CARDWELL C NUCKOLS PhD cnuckolselitecorp1com WWWCNUCKOLSCOM THE SCIENCE OF RECOVERY this business of resentment is infinitely grave We found that it is fatal For when harboring such feeling we shut ourselves off from the sunlight of the Spirit The insanity of alcohol return ID: 775268
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Slide1
THE SCIENCE OF RECOVERY: AN ADVANCED SEMINAR
CARDWELL C. NUCKOLS, PhD
cnuckols@elitecorp1.com
WWW.CNUCKOLS.COM
Slide2THE SCIENCE OF RECOVERY
“…
this
business of resentment is infinitely grave. We found that it is fatal. For when harboring such feeling we shut ourselves off from the sunlight of the Spirit. The insanity of alcohol returns and we drink again. And with us, to drink is to die
.”
Big Book page 66
Slide3THE SCIENCE OF RECOVERY
GRATITUDE (LOVE)A CHANGE IN WORLDVIEWGRANDIOSITY(CHARACTER DEFECTS)
Slide4GRATITUDE
UNCONDITIONAL LOVE
HUMILITY
ACCEPTANCE
FORGIVENESS
SURRENDER
COURAGE AND HONESTY
GRANDIOSITY AND HUMAN SUFFERING
Slide5WHAT DO YOU SEE?
Slide6Slide7NUCLEUS BASALIS
Slide8THE SCIENCE OF RECOVERY: NEUROPLASTICITY
THE NUCLEUS BASALIS IS…THE MODULATORY CONTROL CENTER FOR PLASTICITY
NOVELTY
Slide9THE SCIENCE OF RECOVERY: NEUROPLASTICITY
YOU ARE NEUROPLASTICIANS!
WHAT ENHANCES PLASTICITY?
NOVELTY
THERAPEUTIC RELATIONSHIPS
PHYSICAL EXERCISE
MINDFULNESS
Slide10NEUROPLASTICITY
BRAIN AT ALL AGES IS RESPONSIVE TO ENVIRONMENTAL STIMULI
SYNAPSES CAN CHANGE IN MINUTES WHEN STIMULATED
NEUROPLASTICITY IS MODULATED BY
GENETIC FORCES
EPIGENETIC
FORCES
Slide11ADDICTION AND RECOVERY
Slide12THE SCIENCE OF RECOVERY:GENETICS
GENETICS
A1 ALLELE OF THE DOPAMINE D2 RECEPTOR GENE
FOUND IN ONE-THIRD OF POPULATION
LOW DOPAMINE TONE
Slide13THE SCIENCE OF RECOVERY:GENETICS
TWIN STUDIES SUGGEST GENES AND ENVIRONMENTAL FACTORS EACH INFLUENCE THE VULNERABILITY TO DEVELOPING ADDICTION
STRESS IS ONE, IF NOT THE PRINCIPLE, ENVIRONMENTAL FACTOR THAT INCREASES ADDICTION POTENTIAL
IN BOYS WITH THE A1 ALLELE STRESS WAS SIGNIFICANTLY CORRELATED WITH COGNITIVE FUNCTIONAL PROBLEMS
NOBLE AND BENTON. THE D2 DOPAMINE RECEPTOR GENE AND FAMILY STRESS. INTERACTIVE EFFECTS ON COGNITIVE FUNCTIONING IN CHILDREN.
BEHAV GENET,
1997; 27:33-43.
