Breakingthecycles.com – Changing the Conversations

Check out this video clip of Good Morning America’s January 31, 2010, story, “New Science Offers New Hope for Addicts.”

by Lisa Frederiksen

One of the repeated concerns I hear when giving my presentations is the lack of satisfactory treatment for a dual diagnosis, which occurs when a person is diagnosed with both a mental illness (PTSD, Anxiety, Bipolar, ADHD, schizophrenia) and a substance abuse problem (alcohol or prescription/illegal drugs) and/or an addiction (alcoholism or drug addiction).  Not only is the common concern about the lack of treatment options expressed, but so it the equally important concern about the confusion surrounding what  effective dual diagnosis treatment should look like.

SPECT Surface Scan Showing ADHD, Courtesy Amen Clinics, Inc., www.amenclinics.com

According to the National Alliance of Mental Illness, (NAMI), “Dual diagnosis services [should] integrate assistance for each condition, helping people recover from both in one setting, at the same time. Dual diagnosis services include different types of assistance that go beyond standard therapy or medication: assertive outreach, job and housing assistance, family counseling, even money and relationship management. The personalized treatment is viewed as long-term and can be begun at whatever stage of recovery the consumer is in. Positivity, hope and optimism are at the foundation of integrated treatment.” Looking at the brain scans to the right, showing  the brain of a person with ADHD in the top set of scans and the brain of a person who abuses alcohol in the bottom set of scans, helps to explain why treating one without treating the other makes effective, healthy, long-term recovery just about impossible.

SPECT Surface Scan Showing Alcohol Abuse, Courtesy Amen Clincs., Inc., www.amenclinics.com

To address the available treatment options concern, I am reaching out to my contacts for their input and will let you know what they tell me, but I also urge anyone who is aware of such a program to please let us know via the comment feature to this post.

To more comprehensively address the questions about what constitutes effective dual diagnosis treatment, I went to the NAMI website and am cutting and pasting content from their website below:

Why is an integrated approach to treating severe mental illnesses and substance abuse problems so important?

Despite much research that supports its success, integrated treatment is still not made widely available to consumers. Those who struggle both with serious mental illness and substance abuse face problems of enormous proportions. Mental health services tend not to be well prepared to deal with patients having both afflictions. Often only one of the two problems is identified. If both are recognized, the individual may bounce back and forth between services for mental illness and those for substance abuse, or they may be refused treatment by each of them. Fragmented and uncoordinated services create a service gap for persons with co-occurring disorders.

Providing appropriate, integrated services for these consumers will not only allow for their recovery and improved overall health, but can ameliorate the effects their disorders have on their family, friends and society at large. By helping these consumers stay in treatment, find housing and jobs, and develop better social skills and judgment, we can potentially begin to substantially diminish some of the most sinister and costly societal problems: crime, HIV/AIDS, domestic violence and more.

What are the key factors in effective integrated treatment?

There are a number of key factors in an integrated treatment program.

Treatment must be approached in stages. First, a trust is established between the consumer and the caregiver. This helps motivate the consumer to learn the skills for actively controlling their illnesses and focus on goals. This helps keep the consumer on track, preventing relapse. Treatment can begin at any one of these stages; the program is tailored to the individual.

Assertive outreach has been shown to engage and retain clients at a high rate, while those that fail to include outreach lose clients. Therefore, effective programs, through intensive case management, meeting at the consumer’s residence, and other methods of developing a dependable relationship with the client, ensure that more consumers are consistently monitored and counseled.

Effective treatment includes motivational interventions, which, through education, support and counseling, help empower deeply demoralized clients to recognize the importance of their goals and illness self-management.

Of course, counseling is a fundamental component of dual diagnosis services. Counseling helps develop positive coping patterns, as well as promotes cognitive and behavioral skills. Counseling can be in the form of individual, group, or family therapy or a combination of these.

