Applying the SOAR - Expect resilience, not relapse 180206brauchtworks.com/yahoo_site_admin/assets/docs/... · 3 Applying the Science of Addiction Recovery (SOAR): Expect Resilience,

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Applying the Science ofAddiction Recovery (SOAR):

Expect Resilience, Not Relapse

George S. Braucht; LPC, CPCS & CARES Brauchtworks Consulting www.brauchtworks.com Applying Science to Practice

George S. BrauchtLPC, CPCS & CARESBrauchtworks Consulting

CARES Academy Co-founderEmail: [email protected]

facesandvoicesofrecovery.org

Applying Science to Practice: brauchtworks.com

Applying the Science ofAddiction Recovery:Expect Resilience, Not Relapse

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A Moment of Silent Stillness

“If we had a keen vision of all that is ordinary in human life, it would be like hearing the

grass grow or the squirrel’s heart beat,and we should die of that roar which

is the other side of silence.”George Eliot (Mary Ann Evans). (1872). Middlemarch.

David Crosby. (1988). Compass.

My JOY Notes:

Write down three moments of joy thatyou experienced in the last 24 hours

Expect Resilience: Journaling Matters!

Promoting professional growth and career development M.S. in Experimental/Physiological Psychology

then Community Psychology; taught 1st

psychology class at Georgia College in 1979

Licensed Professional Counselor and Certified Professional Counselor Supervisor: Crisis, AOD & MH recovery; Social justice; Recovery residences & Peer services

Co‐founder and Faculty, Certified Addiction Recovery Empowerment Specialist (CARES) Academy

Lead Curriculum Developer and Faculty, RecoveryPeople’sRecovery Residence Manager Training and the Recovery Outcomes Institute’s REC CAP Training

Georgia Association of Recovery Residences Board & Charter Board Member, National Alliance for Recovery Residences

Certified Trainer in the Partners for Change Outcome Management System with Dr. Barry Duncan’s Heart and Soul of Change Project

George S. BrauchtLPC, CPCS & CARES

Brauchtworks ConsultingApplying Science to Practice

brauchtworks.com

“I just want to help people.”

George S. BrauchtLPC, CPCS & CARES

Brauchtworks ConsultingApplying Science to Practice

brauchtworks.com

“I just want to help people.”

Schedule9:00pm – 12:15pm

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Three Key Takeaways

Like other preventable, treatable and chronic health conditions:

Addiction and recovery affect the _____, mind and behavior

Recovery requires daily and sustained engagement and connections

brain

Over _________ Americans are in long-term recoveryfrom AOD use and we carry the message of _____ and

Expect Recovery!

Three Key Takeaways (cont.)

Like other preventable, treatable and chronic health conditions,

25 million

hope

Identify five aspects of the social model of recovery;

Explain tolerance, withdrawals, addiction, relapse, and recovery based on current neuroscience;

Counteract three common beliefs that stunt recovery or resilience following setbacks or trauma; and

List five contributors to, and two exercises for, resilience or post-trauma growth.

After this session participants will be able to…

Participate in this training’s participant polls by logging your smart phone, tablet

or computer web browser into responseware.com

Enter as a “Guest”with Session ID: ExpectRecovery

Select all that apply. I am a…

Who are you?

A. Person in recoveryB. Certified peer recovery support service providerC. Licensed/certified behavioral health professionalD. Licensed medical professionalE. News reporterF. Ally of people in recoveryG. Apparently in the wrong room!

Participant Poll:response ware.comSession

ExpectRecovery

The Problem

Addictionis a

chronichealth

condition

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Recovery-Oriented Systems of Care (ROSC)

Paradigm Shift to Mutually Enhance Acute Carewith Chronic Support and

Social Model of Recovery Programs

Acute Care Focus on the

Disease Process Disease Experts

& Treatment

Chronic Support Focus on the

Recovery Process Recovery Experts

& Support

Expect relapse!

Expect recovery and resilience!

both/and

Social Model of Recovery

Borkman, Kaskutas, Rooms, Bryan, & Barrows. (1998). An historical and developmental analysis of Social Model Programs. Journal of Substance Abuse Treatment, 15 (1), 7-17.