Slide14THE SCIENCE OF RECOVERY:GENETICS
GENETIC VULNERABILITY
SONS OF ALCOHOLICS HAVE DECREASED SENSITIVITY TO ALCOHOL
ENORMOUS AMOUNT OF DEVELOPMENTAL STRESS
EITHER CAN CAUSE IRREGULARITIES IN BRAIN CHEMISTRY SUCH AS DOPAMINE BLUNTING
Slide15THE SCIENCE OF RECOVERY:GENETICS
Treatment dropout linked to elevated stress response (Drug and Alcohol
D
epd
. 105 (3):202-208, 2009)
Salivary cortisol can predict how long a drug user will remain in treatment
Cortisol measured at base for both men and women in a residential treatment center before giving them stressful tasks
Prior to the stressors cortisol levels were similar for the 21 participants who dropped out as compared to the 81 who completed treatment
Slide16THE SCIENCE OF RECOVERY:GENETICS
Treatment dropout linked to elevated stress response (Drug and Alcohol
Depd
. 105 (3):202-208, 2009
) (continued)
The patients who dropped out had
cortisol levels 3-5 times higher
than those patients who remained in treatment
For each unit of increase in cortisol after the stressful tasks, there was a four-fold increase in risk of dropping out
Slide17THE SCIENCE OF RECOVERY:GENETICS
WHEN YOU DISCONTINUE TO DRINK CIRCUITS ARE STILL PRESENT
CORTICOTROPIN RELEASING FACTOR (CRF) SYSTEM PRODUCES A
CHRONIC STRESS RESPONSE
THAT IS A SET-UP FOR RELAPSE
60-70% OF RELAPSE OCCUR UNDER CONDITIONS OF NEGATIVE EMOTIONAL STATE
Slide18THE SCIENCE OF RECOVERY:GENETICS
A shortage of D2 receptors, some researchers surmise, could predispose a person to addiction.
Nora Volkow,
NIDA
D
irector
, led two studies that involved artificially increasing the number of D2 receptors in rats by administering adenoviral vectors directly into their brains. Viral vectors transmit their genetic material and makeup into foreign cells, in this case increasing the number of D2 receptors in the new cells to match their own.
Slide19THE SCIENCE OF RECOVERY:GENETICS
In one study involving rats and alcohol, the increased number of D2 receptors led the rodents to consume less alcohol, compared with their baseline intake.
In the other study, the D2-receptor increase caused rats to significantly reduce their intake of cocaine.
Slide20Slide21THE SCIENCE OF RECOVERY:GENETICS
Association between DA D2 receptor numbers and drug self-administration (PET)
Increased D2 receptors reduced alcohol consumption
Decreased D2 receptors higher risk
DA D2 receptor levels influenced by stress and social hierarchy
Slide22THE SCIENCE OF RECOVERY:GENETICS
Michael Nader,
a researcher at Wake Forest School of Medicine, is
investigating ways to raise D2-receptor levels naturally
.
One
experiment he helped conduct focused on
five separate groups of four monkeys. Each had been self-administering cocaine to the point of habit and were then deprived of the drug for an eight-month period
. To create a picture of D2-receptor availability, the monkeys were given a radioactive tracer that competes with dopamine for receptors.
Slide23THE SCIENCE OF RECOVERY:GENETICS
The monkeys were then
randomly put in social groups of four and given the opportunity to self-administer the drug again.
Positron emission tomography (PET) imaging of the monkeys over time showed fluctuations in dopamine levels, which allowed the researchers to estimate the changing numbers of available D2 receptors.
After
only three months, the socially dominant monkeys in each group had naturally increased their numbers of D2 receptors
.
Slide24THE SCIENCE OF RECOVERY:GENETICS
There was no increase in the subordinate monkeys
. Further, the subordinate monkeys reverted to using cocaine at much higher levels than the dominant monkeys.
"There is an interesting relationship between D2-receptor numbers and vulnerability to drug addiction," Nader said.
"It appears that individuals with low D2 measures are more vulnerable
compared to individuals with high D2-receptor numbers."
Slide25THE SCIENCE OF RECOVERY:GENETICS
Why did the socially dominant monkeys show D2-receptor increases
?
One hypothesis is
environmental enrichment
.
For the monkeys, it seems, being dominant was the enriching trigger.
One physiological consequence of involvement in 12-step meetings, therefore, could be an increase in the natural production of D2 receptors.
