THE BRAIN MODEL OF ADDICTION Drug Court Conference Normal, OK. September, 2014 Matrix Institute On Addictions Sam Minsky, MA, LMFT

THE BRAIN MODEL OF ADDICTION

Drug Court ConferenceNormal, OK. September, 2014

Matrix Institute On AddictionsSam Minsky, MA, LMFT

© 2006 Matrix Institute

A Major Reason People Take a Drug is They Like

What it Does to Their Brains

Initially, A Person Takes A Drug Hoping to Change their Mood, Perception, or Emotional State

Initially, A Person Takes A Drug Hoping to Change their Mood, Perception, or Emotional State

Translation---Translation---

…Hoping to Change their Brain…Hoping to Change their Brain

After A Person Uses Drugs For A While,Why Can’t They Just Stop?

After A Person Uses Drugs For A While,Why Can’t They Just Stop?

But Then…But Then…

Their Brains

have been Re-Wired by Drug Use

Their Brains

have been Re-Wired by Drug Use

Because…Because…

TRIGGER


Definition

A trigger is a stimulus which has been repeatedly associated with the preparation for, anticipation of or the use of drugs and/or alcohol. These stimuli include people, things, places, times of day, and emotional states.


Triggers and CravingsHuman Brain

00

5050

100100

150150

200200

00 6060 120120 180180

Time (min)Time (min)

% o

f B

asal

DA

Out

put

% o

f B

asal

DA

Out

put

NAc shellNAc shell

EmptyEmpty

BoxBox FeedingFeeding

Source: Di Chiara et al.Source: Di Chiara et al.

FOODFOOD

100100

150150

200200

DA

Con

cent

ratio

n (%

Bas

elin

e)D

A C

once

ntra

tion

(% B

asel

ine)

MountsMountsIntromissionsIntromissionsEjaculationsEjaculations

1515

00

55

1010

Co

pu

latio

n F

req

ue

ncy

Co

pu

latio

n F

req

ue

ncy

SampleNumberSampleNumber

11 22 33 44 55 66 77 88 99 1010 1111 1212 1313 1414 1515 1616 1717

ScrScrScrScrBasBasFemale 1 PresentFemale 1 Present

ScrScrFemale 2 PresentFemale 2 Present

ScrScr

Source: Fiorino and PhillipsSource: Fiorino and Phillips

SEXSEX

Natural Rewards Elevate Dopamine LevelsNatural Rewards Elevate Dopamine Levels


00

100100

200200

300300

400400

Time After CocaineTime After Cocaine

% o

f Bas

al R

elea

se%

of B

asal

Rel

ease

DADADOPACDOPACHVAHVA

AccumbensAccumbens COCAINECOCAINE

00

100100

150150

200200

250250

00 11 22 3 hr3 hr

Time After NicotineTime After Nicotine

% o

f Bas

al R

elea

se%

of B

asal

Rel

ease

AccumbensAccumbensCaudateCaudate

NICOTINENICOTINE

Source: Shoblock and Sullivan; Di Chiara and Imperato

Effects of Drugs on Dopamine Release

100

150

200

250

0 1 2 3 4hrTime After Ethanol

% o

f Bas

al R

elea

se0.250.512.5

Accumbens

0

Dose (g/kg ip)

ETHANOL

Time After Methamphetamine

% B

asal

Rel

ease

METHAMPHETAMINE

0 1 2 3hr

1500

1000

500

0

Accumbens

Triggers and Cravings



Pavlov’s Dog




MATRIX MODEL TREATMENT Triggers - People

•Drug-using friends/dealer

•Voices of drug friends/dealer

•Absence of significant other

•Sexual partners in illicit sex

•Groups discussing drug use


MATRIX MODEL TREATMENT Triggers - Things

•Paraphernalia

•Sexually explicit magazines/movies

•Money/bank machines

•Music

•Movies/TV shows about alcohol and other drugs

•Secondary alcohol or other drug use


MATRIX MODEL TREATMENT Triggers - Places

•Drug dealer’s home

•Bars and clubs

•Drug use neighborhoods

•Freeway offramps

•Worksite

•Street corners


MATRIX MODEL TREATMENT Triggers - Times

•Periods of idle time•Periods of extended stress•After work•Payday/AFDC payment day•Holidays•Friday/Saturday night•Birthdays/Anniversaries

Triggers and CravingsStimulant Users

•Alcohol Use•Drug Using Friends•Environmental Cues• Money• ATM• Freeway Exits• Neighborhoods

•Stimulant - Sex Connection•Boredom


Alcohol Users•Negative Affective States - Especially Anger and Depression•Discontinuation of AA Involvement•Social Availability of Alcohol•Relationship Disruptions•Situational Issues• Happy Hour• Airplane Trips• Holidays

Cognitive Process During Addiction


Relief FromDepressionAnxietyLonelinessInsomniaEuphoriaIncreased StatusIncreased EnergyIncreased Sexual/Social ConfidenceIncreased Work OutputIncreased Thinking Ability

AOD

Introductory PhaseMay Be Illegal

May Be ExpensiveHangover/Feeling Ill

May Miss Work

Conditioning Process During Addiction


Introductory Phase

Triggers•Parties•Special Occasions

Responses•Pleasant Thoughts about AOD

•No Physiological Response

•Infrequent Use

Strength of Conditioned Connection

Mild

Development of Craving Response


Introductory Phase

Entering Using Site

Use of AODsAOD Effects Heart/Pulse Rate Respiration Adrenaline Energy Taste

Development of Obsessive ThinkingIntroductory Phase


Sports

FoodSchool

TV

Girlfriend HobbiesJob

AODFamily

ExerciseParties



Maintenance Phase

Depression ReliefConfidence BoostBoredom ReliefSexual EnhancementSocial Lubricant