A consumer’s social support is critical. Their immediate environment has a direct impact on their choices and moods; therefore consumers need help strengthening positive relationships and jettisoning those that encourage negative behavior.

Effective integrated treatment programs view recovery as a long-term, community-based process, one that can take months or, more likely, years to undergo. Improvement is slow even with a consistent treatment program. However, such an approach prevents relapses and enhances a consumer’s gains.

To be effective, a dual diagnosis program must be comprehensive, taking into account a number of life’s aspects: stress management, social networks, jobs, housing and activities. These programs view substance abuse as intertwined with mental illness, not a separate issue, and therefore provide solutions to both illnesses together at the same time.

Finally, effective integrated treatment programs must contain elements of cultural sensitivity and competence to even lure consumers, much less retain them. Various groups such as African-Americans, homeless, women with children, Hispanics and others can benefit from services tailored to their particular racial and cultural needs.

To learn more about specific mental illnesses, please click here.

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©Lisa Frederiksen, www.breakingthecycles.com. The information contained in this post may be freely used and copied for education and other non-commercial and non-promotional purposes, provided any use or reproduction of the information be accompanied by an acknowledgment of Lisa Frederiksen, Breaking the Cycles.com, as the source. Please note that scans are courtesy of Amen Clinics, Inc. You may have to secure your own permissions to use and/or reprint.

by Lisa Frederiksen

September 14-20 is ADHD Awareness Week. Mental illness and age of 1st use of alcohol (or other drugs) are two of the key risk factors contributing to a person’s development of alcohol abuse problems and/or alcoholism. When you look at the images below showing ADHD before and after treatment and compare them to the brain of someone who abuses alcohol, you can appreciate how hard it would be to “think” straight if you were a person with a mental illness, such as ADHD, and a substance abuse problem. You can also appreciate why it’s important to treat both and to monitor treatment along the way. For as the brain starts to recover from one and/or the other, those changes, in and of themselves, can indicate a need to change medications and/or treatment protocols.

For more information about Attention Deficit Hyperactivity Disorder, ADHD — one of the most common mental disorders that develop in children — visit the NIHM website page, “Attention Deficit Hyperactivity Disorder.”

SPECT of ADHD. Courtesy Amen Clinics, www.amenclinics.com

SPECT of ADHD After Treatment. Courtesy Amen Clinics, www.amenclinics.com

SPECT of 56-year old man with daily drinking of 3-4 drinks/day but NOT an alcoholic. Courtesy Amen Clinics, www.amenclinics.com

by Lisa Frederiksen

Top-down Surface SPECT During Abuse Courtesy Amen Clinics

Top-down Surface SPECT 1 Year After Abuse Courtesy Amen Clinics

Bottom-up Surface SPECT During Abuse Courtesy Amen Clinics

Bottom-up Surface SPECT 1 Yr. After Abuse Courtesy Amen Clinics

My recent post, “SPECT Scans Showing Impact of Alcohol Abuse on the Brain,” shared some 3-D Surface SPECTs completed by the Amen Clinics, which specializes in brain health and innovative diagnosis and treatment for a wide variety of neuropsychiatric, behavioral and learning problems among children, teenagers and adults. The images I’m including in this post are also courtesy of Amen Clinics. I’m including them to first show the brain can change — it can repair the chemical and structural changes caused by alcohol abuse or alcohol dependence (although I must be clear, the extent of change will depend on a number of factors, e.g., extent of the abuse, commitment to following treatment regime, etc.) Secondly, I include them to help all concerned – the person with the drinking problem, the family members who love them and society as a whole – better understand all of this is ‘real.’ Thirdly, to help all of us better understand that the earlier substance abuse is stopped, the better for brain recovery.

