A CONCIOUSNESS RECOVERY MODEL

An integrated model based on a Social Work Strength approach, Neuroscience, Neuroplasticity,

and recent knowledge of gambling addiction.

Ritchie Stewart

A CONTINUUM

REALITY

KNOWLEDGE

NEUROPLASTICITY

STRATEGY

CLIENTSTRENGTHS

ACCEPTING HELPACTIONS

OTHERS

ADDICTION RECOVERY

FANTASY

LIFE

NEW STATE OF

SELF AWARENESS

PERCEPTION OF SELFWHO AM I?

Addict identity CHOICE Wholeness

WORK

“He who loves practice without theory is like a sailor who boards ship without a rudder and compass and never knows where he may cast.”

Leonardo da Vinci

A moral question. A disease. A genetic problem passed through families. A learned behaviour. A social problem. A brain dysfunction. A chemical imbalance .

Gambling is a perversion of instinct of adventure and enterprise on which real progress depends, and to bring it to a mean and trivial level is individually and socially disastrous.All sin is perverted instinct. No sin is more pregnant with moral sin than gambling .G A Studdert –Kennedy. (1920,s)

OR: A dysfuctional way of fulfilling a perceived need which leads to impulsive and harmful behaviours.

Pathological Gambling has been re-classified in 2013 under the Substance Related and Addiction Disorders section .

It was previously categorised as an Impulse Control Disorder in the DSM1V.

“All addictions share the same brain circuits and brain chemicals… the aim of addiction on a biochemical level is to create and altered physiological state of the brain.”

G Mate pp137.

Whether it is genetic or otherwise determined a person has to learn to be an addict by indulging with the addictive agent and so develop the neurological system of addiction. It is all to do with the pleasure/ reward system in the brain. Learning begins in the womb and further learning develops through the pleasure /reward system, initially in attachment, and depends on what is assimilated. Addiction is an individual response and, it’s aetiology is difficult to determine.

1.Gambling is an addiction: it is a fully fledged member of the addiction family and shares the same characteristics.

2. There are many other addictions that do not necessarily involve substances.

3. Addiction is a learned behaviour but many of the drivers could facilitate its development, including moral, genetic, and social factors.

4. In our counselling we face all the above issues with clients and to miss out on how addiction is learned and develops is to leave out strategies for the client to recover.

5. Our basic aim is to facilitate the process for addicts to develop their own strengths to recover from addiction.

Do any changes in the functioning of the brain occur when addiction develops?

If so, what then is addiction anyway?

Before we answer this we need to consider the brain itself.

THE MISSING FACTOR IN ADDICTION COUNSELLING

Ritchie Stewart

Not hardwired… But reshaped from learnings

In the long run, we shape our lives, and we shape ourselves. The process never ends until we die. And the choices we make are ultimately our own responsibility.

Eleanor Roosevelt

To see addiction as the only problem is to leave intact the context that triggered the addiction in the first place G Mate pp398

But also- There are few things that can be done to beat

addiction and addicts have to change many of their parts to carry them out. Yet understanding the brain helps us to understand what those things are and why and how they work. Marc Lewis p306.

The Human heart

Amydala (Nut). This is the centre for emotions.

Hippocampus (Horse). The centre for memory. _

These are a part of the Limbic system in the mid-brain which is the area of the brain where responses to fear, sex and self preservation are centred.

Pre Frontal Cortex: PFC. The thinking area. When gambling a habit may develop and the OFC makes decisions prior to awareness. The work of recovery is to “live” more in the PFC.

Orbitofrontal cortex:OFC: the gateway for sensory perception. VTA: Glutamate from the OFC excites the VTA to produce

dopamine from the Nucleus Accumbans and the VTA gets charged with “meaning,” Gambling meets a perceived need.

Neurotransmitters :Dopamine (produces the wanting) goes to many other areas of the brain and endorphins (provide the “warm blanket” of pleasure) are released from the hypothalamus which further excite the release of more dopamine in a cycle of addiction.

Ventral Striatum. Part of the limbic system becomes a centre of “excited seeking” and synapses become constrained and sculptured to create addict brain neurology.

dACC The negotiating area between mid and higher brain. Formulates the will, the fulcrum of decision making. In response to recurring impulses it tires- Ego –failure,- relapse.

Amagdala and Hippocampus are involved in the dopamine cycle so emotions and memories of wins predominate.

The brain has made an error in assigning meaning to the addictive agent

The brain has condensed the individuals needs into a simple symbol, that stands for real needs. Those needs may have been unable for the individual at the time to meet.

The addictive brain still has plasticity: it can develop new neurological circuits.

Addiction is a dysfunctional way for an individual to meet a perceived need. Mate, 2010.

The addict says: “I need a drink,” or “to gamble,” or whatever the addiction is, when in fact they may be feeling something else; grief, hunger, guilt, thirst, ashamed.

Often shame is the overriding issue… …Heal the shame : heal the addiction.

The cravings come when the need is felt.

