Transcript THE SCIENCE OF RECOVERY APPLYING NEUROBIOLOGY TO …
THE SCIENCE OF RECOVERY: AN ADVANCED SEMINAR
CARDWELL C. NUCKOLS, PhD [email protected]
WWW.CNUCKOLS.COM
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 returns and we drink again. And with us, to drink is to die.
” Big Book page 66
THE SCIENCE OF RECOVERY
GRATITUDE (LOVE)
A CHANGE IN WORLDVIEW
GRANDIOSITY(CHARACTER DEFECTS)
GRATITUDE UNCONDITIONAL LOVE HUMILITY ACCEPTANCE FORGIVENESS SURRENDER COURAGE AND HONESTY GRANDIOSITY AND HUMAN SUFFERING
WHAT DO YOU SEE?
NUCLEUS BASALIS
THE SCIENCE OF RECOVERY: NEUROPLASTICITY
THE NUCLEUS BASALIS IS… THE MODULATORY CONTROL CENTER FOR PLASTICITY
THE SCIENCE OF RECOVERY: NEUROPLASTICITY
YOU ARE NEUROPLASTICIANS!
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WHAT ENHANCES PLASTICITY?
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NOVELTY THERAPEUTIC RELATIONSHIPS
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PHYSICAL EXERCISE
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MINDFULNESS
NEUROPLASTICITY
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BRAIN AT ALL AGES IS RESPONSIVE TO ENVIRONMENTAL STIMULI
SYNAPSES CAN CHANGE IN MINUTES WHEN STIMULATED
NEUROPLASTICITY IS MODULATED BY
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GENETIC FORCES
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EPIGENETIC FORCES
ADDICTION AND RECOVERY
RECOVERY • PREFRONTAL CORTEX ADDICTION • MIDBRAIN • LIMBIC ACUTE ABSTINENCE • BRAIN STEM • LOCUS COERULEUS
THE SCIENCE OF RECOVERY:GENETICS
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GENETICS
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A1 ALLELE OF THE DOPAMINE D2 RECEPTOR GENE
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FOUND IN ONE-THIRD OF POPULATION
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LOW DOPAMINE TONE
THE SCIENCE OF
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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.
THE SCIENCE OF
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RECOVERY:GENETICS GENETIC VULNERABILITY
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SONS OF ALCOHOLICS HAVE DECREASED SENSITIVITY TO ALCOHOL ENORMOUS AMOUNT OF DEVELOPMENTAL STRESS EITHER CAN CAUSE IRREGULARITIES IN BRAIN CHEMISTRY SUCH AS DOPAMINE BLUNTING
THE SCIENCE OF RECOVERY:GENETICS
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Treatment dropout linked to elevated stress response (Drug and Alcohol Depd. 105 (3):202-208, 2009)
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Salivary cortisol can predict how long a drug user will remain in treatment
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Cortisol measured at base for both men and women in a residential treatment center before giving them stressful tasks
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Prior to the stressors cortisol levels were similar for the 21 participants who dropped out as compared to the 81 who completed treatment
THE SCIENCE OF
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RECOVERY:GENETICS
Treatment dropout linked to elevated stress response (Drug and Alcohol Depd. 105 (3):202-208, 2009) (continued)
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The patients who dropped out had cortisol levels 3-5 times higher than those patients who remained in treatment
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For each unit of increase in cortisol after the stressful tasks, there was a four-fold increase in risk of dropping out
THE SCIENCE OF
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RECOVERY:GENETICS WHEN YOU DISCONTINUE TO DRINK CIRCUITS ARE STILL PRESENT
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CORTICOTROPIN RELEASING FACTOR (CRF) SYSTEM PRODUCES A CHRONIC STRESS RESPONSE THAT IS A SET-UP FOR RELAPSE
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60-70% OF RELAPSE OCCUR UNDER CONDITIONS OF NEGATIVE EMOTIONAL STATE
THE SCIENCE OF
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RECOVERY:GENETICS
A shortage of person to addiction.
D2 receptors, some researchers surmise, could predispose a Nora Volkow, NIDA Director, 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.
THE SCIENCE OF
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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.
