Ebel science of addiction grand ronde 2016

UW MEDICINE │ INJURY CONTROL
SCIENCE OF ADDICTION:
AN INJURY PREVENTION PERSPECTIVE
A FFILIATED TR IB ES OF N OR TH WEST IN D IA N S MID -YEA R C ON VEN TION
GR A N D R ON D E, OR
Beth Ebel, MD, MSc, MPH
Harborview Injury Prevention & Research Center
University of Washington/Seattle Children’s Hospital
May 25, 2016
ON GETTING HOME SAFELY
Happily, as they approach their
homes, they will regard you.
Happily may their roads home be
on the trail of pollen.
Happily may they all get back.
In beauty I walk.
—from The Night Chant, a Navajo returning ceremony
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CHILD INJURY IN NATIVE COMMUNITIES
Injury burden falls heavily on among
American Indian/ Alaska Native
communities
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occupant injury
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pedestrian injury
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drowning risk
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poisoning
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household injury
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suicide
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violence
High injury rates are responsible for
chronic health disparities
Injured AI/AN children continue to have
disparities between after injury, even after
rehabilitation care
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INJURIES ARE NOT “ACCIDENTS”
Most injuries are preventable by what we
already know
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Seat belt use
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Enforcement practices
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Impaired driving
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Suicide
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Gun violence
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ALCOHOL AND DRUG RELATED DEATHS
• More than 1 out of
every 10 deaths in
Native American
communities is
linked to alcohol
use
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RISING DRUG USE 2014
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UNDERSTANDING ADDICTION
• Addiction is a maladaptive
form of learning
• Not easily “unlearned”
• Implications:
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Prevention is SO important
Treatment is long-term, like
diabetes and other chronic
illnesses
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ADDICTION IS CHRONIC DISEASE
• Addiction is a chronic disease,
like diabetes
• Estimated 25 million people in
the US are addicted to alcohol
or drugs
• Treatment is long-term, like
diabetes and other chronic
illnesses
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NEED FOR ALCOHOL AND DRUG
TREATMENT HIGH IN AI/AN COMMUNITIES
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HOW DOES ADDICTION WORK?
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mechanisms involved in memory
and learning are hijacked by drugs
of abuse
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Mimics natural rewards such as food
and sex by triggering neural reward
circuits
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Alcohol and drugs drive reward
circuitry in a way that natural
rewards can’t
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Circuit run deep in the brain to the
nucleus accumbens (pleasure), the
prefrontal cortex (decision-making,
planning), and deep brain stem
areas (“lizard brain”)
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HOW DOES ADDICTION WORK?
• Dopamine is neurotransmitter
chemical that triggers the
reward pathways
• Cocaine, methamphetamines,
alcohol, nicotine and opioids
increase dopamine levels
• Long-lasting changes occur
within key regions of the brain
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ADDICTION AND DOPAMINE
• When reward exceeds
expectations, dopamine circuitry
really lights up.
• Conversely, if expectations aren’t
met, dopamine activity drops off.
• Cocaine, heroin, alcohol and
nicotine directly activate the
circuit— regardless of how high
the expectation was.
• Young people are most
susceptible
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WHAT WORKS?
• Prevention
• Reducing Binge Use
• Treatment
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STARTING YOUNG
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Teens are most vulnerable to addiction
when our brains are most plastic.
• All adult smokers started smoking
when they were teenagers.
• Public health officials
• Big tobacco companies
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PREVENTION
Family measures
• Delay high risk drinking
• Talk with your kids
• Set an example
Community measures
• Cost of alcohol
• Access measures
• Health care provider patterns
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PUBLIC HEALTH FALLACY
Separating the why from the how
Why: Smoking kills you
Sad truth : Telling people that “smoking
kills you” doesn’t stop young people from
smoking
How: Truth anti-smoking campaign
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TOBACCO AD
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TRUTH ANTI-SMOKING CAMPAIGN
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WHAT WORKS?
Talk to your children while they
are eating; what you say will stay
even after you are gone.
- Nez Perce tribe
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REDUCE BINGE DRINKING
• Plan ahead
• Alternative routes home
• Brief alcohol interventions with trauma
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TREATMENT OPTIONS
• Chronic disease model
• Harm reduction opportunities
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WHAT IS NEEDED
1. No complacency
2. Work in partnership
with communities
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Planning
Data collection
Strategies
Sustainability
Laws &
enforcement
3. Measure what matters
4. Build from strengths
and tackle problems
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UW MEDICINE │ INJURY CONTROL
QUEST IONS?