COSIG CONFERENCE BROCHURE.pdf - Drexel University College ...

COSIG Co-Occurring Disorders Conference, Hershey PA, May 15-17, 2006
PART II: TRAUMA AND SUBSTANCE
ABUSE USE: THE NEUROPHYSIOLOGY
• UNDERLYING BASIS OF NEUROBIOLOGICAL
DYSREGULATION CAUSED BY TRAUMA (cont.):
2. Dissociative symptoms vary from mild to extreme, interfere with
attention, relationships, sense of initiative. Depression
frequent.
3. Affected brain structures and pathways: brain stem, right
amygdala of limbic system, left hippocampus, prefrontal cortex,
vermis of cerebellum, corpus collosum, left cortex,
hypothalamic-pituitary axis (HPA axis).
4. Affected processes: neuro-endocrine regulation, myelinization,
neuronal migration, neuronal differentiation, synaptic
proliferation, brain growth and functionality, connections
between hemispheres and other internal structures.
PART II: TRAUMA AND SUBSTANCE
ABUSE USE: THE NEUROPHYSIOLOGY
• UNDERLYING BASIS OF NEUROBIOLOGICAL
DYSREGULATION CAUSED BY TRAUMA (cont.):
5. Concept of neurobiological regression (Perry) – retreat from
cortical responses to increasingly less mature levels of brain
functioning and behavior, in response to trauma and
maltreatment (cortex, limbic system, midbrain, brainstem).
6. Potential brain functions compromised by chronic trauma:
recognition and response to danger, interpretation of stimuli,
capacity for self-regulation, memory formation, attention, ability
to acquire information, processing of emotional information,
impulse control, planning, learning from experience.
PART II: TRAUMA AND SUBSTANCE
ABUSE USE: THE NEUROPHYSIOLOGY
• NEUROPHYSIOLOGY OF TRAUMA AND
RELATIONSHIP TO SUBSTANCE USE:
1. Research ongoing, much but not all in animals.
Findings tentative, but some patterns.
2. Common observation: Substance use tends to follow
or parallel traumatic exposure and development of
PTSD.
3. Increased substance use does not occur when
traumatic exposure does not result in PTSD.
PART II: TRAUMA AND SUBSTANCE
ABUSE USE: THE NEUROPHYSIOLOGY
• NEUROPHYSIOLOGY OF TRAUMA AND
RELATIONSHIP TO SUBSTANCE USE (cont.):
4. Common pathways may reinforce substance use in
presence of PTSD:
a. Stress causes activation of HPA Axis, leading to
increase in catecholamines [CRH release in
hypothalamus, ACTH release from pituitary,
cortisol release from adrenal glands,
catecholamine release].
b. Experience of stress, plus hyperarousal due to
catecholamines, create negative mood states,
predisposing to substance use.
PART II: TRAUMA AND SUBSTANCE
ABUSE USE: THE
NEUROPHYSIOLOGY
• NEUROPHYSIOLOGY OF TRAUMA AND
RELATIONSHIP TO SUBSTANCE USE (cont.):
4. Common pathways may reinforce substance use in
presence of PTSD (cont.):
c. Withdrawal from alcohol or cocaine elevates
CRH, leading to catecholamine release,
intensifying hyperarousal and dysphoric state,
predisposing to further substance use.
d. Pre-existing, PTSD-based hyperarousal
exacerbated by additional hyperarousal resulting
from drug withdrawal, further increasing risk of
further use.
PART II: TRAUMA AND SUBSTANCE
ABUSE USE: THE NEUROPHYSIOLOGY
• NEUROPHYSIOLOGY OF TRAUMA AND
RELATIONSHIP TO SUBSTANCE USE (cont.):
5. Functional correlates of above – a potential traumasubstance
abuse cycle:
a. Dysthymia of PTSD triggers use of substances.
b. Use of substances increases likelihood of further
trauma and retraumatization.
c. Retruamatization worsens PTSD symptoms,
increasing risk of further substance abuse.
d. Withdrawal from substances worsens PTSD,
further predisposing to use, trauma, etc.
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