What can family members do? 1st is to learn as much as you can learn about alcohol abuse and alcoholism. Browse through this blog, read my book, If You Loved Me, You’d Stop!..., and look at this terrific website, www.hbo.com/addiction.  2nd is to better understand what has happened to you as a result of trying to make sense out of a loved one’s behaviors when their brains have been compromised as shown in these scans (those resources I’ve just listed will help you with this, as well). 3rd, learn how to calmly and matter-of-factly approach the subject with your loved one without engaging in the typical methods of trying to get them to stop — blaming, shaming, anger, manipulating (throwing away alcohol or trying to catch them sneaking a drink). Those do not work. I know because I tried – for decades – and with various loved ones. Unfortunately, this brain research has only been available in the past ten to fifteen years, but fortunately it is here now and is allowing us to better understand what happens to the brains of those who abuse or are dependent on alcohol and to the brains of those who love them.

If you have specific questions you would like to ask me, leave a reply, or if you’d like it to remain confidential, use the Contact Us link under “On this Site” in the right column.

by Lisa Frederiksen

This is a top down SPECT of a healthy brain. Compare it to the bottom, right image in the block of scans below. Courtesy Amen Clinics, www.amenclinics.com.

Sometimes a picture speaks a thousand words and that is certainly true of the brain imaging that is now possible. Brain imaging technologies developed and/or advanced in the past 15 years, or so, are allowing neuroscientists and medical professionals to study the live human brain like never before. These technologies include SPECT, PET, fMRI, and the like.

With regards to alcohol (or other drugs) and the brain, these imaging technologies provide the visual “evidence” of a clinical assessment and diagnosis of the impact on the brain of a person’s alcohol abuse (defined as drinking more than moderate limits) and/or alcoholism (defined as an addiction to alcohol; addiction is a chronic relapsing brain disease).

To the left,  you will find SPECT scans done by the Amen Clinics and reprinted with permission. The top image is of a healthy brain, and the bottom set of images shows the brain of a 56-year old man with daily alcohol use of 3-4 drinks, however he was NOT an alcoholic. Compare the single brain image (healthy brain) to the brain image in the bottom, right corner of the 4 scans below (daily alcohol use, 3-4 drinks but not alcoholic). The bumpy areas show areas of low blood flow and thus reduced brain activity.

It is important to understand that the brain can change when alcohol abuse is stopped.

Amen Clinics Inc. specializes in brain health and innovative diagnosis and treatment for a wide variety of neuropsychiatric, behavioral and learning problems among children, teenagers and adults. Established in 1989 by Daniel G. Amen, M.D., the center has a national reputation for utilizing brain SPECT imaging for a wide variety of neuropsychiatric problems, including substance abuse, ADD/ADHD, anxiety, depression and memory problems.

SPECT Surface scans of the brain of a 56 Year-old man with daily use of 3-4 drinks but NOT an alcoholic. L to R, scans show brain from the bottom, right side, left side and top down. The image in the bottom right corner (top down) compares to the image above - a top down view of a healthy brain. Courtesy Amen Clinics, www.amenclinics.com

Updated 10.28.09

by Lisa Frederiksen

Underage drinking is often considered a right of passage; something most teens and young adults under 21 go through. As such, the focus is often on keeping young people safe, whether that be parents hosting a party with alcohol and taking away all car keys or offering to drive, no questions asked. Yet, young adults, ages 18-20, have the highest rate of alcohol dependence (alcoholism) in the United States, according to the U.S. Surgeon General’s “2007 Call to Action to Prevent and Reduce Underage Drinking” report.

New and/or advances in brain imaging technologies (e.g., fMRI, SPECT, PET) of the past 1o – 15 years and the resulting research is shedding new light on this issue. Neuroscientists, doctors and other medical professionals are now able to observe how the brain develops and the impact of alcohol on the developing brain.

