceptable level of anxiety. If the area becomes overactive, as is the case in PTSD, then the person’s level of fear is exacerbated. Each experience, whether going to the grocery store or visiting a friend, might be charged with extreme anxiety and perhaps an exaggerated fear of death. Please check brain scan displaying PTSD: http://www.amenclinics.com/the-science/spect-gallery/item/anxiety?category_id=141. Unless this overactive area of the brain is treated, the outcome is poor.
Treatment combines medicines, counseling, and peer-supported groups. Medicines like Depakote, Tegretol or Lithium might reduce the overactive basal ganglia. This results in the reduction of anxiety and decline in fear. As a result, the person is more likely to participate in counseling and group activities with peers. In addition, family relationships can begin to mend, and the person can make inroads toward reconnecting with community. Life becomes less chaotic.
For more information about PTSD, go to the Department of Veterans Affairs: http://www.ptsd.va.gov/index.asp
Next time: I will take a more detailed look at the human side of PTSD. Until then, treat yourself and others with kindness, it’s good for your brain.
Monday, May 13th, 2013
At the Mendota Heights Mental Health Institute (Madision, Wisonsin) in the 1970s, mental health professionals observed that persons discharged to the community, following treatment in a hospital, returned multiple times to the hospital over the years. This phenomena was called, “the revolving door.”
At the Mendota Heights Mental Health Institute, Len Stein, Mary Ann Test, Arnold J. Marx, William H. Knoedler and Deborah J. Allness devised a model of care to disrupt “the revolving door”: the model was called Assertive Community Treatment. Assertive Community Treat or A.C.T., in essence, brings treatment to where the person is living: an apartment, supported-living environment, homeless shelters. They found that treatment interventions needed to be extended into the community in order to strengthen gains made in the hospital.
The Assertive Community Treatment team generally consists of a psychiatrist, team leader, nurses, rehabilitation specialists or generalists, vocational rehabilitation specialist, and a chemical dependency counselor. The idea is to integrate the strengths of the team with a level and frequency that fits the person’s needs at the time.
For example, a person with schizophrenia may need help with medicine adherence. As a result, the A.C.T., team can either bring medicines to the person a number of times a week and do “eyes on meds.” This intervention will reduce the risk of stopping medicines and subsequent risk of symptoms returning. The number of visits each week can be adjusted based on the benefits and outcome.
Another advantage of A.C.T., services is that the team is much more responsive and efficient than traditional services in mitigating a crisis. Since the A.C.T., team is in contact with clients on a routine basis, the team is more sensitive to changes in behaviors. And as a result, the A.C.T., team can adjust their schedule of visits to meet the person’s needs during those critical periods. This may include an unscheduled contact with the team’s psychiatrist.
A.C.T. has another advantage: the team can continue to work with the person for an extended period of time, thereby strengthening gains the person has made in their recovery. This ability to maintain a long-term relationship results in a strong working-knowledge by the team of the person and a sense of confidence by the person that things aren’t going to fall apart again.
A.C.T. teams cover both metro and rural areas. Some of the teams are linked to local mental health centers. In 2005, I was a member of the Great River A.C.T., team in Monticello, MN., which was connected to Central MN. Mental Health Center from St. Cloud, MN. In Willmar, Woodland Centers maintains an A.C.T., team that serves the surrounding area, helping persons with severe mental illness live in their communities.
The model of care designed by the pioneers at Mendota Heights Mental Health Institute in the 1970s has solved the “revolving door” problem. And today, A.C.T., is recognized as an “evidenced-based” practice. The benefits to persons with mental illness have been shown, under scientific scrutiny, to work.
You can learn more about accessing an A.C.T., service in your area by contacting your county social services or local mental health center. For more information about A.C.T. check out this link: http://www.nami.org/Template.cfm?Section=ACT-TA_Center&template=/ContentManagement/ContentDisplay.cfm&ContentID=132547
And until next time, treat yourself and others with kindness, it’s good for the brain.
Sunday, April 28th, 2013
Schizophrenia, like any other serious health disorder, requires time to adapt to the limits set by the illness. Like a person newly diagnosed with heart disease, there are certain life changes that will need to be undertaken in order to cope with the illnes on a day-to-day basis. Unlike heart disease which sets physical limits, such as exercise or eating patterns, schizophrenia impacts areas of emotion, behavior and thought processes.
Persons with schizophrenia need to learn how to cope with changing thinking patterns, perhaps some distored thoughts that enter into their consciousness, making it difficult on certain days to distinguish reality. Or there may be times that feelings of fear arise in certain environments making it challenging to engage in social interactions with friends or family. As a result, it feels safer to withdraw from social engagements.
