Substance Use, Decision Making and the Testing Guidelines The picture gets more complicated…

Natural Rewards Elevate Dopamine Levels 50 100 150 200 60 120 180 Time (min) % of Basal DA Output NAc shell Empty Box Feeding Source: Di Chiara et al. FOOD 100 150 200 DA Concentration (% Baseline) Mounts Intromissions Ejaculations 15 5 10 Copulation Frequency Sample Number 1 2 3 4 6 7 8 9 11 12 13 14 16 17 Scr Bas Female 1 Present Female 2 Present Source: Fiorino and Phillips SEX

…their Brains have been Re-Wired by Drug Use Over time…

Decreased dopamine transporter binding in METH users resembles that in Parkinson’s Disease If DAT is decreased in young METH users (almost to that observed in Parkinson’s Disease), and DAT decreases with age, may we see an increase in the number of Parkinsonian patients over time? Control Meth Source: McCann U.D.. et al.,Journal of Neuroscience, 18, pp. 8417-8422, October 15, 1998.

Cognitive and Memory Effects

Dopamine Transporters in Methamphetamine Abusers 7 8 9 10 11 12 13 1.0 1.2 1.4 1.6 1.8 2.0 Time Gait (seconds) Dopamine Transporter (Bmax/Kd) Motor Activity p < 0.0002 Normal Control Methamphetamine Abuser 4 6 8 10 12 14 16 1 1.2 1.4 1.6 1.8 2 Delayed Recall (words remembered) Dopamine Transporter Bmax/Kd Memory

Differences between Stimulant and Comparison Groups on tests requiring perceptual speed

Longitudinal Memory Performance number correct test

Control > MA 4 3 2 1

MA > Control 5 4 2 1 3

Drugs of Abuse Change the Way We Think For example: Alcohol has long been called the great social lubricant and disinhibitor Meth and cocaine change memory and information processing People make decisions in favor of their drug instead of in favor of their health

So what does this mean? Tips for intervening with substance users to increase the likelihood of success… Write down instructions/explain instructions visually Slow down and repeat often Break the information down into small, bite-sized pieces Check for understanding

So what does this mean? Tips for intervening with substance users to increase the likelihood of success… Maintain calm and create an accepting environment Prioritize risks and needs Maintain support and vigilance for depression – even months after abstinence Chaotic thinking may look like resistance or denial

In training other clinicians… Familiarity with drugs of abuse and their impact on functioning is important Resources include the National Institute on Drug Abuse (www.drugabuse.gov) and the National ATTC Network site (www.nattc.org). These slides will be available at www.psattc.org.

In training other clinicians… A tip sheet was developed for clincians working with methamphetamine using clients by the PAETC and the PSATTC…

Download the tip sheet at… http://www.ucsf.edu/paetc/resources/methusers.pdf Contact me at… tefreese@mednet.ucla.edu