Neurotransmitter Balance: The Key to Understanding Addiction

Howdy!

Neurotransmitter Balance:

The Key to Understanding Addiction

Jeff Sandoz, PhD

Troy University

Acknowledgements

• Special thanks go to Dr. Fred Von Stieff for

permission to use his diagram in this

presentation from his book Brain In

Balance.

• With gratitude for Dr. Daniel Inaba and CNS

Productions Inc. for the use of the

information on slides courtesy of CNS

Productions, Medford Oregon via their

publication Uppers, Downers, All Arounders.

Outline - Neurotransmitter Balance

I. Book Brain In Balance

II. Neurotransmitter System

III. GABA vs Glutamate

IV. Brain Scans & the Future

Brain

Scans

& the

Future

Book

I

Neurotransmitter

Systems

VS.II

III

IV

Mind Map

Visual

I. Book

Rosetta Stone: Understand the 3 Factor

Relationship among Drug Use, Craving &

Neurotransmitters levels.

About the Author

Dr. Von Stieff

•Board-certified Addictionologist•Over 20,000 successful detoxified patients [Evidence-Based Best Practice]•Medical Director three chemical dependency programs•Certified-American Board of Addiction Medicine•Certified-American Society of Addiction Medicine•Certified-California Society of Addiction Medicine•Chief Medical Review Officer-State of California•Legal expert in substance abuse

II. Neurotransmitter Systems

Goal: Learn the rules of HOW THE BRAIN WORKS, making sense of how the neurotransmitters function.

Analogy: Putting together pieces of the Brain Puzzle

Build a puzzle: Start on the borders

& work your way in.

Endocannabinoid

Acetylcholine

GABA

Glutamate

Serotonin

Dopamine

Most healthcare professionals do not understand how addiction and detoxification affect neurochemical systems of patients.

Premise: Brain is Seeking Balance

Purpose: Understand

brain imbalance related to

addiction – Done by

viewing neurotransmitter

levels of patient.

Dynamic State of

EquilibriumNeurotransmitter

Diagram

Add 7 colors of

the rainbow

and white to

enhance your

memory of the

location of each

neurotransmitter.

8 Neurotransmitters

[ROY G

BIV]

Visualizing this diagram helps to

understand what is going on in the person’s

brain.

Specifically how neurochemical balance can be

altered.

8 Basic Neurotransmitter Systems

Diagram: Placing the Neurotransmitters

• Large circle represents

patient’s brain.

• 8 smaller circles

represent eight

neurotransmitter

systems.


• Resembling the

chambers of a six

shooter

• + one more

• & one in the middle.


• Resembling the face of a clock:

• Opiates in the middle.



• Serotonin at 1 o’clock



• GABA between 2 and 3 o’clock



• Glutamate between 4 and 5 o’clock



• Dopamine at 6 o’clock



• Noradrenaline between 7 and 8

o’clock



• Acetylcholine between 9 and 10 o’clock



• Endocannabinoid at 11 o’clock

Visualizing the Neurotransmitter System

Utilize Diagram 4 Times

1) Genetic

Deficiencies

Imbalance due to

Mental Illness,

Trauma, Stress



1) Genetic Deficiencies

Imbalance/MI/Trauma

2) Effect of Self-

Medicating

Drugs




Imbalance/MI/Trauma

2) Effect of Self-

Medicating Drugs

3) Withdrawal &

Detox




Imbalance/MI/Trauma

2) Effect of Self-

Medicating Drugs

3) Withdrawal & Detox

4) Stabilization:Add

Meds to Correct or

Balance the System

Address & Analyze Patient

Neurochemical Imbalance

Genetic Deficiencies, Predispositions in

Family -Stress/Mental Illness, Trauma

Sources –Psychosocial History, Genogram,

Family Drinking Survey.

Helpful information with regard to genetic

issues – neurotransmitter deficiencies and

imbalances.

1

Diagram 1 – Showing the Genetic

Ailment• Disposition –Mental status/

emotional mood

• Background – Family members DSM-V

• Cravings –Past/Present Drug Use

• Sketch diagram/X marks neurotransmitter

• Review notes on possible neurotransmitters out of balance. Review research on pubmed.com.

Neurotransmitter XAcetylcholine

Endocannabanoid

Serotonin

GABA

Glutamate

Dopamine

Noradrenaline

Opiate

Diagram 1 – Showing the Genetic Ailment

• Genetic Predispositions in Family

Condition X

Alcoholism

Bipolar

Anxiety

Depression X

Schizophrenia

Drug Addiction

Eating Disorders

PTSD

Other

Neurotransmitter

Acetylcholine

Endocannabanoid

Serotonin 5-HT2A

GABA

Glutamate

Dopamine

Noradrenaline

Opiate

Diagram 1 – Showing the Genetic Ailment

• Example - Cocaine Addiction & Depression

• Drug of Choice Cocaine. Review research on pubmed.com.

