Draft 2.docx

Draft 2 Tramadol is an Opioid agonist that Blocks reuptake of serotonin and norepinephrine, but has a risk of serotonin syndrome. Genetics: According to the National Institute on Drug Abuse (2020), between 40-60% of a client’s vulnerability to substance use disorders may be attributed to genetic fac...

Draft 2 Tramadol is an Opioid agonist that Blocks reuptake of serotonin and norepinephrine, but has a risk of serotonin syndrome. Genetics: According to the National Institute on Drug Abuse (2020), between 40-60% of a client’s vulnerability to substance use disorders may be attributed to genetic factors. Vulnerability involves complex interactions between multiple genes, and between genes and the environment. For example, specific genetic factors predispose an individual to alcohol dependence and tobacco use. Genetic involvement may impact an individual’s experience of a drug as pleasurable or not or how long a drug remains in the body. Epigenetic factors influence whether genes associated with substance use disorder are activated. Neuroanatomy: Brain circuits that mediate reward, impulse control, decision-making, learning, and emotions play a role in substance use disorder. The mesolimbic dopamine pathway has been identified as the key pathway that mediates reward.  The mesolimbic pathway connects the ventral tegmental area of the midbrain to the ventral striatum of the basal ganglia. The pathway begins in the ventral tegmental area (VTA) and connects to the ventral striatum/nucleus accumbens, amygdala, hippocampus, and prefrontal cortex (PFC). The VTA is one of the major dopamine-producing areas of the brain. The nucleus accumbens is an area found within the ventral striatum and has a strong association with motivation and reward. Conditions that involve impulsive or compulsive behaviors, such as substance use disorder, obsessive-compulsive disorder (OCD), and obesity may relate to inefficient processing in the prefrontal cortex/striatal circuitry (Stahl, 2021).  Neural Network Anatomy: The mesolimbic pathway is the pathway most associated with reward. It regulates emotional behaviors, reward, & pleasure. Overaction of the mesolimbic pathway causes symptoms. Drugs and alcohol act directly on brain receptors leading to a release of dopamine, the neurotransmitter associated with reward. As substance use increases, brain circuits adapt by reducing sensitivity to dopamine, leading to tolerance and the need to increase the use of a substance to achieve the same high. ​Medications for Substance Use Disorder (SUD) block dopamine specifically in the lesolimbic pathway. Neural Signaling: Dopamine is the major neurotransmitter of the mesolimbic pathway. Dopamine is responsible for regulating the brain’s motivation, pleasure, and reward center. Dopamine is released in response to natural pleasurable activities or situations, such as achieving an accomplishment, enjoying a good meal, or participating in an athletic activity. Addictive drugs cause a surge of dopamine in the ventral striatum or nucleus accumbens. Repeated use can lead to changes in brain circuitry, leading to craving, addiction, dependence, and withdrawal (Stahl, 2021). Medications which treat addiction target dopamine. A substance use disorder diagnosis may be seen alone or in combination with other mental health diagnoses. Dual diagnoses are common in addiction medicine. For example, up to 60% of adolescents in community-based substance use disorder treatment programs may meet the diagnostic criteria for another mental health condition Alcohol use commonly begins during early adulthood, when times of stress & emotional fatigue are more common. Early drug use is a risk factor for the later development of substance abuse disorder Common comorbidities include: Anxiety disorders, Psychotic illness, Bipolar disorder, Depression, Borderline personality disorder , & Antisocial personality disorder Tolerance - With repeated ingestion of a drug, the drug shows decreased effect. Increasing doses are required to achieve the effects noted with the original administration. Dependence - State of adaptation produced with repeated administration of certain drugs so that physical symptoms occur when the drug is discontinued abruptly. Addiction - A change in behavior caused by biochemical changes in the brain after continued substance use characterized by preoccupation with and repeated use of a substance despite negative outcomes. Intoxication - Condition following the ingestion of a substance resulting in changes in level of consciousness, cognition, perception, judgment, and behavior. MAT substitutes the drug of abuse for a prescribed medication that targets the same receptor as the preferred substance. goals of MAT decreased illegal activity, improved treatment retention, improved birth outcomes in people who use substances while pregnant, increased quality of life, reduced human immunodeficiency virus (HIV) and Hepatitis B & C infection, & improved survival studies indicate dopaminergic activity in the activation of the right ventral striatum (RVS) in response to images of food in individuals with binge-eating disorders Drugs used in obesity: Phenterine (Phentermine/topiramate), Bupropion (bupropion/naltrexone), lorcaserin, & zonisamine. Avoid bupropion & bupropion together with anorexia nervosa & bulimia because bupropion lowers the seizure threshold. Drugs used in anorexia nervosa: olanzapine Drugs used in bulimia: fluoxetine Drugs used in binge eating disorders: lisdexamfetamine, topiramate, & bupropion The use of benzodiazepines on a symptom-triggered regimen is the preferred approach for withdrawl symptoms bupropion (Zyban): enhance the noradrenergic and dopaminergic release, Start 1 to 2 weeks before quit date, Tobacco free by therapy 7 to 12 weeks, may need longer varenicline (Chantix) Nicotine receptor partial agonist.Highly selective to the Alpha-4 beta-2 nicotinic receptor & moderately selective to the 5-HT3 receptor. Start a week before quit date in adults > 18 yrs of age ONLY x 12 weeks. Gum: Nicorette: For people who smoke within 30 minutes of awakening: the 4 mg dose is recommended.