The Impact of Substance Abuse in 2009

1. Striving for Collaboration Among Substance Abuse ProfessionalsGeorgia School of Addiction Studies Presented by: Penny Norton, CEOSavannah, Georgia September 1, 2011

2. The Impact of Substance Abuse in 2009 • The annual total estimated societal cost of substance abuse in the U.S. is $510.8 billion. • By 2020 behavioral health disorderswill surpass all physical diseases as a major cause of disability worldwide. • Half of all lifetime cases of mental and substance use disorders begin by age 14.

3. SAMHSA’s Goal – To Improve People’s Lives Health – Overcoming or managing one’s disease(s) as well as living in a physically and emotionally healthy way; Home – A stable and safe place to live that supports recovery; Purpose – Meaningful daily activities such as a job, school, volunteerism, and the independence to participate in society; and Community – Relationships and social networks that provide support, friendship, love and hope.

4. Leading Medical Cause of Death in Adults • Cause of Death • Heart Disease • Cancer • Injuries (Car Crashes) Key Contributing Factors Smoking and Diet Smoking and Diet Alcohol Source: Center for Disease Control, 2001

5. Leading Medical Cause of Death in Youth • Cause of Death • Injuries (Car Crashes) • Homicide • Suicide Key Contributing Factors Alcohol Guns and Alcohol Depression and Alcohol Source: Center for Disease Control, 2001

6. Smoking Cessation and Prevention Efforts Individual Actions: Policy Actions: • Rotating warning messages on all advertising. • Smoke-free seating on airlines and restaurants. • Smoke-free worksites and public buildings. • Access restrictions for vending machines and tobacco products in general. • Increase excise tax on tobacco products. • Get regular medical checkups. • Cut down and don’t inhale. • Use tobacco products with low tar and nicotine levels. • Quit smoking. Use nicotine patches/go to “smoke-stop” workshops. • Expect to die sooner if you smoke. Source: Putting the Pieces Together: A Guide to Community Actions for the Prevention of Alcohol Problems.

7. Heart Disease Risk Reduction Efforts Individual Actions: Policy Actions: • Avoid foods high in salt, fats and cholesterol. • Watch for a history of heart disease in your family. • Exercise to keep your weight down and don’t smoke. • Avoid stress. • Mandatory package labeling on food products. • Mandatory changes in physical examination forms used by physicians. • Insurance premium incentives for non-smokers. • Implementation of worksite fitness programs and facilities. Source: Putting the Pieces Together: A Guide to Community Actions for the Prevention of Alcohol Problems.

8. Drinking and Driving Individual Actions: Policy Actions: • Designated drivers • 2. Court monitoring • Public awarenesscampaigns • 4. Citizen advocacy groups like MADD, SADD and BADD • Raising the minimum drinking age from 18 to 21 • Lowering BAC levels from .12 to .10 to .08 • Legalizing and integrating sobriety checkpoints • 4. Stronger laws for repeat offenders as well as vehicle impoundment and interlock systems Source: Putting the Pieces Together: A Guide to Community Actions for the Prevention of Alcohol Problems,.

9. Fundamental Principles of Environmental Strategies on Alcohol Issues • Alcohol issues represent the problem. • Data provides the evidence to act. • The “intervention” needs to be done on the contributing factors. • Current policies, practices and conditions represent the contributing factors.

10. Alcohol in Our Society • Once sold only through taverns and liquor outlets, alcohol is now sold in grocery stores, convenience stores, gas stations, airplanes, on the Internet and even at drive-through purchase points. • Increasing availability and accessibility not only makes alcohol easier to obtain, but also changes our thinking about drinking. Source: Mosher and Colman, “Alcohol Availability in a Public Health Perspective: A Scripted Slide Show Presentation.” Trauma Foundation, San Francisco General Hospital, Dated July 7, 1987, p. 2.

11. Increase Taxes on Alcohol “Top priority should be given to raising beer taxes. Excise tax rates for ALL alcoholic beverages should be increased to keep pace with inflation.”

12. ©LisaFrederiksen,www.breakingthecycles.com Advances in Brain Imaging Technologies MRI – Magnetic Resonance Imaging PET – Position Emission Tomography SPECT – Single Photon Emission Computed Tomography AMR – Axial Magnetic Resonance

13. ©LisaFrederiksen, www.breakingthecycles.com What They’ve Learned… • Alcoholism is a disease, one of the diseases of addiction; addiction is a chronic relapsing brain disease (NIDA. NIAAA, AMA) • There are 3 stages of drinking: Use, abuse and addiction • Abuse always precedes addiction and causes chemical and structural changes in the brain. (NIDA, NIAAA, WHO/AUDIT) • The brain goes through a critical stage of development from ages 12-20, often through 25; alcohol abuse during this development stage is especially problematic. (NIDA, NIAAA, AMA)

14. ©LisaFrederiksen, www.breakingthecycles.com The “3-Brain” Brain Complex Reptilian: breathing, heartbeat and motor skills Limbic System: emotions, fight-or-flight, pleasure/reward/pain center Cerebral Cortex:the “thinking” part of our brain – reasoning, cause and effect – the “executive center”

15. ©LisaFrederiksen, www.breakingthecycles.com Alcohol and the Brain’s Limbic System – Pleasure Reward Center of the Brain The Dopamine (Neurotransmitter) Connection Dopamine is one of the major “pleasure” neurotransmitters – no dopamine; no pleasure.

16. ©LisaFrederiksen, www.breakingthecycles.com How Alcohol Hijacks the Brain… Alcohol in moderation...normal neural network – good feeling / reward for the behavior of drinking; activates the same neural networks as those linked to behaviors for survival (eat when hungry…) Alcohol Abuse… triggers rapid surges in dopamine causing brain to reduce dopamine production, in time, to reduce dopamine receptors Leaves brain wanting more alcohol to get the “feel good”feeling (the one it associates with drinking); something it can’t get because the brain has turned down the radio dial on dopamine production If abuse continues and brain crosses invisible line to addiction…person experiences craving, loss of control, physical dependence and tolerance – cravings can be 3-5 times stronger than those hardwired for survival, e.g., eating when hungry

17. ©LisaFrederiksen, www.breakingthecycles.com Neural Networks Instinctual Repetitive Activation Those used are strengthened / embedded, creating “brain maps”…

18. The Drinkers’ Pyramid Alcohol Dependent Risky Drinkers Low-Risk Drinkers Abstainers

19. Screening and Brief Intervention (SBI) • SBI has begun to emerge asa critical strategy for targeting individuals who exceed low-risk guidelines. • The primary goal is to reduce harm and societal cost associated with risky drinking.

20. Defining Responsible Drinking • The Domino Strategy is built on the same public health model as national efforts to reduce tobacco use, heart disease and obesity. • It provides clarity by defining specific behaviors that will help people who drink alcohol, reduce their risk of harming themselves or others. • Teaching people how to drink responsibly is no less important than conversations about how to keep your blood pressure in check or how to lose weight.

21. For more information and resources go to:www.faceproject.org