• Family Conditions DSM-V Parental Alcohol Addiction

Condition X

Alcoholism

Bipolar

Anxiety

Depression X

Schizophrenia

Drug

Addiction

Eating Disorders

PTSD

Other

?

http://pubmed.com/


Neurochemical ImbalanceDrugs/Alcohol affect Neurotransmitter System

–to chemically compensate for deficits/excess

Alcohol Consumption Record, Substance Use History & Comprehensive Drinker Profile. Verify with Family Members

Helpful information regarding understanding patterns of drinking/drug use – Refer to ‘Drug Index’ in book which lists of drugs and their neurochemical/ neurotransmitters agonistic and antagonistic effects.

2

Neurotransmitter

Acetylcholine

Endocannabanoid

Serotonin

GABA

Glutamate[slight]

DopamineD1, D2 Agonist

Noradrenaline

Opiate

}Diagram 2 – Effects of Drug Abuse

• Explore findings on

pubmed.com. How

specific drugs

[stimulate/inhibit]

production of affected

neurotransmitters.

• Patient chooses drugs

that boost lacking/low

neurotransmitters.

Example- Cocaine Addiction, Genetically Depressed Patient

http://pubmed.com/

Neurotransmitter

Acetylcholine

Endocannabanoid

Serotonin

GABA

Glutamate[slight]


Noradrenaline

Opiate

Diagram 2 – Effects of Drug Abuse• Example - Cocaine Addiction on Genetically Depressed Patient

• How the drug influences original genetic deficiencies

• Arrows show if drug influences [stimulates/inhibits] production of affected neurotransmitter. Effect of self-medication.

Condition X

Alcoholism

Bipolar

Anxiety

Depression X

Schizophrenia

Drug Addiction X

Eating Disorders

PTSD

Other

Neurotransmitter

Acetylcholine

Endocannabanoid

Serotonin

GABA

Glutamate[slight]


Noradrenaline

Opiate

}Self-Medication

Action of Drug –Self Medication produces Desired

Effect (Balance) in Diagram 2 cancels out any

Deficiencies in Diagram 1. Diagram 2

Diagram 1

Diagram 1 & 2 Match-Up

?

Withdrawal/detoxification alters

neurotransmitter levels.1. Pattern parallels/surpasses initial

assessment in Genetic Deficiencies.

2. More likely will rebound with

Withdrawal/Detox affect.

3



Diagram 3 – Anticipating Effect of

Withdrawal on Neurotransmitter Levels• Neurochemical imbalances caused by drugs will

lead to withdrawal

Effect of

withdrawal

once cocaine

is

discontinued.

Diagram 3 –Withdrawal • Withdrawal = Brain’s method of up-regulation.

• (Returning Brain’s neurochemical balance to

original genetic baseline.)

• Severe agitation

Could signify

by negative or

minus sign “-”

in areas of

down arrows. --



Medications balance Neurotransmitter

levels.

1. Review medication to block the ‘high’.

2. to lower specific neurotransmitters

3. to raise specific neurotransmitters

4

Diagram 4 – The Treatment PlanAfter viewing Diagrams 1, 2 & 3; consider how to eliminate

craving once the drugs of choice are removed.

• Visualize ALL corrective measures.

• Show effects of Medications use to correct:

1) Genetic Deficiencies, 2) Drug Abuse, 3) Withdrawal.

Diagram 4 –Treatment DiagramAll Corrective Measures

• Close up –Detail Medication affects to

remedy depression & cocaine addiction

Neurotransmitter

Acetylcholine

Endocannabanoid

Serotonin Medication – depends on symptoms

GABA

Glutamate Slowly

Dopamine Agonist

Noradrenaline

Opiate

Why Use These Diagrams?• Visualization through diagrams emphasizes

which neurotransmitters impact:

Neurotransmitter X

Acetylcholine

Endocannabanoid

Serotonin

GABA

Glutamate

Dopamine

Noradrenaline

Opiate

1) Drug Use,

2) Mental Status &

3) Neurotransmitter

Inadequacies

4) Greatly Improve

Quality & Outcome

of Patient Treatment

5) Science-Based,

not Intuition

Why Use These Diagrams?• Improve skills in gathering the right Information

Neurotransmitter X

Acetylcholine

Endocannabanoid

Serotonin

GABA

Glutamate

Dopamine

Noradrenaline

Opiate

1) Genetic Makeup,

2) Desired Drugs

3) Last Use of Drug

4) Current Feelings

5) Level of CravingIf uncertain, take

no action. Instead,

Gather more Data!