Schizophrenia, like heart disease, requires a variety of coping skills and consistent follow-through to achieve a good outcome. Besides medicine, persons with schizophrenia do better if there is a connection to some type of support in their lives. This may come in the form of a peer support group: a group that is dealing with the same types of problems that they are. A peer support group allows sharing and reduces a sense of alienation or isolation. In addition, “natural supports” consisting of peers, family or church helps nuture a sense of support and “normalization.” People with schizophrenia should be as much a part of their community as a person who has suffered a heart disorder.
Perhaps, arguably, the best essay, I have ever read on coping with schizophrenia, was written by a person struggling with schizophrenia. Esso Leete, wrote “How I Perceive My Illness” in 1989. Ms. Leete, besides having a beautiful name, describes eloquently and in detail how she manages her day-to-day life. I would strongly encourage you to read this in order to get a better feel for what schizophrenia is about: http://www.eastcommunity.org/shop/images/EssoLeete.pdf
Schizophrenia is a severely debilitating illness, but with knowledgeable interventions and support, a person can live a healthy and productive life.
Until next time, treat yourself with kindness; it’s good for your brain.
Wednesday, April 24th, 2013
Up to this point in Gray Matters, I have provided basic information about mental illness: a first-episode of schizophrenia, medicines to treat mental illness and a typical attempt to get help during an emergency. But, how can a doctor or psychiatrist be sure that a person has a mental illness? There’s no definitive test to measure symptoms or signs of mental illness. Unlike tests that measure changes in a heart, during a heart attack, mental health doesn’t have a blood test or use of electrodes that display brain abnormalities or changes.
However, some psychiatrists and clinics are trying to use brain scans to better treat mental illnesses. Dr. Amen, of Amen Clinics, has been using SPECT scans, much like a CAT scan, to evaluate mental illness and treatment for almost two decades.
SPECT scans show two important pieces of information that a CAT scan doesn’t: 1) the metabolic function of neurons (much like telling if a car engine is hitting on all cylinders) and 2) blood flow throughout the brain or what is called “tissue perfusion.” Amen uses this information to diagnose a variety of mental illnesses, from obsessive compulsive disorder, depression, to substance abuse disorders.
In addition, with SPECT scan information, Dr. Amen is able customize treatment, using the correct medicine for the problem. For example, he might identify that a person’s SPECT scan shows a severe case of anxiety and depression; he then prescribes an antidepressant. He can monitor the progress of the treatment by doing another SPECT scan at a later point, which tells him if the treatment is on target or not.
There are critics of SPECT scans, who don’t believe that it provides clear-cut evidence for making a diagnosis. However, Dr. Amen stands behind the use of SPECT scans as another tool that a psychiatrist can use to improve the outcome of treatment.
See for yourself by going to http://www.amenclinics.com/the-science/spect-gallery.
Next time I’d like to explore how a person with schizophrenia learns to cope with the illness and has a productive and connected life. Until then, be kind to yourself, it’s good for your brain!
Sunday, April 14th, 2013
In an earlier post, “Mental Illness is a Brain Disorder,” a young man, in his first year of college, starts to exhibit symptoms of schizophrenia. And now the young man’s parents are trying to help him get treatment so that he can return to school. What typically happens next?
Many first-episodes come to the attention of law enforcement and emergency department staff. Once in the emergency department, if the person is exhibiting symptoms and signs of psychosis, the person may be put on a physician’s emergency hold order (PEHO), which allows for a 72-hour evaluation in the hospital. This will help trained professionals to determine what is going on with the person. Are there physical problems causing the symptoms? or medicines? or even street drugs?
Once it is determined that the young man is experiencing signs and symptoms of schizophrenia, the first-line of treatment is to give an atypical psychotropic medicine. The psychotropic will act on receptors in the brain and reduce the severity of the symptoms like hallucinations. See “Medicines: Help but not a Magic Bullet”: http://graymattersmentalhealth.areavoices.com/wp-admin/post.php?post=67&action=edit
It’s important to note that the young man has the right to refuse the medicine. At this point, this is where treatment often becomes challenging to a treatment team, family and patient: the team, including the psychiatrist, needs to make a decision about whether the situation is an emergency or not. If it is not an emergency, then the young man can refuse the medicine. However, if it is deemed an emergency, then the medicine can be authorized to be given.
Another scenario involves the county: a pre-petition screening is conducted by a trained social worker, who interviews the patient. Based on information from the patient and collaborating information from family, the school, and mental health team in the hospital, the social worker returns to his office and reviews the report with a team. The team will make a determination on whether to begin a civil court process to commit the young man or not.
In a future post, I will discuss the commitment process.