Vocational DisruptionRelationship Concerns

Financial ProblemsBeginnings of Physiological

Dependence



Maintenance Phase

Entering Using Site

Physiological Response

Use of AODs

AOD Effects

Heart Rate

Breathing Effects

Adrenaline

Effects Energy Taste

Heart

Blood

Pressure

Energy


Development of Obsessive Thinking

Maintenance Phase

AOD

FoodSchool

TV

Girlfriend HobbiesJob

AODFamily

ExerciseParties



Dependence Phase

Social CurrencyOccasional EuphoriaRelief From LethargyRelief From Stress

Nose BleedsInfections

Relationship DisruptionFamily Distress

Impending Job Loss



Dependence PhaseStrength of Conditioned

ConnectionTriggers•Weekends•All Friends•Stress•Boredom•Anxiety•After Work•Loneliness

Responses•Continual Thoughts of AOD

•Strong Physiological Arousal

•Psychological Dependency

•Strong Cravings•Frequent Use

STRONG


Development of Craving ResponseDependence Phase

Thinking of Using

Mild Physiological Response

Entering Using Site

Heart Rate Breathing Rate Energy Adrenaline Effects

Powerful Physiological Response

Use of AODs AOD Effects

Heart Rate Breathing Rate Energy Adrenaline Effects

HeartBlood PressureEnergy


Development of Obsessive Thinking

Dependence Phase

AOD

FoodAOD

TV

Girlfriend AODJob

AODFamily

AODParties


Cognitive Process During AddictionDisaster Phase

Relief From FatigueRelief From StressRelief From Depression

Weight LossParanoia

Loss of FamilySeizures

Severe DepressionUnemployment

Bankruptcy



Disaster PhaseStrength of Conditioned

Connection

Triggers•Any Emotion•Day•Night•Work•Non-Work

Responses•Obsessive Thoughts About AOD

•Powerful Autonomic Response

•Powerful Physiological Dependence

•Automatic Use

OVERPOWERING



Disaster Phase

Thoughts of AOD Using Place

Powerful Physiological Response

Heart Rate Breathing Rate Energy Adrenaline

Effects


Development of Obsessive Thinking Disaster Phase

AOD

AODAOD

AOD

AOD AOD

AOD AODAOD

AODAOD



Alan Leshner NIDA

© 2006 Matrix InstituteAlan Leshner NIDA




The Memory of Drugs

Nature Video Cocaine Video

Front of Brain

Back of Brain

Amygdalanot lit up

Amygdalaactivated


MA > Control

5

4

2

0

1

3


Control > MA

4

3

2

0

1


Prolonged Drug Use Changesthe Brain In Fundamentaland Long-Lasting Ways

CompulsiveDrug Use(Addiction)

CompulsiveDrug Use(Addiction)

VoluntaryDrug UseVoluntaryDrug Use

Addiction Is A Brain DiseaseExpressed As Compulsive Behavior

Both Developing and Recovering From It Depend onBehavior and Social Context


Which is why:Treatment is critical component

for long term recovery and must develop

effective interventions!

Alan Leshner NIDA

Triggers & Cravings


Trigger Thought Craving Use


Trigger

Thought

Craving

Use

Triggers & Cravings


Thought Stopping


•Visual Imagery•Snapping•Relaxation•Call Someone•Pray•Urge Surfing


CREATE EXPLICIT STRUCTURE AND EXPECTATIONS

• Scheduling creates a portable structure• Eliminates avoidable triggers• Conceptualizes “One day at a time”.• Reduces anxiety• Counters the addicted lifestyle• Provides the basic foundation for an ongoing recovery• Gives the facilitator and the group a window into areas of

relapse risk exposure.


Daily/Hourly Schedule

Date: ________ Date: ________ Date: ________

7:00 ____________________ 7:00 ____________________ 7:00 ____________________ 8:00 ____________________ 8:00 ____________________ 8:00 ____________________ 9:00 ____________________ 9:00 ____________________ 9:00 ____________________ 10:00 ___________________ 10:00 ___________________ 10:00 ___________________ 11:00 ___________________ 11:00 ___________________ 11:00 ___________________ 12:00 ___________________ 12:00 ___________________ 12:00 ___________________ 1:00 ____________________ 1:00 ____________________ 1:00 ____________________ 2:00 ____________________ 2:00 ____________________ 2:00 ____________________ 3:00 ____________________ 3:00 ____________________ 3:00 ____________________ 4:00 ____________________ 4:00 ____________________ 4:00 ____________________ 5:00 ____________________ 5:00 ____________________ 5:00 ____________________ 6:00 ____________________ 6:00 ____________________ 6:00 ____________________ 7:00 ____________________ 7:00 ____________________ 7:00 ____________________ 8:00 ____________________ 8:00 ____________________ 8:00 ____________________ 9:00 ____________________ 9:00 ____________________ 9:00 ____________________ 10:00 ___________________ 10:00 ___________________ 10:00 ___________________11:00 ___________________ 11:00 ___________________ 11:00 ___________________

Notes: _____________________________________________________________________________

Reminders: ______________________________________________________________________________

•

Documents

THE BRAIN MODEL OF ADDICTION Drug Court Conference Normal, OK. September, 2014 Matrix Institute On Addictions Sam Minsky, MA, LMFT