Slide26Slide27THE SCIENCE OF RECOVERY:GENETICS
Social interventions can change neurobiology
Increased DA D2 receptors
Reduced self-administration
Behavioral interventions could counteract the aversive effects of drug abuse and reinforce the power of group approaches
Slide28THE STRIATUM
The basal ganglia are nestled inside cortex, surrounding the thalamus (see image above). The striatum (part of the basal ganglia circuitry) is composed of the putamen, caudate, and nucleus accumbens. Other important parts of the basal ganglia are the globus pallidus (which has an internal and an external segment,
GPi
and
GPe
respectively) and the
subthalamic
nucleus (STN).
Slide29NEURAL PATHWAYS
Slide30CORTICOSTRIATAL CIRCUITRY
This impairment could arise from two general
pathologies in
corticostriatal circuitry: addicts could
have pathologically
strengthened drug-seeking
behaviors,
or
they could have pathological impairments in
the capacity
to control drug-seeking
behaviors. These two
possibilities are not mutually
exclusive.
Corticostriatal
circuitry
has
two subcircuits: the
limbic subcircuit
, which
comprises brain
regions
such as
the prefrontal cortex, the amygdala, the
nucleus accumbens (NAc)
and
the ventral
tegmental
area (VTA);
and the motor subcircuit,
which contains
the motor cortex, the dorsal striatum and
the
substantia nigra.
Slide31CORTICOSTRIATAL CIRCUITRY
Slide32CORTICOSTRIATAL CIRCUITRY
Corticostriatal projections are responsible not
only for
generating learnt, well-established
behaviors such as
in drug taking, but also for changing
behaviors in response
to a variable environment, and thereby
generating new
adaptive
behaviors
Addicts have
difficulty modulating drug-seeking
behaviors
with
information that should suppress the
behavior
Slide33CORTICOSTRIATAL CIRCUITRY
T
he
NAc
serves as
a gateway through which information that has
been processed
in the limbic subcircuit gains access to
the motor subcircuit.
R
elapse
to compulsive drug seeking
arises from
an impaired ability of the limbic subcircuit to
effectively process
and/or use the negative
environmental contingencies
associated with relapse. The result is
that behavior
is dominated by the previously learnt,
well-established
drug-seeking
strategies.
Slide34Nucleus
Accumbens
Ventral TegmentalArea
Dopamine
Opioid
Peptides
Naltrexone
Arcuate
Nucleus
THE SCIENCE OF
RECOVERY:
DOPAMINE (DA) TONE
Slide35THE SCIENCE OF RECOVERY: DOPAMINE (DA) TONE
TWO TYPES OF LOW DA TONE (CONTINUED)
SYMPTOMS WILL BE THOSE OF REDUCED DA TONE AT NAc REGARDLESS OF THE LOCATION OF FEEDBACK PROBLEM
FROM TREATMENT PERSPECTIVE WHAT DIFFERENTIATES WHETHER DA OR OPIOID CAUSATION OF LOW DA TONE IS….
HISTORY OF DRUG USAGE AND EFFECTS THAT USER EXPERIENCES
Slide36THE SCIENCE OF RECOVERY: DOPAMINE (DA) TONE
SUFFICIENT
DA TONE IN REWARD CIRCUITRY YIELDS ADEQUATE
ATTENTION
MOTIVATION
ATTACHMENT
HEDONIC TONE
Slide37THE SCIENCE OF RECOVERY: DOPAMINE (DA) TONE
REDUCED OR LOW DA TONE
ANHEDONIC RELATIVE TO THOSE AROUND THE INDIVIDUAL
SENSE OF NOT FITTING IN
POOR ATTENTION
POOR LEVEL OF MOTIVATION
RESTLESS
IRRITABLE
DISCONTENTED
Slide38PREFRONTAL CORTICAL DOPAMINE
Optimal levels of prefrontal cortical dopamine are critical to various executive functions such as working memory, attention, inhibitory control, and risk/reward decisions, all of which are impaired in addictive disorders such as alcoholism.
