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NEUROSCIENCE OF ADDICTION: A New Way To Think About Recovery Presented by Daniel Hochman, MD March 28, 2018
NEUROSCIENCE OF ADDICTION:A New Way To Think About Recovery
Presented by Daniel Hochman, MD
March 28, 2018
Thomas Durham, PhD
Director of Training
NAADAC, the Association for Addiction
Professionals
www.naadac.org
Produced By
NAADAC, the Association for Addiction Professionalswww.naadac.org/webinars
www.naadac.org/webinars
www.naadac.org/neuroscience-addiction-webinar
Cost to Watch:Free
CE Hours Available:1.5 CEs
CE Certificate for NAADAC Members:Free
CE Certificate for Non-members:$20
To obtain a CE Certificate for the time you spent watching
this webinar:
1. Watch and listen to this entire webinar.
2. Pass the online CE quiz, which is posted at
www.naadac.org/neuroscience-addiction-webinar
3. If applicable, submit payment for CE certificate or join
NAADAC.
4. A CE certificate will be emailed to you within 21 days of
submitting the quiz.
CE Certificate
Using GoToWebinar – (Live Participants Only)
Control Panel
Asking Questions
Audio (phone
preferred)
Polling Questions
LEARNING OBJECTIVES
Highlight the most
evidence-based research
we have on what drives
addiction.
Learn an easy to use, holistic
model that improves relapse
prevention and outcomes.
1 32
List the most common
misconceptions about
substance use disorder, and
studies that refute them.
● 1 in 10 over 12 years old is addicted to drugs or alcohol right now.
● In any given year, about 1 in 2 people are addicted to at least one of the following: tobacco, alcohol, illicit drugs, eating, gambling, Internet, love, sex, exercise, work, and shopping.
● These numbers are even higher for lifetime prevalence.
● Only 1 in 10 addicted to alcohol or drugs gets treatment.
STATS ON ADDICTION
MISCONCEPTIONS ABOUT SUBSTANCE USE DISORDER
Most of addiction is caused by genes.
-True-False
● Genes cause traits. Not deterministic.
● Genes turn on and off (epigenetics).
● Even having all of the “addiction genes” doesn’t consistently cause addiction.
● Primate studies have turned off “addiction genes” if raised with warm nurturing.
● Pregnancy and early environment can also turn on and off genes.
● Lance Dodes: “the most important finding of research into a genetic role for alcoholism is that there is NO SUCH THING as a gene for alcoholism.”
50-70% OF ADDICTION IS CAUSED BY GENES
Brain abnormalities you are born with will remain and cause addiction.
-True-False
● There are indeed differences seen on fMRI between addict vs non-addict brains.
● Anything we do changes our brain.
● Example: there are also differences between cab driver vs non-cab driver brains.
● The differences detected are reversible.
● The brain is incredibly adaptable and plastic.
BRAIN ABNORMALITIES CAUSE ADDICTION
Addiction is a choice. You can choose whether or not you do anything.
-True-False
● ”Just say no” campaign ineffective.
● Functional brain imaging shows choices are made before the subject is aware of it.
● Our choices are mostly implicit, automatic.
● Think of this as a consciousness problem, not a choice problem.
ADDICTION IS A CHOICE
SO WHAT DOES CAUSE ADDICTION?
● We actually need the addiction pathway for:
○ Motivation
○ Reward
○ Impulsivity
● Addiction is actually an OVER-adaptation, not a lacking of anything.
WE’RE ALL WIRED FOR ADDICTION
1. Lack of Belonging
2. Poor Impulse Control
3. Emotional Distress (frustration intolerance)
THE 3 LEARNED TRAITSIN ADDICTION
● Long before your first drug!
● Often raised with an emphasis on:
○ Results & Achievement (not the effort/journey) = emptiness
○ Pleasing others (not self efficacy/actualization) = lack of purpose
○ Criticism (not praise) = lack of belonging, hopeless, poor impulse control
● …LIFE IS JUST NOT FUN
WHERE DOES ADDICTION BEGIN?
● Stressful childhoods cause underdeveloped
reward pathways, less dopamine and opiate
receptors.
● The body compensates by seeking external
surges in dopamine through addiction.
● The internal mechanism to produce dopamine
learns to shut down.
● = RELIANCE ON ADDICTION
WHAT DOES THIS DO TO THE BRAIN?
A HELPFUL WAY OF UNDERSTANDING ADDICTION
National Institute on Drug Abuse:
“A chronic, relapsing brain disease that’s characterized by compulsive drug seeking and use, despite harmful consequences.”
-negative implications, sets a critical tone from the outset, limited to chemicals/compounds
Alternative definition:
“Seeking pleasure to escape intolerable emotion.”
DEFINITIONS
THE CURRENT OF ADDICTION
AN INTEGRATED, HOLISTIC MODEL
● Ask the patient what they already know
● Ask if they would like to know more
● Educate briefly, with relevant info
● Be sensitive to shaming, judging
● Excessive education can quickly turn into lecturing and disapproval
But First: INFORMATION IS NOT TREATMENT
The PAIN!
● Source of PAIN
● Perception of the PAIN
● Intolerance for the PAIN
● Behaviors to escape PAIN
● Shame about the PAIN
Addiction is your hook. They can’t deny something’s wrong.
SO WHAT ARE WE GOING AFTER?
● Soothing & grounding techniques
● Distraction
● Transferring addiction
● Accountability
● Relapse Planning
...But you have to ease into it.INTRODUCE SKILLS TO DIRECTLY ADDRESS HABITS IN ADDICTION
● “Urge surfing”
● Anticipation
● Teach a broader understanding
of cravings and attachment
TEACH A TOLERANCE FOR CRAVINGTHROUGH THE PEAK
● Look for romanticizing
● Teach pleasure from health vs. false
pleasure from pain avoidance
● Impermanence: look for a sense of
entitlement to a stress free life
● Look for false pleasures from seemingly
healthy things (people pleasing,
appearance, obsessions)
REFRAME THE PLEASURES
● This is the source of all addiction. Always.
Otherwise it’s not addiction, it’s just recreational.
● Our emotions are our best teachers/signals/guides.
● Pains come up in life over and over, forever.
● Explore pains of overt traumas, neglect, lack of belonging, feeling
different, shame over life or addiction, lost time, failed relationships,
etc.
● DEVELOP ACCEPTANCE AND FORGIVENESS!
DEVELOP A HEALTHY RELATIONSHIP WITH PAIN
● Unprogram results-oriented processing
● The basics: nutrition, sleep, exercise
● Ritual
● Stillness, mindfulness
● Giving, compassion, openness, connection
● Process (not content) driven activity
● “Self Religion” (principles to live by)
● Goals with no end
MODEL HEALTH FOR SELF EFFICACY
Which of these 5 phases do you feel most comfortable working with?
1. Emotional Pain2. Tolerating Cravings3. Addiction (the behavior itself)4. False Pleasures5. Modeling Health
● Cases?
● Questions?
● Let’s Discuss!
www.naadac.org/neuroscience-addiction-webinar
Cost to Watch:Free
CE Hours Available:1.5 CEs
CE Certificate for NAADAC Members:Free
CE Certificate for Non-members:$20
To obtain a CE Certificate for the time you spent watching
this webinar:
1. Watch and listen to this entire webinar.
2. Pass the online CE quiz, which is posted at
www.naadac.org/neuroscience-addiction-webinar
3. If applicable, submit payment for CE certificate or join
NAADAC.
4. A CE certificate will be emailed to you within 21 days of
submitting the quiz.
CE Certificate
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