1. Emphasize social & interpersonal connection as the foundation of recovery.

2. Value experiential knowledge.

3. Promote peer-to-peer connections, mutual aid and other supportive environments in which recovery or wellbeing is the common bond.

4. Require active work in an individualized recovery program.

5. Emphasize peer-to-peer AND practitioner-client relationships that mutually blend to enhance treatment and recovery or wellness plans.

If you want to travel fast, go alone. To go far,

travel with many.

African Proverb

Until lions have historians, tales of hunting will always glorify the hunter.

African Proverb

The solutions: Listen to recoverystories of the benefits ofsustained connections

Recovery Screening Test

1. Place both feet on the floor

2. Lift your right foot off thefloor and make clockwisecircles.

3. With your right hand, drawa "6" in the air.

If your foot stopped or changed direction,recovery is possible for you!

Recovery isa Process

Applying the SOAR

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Participate in this training’s participant polls by logging your smart phone, tablet

or computer web browser into responseware.com

Enter as a “Guest”with Session ID: ExpectRecovery

Based on research, what percentage of people who achieve 1-3 years of abstinence do not return to AOD use?

a. 26%b. 36%c. 66%d. 86%

The Likelihood of Sustaining Abstinence Another Year Grows Over Time

36%

66%

86%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1 to 12 months 1 to 3 years 4 to 7 years

Duration of Abstinence

% S

usta

inin

g A

bsti

nenc

eA

noth

er Y

ear

.

After 1 to 3 years, less than half return to AOD use

After about 5 years, only 14% resume AOD use

Dennis, Foss & Scott (2007). An eight-year perspective on the relationship between the duration of abstinence and other aspects of recovery. Evaluation Review, 31(6), 585-612.

Over a third of people with

less than a year of abstinence will sustain it another year

Dennis, M.L., Foss, M.A., & Scott, C.K (2007). An eight-year perspective on the relationship between the duration of abstinence and other aspects of recovery. Evaluation Review, 31(6), 585-612.

Recovery, on average, looks like…Duration of Abstinence

1-12 Months 1-3 Years 4-7 Years

Virtual elimination of illegal activity and illegal income

Better housing and living situations

Increasing employment and income

More clean and sober friends

Less illegal activity and incarceration

Less homelessness, violence and victimization

Less use by others at home, work and by social peers

More social and spiritual support Better mental health Housing and living situations

continue improving Dramatic rise in employment and

income: Dramatic drop in # who live below the poverty line

Behavior is always a

function of people

interacting with

environments

The Answer B = P X EWhen were Dr. Bruce

Alexander’s rat park studies

published?

Genetics and your history of experiences (P) influenceshow your brain reacts…

Along with environmental (E)contributions

Individual Variability

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Yellow =where cocaine binds

in the brain

Individual Variability: A brain on drugs

The Mind says,“This must be life enhancing

(or not)!”

People vary in what they find pleasurable because of how their brains react to experiences likesex, drugs, rock-n-roll…

Individual Variability (cont.)

One reason is that we like what

happens in our brains

Why do we use alcohol and other drugs?

The Brain (and Mind)

Applying the SOAR

Communication in the Brain

Neuron: single cell

Neurotransmitters: chemicals used to communicate across neuron’s synapses

Experiences and learning cause synapse connections and

strengthening

The Brain Approximately 4-6 pounds

Estimated 100 billion neurons 10,000 varieties of neurons

Neurons communicate via electro-chemical processes

Miles of blood vessels

Estimated 1010 connections among neurons Sensory patterns and change detection plus map and

meaning-making The Mind

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Adolescence (cont.)

Purple/blue = fully maturewith dense connections

Responsible for initiating and controlling every: sensation movement/behavior emotion thought

That makes up the humanexperience!

Some of the most important changes in the brain occur in adolescence (years 10-25)

The Brain (cont.)