Imaging studies of alcoholics have demonstrated less dopamine in the striatum
Volkow ND; Wang GJ;
Telang
F; Fowler JS; Logan J; Jayne M; Ma Y;
Pradhan
K; Wong C: Profound decreases in dopamine release in striatum in detoxified alcoholics: possible orbitofrontal involvement. J
Neurosci
2007; 27:12700–12706
Slide39PREFRONTAL CORTICAL DOPAMINE
Less dopamine in the prefrontal cortex, which governs executive functions, is important because it could
impair the addicted person’s ability to learn and utilize informational/behavioral strategies critical to relapse prevention.
This is supported by literature that links prefrontal cortical dopamine with executive functions, such as attention, working memory, behavioral flexibility, and risk/reward decision making, all of which are impaired in addictive disorders such as alcoholism.
Floresco
SB; Magyar O:
Mesocortical
dopamine modulation of executive functions: beyond working memory. Psychopharmacology (
Berl
) 2006; 188:567–585
Slide40PREFRONTAL CORTICAL DOPAMINE
It is tempting to speculate that the failure to incorporate past negative consequences in a decision to drink alcohol during abstinence is related to decreased prefrontal cortical dopamine in alcoholism.
Unclear whether decreased dopamine transmission in alcoholism represents a premorbid trait or alcohol-induced state
Narendran
, et al. Decreased Prefrontal Cortical Dopamine Transmission in Alcoholism.
Am J
Pscyhiatry
.
2014;171:881-888.
doi:10.1176/appi.ajp.2014.13121581
Slide41THE SCIENCE OF RECOVERY: DOPAMINE (DA) TONE
INCREASING DA TONE AT NAc
THREE POSSIBLE APPROACHES
INCREASE AMOUNT OF DA RELEASED-CURRENTLY HAVE MEDS LIKE SUBOXONE THAT WILL DO THIS
INCREASE NUMBER OF RECEPTORS-MEDS NOT AVAILABLE FOR THIS
REDUCING REUPTAKE OF DA-HAVE MEDS THAT WILL DO THIS (PROVIGIL)
Slide42THE SCIENCE OF RECOVERY: THE OPIATE EXPERIENCE
HIGH
ABNORMALLY NORMAL
SUBJECTIVE W/DRAWAL
ACUTE ABSTINENCE SYN.
Slide43THE SCIENCE OF RECOVERY: DOPAMINE (DA) TONE
SUBUTEX
-
Buprenorphine. sublingual (SL)
2mg and 8mg tablets
SUBOXONE
-
Buprenorphine/Naloxone SL tablets AND FILM
Zubsolv
SL
PARTIAL AGONIST
Increasing dose does not increase effect like a full agonist
Slide44Slide45THE SCIENCE OF RECOVERY: DOPAMINE (DA) TONE
BUPRENORPHINE-Very high affinity for mu opioid receptor
Mu receptor will choose buprenorphine over other opioids
Buprenorphine will displace other opioids
Slow dissolution from mu receptor
Half-life on receptor is 34-36 hrs
Heroin on and off receptor in millisecond
At Buprenorphine dose of 16mg almost no binding to other opioids
Slide46PHARMACOLOGICAL
NALTREXONE
(
Revia, Vivitrol
)
Pure antagonist
Poor compliance
Less than 10% for street addicts
Better compliance
Healthcare professionals
Parole/Probation
New suspension with q30d administration should dramatically increase compliance and reliability of drug
Slide47VIVITROL Carton Components
47
Slide48VIVITROL
Slide49VIVITROL
Slide50VIVITROL
Slide51VIVITROL
Slide52VIVITROL
Slide53Important Safety Information
VIVITROL is contraindicated in patients receiving opioid analgesics or with current physiologic opioid dependence,patients in acute opiate withdrawal, any individual who has failed the naloxone challenge test or has a positive urine screen for opioids, or in patients who have previously exhibited hypersensitivity to naltrexone, PLG, carboxymethylcellulose or any other components of the diluent. VIVITROL patients must be opioid free for a minimum of 7-10 days before treatment. Attempts to overcome opioid blockade due to VIVITROL may result in a fatal overdose. In prior opioid users, use of opioids after discontinuing VIVITROL may result in a fatal overdose because patients may be more sensitive to lower doses of opioids.