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THE SCIENCE OF RECOVERY:GENETICS
Association between DA D2 receptor numbers and drug self-administration (PET)
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Increased D2 receptors reduced alcohol consumption
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Decreased D2 receptors higher risk
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DA D2 receptor levels influenced by stress and social hierarchy
THE SCIENCE OF
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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.
THE SCIENCE OF RECOVERY:GENETICS
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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.
THE SCIENCE OF
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RECOVERY:GENETICS
There was no increase in the subordinate
monkeys.
monkeys.
Further, the subordinate monkeys reverted to using cocaine at much higher levels than the dominant "There is an interesting relationship between vulnerability to drug addiction," Nader said.
D2-receptor numbers and
"It appears that individuals with low D2 measures are
compared to individuals with high D2 receptor numbers."
more vulnerable
THE SCIENCE OF
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RECOVERY:GENETICS
Why did the socially dominant monkeys show D2-receptor increases?
One hypothesis enrichment.
is
environmental
For the monkeys, it seems, being dominant was the enriching trigger.
One physiological involvement in consequence 12-step of meetings, therefore, could be an increase in the natural production of D2 receptors.
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THE SCIENCE OF RECOVERY:GENETICS
Social interventions can change neurobiology
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Increased DA D2 receptors Reduced self-administration
Behavioral interventions could counteract the aversive effects of drug abuse and reinforce the power of group approaches
THE STRIATUM
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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).
NEURAL PATHWAYS
CORTICOSTRIATAL
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CIRCUITRY
This impairment could arise from two general pathologies in corticostriatal circuitry: addicts could have pathologically strengthened drug seeking behaviors, or pathological impairments in the capacity to control drug-seeking behaviors. These two possibilities are not mutually exclusive.
they could have Corticostriatal circuitry has two subcircuits: the limbic subcircuit, which comprises brain regions such as the prefrontal cortex, the amygdala, the nucleus accumbens (NAc) and striatum and the substantia nigra.
the ventral tegmental area (VTA); and the motor subcircuit, which contains the motor cortex, the dorsal
CORTICOSTRIATAL CIRCUITRY
CORTICOSTRIATAL
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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 drug-seeking difficulty modulating behaviors with information that should suppress the behavior
CORTICOSTRIATAL
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CIRCUITRY
The NAc serves as a gateway through which information that access to the motor subcircuit.
has been processed in the limbic subcircuit gains Relapse to compulsive 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.
drug seeking
THE SCIENCE OF RECOVERY: DOPAMINE (DA) TONE
Ventral Tegmental Area Nucleus Accumbens Arcuate Nucleus Dopamine Opioid Peptides Naltrexone
THE SCIENCE OF RECOVERY: DOPAMINE (DA) TONE
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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….
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HISTORY OF DRUG USAGE AND EFFECTS THAT USER EXPERIENCES
THE SCIENCE OF RECOVERY:
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DOPAMINE (DA) TONE SUFFICIENT
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DA TONE IN REWARD CIRCUITRY YIELDS ADEQUATE
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ATTENTION MOTIVATION ATTACHMENT HEDONIC TONE
THE SCIENCE OF RECOVERY:
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DOPAMINE (DA) TONE REDUCED OR LOW DA TONE
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ANHEDONIC RELATIVE TO THOSE AROUND THE INDIVIDUAL
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SENSE OF NOT FITTING IN POOR ATTENTION POOR LEVEL OF MOTIVATION RESTLESS IRRITABLE DISCONTENTED
PREFRONTAL CORTICAL
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DOPAMINE Optimal functions levels such of as prefrontal cortical dopamine are critical to various executive working memory, attention, alcoholism.
inhibitory control, and risk/reward decisions, all of which are impaired in addictive disorders such as Imaging studies demonstrated striatum less of alcoholics dopamine in have the
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
PREFRONTAL CORTICAL DOPAMINE
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Less dopamine in the prefrontal cortex, which governs
ability
executive
to
functions,
learn informational/behavioral strategies
is because it could impair the addicted
and
important
person’s utilize 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
PREFRONTAL CORTICAL DOPAMINE
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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.