Diagrams – Valuable to Field of Detoxification

• Confused? Learn more of neurotransmitter systems

• Practice with patients until proficient

• Look at drugs in a new way: actions on

neurotransmitter sites & chain reaction effects.

NeurotransmitterX

Acetylcholine

Endocannabanoid

Serotonin

GABA

Glutamate

Dopamine

Noradrenaline

Diagram Synopsis 1)Genetic Baseline of Neurochemical Deficiencies

– Note the Imbalance!

2)Drugs addicted to & affected Neurotransmitters

3)How Detox alter Neurotransmitter levels

4)Corrective Medications used for

a) Safe Withdrawal

b) Rids Cravings

c) Correct Genetic Imbalance

which led to addiction

Neurotransmitter X

Acetylcholine

Endocannabanoid

Serotonin

GABA

Glutamate

Dopamine

Noradrenaline

Opiate

Caveat

• All medications must be used with caution

• High degree of variability between each

individual’s brain chemistry and the reaction to

drugs.

• Caveat: Drug Index in his book is not a guide, but

it is a list for general understanding.

Dr. Von Stieff

Before Using These DiagramsBe familiar with the

effects of alcohol and drugs upon each of the neurotransmitters.

Be familiar with the effects of the therapeutic medications as well.

1. Genetics/Trauma/MI

2. Drug of Choice

3. Detox

4. Adjusting levels


2. Drug of Choice

3. Detox

4. Adjusting levels

Glutamate Responsible

for sending

signals

between

nerve cells &

plays an

important role

in learning &

memory.

Ketamine,

Phencyclidine

Alcohol

Schizophrenia (if

too low or too

high), mood

disorders,

anxiety

disorders,

ADHD, OCD,

bipolar disorder.

(Schizophrenia, mood &

anxiety disorders) –

currently in development .

(ADHD)-

Amantadine, Lamotrigine

(OCD & Tourette’s

syndrome)- Topiramate ,

Pregabalin


2. Drug of Choice

3. Detox

4. Adjusting levels

Why Use These Diagrams?

These are at best approximations as there is no perfect drug profile for each patient. It is a work in progress.

Reported success rate of 85% without relapse.


2. Drug of Choice

3. Detox

4. Adjusting levels

Let’s Begin!

Address & Analyze Patient Neurochemical

Imbalance

Diagram 1: Genetic AilmentGenetic Deficiencies, Predispositions in

Family -Stress/Mental Illness, Trauma

• Client Information within intake forms

• Current Disposition & Background History

• Craving• Past/present drug use with diagram to illustrate

genetic balance of neurotransmitters: Too much/little?

• Reflects neurotransmitter balance prior to using any

drugs.

?

?

Diagram 1: Show Genetic Ailment• Jot down information next to the diagram overall genetic

predispositions that run the family (viz., family history of

alcoholism, bipolar disorder, schizophrenia, etc.).

• Genetic Diagram of patient

• Addicted to Cocaine

• Dx Depression Image page 206

5HT2A

Diagram 2: Show Drug Effects • Diagram illustrates how drugs influence original

neurochemical genetic deficiencies/overabundance

• Include drugs that patient uses/craves & draw

arrows to illustrate stimulation [arrow up], or

inhibition [arrow down ] for each affected

neurotransmitter.

• Rule of thumb: Drugs patient uses most account

for neurotransmitters lacking in system.

• [Self Medication]. Action of drugs typically

cancel out deficits found in first diagram.

Diagram 2: Show Drug Effects • Effects of cocaine on genetically depressed

patient.

Image on page 207 D1, D2

Diagram 3: Anticipating Effects of

Withdrawal on Neurotransmitter Levels

• In chemical

dependency-

what goes down

must come up.

& vice versa.

-

+



• Neurochemical imbalance caused by

drugs leads to withdrawal if drug use was

significant to cause the down-regulation of

their systems.



• Effects of withdrawal - cocaine discontinued.

Image on page

208

D2



• Withdrawal = brain’s method of up-

regulation.

• Up-regulation = returning the brain’s

neurochemical balance to its original genetic

baseline.

• Withdrawal - observable symptoms:

significant agitation, other unfavorable

symptoms associated with detoxification.



• Place large negative signs ‘—’ or 1 or

2 arrows pointing down near each

circle that represents the affected

neurotransmitter system.

• Purpose: help to visualize what is

going to occur if those drugs are

stopped and patient goes into

withdrawal.