VIVITROL[full prescribing information]. Cambridge, MA: Alkermes, Inc; May 2009.
53
Slide54THE SCIENCE OF RECOVERY:GLUTAMATE
NOTION THAT ADDICTION EQUALS TOO MUCH DOPAMINE IS A GROSS OVERSIMPLIFICATION
IN ANIMAL STUDIES
EVEN WHEN DA RECEPTORS ARE BLOCKED SOME DRUG-SEEKING BEHAVIOR PERSISTS
EXTERNAL CUE DRIVEN
DRUGS AFFECTING DA DIRECTLY HAVE BEEN INEFFECTIVE
INDIRECT APPROACHS SUCH AS INCREASING GABA EFFECT AND REDUCING GLUTAMATE EFFECT SEEM MORE PROMISING (EXAMPLE-TOPIRIMATE)
BRAIN WORKS. VOL 18, NO 5, SEPT/OCT 2008, PGS 1 AND 2.
Slide55THE SCIENCE OF RECOVERY: GLUTAMATE
TWO STAGE MODEL OF ADDICTION
STAGE 1-OCCASIONAL DRUG USE BECOMES INCREASINGLY CHRONIC AND UNCONTROLLED. THE NEUROBIOLOGICAL SOURCE OF THESE SYMPTOMS IS DRUG-INDUCED DEREGULATION OF THE BRAIN’S REWARD CENTER
DOPAMINE
STAGE2-ADDITIONAL FEATURES INCLUDE WITHDRAWAL SYMPTOMS, PERSISTENT VULNERABILITY TO RELAPSE WITH ALTERATIONS IN DECISION MAKING AND OTHER COGNITIVE PROCESSES
DRUG-INDUCED SIGNALS BY NEUROTRANSMITTER GLUTAMATE FROM BRAIN AREAS PRIMARILY ASSOCIATED WITH JUDGMENT
Slide56THE SCIENCE OF RECOVERY: GLUTAMATE
CHANGES IN BRAIN GLUTAMATE SIGNALING INDUCED BY CHRONIC DRUG EXPOSURE HAS A WIDE VARIETY OF NEUROBIOLOGICAL EFFECTS INSTRUMENTAL IN THE TRANSITION FROM DRUG ABUSE TO ADDICTION (KAVALIS,2009)
THESE NEURAL ALTERATIONS LIMIT THE ABILITY TO ADAPT TO NEW INFORMATION (TO STOP TAKING DRUGS IN SPITE OF ADVERSE CONSEQUENCES)AND STRENGHTEN THE POWER OF DRUG LEARNED ASSOCIATIONS
Slide57Slide58THE SCIENCE OF RECOVERY: GLUTAMATE
Addiction as impairment in reversal learning
IN ADDICTION…
“WHEN I USE DRUGS I FEEL GOOD”
CHANGES TO
“WHEN I USE DRUGS BAD THINGS HAPPEN”
NEW RULE BUT CANNOT ADAPT
Slide59THE SCIENCE OF RECOVERY: GLUTAMATE
ADDICTS CAN LEARN A NEW RULE BUT RUN INTO PROBLEMS WHEN THE RULES CHANGE
COCAINE AND ALCOHOL ABUSERS WERE ASKED TO PRESS KEY EACH TIME THEY SAW A GREEN RECTANGLE ON THE SCREEN
AFTER 500 REPETITIONS TOLD NOT TO PRESS KEY WHEN SAW GREEN RECTANGLE
CONTROLS EASILY ADAPTED WHILE ADDICTS KEPT PUSHING THE KEY EVEN AFTER GIVEN FEEDBACK
IMPAIRED
REVERSAL LEARNING
DUE TO DRUG USE AND NOT GENETICS
Slide60THE SCIENCE OF RECOVERY: COGNITIVE FUNCTION
Addiction is a disorder of altered cognition
Addiction impacts…
LEARNING
MEMORY
ATTENTION
REASON
IMPULSE CONTROL
Effects are particularly disruptive when exposed during brain development and in the co-occurring population
Slide61THE SCIENCE OF RECOVERY: COGNITIVE FUNCTION
Cognitive deficits in chronic drug abuse
Withdrawal produces cognitive symptoms
Cocaine-deficits in
cognitive flexibility
Amphetamine-deficits in attention and impulse control
Opioids-deficits in
cognitive flexibility
Ethanol-deficits in working memory and attention
Cannabis-deficits in
cognitive flexibility
and attention
