Dr. Kevin McCauley: Addiction & Recovery 2022 ~ COMMUNITY EVENT!

6227 St. Charles Avenue,New Orleans LA 70118

18 January, 2023

Description

Presentation/Discussion Outline: I. Addiction: a disorder of reward learning, decision-making and self-awareness 1. Definitions of addiction and disease a. The American Society of Addiction Medicine’s definition of addiction b. The DSM-5 symptomology of addiction (Substance Use Disorder) c. The evolving concept of “disease” and whether addiction fit it d. A Public Health/Ecological Model of addiction and recovery 2. Discrepant research findings that challenge the “disease model” of addiction a. Returning Vietnam veterans and heroin (Robins) b. Rat Park (Alexander) c. Addiction as a learned/learning disorder (Lewis) d. Drug use as conscious choice & the desistence narrative (Heyman) II. Recent advances in the pathophysiology of addiction 1. Epigenetics: a new understanding of heritability of addiction & recovery a. The Overkalix Study and transgenerational trauma transmission b. Nicotine primes cocaine use (Kandel and Kandel) 2. Psychoneuroimmunology: the gut-brain-immune loop a. Inflammation and the brain b. The role of microglia in brain disease and repair III. The Five Current, Leading Neuroscientific Explanations of Addiction 1. Genetic vulnerability a. The Taq1A1 allele & Reward Deficiency Syndrome (Blum) 2. Dopamine and reward processing a. Incentive-Sensitization (Robinson and Berridge) b. Dopamine kinetics and receptor effects (Volkow) 3. Pathology of memory and learning a. Glutamate “spillover” and glial cells (Kalivas) b. Reward Learning pathology and the concept of “powerlessness” 4. Stress and the “Dark Side” of addiction (Koob and LeMoal) a. Hedonic homeostasis and allostasis 5. Pathology of motivation and Choice (Volkow, Goldstein) a. Anterior Cingulate Cortex and social cognition b. Insular Cortex, interoception and alexithymia c. Orbitofrontal Cortex and value/risk calculation d. Frontal hypofunctionality and the concept of “unmanageability” IV. The Implications of a Disease of Volition a. Avoiding relapse with a broken risk processor b. Recovery Management as risk management c. Evidence base for AA (Kelly & Humphries) d. What aviation safety programs can teach us about recovery e. The Social Determinants of Choice Presentation/Discussion Objectives: At the end of this course participants should be able to: 1. Describe the latest neuroscientific explanations of substance use disorder pathophysiology and interpret Substance Use Disorder symptomology in light of this research. 2. Describe and analyze the arguments for and against the conceptualization of addiction as a brain disease. 3. Define psychoneuroimmunology and explain its connection to substance use disorder. 4. Define social determinants of health and explain the role they play in vulnerability to substance use disorder.