Abstract
Drugs and the Brain: Lessons for Early Intervention and the Treatment of Addiction
Dan I. Lubman
Turning Point, Eastern Health and Monash University, Melbourne, Australia
Over the past 50 years, advances in the neuroscience field have allowed the delineation of brain circuits underpinning drug reward as well as mapping changes associated with chronic drug use and addiction. Research across human cohorts with diverse drug addictions have identified consistent alterations within the brain’s reward circuitry that result in increased responsiveness to drugs and situations that predict drug reward, as well as a diminished response to natural rewards. At the same time, dysfunction within frontal brain circuits impact on decision-making and promote ongoing drug seeking and drug taking.
However, emerging literature on early onset substance use, suggests that the adolescent brain may be more vulnerable to the effects of addictive substances because of the extensive neuromaturational processes that are occurring during this period. While such findings are suggestive of disrupted developmental trajectories in early onset users, there is growing evidence that adverse events during childhood (e.g. early trauma or abuse) may also impact on brain development.
This presentation will explore recent research examining the neurobiology of addiction, its relationship to adolescent development, and implications for policy and practice. In particular, recent work examining novel approaches for both early intervention and the treatment of addiction will be discussed.
Margaret Tobin Oration: Volatility, Courage & Leadership in Psychiatry
S Stafrace1,2
1Alfred Psychiatry, Alfred Health, Melbourne, Victoria, Australia
2Monash University, Melbourne, Victoria, Australia
Margaret Tobin wrote in 1998 that the psychiatrist’s role was “challenging and exciting”. There was plenty of that in her career, but what really stood out in abundance was her courage. She was willing to confront systems and behaviours that failed to serve the interests of patients. This should be an inspiration to any psychiatrist aspiring to leadership.
In this presentation, I will provide an overview of some of the key initiatives we have undertaken at Alfred Health, including Timely Quality Care, a project designed to reduce waiting times in the emergency department; and our experience as a lead agency to a headspace Youth Early Psychosis Program in South-East Melbourne. In improving what we offer, a focus on values, practice principles and partnerships with consumers, carers & the community sector have been key themes. The learnings of these experiences will be outlined.
Looking to the future, the mental health policy context is becoming increasingly volatile, more so in the primary & community sector than in the tertiary space traditionally occupied by specialist clinical services. The Commonwealth’s mental health reform plan, the National Disability Insurance Scheme and the social and technological changes of the past two decades will transform how we conduct our profession. I will argue that psychiatrists and the college must embrace this volatility. Resisting change may create the illusion of stability but will ultimately expose our profession to greater disruption in future. A focus on what matters in delivering healthcare will provide a foundation for the courageous leadership needed if we are to successfully navigate competing interests (our own included) and ensure that the most vulnerable patients and their families receive clinical care that is demonstrably excellent.