Nicotine-deficits in working memory and declarative learning
Slide62THE SCIENCE OF RECOVERY: COGNITIVE FUNCTION
Why give an alcoholic or addict a 60 minute didactic or video?
A new format
15-20 minute simple didactic
How to participate in treatment
10 minute questionnaire
30 minute discussion group
Slide63THE SCIENCE OF RECOVERY: COGNITIVE FUNCTION
I THINK………..
I FEEL…………..
I LEARNED……
MY FUTURE BEHAVIOR WILL CHANGE…
Slide64THE SCIENCE OF RECOVERY
RELAPSE FALLS ALONG A SPECTRUM
Slide65THE SCIENCE OF RECOVERY CRAVING MANAGEMENT
Though
some relapse triggers can be consciously avoided, such as people, places and things related to drug use, other
subconscious triggers related to the brain's reward system may be impossible to avoid
-- they can gain entry to the unconscious brain, setting the stage for relapse
.
Baclofen
, commonly used to prevent spasms in patients with spinal cord injuries and neurological disorders
, can help block the impact of the brain's response to "
unconscious" drug triggers
well before conscious craving occurs.
Slide66THE SCIENCE OF RECOVERY CRAVING MANAGEMENT
Subliminal
drug "reminder cues" (the sights, sounds, smells, and memories of the drug) could activate the brain's reward circuit
.
23 cocaine-dependent men, ages 18 to 55. Each reported using cocaine on at least eight of 30 days before screening. Inclusion in the study required that they stay for up to 10 days in a supervised inpatient drug treatment facility
, be drug-free for the duration, not be on any medication affecting dopamine or neurotransmitter response, and have no history of psychosis, seizures, or brain syndromes unrelated to cocaine use.
Slide67THE SCIENCE OF RECOVERY CRAVING MANAGEMENT
Upon admission, patients were randomized to receive
baclofen or placebo
. Over the first six days, patients in the baclofen group received the medication in increasing dosage to 60 mg. While on the full 60 mg dose of baclofen, patients were
placed in an fMRI and shown a series of images, to measure their neural responses to "ultra-brief" pictures of cocaine or other comparison pictures
. Each of the ultra-brief 33
msec
"target" pictures was immediately followed by longer picture of non-drug objects or scenes. Under these conditions,
the participants are aware of the longer pictures, but the ultra-brief target pictures remain completely outside conscious awareness -- they are "backward-masked."
Slide68THE SCIENCE OF RECOVERY CRAVING MANAGEMENTNT
What the team found was that
the patients who were treated with
baclofen showed a significantly lower response in the reward and motivational circuits to subliminal cocaine cues versus neutral cues, as compared to the placebo-treated control group.
K. A. Young, T. R. Franklin, D. C. S. Roberts, K.
Jagannathan
, J. J.