Circuits Involved inDrug Use and Addiction

Each of these brain regions must be considered when developing strategies to effectively treat addiction

1

2

3

4Where addiction starts in the brain

The limbic system Reacts subconsciously

to environmentalstimulation & patterns

Creates powerful emotions& memories, both pleasant[joy] and unpleasant [fear], that drivesurvival [instinctual] behavior

NAcc = Releases oxytocin, dopamine, etc. VTA = Prediction errors and learning FC = Integrates body-based AND others’

emotions into decision-making

00

5050

100100

150150

200200

00 6060 120120 180180

Time (min)Time (min)

% o

f B

asal

DA

Ou

tpu

t%

of

Bas

al D

A O

utp

ut

NAc shellNAc shell

EmptyEmpty

BoxBox FeedingFeeding

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

FOODFOOD

100100

150150

200200

DA

Co

nce

ntr

atio

n (

% B

asel

ine)

DA

Co

nce

ntr

atio

n (

% B

asel

ine)

MountsMountsIntromissionsIntromissionsEjaculationsEjaculations

1515

00

55

1010

Co

pu

lation

Freq

uen

cyC

op

ulatio

n F

requ

ency

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 levels

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00100100200200300300400400500500600600700700800800900900

1000100011001100

00 11 22 33 44 5 hr5 hr

Time After AmphetamineTime After Amphetamine

% o

f B

asal

Rel

ease

% o

f B

asal

Rel

ease

DADADOPACDOPACHVAHVA

AccumbensAccumbens AMPHETAMINEAMPHETAMINE

00

100100

200200

300300

400400

00 11 22 33 44 5 hr5 hrTime After CocaineTime After Cocaine

% o

f B

asal

Rel

ease

% o

f B

asal

Rel

ease

DADADOPACDOPACHVAHVA

AccumbensAccumbensCOCAINECOCAINE

00

100100

150150

200200

250250

00 11 22 33 44 5hr5hrTime After MorphineTime After Morphine

% o

f B

asal

Rel

ease

% o

f B

asal

Rel

ease

AccumbensAccumbens

0.50.51.01.02.52.51010

Dose (mg/kg)Dose (mg/kg)

MORPHINEMORPHINE

00

100100

150150

200200

250250

00 11 22 3 hr3 hrTime After NicotineTime After Nicotine

% o

f B

asal

Rel

ease

% o

f B

asal

Rel

ease

AccumbensAccumbensCaudateCaudate

NICOTINENICOTINE

Effect of drugs on dopamine release

Source: Di Chiara and Imperato (as adapted for National Institute on Drug Abuse Presentation)

Brain Adaptation to AOD Use

1. Use changes neurotransmitter levels

2. Brain stops neurotransmitter production to re-establish biological balance (homeostasis)

3. Result a period of reduced brain functioning before returning to normal Craving

Brain Adaptation to Repeated AOD Use

1. Anticipation of Use changes neurotransmitter/ hormone levels = boosts emotions & pre-use preparations

2. Result more of the drug is needed to get the desired effect =

Tolerance

Understanding people’s behavior while using AOD or in early-middle recovery

Brain systems changes occur over time and take time to re-set

Override factual memory storage (hippocampus) and logical reasoning (prefrontal cortex) and re-set behavioral priorities

Helps explain behavior that “flies” in the face of logic, e.g., return to AOD use, lying, etc.

Why return to AOD use? (B=PXE) Cravings are due to external (E) &

internal (P) triggers/anchors that set off a physiological chain reaction from the brain or the body

fight/flight/tend/etc.

Examples of external (E) triggers:± People: “That wrong crowd”± Places: The Corner, Celebrations± Things: Cash, Payday, Fridays, overhearing a

conversation, a song/tune, a commercial, drug paraphernalia, etc.

Examples of internal (P) triggers:HALT: states of deprivation or excess

Hungry or HappyAngry or AggrandizedLonely or LoveTired or Tempted

Why return to AOD use? (B=PXE) (cont.)

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setsand re-sets

brain systems and our priorities

Therefore, brain adaptation accounts for cravings and returning to alcohol and other drug use that…

Explains seemingly weak-willed or otherwise unexplainable behavior

Causes both structural/physical andfunctional changes in brain structures and neurotransmitter pathways

and…

changes the mind!

So, prolonged AOD use…..

