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Substance Use, Decision Making and the Testing Guidelines The picture gets more complicated…
Substance Use, Decision Makingand the Testing Guidelines
The picture gets morecomplicated…
0
50
100
150
200
0 60 120 180Time (min)
% o
f Bas
al D
A O
utpu
t
NAc shell
EmptyBox Feeding
Source: Di Chiara et al.
FOOD
100
150
200
DA
Con
cent
ratio
n (%
Bas
elin
e)
MountsIntromissionsEjaculations
15
0
5
10
Copulation Frequency
SampleNumber
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
ScrScrBasFemale 1 Present
ScrFemale 2 Present
Scr
Source: Fiorino and Phillips
SEX
Natural Rewards ElevateNatural Rewards ElevateDopamine LevelsDopamine Levels
…their Brains
have been Re-Wired by Drug Use
Over time…
Source: McCann U.D.. et al.,Journal of Neuroscience, 18, pp. 8417-8422, October 15, 1998.
Decreased dopamine transporterbinding in METH users resembles that
in Parkinson’s Disease
Control Meth
Cognitive andMemory Effects
Dopamine Transporters in Methamphetamine Abusers
p < 0.0002
Normal Control
Methamphetamine Abuser
7 8 9 10 11 12 131.0
1.2
1.4
1.6
1.8
2.0
Time Gait (seconds)
Dop
amin
e Tr
ansp
orte
r(B
max
/Kd)
Motor Activity
468101214161
1.2
1.4
1.6
1.8
2
Delayed Recall(words remembered)
Dop
amin
e Tr
ansp
orte
rBm
ax/K
d
Memory
Differences between Stimulant andComparison Groups on tests requiring
perceptual speed
0
20
40
60
80
100
Me
an
Sc
ore
s
Digit Symbol** Trail Making A* Trail Making B**
Comparison (n=80 Stimulant (n=80)
Longitudinal Memory Performance
test
num
ber c
orre
ct
0
5
10
15
20
25
Word Recall Word
Recognition
Picture Recall Picture
Recognition
control
baseline
3 mos
6 mos
Control > MA
4
3
2
0
1
MA > Control
5
4
2
0
1
3
Drugs of AbuseChange 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 toincrease the likelihood of success…
• Write down instructions/explaininstructions 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 toincrease the likelihood of success…
• Maintain calm and create an acceptingenvironment
• 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 theirimpact on functioning is important
• Resources include the National Instituteon Drug Abuse (www.drugabuse.gov) andthe National ATTC Network site(www.nattc.org).
• These slides will be available atwww.psattc.org.
In training other clinicians…
• A tip sheet was developed for clinciansworking with methamphetamine usingclients by the PAETC and the PSATTC…
Download the tip sheet at…http://www.ucsf.edu/paetc/resources/methusers.pdf
Contact me at…[email protected]