• EXAMPLE: Withdrawal of Opiates (heroin or

OxyContin). Decrease in GABA, Dopamine and

Opiates [arrows all pointing down].



• EXAMPLE: Withdrawal from alcohol.

Decrease in Serotonin, GABA and

Dopamine; increase in Glutamate.



• EXAMPLE: Withdrawal from

methamphetamine. Decrease in Dopamine

and Noradrenaline.



• EXAMPLE: Withdrawal from

benzodiazepines. Extremely low GABA.

Insight: Diagrams 1, 2 and 3 can

shed light on underlying mental

disorders such as Bipolar Disorder.

1 2 3

+ + =

Caveat: Anticipate in advance

what the patient’s neurological

level will be while in acute

withdrawal. To do so will ensure

smooth progress during

detoxification.

Sketching out Diagrams 1, 2 and 3

• Will provide essential information on how

to eliminate cravings once the drug(s) of

choice is/are taken away.

• Analyze this carefully to take corrective

measures with medications that will stop

cravings<before they start>.

Diagram 4: The Treatment Plan

• Use this diagram to plan treatment for

patient detoxification, cravings and other

disorders like depression.

• Diagram the effect each

medication has on the patient’s

neurochemicals, including any

discrepancies, or overlying conflict

between the effects of medication.

Diagram 4: The Treatment Plan

• Treatment diagram - Display of the effect of

each medication when remedying

depression & cocaine addiction.

Image on page 210


• Visualization assists in understanding.

• Writing them down assists as a quick

reference.

• Process: to see quickly which

neurotransmitters have significant

impact on patient drug use, mental

status, and or other neurotransmitter-

influenced inadequacies.


These are approximations as there

is no perfect drug profile for each

patient. It is a work in progress.

Using These DiagramsKey points of focus:

1) Practice

2) Become adept at gathering information from the patient

3) Utilize basic data forms to gather information uniformly

4) Use information about family and determine genetic makeup and the drugs have been used by other family members.[This will give you an insight into the specific patient].

5) Carefully note any adverse reactions to drugs.

6) Include notations as when the patient’s last use of the drug, how the patient feels currently, & what the patient is

craving.

Diagrams -Synopsis

• When in doubt, when uncertain— get more data. Do not throw darts in the dark. Making a hasty decision when there is uncertainty is dangerous.

• After gathering more data, organize data into a coherent structure which is plausible. Evaluate danger with opportunity, take action, watch for change and positive results.

• Be familiar with the Drug Index on pages 217-220. Nota Bene: rapid advances in research findings are crucial in updating this index.

Genetics/Trauma/MI

Diagram 1- patient neurotransmitter

system reveals genetic baseline

profile of neurochemicals from birth.

Probably reflects an imbalance.

Drug(s) of ChoiceDiagram 2- List of addictive drugs/

substances taken and resultant

neurotransmitter levels: stimulating/

inhibiting & to what degree.

Detox

Diagram 3- How detoxification

alters neurochemical levels.

Adjusting levelsDiagram 4- Illustration of what happens to

patient’s neurochemical levels once

medication is administered.A) Assists in a safe withdrawal process.

B) Helps to reduce the level of cravings.C) Corrects genetic imbalances leading to

addictions.

Diagram Synopsis

Dr. Fred

Von

Stieff .

Diagram 1- patient’s neurotransmitter system

revealing genetic baseline profile of

neurochemicals from birth. Probably reflects

an imbalance.

Diagram 2- List of addictive substances/drugs

taken and resultant neurotransmitter levels:

stimulating/ inhibiting & to what degree.

Diagram 3- How detoxification alters

neurochemical levels.

Diagram 4- Illustration of what happens to

patient’s neurochemical levels once medication

is administered.A) Assists in a safe withdrawal process.

B) Helps cravings.

C) Corrects genetic imbalances leading to addictions.

Practice!

III. GABA versus Glutamate

Gamma-Aminobutyric Acid

acts as an inhibitory neurotransmitter

Gamma-Aminobutyric Acid

Glutamate – Brain Agitator –

Most abundant excitatory neurotransmitter

Glutamate

Blue Blue ‘Unglue’-timate

Brain Agitate

Alcohol Withdrawal - Seizures

Brain Attempts to Rebalance-

With Self Medication

DID YOU KNOW THAT A

Brain with High Glutamate Levels is Agitated?

Result: Brain Stimulation & Activation

Who wins in a

race?

It depends . . .

. . . On how far

you go!

Gets off to a quick

start. But fades after a

mile.

Off to a slow start.

Builds momentum

in the long run.