The image below is a time-lapse of brain imaging studies reprinted with permission from Dr. Paul Thompson of UCLA’s Laboratory of Neuro Imaging. This image study shows brain development, ages 5 through 20 and beyond. It was thought (until these new brain imaging capabilities) that the brain was fully developed by adolescence. We now know it’s not. There is a critical developmental stage identified as pruning and strengthening that goes on during the teen years — often through age 25 (explained in more detail at The Partnership for a Drug-Free America® website, A Parent’s Guide to the Teen Brain). Pruning is when neural connections (called gray matter) that are not used or are redundant fall away (get “pruned”), and those that are used get strengthened, which makes the remaining neural connections more efficient (similar to the way an insulted cable wire works more efficiently than a non-insulated one).

Image: Thompson, Paul. Ph.D., Time-Lapse Imaging Tracks Brain Developing from ages 5 to 20, UCLA Lab of Neuro-Imaging and Brain Mapping Division, Dept. Neurology and Brain Research Institute, http://www.loni.ucla.edu/~thompson/DEVEL/PR.html Permission: Dr. Paul Thompson 5.7.09

About Neural Connections
We are born with about 100 billion brain cells — billions of them — also known as neurons but only a relatively small fraction are ‘wired.’ From birth to around puberty, our brains are ‘wiring’ neural networks like crazy — a wiring process that allows neurons to “talk” to one another via neural connections.

A neural connection requires brain cells (neurons), synapses (the gap between the branchlike extensions of a brain cell) and neurotransmitters (the chemical messenger that takes a message from one brain cell, across the synapse, to receptors on the receiving brain cell). There is an expression sometimes used for this process — “neurons that fire together, wire together“ and this wiring together is sometimes called a “brain map.”  (Norman Doidge, M.D. The Brain That Changes Itself)

Over the course of our lives, we create neural connections (brain maps) for all of the functions our bodies and brains do. In other words, we create neural connections for riding a bike or typing on a computer or talking on the phone or reading a book or running, breathing, reciting multiplication tables, eating, talking with our hands — everything!

Alcohol works on neural connections in many parts of the brain. When it comes to alcohol abuse and/or addiction (alcoholism), the neural connections most effected are those in the Limbic System (the pleasure/reward/pain center of the brain) because those connections require the neurotransmitter, dopamine. Dopamine is our “feel good” neurotransmitter — without it, we have a hard time feeling pleasure. Thus, when we drink, it’s these neural networks that “tell” the brain that drinking makes us feel good. We develop a memory of that feeling (thanks to other neural networks), which is why people want to drink, again. Think about it — if there were no feel good feelings from drinking alcohol, we likely wouldn’t drink it.

About Alcohol Use / Abuse / Addiction — Why It Matters How Much A Person Drinks
It’s important to understand there are three stages of drinking — use / abuse / addiction. It’s common to assume that drinking is either normal or alcoholic. With this assumption, it’s common to excuse some rotten drinking behaviors (e.g., fights, DUIs, arguments) because we don’t want to think of our loved on as an alcoholic. Understanding the differences and the consequences can help us want to intervene earlier rather than later in order to help young people stop their abusive drinking before they cross the invisible line to addiction.

• Alcohol use is defined as moderate drinking — 7 standard drinks per week, with no more than 3 of those 7 drinks in a day, for women, and 14 standard drinks per week, with no more than 4 of those drinks in a day, for men. A standard drink is either 5 ounces of wine OR 12 ounces of beer OR 1.5 ounces of spirits (vodka, for example). [Note: 35% of American adults do not drink any alcohol -- none.]

• Alcohol abuse is when a person exceeds these drinking limits and has problems related to their drinking, such as arguments with family and friends about their drinking, binge drinking (defined as 4 or more drinks for women and 5 or more drinks for men), blackouts, lying about how much they’re drinking, driving while under the influence, work or school performance problems, arrests, unplanned or unprotected sex — in other words, doing things they just would not do if they hadn’t been drinking.