Suh
, R. R. Wetherill, Z. Wang, K. M.
Kampman
, C. P. O'Brien, A. R. Childress.
Nipping Cue Reactivity in the Bud: Baclofen Prevents Limbic Activation Elicited by Subliminal Drug Cues
.
Journal of Neuroscience
, 2014; 34 (14)
Slide69ROBIN WILLIAMS
“I realized... you keep going with this, you’ll wake-up in a field with a small animal,” laughed Williams. “If you’re violating your standards faster than you can lower them, time to go away.”
Slide70THE SCIENCE OF RECOVERY: HABIT
YOU CANNOT EXTINGUISH A BAD HABIT;
YOU CAN ONLY CHANGE IT
Slide71THE SCIENCE OF RECOVERY: HABIT
THE CUE TRIGGERS THE ROUTINE AND ALSO TRIGGERS THE CRAVING FOR THE REWARD TO COME
Slide72THE SCIENCE OF RECOVERY: HABIT
When a habit begins the whole brain is activated as it actively processes all of the stimuli
After this phase the higher brain begins to reduce level of activation
Then even the memory centers reduce activity
BASAL GANGLIA has now taken control of recalling the patterns and acting on them
Slide73BASAL GANGLIA
Slide74THE SCIENCE OF RECOVERY: HABIT LOOP
Slide75THE SCIENCE OF RECOVERY: HABIT
CUE AND REWARD BECOME INTERTWINED CREATING A CRAVING (CONDITIONING)
In a habit the brain reduces emphasis on decision making
Pattern unfolds automatically unless you find a new routine
After craving develops, cannot extinguish a bad habit, you can only change it
Slide76THE SCIENCE OF RECOVERY: HABIT LOOP
Slide77THE SCIENCE OF RECOVERY: HABIT
ALMOST ANY HABIT CAN CHANGE IF YOU KEEP THE SAME CUE(S) AND SAME REWARD
ALCOHOLICS ANONYMOUS changes the habit loop
ALCOHOLICS ANONYMOUS succeeds because it helps use the same cues and get the same rewards but shifts the routine
Slide78THE SCIENCE OF RECOVERY: HABIT
To change a habit must address the same cues and rewards as before and feed the craving by inserting a new routine
WHAT DO ALCOHOLICS AND ADDICTS CRAVE?
It isn’t a craving to be drunk
Physical effects of alcohol are the least rewarding (the same can be said for cocaine, methamphetamine, etc.)
Is it connection, reduce anxiety, forget worries?
Meetings and companionship-another bar to escape to, catharsis, distraction
Slide79THE SCIENCE OF RECOVERY: HABIT
What is the pleasure we seek in the first place?
Is it…
COMPLETION
RELAXATION
TO FORGET
TO CONNECT
TO REWARD MYSELF
TO GIVE ME COURAGE
TO FEEL LIKE YOU BELONG AS ONE OF THE GROUP
Slide80THE SCIENCE OF RECOVERY: HABIT
ALMOST ANY HABIT CAN CHANGE IF YOU KEEP THE SAME CUE(S) AND SAME REWARD
ALCOHOLICS ANONYMOUS changes the habit loop
AA offers…
Escape
Catharsis
Distraction
Relief via talking
Slide81THE SCIENCE OF RECOVERY: HABIT
ALCOHOLICS ANONYMOUS succeeds because it helps use the same cues and get the same rewards but shifts the routine
AA
forces new routines for what to do each night as opposed to
drinking
To change a habit must address the same cues and rewards as before and feed the craving by inserting a new routine
WHAT DO WE CRAVE?
Is it connection, reduce anxiety, forget worries?
Meetings and companionship-another bar to escape to, catharsis, distraction
Slide82THE SCIENCE OF RECOVERY: HABIT
What is the thirst behind the thirst?
“I was thirsty because I was feeling incomplete and alcohol helped me feel more connected, more alive.”
