Educational Workshop on Addiction

About the Workshop

The conference will be accompanied by an Educational Workshop on Addiction. The Workshop is primarily designed for psychiatry and neurology residents and clinical psychologists in training, however students and interested professionals are welcome to attend as well.

The Workshop will cover a wide array of topics spread over three sessions, time-coordinated with the scientific programme of the SNC'15, to enable workshop participants' attendance at plenary talks and their socialising with the SNC'15 participants during the lunch break by the posters.

The Workshop is being organized by the Faculty of Medicine of the University of Ljubljana in partnership with SiNAPSA.

Core Programme of the Educational Workshop (Lectures)

(Work in small groups planned during all days for pre-registered applicants only.)

Saturday, 16 May | Kosovel Hall, Cankarjev dom


8:30	Session I: Neurobiology
8:30	Learning mechanisms of drug dependence (presentation) Jennifer Murray
9:30	Pleasant and unpleasant effects of alcohol (presentation) Dorit Ron

14:30	Session II: Alcohol addiction: Stigma, ethical challenges and treatment
14:30	How can science help explain ethical issues related to alcohol dependence syndrome? (presentation) Zdenka Čebašek Travnik
15:00	Alcohol addiction treatment (presentation) Darja Boben Bardutzky
15:30	(Neuro)science and alcohol dependence syndrome related stigma (presentation) Mirjana Radovanović
16:00	Summary discussion

17:00	Session III: Addiction, ADHD and psychoactive substance abuse
17:00	Addiction, comorbidity and new psychoactive substances (presentation) Nuša Šegrec
17:30	Epidemiology and clinical presentation of ADHD (presentation) Mirjana Delić
17:50	Differential diagnosis and comorbidity in ADHD (presentation) Andrej Kastelic
18:10	Treatment of adults with ADHD (presentation) Mirjana Delić
18:30	ADHD, psychoactive substance abuse, addiction disorders and treatment (presentation) Andrej Kastelic
18:50	Summary discussion

Abstracts

Learning mechanisms of drug dependence
Jennifer Murray

The development of drug dependence relies heavily on an aberrant learning history. Initially, the experience of the drug itself is linked with environmental cues through a process of Pavlovian conditioning. The unconditioned drug stimulus becomes associated with conditioned stimuli that can then come to instigate goal-directed drug seeking. Over time, a shift in the circuitry maintaining the drug-seeking behaviour occurs. This transition from a dominant role of the mesolimbic dopamine system to the nigrostriatal dopamine system is reflected behaviourally in a transition to habitual drug seeking. At this stage, the drug-seeking behaviour is resistant to devaluation of the drug stimulus, indicating a loss of outcome value as the dominate source of motivation, and instead implicating the drug-associated conditioned stimulus as the driving force of the behaviour. From a clinical standpoint, increased focus on the impact of associated environmental cues in perpetuating drug habits should be of use. Unfortunately, approaches utilizing extinction processes such as cue-exposure therapy have been less than successful in prolonging abstinence. One of the factors that may contribute to that is our often narrow approach to understanding the role of the drug itself. Importantly, a drug is not only a rewarding Pavlovian unconditioned stimulus or operant reinforcer. The drug experience can also function as a conditioned stimulus, indicating the presence of another appetitive environmental stimulus, as well as set occasions for when other conditioned-unconditioned stimulus associations are available. Combined, understanding the functional significance of the impact on neural processes of the drug experience in various learning domains will provide a more solid foundation for moving forward in the development of treatment techniques.