The GABA and Glutamate Balance

Consuming

Alcohol Raises

GABA

levels

QUICKLY

Glutamate

[agitate] levels

rise more

slowly

Consuming

more Alcohol

Raises GABA

levels even

more

Glutamate

[agitate] levels

will continue to

rise.

Consuming

even more

Alcohol Raises

GABA

levels

Glutamate

[agitate] levels

continue to

catch up.

Cravings

CRAVINGS

CRAVINGS

NO LONGER

Consuming Alcohol

causes GABA

levels to drop

Glutamate

[agitation] levels

rise more quickly

& CRAVINGS

begin

Seizure Line

Cravings

CRAVINGS

CRAVINGS

GABA plummets! No

Alcohol for some time.

CRAVINGS get worse.

Glutamate levels high &

Seizures begin.

Topomax & Campral

boost GABA Level

Acamprosate, glutamate antagonist, is useful in alcohol dependence.

Topiramate, glutamate antagonist & GABA agonist, useful in alcohol

dependence.

Seizure Line

Analogy:

Pull

thumb

Overuse of Benzodiazepine

Too Much Valium [Diazepam]

Grandma

AaronAziz

Barb

Bev

Overuse produced

tolerance

paradoxical effect

inciting agitation

Site

becomes

disabled

burned

out

Unopposed

GABAa1 VERY PREDICTABLE => VERY UNPREDICTABLE

Use other 5 GABA SitesAlcohol

Main Point

• Severity of withdrawal

symptoms depends on the

imbalance between Glutamate and

GABA levels

• Severity of withdrawal does not

depend on the amount of alcohol

consumed.

Acute Alcohol Withdrawal Syndrome

• Detoxification Treatment = returning patients

neurotransmitters to normal genetic state as

safely as possible.

• Severity of withdrawal does not depend on the

amount of alcohol consumed.

• Severity of withdrawal symptoms depends on

the imbalance between Glutamate and GABA

levels.

• Severity of withdrawal depends on malnutrition

and dehydration.


(AWS) -three levels

• 1) Mild Withdrawal-

• 2) Moderate Withdrawal-

• 3) Severe Withdrawal-


• AWS 1) Mild Withdrawal- -very

shaky, no delirium tremens. Some

tremors and hypertension.

• GABA-Glutamate differential mild.

Acute Alcohol Withdrawal Syndrome• AWS –2) Moderate Withdrawal- greater

discrepancy between GABA & Glutamate levels.

• Greater imbalance manifests in hypervigilant state,

rapid heart rate, supraventricular tachycardia and

severe agitation.


• AWS 3) Severe Withdrawal- Glutamate

exceedingly high/ GABA incredibly low.

• Delirium tremens & visual hallucinations,

possible seizures.

Harnessing the Power of Neurotransmitters

Campral -

medication

used with

counseling in

treating

alcohol

dependence.

Harnessing the Power of Neurotransmitters

Prozac, [SSRI]-

raises Serotonin

levels. More

positive thoughts,

feeling better.

Balances

neurotransmitters,

to correct

compulsivity,

neuroticism &

improve quality of

life.

IV. Brain Scans and the Future

Demonstration:

• Need 1 Volunteer

Since we are ‘shooting for the

stars’ what if we look to the

future for a clue?

Star Trek NG Tricorder

Brain-Scan for Level of Activity

Scan 1 Scan 2

The Human Connectome Project http://www.humanconnectomeproject.org/

• Navigate the brain in a way that was never before

possible; fly through major brain pathways, compare

essential circuits, zoom into a region to explore the cells

that comprise it, and the functions that depend on it.

http://www.humanconnectomeproject.org/

Imagine: Future Computerized Diagram Format

1) Trauma, Genetic

Predisposition, Stress

problems, Mental

Disorders

2) Self Medicating

(Chemical

Dependency)

3) Withdrawal

4) Stabilization

Will utilize the graphic display for each stage:

1) Genetic deficiencies/trauma/Mental Illness-

patient tries to balance this new self-medication

[alcohol & drugs].

2) Drugs & alcohol affect neurotransmitter

levels.

3) Withdrawal/detoxification alters

neurotransmitter levels.

4) Medication affecting balance of

neurotransmitters for stabilization & recovery.

Systems seek a natural balance.

•Trauma •Genetic Predisposition •Stress problems•Self Medicating (Chemical Dependency)•Mental Disorders

Remember!

Summary

• Addiction – a

dreaded disease.

With proper

treatment the brain

can return to

proper balance.

Thank you!

Questions

????

[email protected]

mailto:[email protected]

Neurotransmitter Balance: The Key to Understanding Addiction

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