Relapse prevention 2 hours

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1-1

Session 1:Triggers and Cravings

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Changes in the Brain

Limbic System

Prefrontal Cortex

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Conditioning

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I.P. Pavlov (1849–1936)

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Pavlov’s Dog

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A Definition of AddictionAmerican Society of Addiction Medicine

A primary, chronic, neurobiologic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. Addiction is characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving.

Graham, A.W.; Schultz, T.K.; Mayo-Smith, M.F.; Ries, R.K.; and Wilford, B.B. eds. Principles of Addiction Medicine, Third Edition. Chevy Chase, MD: American Society of Addiction Medicine, Inc., 2003.

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The Addictive Process

Introductory phase Maintenance phase Disenchantment phase Disaster phase

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Addictive ProcessIntroductory Phase

PositivesRelief from

DepressionAnxietyLonelinessInsomnia

EuphoriaIncreased statusIncreased energyIncreased sexual/social confidenceIncreased work outputIncreased thinking ability

METHAMPHETAMINE(METH)

NegativesMay be illegal

May be expensiveMay cause missing work

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Matrix IOP 1-9

Conditioning Process During AddictionIntroductory Phase

Triggers• Parties• Special occasions

• Other events

Responses

• Pleasant thoughts about meth

• Infrequent use

Strength of Conditioned Connection:

Mild

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Development of Obsessive ThinkingIntroductory Phase

Sports

FoodSchool

TV

Girlfriend HobbiesJob

MethFamily

ExerciseParties

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Development of Craving ResponseIntroductory Phase

Entering Using Site

Use of Meth

Heart/pulse rate

Respiration

Adrenaline

Energy

Meth taste

Meth Effects

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Matrix IOP 1-12

PositivesDepression reliefConfidence boostBoredom reliefSexual enhancementSocial lubricant

NegativesEmployment/school

disruptionsRelationship concerns

Financial problemsBeginnings of physiological

dependence

Addictive ProcessMaintenance Phase

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Matrix IOP 1-13

Strength of Conditioned Connection:

Triggers• Parties• Friday nights• Friends• Alcohol• “Good times”• Sexual situations

Responses• Thoughts of meth• Eager anticipation

of meth use• Mild physiological

arousal• Cravings occur as use

approaches• Occasional use

Moderate

Conditioning Process During AddictionMaintenance Phase

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Matrix IOP 1-14

Meth

FoodSchool

TV

Girlfriend HobbiesJob

MethFamily

ExerciseParties

Development of Obsessive ThinkingMaintenance Phase

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Entering Using Site

Physiolog-ical Response

Use of Meth

Meth Effects

Heart Breathing Adrenaline effects Energy Meth taste

Heart Blood

pressure

Energy

Development of Craving ResponseMaintenance Phase

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PositivesSociabilityOccasional euphoriaRelief from fatigueRelief from stress

NegativesWithdrawal depression

ParanoiaTweaking

Relationship disruptionsFamily distress

Impending job loss

Addictive ProcessDisenchantment Phase

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Matrix IOP 1-17

Strength of Conditioned Connection:

Triggers• Fatigue• All friends• Stress• Boredom• Anxiety• Free time• Sexual arousal• Loneliness

Responses• Continual thoughts

of meth• Strong physiological

arousal• Psychological

dependency• Strong cravings• Frequent use

STRONG

Conditioning Process During AddictionDisenchantment Phase

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Matrix IOP 1-18

Meth

FoodMeth

TV

Girlfriend MethJob

MethFamily

MethParties

Meth

Development of Obsessive ThinkingDisenchantment Phase

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Thinking of Using

Mild Physiological Response

Entering Using Site

Heart rate Breathing rate Energy Adrenaline effects

Powerful Physiological

Response

Use of Meth Meth Effects

Heart rate Breathing rate Energy Adrenaline effects

Heart Blood

pressure Energy

Development of Craving ResponseDisenchantment Phase

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PositivesRelief from fatigueRelief from stressRelief from depression

NegativesWeight loss

ParanoiaLoss of family

SeizuresSevere depression

UnemploymentBankruptcy

Addictive Process Disaster Phase

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Matrix IOP 1-21

Strength of Conditioned Connection:

Triggers• Any emotion• Day• Night• Work• Free time

Responses• Obsessive thoughts

about meth• Powerful autonomic

response• Powerful physiological

dependence• Automatic use• Persistent paranoia

OVERPOWERING

Conditioning Process During AddictionDisaster Phase

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Matrix IOP 1-22

Meth

Meth

Meth

Meth Meth

Meth MethMeth

MethMeth

Meth

Development of Obsessive ThinkingDisaster Phase

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Thoughts of Meth- Using Place

Powerful Physiological Response

Heart rate Breathing rate Energy Adrenaline

effects

Development of Craving ResponseDisaster Phase

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Matrix IOP 1-24

Trigger

Thought

Craving

Use

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Interruption

Trigger

Thought

Craving

Use

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Thought Stopping

Visualization Rubberband snap Relaxation Calling someone

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Thought Stopping

Visualization

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Thought Stopping

Rubberband Snap

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Thought Stopping

Relaxation

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Thought Stopping

Calling Someone