Terrence D. Walton, MSW, CSAC
Director of Treatment
Pretrial Services Agency for the
District of Columbia
Terrencewalton@aol.com
Intoxication
Withdrawal
Damage
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Assessing Risk and Needs
Recommending Release Conditions
Returning to Court
Supervision Compliance
Pretrial Success or Failure
Mood Altering
Chemicals: An
Overview
1.
2.
3.
4.
5.
Legal & Illicit
Street Drugs and
Prescribed Drugs
Hard Drugs & Soft
Drugs
Very Addictive &
Less-Addictive
Natural and
Synthetic
1.
2.
3.
4.
5.
6.
Stimulants
Depressants
Opioids
Cannabinols
Hallucinogens/
Dissociatives
Inhalants/
Deliriants/Other
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Bottle to Blood to Brain
Route of Administration:
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Smoke
Sniff
Snort
Shoot
Swallow
The Blood Brain Barrier
Neurocompatibility
1. Power (brain impact)
2. Popularity (acceptability)
3. Presence (accessibility)
4. Pay off (onset & intensity)
5. Persistence (length of high)
6. Patterns (of use)
7. Penalty (onset & intensity)
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Why do people do drugs?
Why can’t some people
stop?
Pleasure
Relief
Use
Escape
Stimulation
1. Physiological Dependence
2. Psychological Dependence
A medical condition
characterized by impairment
within both the brain’s reward
and executive functions centers
and resulting in compulsive,
repetitive, self-destructive
substance use
What’s happening in the
brain and body to cause
this?
The brain adapts to the effects of
substance use by over-releasing
chemicals that produce the
opposite effect. If the use stops
abruptly, the over release of
opposing chemicals continues
for a period of time causing
withdrawal symptoms.
Neuro-adaption (tolerance) occurs
when neurons become less sensitive
to the presence of a depressant or
opiate as a result of the brain’s
attempt to return to normal. For
instance, in response to the presence
of alcohol the brain may reduce the
number of receptors available to
detect alcohol.
Neuro-sensitization occurs when
neurons become more sensitive to
the presence of a stimulant. As a
result, the neurons will only fully
activate when the current reward is
expected to be greater than the
average of previous rewards
(“reward prediction error”)
What’s happening in the
brain to cause psychological
dependence?
Addiction
& the Brain
Neurochemistry:
The Basics
Any use causes acute and
temporary changes and
prolong use changes the brain
in fundamental, destructive
and long lasting ways
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Involved in all physical/emotional/
cognitive function
Metabolism, muscle movement, reflex
Mood, reactivity, emotions
Cognition, memory, etc.
Affinity
Activation
FOOD
WATER
SEX
NURTURING
ACCOMPLISHMENT
Prefrontal Cortex
Nucleus Accumbens
Ventral
Tegmental Area
Brain Effects from
Chronic
Substance Abuse
Interact with neurochemistry
 Results:
 Feel Good –
euphoria/reward
 Feel Better – reduce
negative feelings
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Dopamine – excitement &
reward
 Serotonin – feel – “normal”
 Endorphin/Enkephalin –
pain relief, reward, craving
 GABA – lowers anxiety

1. Amount of dopamine
produced
2. Length of time dopamine is
available
3. Number of dopamine
receptors
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Rewarding behaviors can become
routine
Obsessive, preoccupation, compulsion
“Subconscious” control of the behavior
Difficult to extinguish behaviors
Resistant to change
Cognitive
Behavioral
Treatment
Relapse
Prevention
CoOccurring
Disorders
Motivation
Enhancement
Medication
Assisted
Treatment
 Report to court
 Avoid criminal activity
 Maintain employment
 Maintain residence
 Stay away from person or place
 Report to pretrial agency in person or by phone
 Drug testing
 Avoid alcohol and illicit drug use
 Participate in treatment as directed by …
TerrenceDwalton@ gmail.com