Chemical Dependency a New Paradigm. Richard L. Hinchman, M.D., FACOG, FASAM. Your Brain on Drugs in the 1980’s. What the mind does not know, the eyes cannot see. If drugs and alcohol were the problem ……. 10. Animal Models. Alcohol (P) Preferring Mice Alcohol (NP) Non-preferring Mice.
Richard L. Hinchman, M.D., FACOG, FASAM
Schuckit, M.A. et. al., Five year clinical course associated with DSM-IV alcohol abuse ……Am. J. Pshchiat. 158: 1084-1090
Did not previously meet DSM-IV criteria for Abuse
NESARC 2001-02 study
Young people who begin drinking before age 15 are 4x more likely to develop alcoholism than those who wait until they are 21 to drink
NIAAA January 2000
Adults Rely More on the Frontal Cortex
While Teens Rely More on the Amygdala
Deborah Yurgelon-Todd 2000.
> 4 drinks per occasion
> 3 drinks per occasion
C: Have you ever tried to Cut down on your drinking?
A: Do you become Annoyed when people talk to you about your drinking?
G: Do you ever feel Guilty about your drinking?
E: Have you ever had an “Eye Opener” (a drink in the morning)
C: Have you ever ridden in a Car driven by someone (including yourself) who was “high” or had been using alcohol or drugs?
R: Do you ever use alcohol or drugs to Relax, feel better about yourself, or to fit in?
A: Do you ever use alcohol or drugs while you are Alone?
F:Do you ever Forget things you did while using drugs or alcohol?
F:Do your Family or Friends ever talk to you about your drinking or drug use?
T:Have you gotten into Trouble while you were using alcohol or drugs?
“Yes” to 2 or more is predictive of a Substance Use Disorder
>/= 3 of the following in a 12 month period
Level II.1 Intensive Outpatient (IOP)
Level II.5 Partial Hospitalization
Level III.1-III.5 Non-hospital Residential
Level III.7 Inpatient Medically Monitored
Level IV General Hospital with ICU
Aftercare: Facilitated meetings to help
with reentry to family, work &
society (6-12 months)
Robert L. Dupont, M.D.
After 5 years – if you are sober, you probably will stay that way.
It takes a year of abstinence before less than half relapse
Dennis et al, Eval Rev, 2007
Prolonged use of a short acting opiate reverses this cascade resulting in increased pain
Chronic opiate use for non-cancer pain relief
Denmark has the highest per capita use of opioids in the world
Eriksen, Bruera, et.al. Critical issues on opioids in chronic non-cancer pain. An epidemiological study. Pain 2006; 125: 172-179
Ravndal E. Amundsen EJ. Mortality among drug users after discharge from inpatient treatment: Drug Alcohol Depend. 2010;108(1-2):65-69
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