• Alcohol addiction (aka alcoholism) is a chronic, relapsing brain disease caused by biological, environmental and developmental factors. It occurs when a person’s alcohol abuse causes chemical and structural changes in their brain (by interrupting normal neural connections), which sets up the characteristics of alcoholism:  tolerance, cravings, loss of control and physical dependence, in addition to the behaviors just described under alcohol abuse.

According to the World Health Organization’s AUDIT, all alcoholics go through the alcohol abuse stage but not all alcohol abusers become alcoholics. Alcoholism cannot be cured (meaning you can not go back to drinking after a period of time of abstinence), but it can be treated. Alcohol abuse drinking patterns, on the other hand, can be changed.

The Impact of Alcohol Use on the Developing Brain
As you look the time-lapse image, again, notice how the brain develops from back to front (yellow/green to purple/fushia). This means that the portions of the brain that deal with emotion, memory, learning, motivation and judgment are the last to develop and, as such, are the most deeply affected by alcohol (or drug abuse) during ages 12 through 20, often through age 25.

For example, if a young adult repeatedly abuses alcohol (or drugs), the neural connections associated with memories and experiences related to alcohol abuse are the ones that are strengthened and thus embedded. By the same token, neural connections damaged by or not used because of alcohol abuse (those related to learning or judgment, for example) are pruned or not strengthened. This late stage brain development also explains why teens don’t know why they do some of the things they do, and why they take risks they likely would not engage in if they had a fully developed brain and the hindsight (memories and experiences) that go with it. Because the brain is NOT fully developed, adolescents are more vulnerable than adults to many of the effects of alcohol (e.g., memory, long-term cognitive deficits), and less vulnerable to others (e.g., sleepiness, loss of balance).

Facts About Alcohol Abuse During Brain Developmental Ages 12 – 25

• According to NIAAA, nearly half of all people who ever met the diagnostic criteria for alcoholism in their lifetime were addicted (aka alcoholics) by age 21 and two-thirds were addicted by age 25. Thus, alcoholism is really a young person’s disease, but it often takes a person another 10 – 15 years before they seek treatment, which is why we generally think of alcoholism as something that happens to older adults.

• Age of first use is the most significant risk factor for a person becoming alcohol dependent (an alcoholic).

• Teens who start drinking before age 15 are 5 times more likely to develop alcohol problems as adults.

Understanding the impact of alcohol on the brain — especially during its critical developmental stage of ages 12 through 20 and beyond — is shedding a whole new light on the issue of underage drinking. In closing, it may also be helpful to know that the BRAIN CAN CHANGE and go back to “normal” if alcohol abuse is stopped.

For article sources and additional information:

• To learn more about addiction: www.hbo.com/addiction
• To assess your own or someone else’s drinking: www.rethinkingdrinking.niaaa.nih.gov
• To learn more about the teen brain and alcohol/drugs: www.drugfree.org/TeenBrain/science/
• For a variety of information about alcohol abuse and alcoholism: www.niaaa.nih.gov/AboutNIAAA/
• For a statistical snapshot of underage drinking: http://www.niaaa.nih.gov/AboutNIAAA/NIAAASponsoredPrograms/StatisticalSnapshotUnderageDrinking.htm
• For a variety of posts and comments on a variety of alcohol related topics, especially those that can help the family and friends of someone who drinks too much: www.breakingthecycles.com

NOTE: This post was revised October 14, 2009.

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For this kind of information, as well as the latest research and information on brain development and the disease of alcoholism, facts about alcohol abuse not commonly known, hope for the more than fifty percent of American adults and one in four children who have a family member who drinks too much, as well as research and information on the related issues of co-addictions, underage drinking dual diagnoses, codependency and more, please consider buying my book, If You Loved Me, You’d Stop!

©Lisa Frederiksen, www.breakingthecycles.com. The information contained in this post may be freely used and copied for education and other non-commercial and non-promotional purposes, provided any use or reproduction of the information be accompanied by an acknowledgement of Lisa Frederiksen, Breaking the Cycles.com, as the source