Addiction
primary, chronic disease of brain reward, motivation, memory, and related circuitry
- problem behavior pattern or problematic experience
- unhealthy relationship between person and mood-altering substance, experience, event, or activity
ABCs
A - Inability to consistently Abstain B - Impairment in Behavioral control C - Craving D - Diminished recognition of significant problems E - Dysfucntional Emotional response
Biopsychosocial model of addiction
complex interactions between biological, psychological, and socio-cultural factors
- origins are complex
Addiction is a brain disease……
drugs/alcohol change the brain –> they can be long-lasting
Prefrontal cortex
- enables us to assess situations, make sound decisions
- keep out emotions/desires under control
- brain develops into adulthood and undergoes significant change during adolescence
Voluntary/Involuntary
initial decision to use is mostly voluntary
- once addicted –> self control is seriously impaired
Brain imaging of substance abusers
physical changes in areas of brain that are critical to judgement, decision making, learning, memory, etc
Long term use rewires the brain
trigger adaptation in habit or non-conscious systems
- conditioning –> cues become associated with experience/cravings
- learned reflex –> extremely robust
Rewarding
drugs/alcohol interact with circuits
–> euphoria, reduced negative feelings, “normal”, cravings
Natural Rewards
Food
Sex
Water
Nurturing
What do all drugs of abuse do?
directly/indirectly flood brain’s reward circuit with dopamine
- DA = regulation of movement, emotion, cognition, motivation, pleasure
- overstimulation of reward produces euphoria –> repetition
Lasting effects of brain
brain adjusts to overwhelming surges of dopamine by producing less dopamine and fewer receptors
- ability to experience pleasure is reduced
- need drugs in larger amounts
Risk factors
Genetics, early onset, childhood trauma, mental illness
Attempt to control
nearly all addicts believe when they start, they can stop on their own
- some are successful –> many fail
Treatment
addiction is treatable –> can be managed
- involves deeply embedded behaviors
- combo of meds and behavioral therapies
Behavioral Therapies
engage people
modify attitudes/behaviors
increase skills to hangle triggers/cravings
enhance effectiveness of meds
help people to remain in treatment in longer
Role of medications
treating withdrawal symptoms
treat cravings
prevent relapse
NOT A ONE SIZE FITS ALL
Stages of change
Meet people where they are at Pre-contemplation Contemplation Planning/Preparing Action Relapse Maintenance
Treatment should be….
pragmatic and flexible
- readily available
- strength-based
- holistic
- empowering
Treatment purpose
trajectory of change
when given a choice -> clients choose right level of care
Relapse
doesn’t mean failure
- likely that relapse happens –> serves as trigger for renewed intervention
Trauma & addiction
2/3 of people seeking treatment for substance abuse report 1 or more traumatic life events
3 R’s of trauma
Realizing prevalence of trauma
Recognizing how trauma affects individuals
Responding by putting knowledge into practice
Trauma-informed approach
Safety Trustworthiness and transparency Collaboration and mutuality Empowerment Voice and choice Peer support Resilience and strength-based Cultural, historical and gender issues