Pleasant and unpleasant effects of alcohol
Dorit Ron

Alcohol addiction is one of the most prevailing psychiatric disorders. Alcohol abuse is associated with serious global health as well as socioeconomic consequences. Unlike most drugs of abuse alcohol does not have a single pharmacological site of action. Thus, the mechanisms that underlie the disease, e.g. the transition from recreational use to abuse are poorly understood, and thus pharmacotherapies available to treat the disorder are very limited. Dr. Ron will present two examples from her group’s research showing that elucidating the molecular mechanisms by which alcohol affects the adult brain can lead to the identification of novel drug targets to treat the disease. First, using rodent models that mimic social drinking and uncontrolled excessive intake she will show that the transition from social to compulsive alcohol drinking results from the disregulation of the expression and function of the neurotrophic factor, BDNF, in a specific brain circuitry. She will then present data suggesting that restoring the normal function of the BDNF signaling pathway reverses the escalation of alcohol use. The second part of her presentation will focus on mTORC1, a kinase important for learning and memory. Dr. Ron will show that excessive drinking of alcohol leads to the activation of mTORC1 in specific brain regions, resulting in the translation of synaptic proteins. She will then describe the physiological and behavioral consequences of mTORC1 activation, and present data implicating mTORC1 in maladaptive forms of learning and memory that underlie alcohol-related behaviors. Finally, she will describe the potential use of mTORC1 as valuable target for the treatment of alcohol use and abuse disorders.

How can science help explain ethical issues related to alcohol dependence syndrome?
Zdenka Čebašek Travnik

Talking about addictions put at the forefront the type of dependence, effects of psychoactive substances and therapeutic efforts to reduce the impact of this disease. To rediscover the values of life, we increasingly deal with the ethics – in our case the ethics of addiction, particularly addiction to alcohol. Ethics is becoming an important tool to understand behavior of the addicted person and an indispensable element in all areas dealing with addiction: epidemiology, prevention, motivational processes, treatment and recovery.
Some authores claim that alcohol and drug research has a lack of scientificc production related to ethical, legal and social issues. But the advances in neuroscience are changing how mental health issues such as addiction are understood and addressed as a brain disease. Although a brain disease model legitimizes addiction as amedical condition, it promotes neuro-essentialist thinking, categorical ideas of responsibility andfree choice, and undermines the complexity involved in its emergence.
Addiction neuroethics raise important ethical questions. Some of them are: (1) Are people who use drugs or alcohol morally responsible for their behavior?, (2) Under what circumstances is it justified to test individuals for drug and alcohol use?, (3) Is it acceptable for health-care professionals to prescribe and keep people on addivtive drugs that are otherwise illegal, and if so, under what circumstances?

Alcohol addiction treatment
Darja Boben Bardutzky

The method of treatment of alcohol addiction currently used in Slovenia can be seen as a result of rich experience and great efforts by a number of experts throughout almost fifty years. The method is based on the concept of addiction as a disease.
The treatment can be presented as a sequence of phases. The preparation phase is followed by intensive treatment phase and then maintenance phase. We always try to find for each individual a suitable combination of pharmacological, psychological and social interventions, which are needed in different phases of addiction treatment.
As far as pharmacological treatment is concerned, three groups of medicaments are used: medication for the withdrawal syndrome, for abstinence maintenance and for co-morbidity treatment.
Psychotherapy in different modalities (psychodynamic, systemic, family, RT, CBT, TA …) and in different contexts (group, family, individual), sociotherapy, psychoeducation, occupational and other therapies are practiced as part of the treatment.
Considering that addiction involves problems on the level of relationships, inclusion of the patients’ relatives is considered very important. Thereby, the role of the family members of the treated person changes from the role of the helper to the role of someone who needs help. Programs with a clearly defined structure are more effective as they enable managing compulsive behavior, existential emptiness, and anxiety. Combining intensive emotional support with some external control mechanisms provides the patients with the best possible opportunities to learn new ways of fulfilling their basic psychological needs without manipulations.
There is evidence to support that the duration of rehab models should be three months, and that is approximately the right time for the brain to be “reset” and get rid of the direct influence of drugs. A longer period of time is needed to establish the automatization of new, different, more self-protecting and healthy ways of patient’s behavior.