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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
THE SCIENCE OF RECOVERY: DOPAMINE (DA) TONE
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INCREASING DA TONE AT NAc
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THREE POSSIBLE APPROACHES
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INCREASE AMOUNT OF DA RELEASED CURRENTLY HAVE MEDS LIKE SUBOXONE THAT WILL DO THIS
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INCREASE NUMBER OF RECEPTORS-MEDS NOT AVAILABLE FOR THIS
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REDUCING REUPTAKE OF DA-HAVE MEDS THAT WILL DO THIS (PROVIGIL)
THE SCIENCE OF RECOVERY: THE OPIATE EXPERIENCE
HIGH
ABNORMALLY NORMAL SUBJECTIVE W/DRAWAL ACUTE ABSTINENCE SYN.
THE SCIENCE OF RECOVERY: DOPAMINE (DA) TONE
• • • •
SUBUTEX
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Buprenorphine. sublingual (SL)
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2mg and 8mg tablets SUBOXONE
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Buprenorphine/Naloxone SL tablets AND FILM Zubsolv SL PARTIAL AGONIST
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Increasing dose does not increase effect like a full agonist
THE SCIENCE OF RECOVERY: DOPAMINE (DA) TONE
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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
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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
PHARMACOLOGICAL
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NALTREXONE
• • (
Pure antagonist Revia, Vivitrol Poor compliance
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Less than 10% for street addicts
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Better compliance
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Healthcare professionals Parole/Probation
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New suspension with q30d administration should dramatically increase compliance and reliability of drug
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VIVITROL Carton Components
VIVITROL
VIVITROL
VIVITROL
VIVITROL
VIVITROL
Important Safety Information
53 • 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.
THE SCIENCE OF
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RECOVERY:GLUTAMATE NOTION THAT ADDICTION EQUALS TOO MUCH DOPAMINE IS A GROSS OVERSIMPLIFICATION IN ANIMAL STUDIES
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EVEN WHEN DA RECEPTORS ARE BLOCKED SOME DRUG-SEEKING BEHAVIOR PERSISTS
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EXTERNAL CUE DRIVEN
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DRUGS AFFECTING DA DIRECTLY HAVE BEEN INEFFECTIVE
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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.
THE SCIENCE OF
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RECOVERY: GLUTAMATE
TWO STAGE MODEL OF ADDICTION
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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
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DOPAMINE
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STAGE2-ADDITIONAL FEATURES INCLUDE WITHDRAWAL SYMPTOMS, PERSISTENT VULNERABILITY TO RELAPSE WITH ALTERATIONS IN DECISION MAKING AND OTHER COGNITIVE PROCESSES
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DRUG-INDUCED SIGNALS BY NEUROTRANSMITTER GLUTAMATE FROM BRAIN AREAS PRIMARILY ASSOCIATED WITH JUDGMENT
THE SCIENCE OF RECOVERY: GLUTAMATE
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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
THE SCIENCE OF RECOVERY:
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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
THE SCIENCE OF RECOVERY:
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GLUTAMATE ADDICTS CAN LEARN A NEW RULE BUT RUN INTO PROBLEMS WHEN THE RULES CHANGE
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COCAINE AND ALCOHOL ABUSERS WERE ASKED TO PRESS KEY EACH TIME THEY SAW A GREEN RECTANGLE ON THE SCREEN
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AFTER 500 REPETITIONS TOLD NOT TO PRESS KEY WHEN SAW GREEN RECTANGLE
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CONTROLS EASILY ADAPTED WHILE ADDICTS KEPT PUSHING THE KEY EVEN AFTER GIVEN FEEDBACK
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IMPAIRED REVERSAL LEARNING DUE TO DRUG USE AND NOT GENETICS
THE SCIENCE OF RECOVERY:
• • •
COGNITIVE FUNCTION Addiction is a disorder of altered cognition Addiction impacts…
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LEARNING
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MEMORY ATTENTION REASON IMPULSE CONTROL Effects are particularly disruptive when exposed during brain development and in the co-occurring population
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THE SCIENCE OF RECOVERY: COGNITIVE FUNCTION Cognitive deficits in chronic drug abuse
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Withdrawal produces cognitive symptoms
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Cocaine-deficits in
cognitive flexibility
Amphetamine-deficits in attention and impulse control
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Opioids-deficits in
cognitive flexibility
Ethanol-deficits in working memory and attention Cannabis-deficits in
cognitive flexibility
and attention
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Nicotine-deficits in working memory and declarative learning
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THE SCIENCE OF RECOVERY: COGNITIVE FUNCTION
Why give an alcoholic or addict a 60 minute didactic or video?
