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Slide 1
The Science of Recovery
Brain, Behavior & Addiction
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Slide 2
Prolonged Drug Use Changes
the Brain In Fundamental
and Long-Lasting Ways
Science Has Shown That…
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Slide 3
The Brain Can Heal
And Remains Ever Changing
Science Has Also Shown That…
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Slide 4
“Well Being Is A Skill That Must
Be Practiced Not Unlike Learning
To Play an Instrument”
Dr. Richard Davidson
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Slide 5
Where to Start
Myths vrs Research:
1. People have to “hit bottom”
2. Person needs to accept they are an “alcoholic” or an
“addict”
3. “Addicts” need inpatient/residential rehabrestrictive treatment that is safe
4. “Addicts” are either ready to change – or not.
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Slide 6
Myth vrs Research:
5. “Addicts” need to be strongly confronted to break down
their denial
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Slide 7
First Thing Professionals Can Do
Change Our Language
Challenge Our Own Internal Myths
Work on our own bias
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Slide 8
Active Addiction:
Continually fires and strongly (efficiently) wires pathways in the brain which…
Reacts to it’s environment…
To create powerful emotional “memories” At a biochemical level In the part of the brain that drives behaviors
for survival.
–Mostly unconscious!
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Slide 9
Recovery
Balance Frontal Cortex and Meso Limbic systems
Re-establish/Create healthier pathways =
Better decision making!
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Slide 10
It Takes Time!
More you (repeat)…positively or negatively =
More efficiently and powerful pathway becomes
Time and practice needed to change pathways of strongly wired negative
connections
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Slide 11
Fundamental Skills For Long Term
Recovery
1. Learn relapse triggers and how to manage them
2. Change destructive thinking/feeling patterns
3. Identify emotional states and manage them
All related to changing brain wiring
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Slide 12
Consider Two States/Stages
Stage One - Early Recovery Cravings
Emotional Swings
Confusion
Old Thought Patterns Creating Negative Emotions
“Who am I!?”
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Slide 13
Role of Clinician
Help through EBPs (Recovery Science)
To Move Brain From:
Pro Using to Pro Recovery Patterns of Thinking
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Slide 14
Early Recovery
Managing Cravings Fundamental Skill
Common thought of ways to manage:
Avoidance
Extinguish
What’s the problem?
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Slide 15
Craving CrushersHealing The Addicted Brain
1. Talking about it right away
2. Distraction
3. Flash Cards
4. Stress Management Techniques
5. Visualization
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Slide 16
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Slide 17
MAT – Evidenced Based?You Bet!
↓ Drug use
↓ Deaths
↓ Criminal activity
↓ Risk/spread of HIV
↑ Retention in treatment
↑ Work engagement/social roles
↑ Pregnancy/child outcomes
J.Subst Abuse Tx 2014, Addiction 2013, J Biol Psychiatry 2011
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Slide 18
Meds used in Tx and Recovery
1. Subutex (Buprenorphine)
2. Suboxone (Buprenorphine & Naloxone)
3. Naltrexone – Oral or Vivitrol (Naltrexone Injection)
4. Methadone
5. Campral – Alcohol – Helps brain healing
6. Gabapentin – Marijuana withdrawl
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Slide 19
Medical Mgmt and Recovery
Naltrexone
Blocks opioid receptors
FDA approved for opioid and alcohol addiction
No diversion
Daily pill or monthly shot
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Slide 20
Contingency Mgmt – Motivational Incentives
Tool to enhance treatment and facilitate recovery
Target specific behaviors
Celebrate success of behavioral changes
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Slide 21
Adjunct to other therapeutic clinical methods
Helps motivate patients through stages of change to achieve identified goal
Reward/Recognition to celebrate achieved change
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Slide 22
Why Motivational Incentives?