(Neuro)science and alcohol dependence syndrome related stigma
Mirjana Radovanović

Addiction as a brain disease is a broadly accepted concept. Nonetheless alcohol dependence syndrome (as defined in ICD-10) or alcohol use disorder (as defined in DSM V) is the one with the highest level of stigma among mental disorders. This finding is similar across countries and continents. The bio-psycho-social model of understanding addiction increased awareness about the disease, provided a background for securing some funding by the health insurance companies of the addiction treatment programs and is supported by the results of numerous scientific studies, particularly from the 1990s onward.
This presentation does not provide an extensive literature review. Rather, it will address some clinically relevant factors contributing to the high level of stigma attached to addiction and alcohol dependence syndrome in particular. Basic neurosciences on one end inform more clinically oriented studies on the other end of the scientific spectrum, all of which in turn provide some insight into a very complex phenomenon of stigma underpinning beliefs, attitudes and behaviors, which medical professionals bring into everyday practice.

Addiction, comorbidity and new psychoactive substances
Nuša Šegrec

Patients with substance use and related addictive disorders have higher prevalence of co-morbid mental health disorders compared to general population; and vice versa, the prevalence of substance use disorders is higher among patients with other mental disorders than in general population. Un(der)treated one or both diseases lead to worse treatment outcomes and is associated with several negative physical and psycho-social consequences. However, it is known that some psychoactive substances (eg. stimulants, cannabis) can induce psychiatric side effects such as psychosis, anxiety, mood disturbances and suicidality or worsen the symptoms of previously existed mental disorder.
Further, we can monitor the occurrence of new psychoactive substances (NPS) in past few years, so called designer drugs, legal highs, herbal highs, research chemicals,…Beside mimicking the effects of illicit substances and being relatively cheap, they became highly available, mostly through internet smart shops and darknets. There are almost no existing studies about possible short and long term side effects of NPS, but we can find reports of toxicity on physical and mental health – unfortunately, some of them with fatal outcome. The author will present the most frequently used NPS (with focus on synthetic cannabinoides and synthetic cathinones), especially psychiatric side effects, which can be very miscellaneous. A case-report of synthetic cathinone - induced psychosis will be presented to.

Epidemiology and clinical presentation of ADHD
Mirjana Delić

Differential diagnosis and comorbidity in ADHD
Andrej Kastelic

Treatment of adults with ADHD
Mirjana Delić

ADHD, psychoactive substance abuse, addiction disorders and treatment
Andrej Kastelic

Attention-deficit/hyperactivity disorder (ADHD) is a mental health condition characterized by a persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequently displayed and more severe than is typically observed in individuals at a comparable level of development. This pattern of behavior usually becomes evident in the preschool or early elementary years. For many individuals, ADHD symptoms improve during adolescence or as age increases, but the disorder can persist into adulthood (adult ADHD). Common co-existing conditions in adults include anxiety, mood disorders, personality disorders, obsessive-compulsive disorder and substance use disorder (SUD). There is the extreme variability of the disorder over time, within the same individual, between individuals, and across different circumstances. Suggestions for recognizing these co-morbidities and distinguishing them from ADHD and perspectives on their possible impact on ADHD treatment will be presented. Considering the high rate of ADHD co-morbidity among SUD patients, it is crucial to promote a systematic diagnostic and therapeutic approach to this disorder in specialized addiction treatment settings. This includes drug treatment for adults, which should always form part of a comprehensive treatment programme that addresses psychological, behavioral and educational or occupational needs. Although stimulant medications are recommended as the first-line treatment for ADHD because of their documented short-term effects in children and adults, less is known about their effects on long-term outcome in adults. The authors will present and discus the prevalence, assessment, diagnostic and comorbidity issues, and pharmacotherapeutic and psychological interventions in substance-abusing adults with ADHD.

Appearances in the media

report about the SNC and interview with Robin Carhart-Harris on Radio Študent
interview with Robin Carhart-Harris in Sobotna priloga

Supported by

Operacijo delno financira Evropska unija iz Evropskega socialnega sklada ter Ministrstvo za izobraževanje, znanost in šport. Operacija se izvaja v okviru Operativnega programa razvoja človeških virov za obdobje 2007-2013, razvojne prioritete 3: Razvoj človeških virov in vseživljenjskega učenja; prednostne usmeritve 3.3: Kakovost, konkurenčnost in odzivnost visokega šolstva.

Page last updated: Thursday, July 16^th 2015