A new format
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15-20 minute simple didactic
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How to participate in treatment
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10 minute questionnaire
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30 minute discussion group
THE SCIENCE OF RECOVERY: COGNITIVE FUNCTION
I THINK………..
I FEEL…………..
I LEARNED…… MY FUTURE BEHAVIOR WILL CHANGE…
THE SCIENCE OF RECOVERY
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RELAPSE FALLS ALONG A SPECTRUM
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COMPULSIVE RELAPSE PREFRONTAL CORTEX OFF-LINE
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REGULATED RELAPSE SOME PREFRONTAL AVAILABILITY
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LITTLE OR NO RELAPSE PREFRONTAL CORTEX AVAILABLE
THE SCIENCE OF RECOVERY
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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.
THE SCIENCE OF RECOVERY
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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, syndromes unrelated to cocaine use.
or brain
THE SCIENCE OF RECOVERY
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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."
THE SCIENCE OF RECOVERY
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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)
ROBIN WILLIAMS
“I realized... you keep going with this, you’ll wake-up in a field with a small Williams.
animal,” laughed “If you’re violating your standards faster than you can lower them, time to go away.
”
THE SCIENCE OF RECOVERY: HABIT
YOU CANNOT EXTINGUISH A BAD HABIT;
YOU CAN ONLY CHANGE IT
THE SCIENCE OF RECOVERY: HABIT
THE CUE TRIGGERS THE ROUTINE AND ALSO TRIGGERS THE CRAVING FOR THE REWARD TO COME
THE 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
BASAL GANGLIA
THE SCIENCE OF RECOVERY: HABIT LOOP
CUE REWARD ROUTINE
THE 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
THE SCIENCE OF RECOVERY: HABIT LOOP
SAME CUE(S) SAME REWARD DIFFERENT ROUTINE
THE 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
THE SCIENCE OF
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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?
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It isn’t a craving to be drunk
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Physical effects of alcohol are the least rewarding (the same can be said for cocaine, methamphetamine, etc.)
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Is it connection, reduce anxiety, forget worries?
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Meetings and companionship-another bar to escape to, catharsis, distraction
THE SCIENCE OF
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RECOVERY: HABIT
What is the pleasure we seek in the first place?
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Is it…
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COMPLETION
• • • • • •
RELAXATION TO FORGET TO CONNECT TO REWARD MYSELF TO GIVE ME COURAGE TO FEEL LIKE YOU BELONG AS ONE OF THE GROUP
THE 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
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AA offers…
• • • •
Escape Catharsis Distraction Relief via talking
THE 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
THE SCIENCE OF
•
RECOVERY: HABIT
What is the thirst behind the thirst?
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“I was thirsty because I was feeling incomplete and alcohol helped me feel more connected, more alive.”
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Bill Wilson, “Before A.A. we were trying to drink God out of a bottle.”
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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
THE SCIENCE OF
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RECOVERY: HABIT
What is the thirst behind the thirst?
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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.”
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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.”
THE SCIENCE OF
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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:
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Could only stay sober by habit replacement until a major crisis hit
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Add spiritual element and now can get through these tough times
DOPAMINE (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
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REMOVE OVARIES OF FEMALE RAT (NO LONGER PRODUCE ESTROGEN) AND REDUCE DRUG SEEKING BEHAVIOR FOR COCAINE AND AMPHETAMINE
DOPAMINE (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
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DOPAMINE (DA) TONE-GENDER DIFFERENCES FEMALE RESPONSE VARIES ACROSS MENSTRUAL CYCLE AS LEVELS OF ESTROGEN AND PROGESTERONE WAX AND WANE (2007, SUZETTE EVANS, COLUMBIA UNIVERSITY)
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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
DOPAMINE (DA) TONE-GENDER
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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
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THIRTY-FOUR (34) PERCENT OF WOMAN IN FIRST GROUP HAD NOT SMOKED AT 30 DAYS
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FOURTEEN (14) PERCENT OF WOMEN IN THE SECOND GROUP HAD NOT SMOKED AT 30 DAYS (2008, SHARON ALLEN, UNIVERSITY OF MINNESOTA MED SCHOOL)