The brain has been changed: It has become over-sensitised to the addictive agent;

the brain craves a repeat dose, wanting is created. Glutamate from the OFC to the VTA and dopamine looping back to the OFC creates goals to be pursued.

AND: tolerance has developed, meaning larger doses of the

addictive agent are needed to produce a desired affect. The number of dopamine receptors has been reduced.

Neural circuitry of addiction (Hammer 2002)

Obviously it is inappropriate to lecture clients on neurology but the basic mechanisms of addiction and healing can be easily shown with potentially powerful outcomes .

Understanding more about addictions. Taking away fault. Giving hope for recovery. Giving power back to the client.

Lewis 2011

Lewis 2011

Lewis 2011Lewis 2011

“That was very helpful. I can refer back to this.. It helps me to process …definitely helped my understanding.” Murray

“Very helpful to understand what I should do.” Tina. “The best explanation I have heard. Can I have a photo of

that…easily understood explanation… makes sense.. can understand” Jared.

“ A big turning point. The knowing ‘why’ has definitely helped.” Lisa. T

“Yes I understand,...helps me to understand what is going on in my brain….makes me realise I need a plan….especially when I get a job.” Douglas.

Is a lifetime commitment, it is never complete,

Involves change, Hard work, Taking risks and being open to new things, Believing that there is a better life possible, Developing a spiritual understanding, Connecting with others on the same path- it

has a communal dimension.

Healing occurs in a sacred place located within us all. “when you know yourselves you will be known.” G Mate pp421

If the bugle makes an uncertain sound who will prepare for battle. 1 Cor 14 v8

“Against ignorance the Gods are powerless,” and knowledge can open a door to healing ourselves.

1. Relapse prevention Learn to say No in a way that takes hold and with a

different view of oneself, and ago fatigue does not eat away at your resolve. Say NO to the addiction itself.

Learn to limit the sensory inputs that trigger addiction.

2. Recovery Develop other pleasure reward pathways. “Fill your

life with meanings rich enough at least to compete with, if not defeat the well- worn (sculptured) synapses of imagined value.” Marc Lewis pp305

The key to recovery and to thinking. No matter how good our logic, or what

truth we know only perception changes emotions, and the path we take.

The task in counselling for recovery is to give the client the vision of what he/she can become, and knowledge of brain plasticity makes new possibilities real.

A CONTINUUM

REALITY

KNOWLEDGE

NEUROPLASTICITY

STRATEGY

CLIENTSTRENGTHS

ACCEPTING HELPACTIONS

OTHERS

ADDICTION RECOVERY

FANTASY

LIFE

NEW STATE OF

SELF AWARENESS

PERCEPTION OF SELFWHO AM I?

Addict identity CHOICE Wholeness

WORK

Gambling can become an Addiction which needs specialist intervention: gamblers can stop from gambling with help.

The client must accept the task and work in recovery. Addictions changes the brain. Recovery learning's can

develop new reward pathways which can defeat the old ones and give more enduring rewards. Knowledge of this is important.

Removal of gambling triggers, supporting new rewarding behaviours, providing a safe environment is helpful.

Management of finances and creating accountability is necessary.

Recovery is a journey: healing is possible for the Gambler. The clients self perception can be change with a strengths

based approach and this is crucial for self belief and progress.

Other interventions are important; medication, specialist referrals in healing of the whole person.

Gambling can become an Addiction which needs specialist intervention: gamblers can stop from gambling with help.

Addictions changes the brain. Recovery learning's can develop new reward pathways which can defeat the old ones and give more enduring reward.

Removal of gambling triggers, supporting new rewarding behaviours, providing a safe environment is helpful.

Management of finances and creating accountability is necessary.

Recovery is a journey: healing is possible for the Gambler. The clients self perception can be change with a strengths

based approach and this is crucial for self belief and progress.

Other interventions are important; medication, specialist referrals.

• SELECT BIBLIOGRAPHY Norman Doidge, The Brain That Changes

Itself 2007, Penguin Books Marc Lewis, Memoirs of an Addicted Brain

2011,Scribe Publications Ltd. Gabor Mate, In the Realm of Hungry Ghosts

2008, North Atlantic Books, California. Suomi et al, Problem Gambling and Family

Violence. Asian Journal of Gambling and PH Public Health 2013.

Barbara Arrowsmith –Young , The Woman who Changed her Brain. 2013. TEDxToronto.

There is a high correlation reported between problem gambling and family violence but little research into this area.

Gambling problems preceded victimisation and perpetration of family violence. There is co-occurrence of the two problematic behaviours. (Suomi 2013). This is not surprising considering financial control was one of the main strategies of family members along with other supportive strategies.

Also reported are impaired family relationships, emotional problems and financial difficulties. (Crisp, 2014 et al).

Family problems significantly influence the recovery process.

Ethically the primary goal of family intervention needs to be to get someone into treatment, (Heineman 1994) and while it is still true protection of the family is of overriding importance.