• Minimum investment for increased retention
• Adoption of an evidence-based practice
• Limited training
• Motivates staff (possible retention)
• Provides a fun environment
• Promotes teamwork
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Slide 23
Stage Two – Recovery Management
Long Term Recovery Balancing Emotions and Thoughts
Feelings of Self-Efficacy
Confidence in high risk social situations
Feeling sense of community
General well being
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Slide 24
Transitioning to Long Term Recovery
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Slide 25
Group Therapy – Oldest EBP
Learn/relearn social skills
Provide useful information to new group members
Witness recovery of others
Witness/learn how others deal with similar problems
Offer family like experiences
Add needed structure and accountability
Experience sense of Altruism
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Slide 26
Important Components
Specialized training:
Group Work and
Group Work with people who have SUD’s
Clear Understanding of why group for SUD
Denial/Defenses
Complex Set of Defenses and Character Pathology
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Slide 27
Mindfulness Meets ACT
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Slide 28
Mindfulness meets ACT
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Slide 29
Cognitive Behavioral Therapy
•Emphasize role of thinking in:
– How we feel
– What we do
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Slide 30
Cognitive Behavioral Therapy
• Not a Distinct therapeutic technique
• Classification of therapies
• Commonality: Automatic Thoughts =
Feelings = What we do
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Slide 31
Break Negative Habit Loops
Creates New Neural Pathways
Cognitive Behavioral Therapy
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Slide 32
CBT
Components: Oppositional to on-going talk therapy
Instead:
Identify old thought patterns
Learn/practice new patterns
Stimulate critical thinking
Develop Skill – Rewire Brain!
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Slide 33
Why Do We Like It?
Short term
Extensively evaluated, solid research and results – Multi cultural
Structured, goal oriented
Flexible, can be adapted to wide range of settings
Compatible with other treatments
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Slide 34
Interactive SequenceCORE BELIEFS
Conditional Beliefs Situations
Automatic Thoughts
Feelings
Behaviors
Results in Relapse
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Slide 35
Cognitive Restructuring
You help client:
Observe Thoughts and Thinking Patterns
Identify whether thoughts are significantly negative or not based in reality (cognitive distortions)
Uses thought record to examine the evidence and construct alternative thought
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Slide 36
Automatic Thoughts
Reactions – “I don’t want to go, why did I say yes” (to 12-step mtg)
Monologue – “Now I can’t get out of it AND I still have to drop urines whenever they tell me to – this is stupid!”
Imagery – Picture of themselves sitting at a meeting feeling miserable
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Slide 37
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Slide 38
Alcoholics Anonymous
Most successful self-help group in terms of
numbers
Exists in 150 different countries worldwide
Many Online AA groups (international)
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Slide 39
Purpose
Poorly Studied
Poor methodology
Medical community knew it had success but didn’t know how/why TSF worked
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Slide 40
Since 1990’s
Behavior Change Research
Mechanisms in behavior change
TSF could potentially:
Reduce Health Care Burden
Could work with clinical Interventions –specifically designed to get patients involved in Recovery Support Services
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Slide 41
Research methods improved
2009 Pub Addiction Research and Theory:
Boosts coping skills
Maintain motivation of ongoing recovery
Boosts self efficacy
Decrease craving impulsivity
Reduces Depression
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Slide 42
Self Help Groups
Google: “Addiction recovery self help
groups”! 346,000 hits
How to define self help group?
Voluntary
Free (runs on donations)
Open ended
Anonymous
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Slide 43
Confidence in high risk social situations
Changing social networks
Increase rates of full remission
Therapists: AA “warm handoff”
Physicians and Therapists – higher rate of cooperation
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Slide 44
What About Trauma Informed
The Future of Healing: Shifting From
Trauma Informed Care to Healing Centered
Engagement Dr. Shawn Ginwright, Associate Professor of Education, and African American
Studies at San Francisco State University and the author of Hope and Healing in
Urban Education: How Activists are Reclaiming Matters of the Heart.
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Slide 45
“A healing centered approach to addressing
trauma requires a different question that moves
beyond “what happened to you” to “what’s right
with you” and views those exposed to trauma as
agents in the creation of their own well-being
rather than victims of traumatic events.”
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Slide 46
Core Components of HCE
Healing Centered Engagement is culturally
grounded and views healing as the
restoration of identity.
Healing Centered Engagement is asset
driven and focuses on well-being we want,
rather than symptoms we want to suppress.
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Slide 47
Healing Centered Engagement supports
clients and providers with their own healing.
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Slide 48
Summary
Where attention goes, neurons fire.
And where neurons
fire, they can re-wire.Daniel Siegel, The Mindful Brain: Reflection
And Attunement in the Cultivation of Well-
Being (2007), p. 291
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