Bill Wilson, “Before A.A. we were trying to drink God out of a bottle.”
Gerald May- a deep yearning for fulfillment or completion; a longing to love and be loved and a desire for the source of this love-God
Slide83THE SCIENCE OF RECOVERY: HABIT
What is the thirst behind the thirst?
The great analyst Carl J. Jung put it thus,
“
His craving for alcohol was the equivalent, on a low level, of the spiritual thirst of our being for wholeness, expressed in medieval language: the union with God.”
An
intense, urgent, or abnormal desire or longing. At the time it seems more painful than any other longing. It subsumes us and we are a slave to it…and it seems it will never end. Although not understood in that moment, it is really a powerful thirst to go “home.”
Slide84THE SCIENCE OF RECOVERY: HABIT
REPLACEMENT ROUTINES ONLY BECOME DURABLE NEW BEHAVIORS WHEN SPIRITUALITY IS ADDED (this is what gets you through the major crises in your life)
PATTERN:
Could only stay sober by habit replacement until a major crisis hit
Add spiritual element and now can get through these tough times
Slide85DOPAMINE (DA) TONE-GENDER DIFFERENCES
WOMEN ESCALATE FASTER TO HEAVY USE
WOMEN MORE READILY SUCCUMB TO SOCIAL AND PHYSICAL DAMAGE
REPRODUCTIVE HORMONES MAY UNDERLIE THIS SUSCEPTIBILITY
REMOVE OVARIES OF FEMALE RAT (NO LONGER PRODUCE ESTROGEN) AND REDUCE DRUG SEEKING BEHAVIOR FOR COCAINE AND AMPHETAMINE
Slide86DOPAMINE (DA) TONE-GENDER DIFFERENCES
ESTROGEN MAY SPUR ADDICTION BY STIMULATING BRAINS REWARD PATHWAYS ENHANCING “HIGH” BY INCREASING DA
(ANTHES, EMILY. “SHE’S HOOKED”.
SCIENTIFIC AMERICAN MIND.
MAY/JUNE 2010, PGS.14-15.)
PROGESTERONE APPEARS TO OPPOSE ESTROGEN’S ABILITY TO PROMOTE ADDICTION
GIVE BOTH ESTROGEN AND PROGESTERONE TO RATS WITHOUT OVARIES AND NO ACCELERATION OF ADDICTION
Slide87DOPAMINE (DA) TONE-GENDER DIFFERENCES
FEMALE RESPONSE VARIES ACROSS MENSTRUAL CYCLE AS LEVELS OF ESTROGEN AND PROGESTERONE WAX AND WANE
(2007, SUZETTE EVANS, COLUMBIA UNIVERSITY)
STIMULANTS MORE PLEASURABLE TO WOMEN DURING ESTROGEN-DOMINATED FOLLICULAR PHASE WHICH OCCUPIES APPROXIMATELY 2 WEEKS FROM ONSET OF PERIOD UNTIL OVULATION THAN DURING THE LUTEAL PHASE AFTER OVULATION WHEN BOTH ESTROGEN AND PROGESTERONE ARE HIGH
Slide88Slide89DOPAMINE (DA) TONE-GENDER DIFFERENCES
ASKED ONE-HALF OF 202 FEMALE CIGARETTE SMOKERS TO TRY TO ABSTAIN DURING LUTEAL PHASE AND THE OTHER HALF TO TRY TO ABSTAIN DURING THE ESTROGEN RICH FOLLICULAR PHASE
THIRTY-FOUR (34) PERCENT OF WOMAN IN FIRST GROUP HAD NOT SMOKED AT 30 DAYS
FOURTEEN (14) PERCENT OF WOMEN IN THE SECOND GROUP HAD NOT SMOKED AT 30 DAYS
(2008, SHARON ALLEN, UNIVERSITY OF MINNESOTA MED SCHOOL)
Slide90