Partial Recovery of Brain Dopamine Transportersin Methamphetamine (METH)

Abuser After Protracted Abstinence

Normal Control METH Abuser(1 month detox)

METH Abuser(14 months detox)

0

3

ml/gm

Source: Volkow, ND et al., Journal of Neuroscience 21, 9414-9418, 2001.

However, recovery is real!

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Normal

10 days of abstinence

100 days of abstinence

Source: Volkow ND, Hitzemann R, Wang C-I, Fowler IS, Wolf AP, Dewey SL. Long-term frontal brain metabolic changes in cocaine abusers. Synapse 11:184-190, 1992; Volkow ND, Fowler JS, Wang G-J, Hitzemann R, Logan J, Schlyer D, Dewey 5, Wolf AP. Decreased dopamine D2 receptor availability is associated with reduced frontal metabolism in cocaine abusers. Synapse 14:169-177, 1993.

Your Brain on Drugs Today: Prolonged Substance Use Injures The Brain & Healing Takes Time

Normal levels of brain activity in PET scans show up in yellow to red

After 100 days of abstinence, we can see brain activity “starting” to recover

Reduced brain activity after regular use can be seen even after 10 days of abstinence

Brain-Mind-Behavior Changes

Brain adaptation accounts for:1. Drug intoxication & withdrawal2. Tolerance & wanting to use3. Cravings (relapse) & needing to

use4. Recovery

Resilience and Recovery Capital

Applying the SOAR

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The recovery rates after alcohol or other drug (AOD) treatment are as good or better than the recovery rates of people treated for other chronic illnesses like diabetes or hypertension.

a. Trueb. False

Neuroscience research shows that: The brain has a remarkable ability

to change, adapt and heal = recovery

Two keys: 1) length of timeand 2) one’s experiencesafter alcohol and other drugs are out of the body

Expect Recovery!

The recovery process takes time

For the brain to adapt and: Heal = adjust to the absence of the

drug Replace responses to triggers Learn new ways of experiencing

pleasure

Managing recovery or healing and rewiring the brain by: Active and sustained engagement

with the recovery community Focus on progressive wellness

Biological/physical Emotional/behavioral Environmental

$ Personal and environmental resources for initiating and sustaining recovery

$ Individual and cultural variability

$ Interacts with situation and problem severity to shape selection of the intensity and duration of recovery supports needed at that point in the recovery process

Recovery capital (PXE)

The opposite of addictionis connection,

not abstinence

Recovery capital (PXE)

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Recovery Capital & Many Pathways

Mutual support groups

Professional treatment

Faith-based groups

Medication-assisted treatment

“Natural” or on your own

And more indigenous routes

A menu of options

*

*

*

*Happiness’ three aspects

feed into life

satisfaction*

ResilienceTedeschi, R. G. & Calhoun., L. E. (1999). The

Posttraumatic Growth Inventory:

Measuring the positive legacy of trauma. Journal of Traumatic Stress, 9

(3), 455 – 471.

Three Ps Stunt Recovery After Setbacks/Trauma

Sandberg, S. & Grant, A. (2017). Option B: Facing adversity, building resilience and finding joy. New York: Knopf

1. Personalization: Believing that we are at fault or personally responsible

2. Pervasiveness: Believing that an event will affect all areas of our life

3. Permanence: Believing that the aftershocks of an event will last forever

Five Contributors to Post-trauma Growth


1. Understand the response to trauma: shattered beliefs about the self, others and the future

2. Anxiety reduction: techniques for controlling intrusive thoughts and images

3. Constructive self‐disclosure: telling the story



4. Create a trauma narrative: embrace the paradox of loss and gain, grief and gratitude, and vulnerability and strengths

personal strengths called upon some relationships improved spiritual life strengthened how life itself

was better appreciated and what new doors opened

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5. Articulate life principles and stances that are more robust to challenge. May include new ways to:

Be altruistic

Accept growth without survivor guilt

Craft a new identity as a trauma survivor or newly compassionate person, and

Take seriously the s/heroic journey myth to tell the world an important truth about how to live = Advocacy

“When we are no longer able to change a situation, we are challenged to change ourselves.”

Viktor Frankl. (1946). Man’s search for meaning.

Three Exercises for Post-trauma Growth


“Having fun is a form of self‐compassion; just as we need to be kind to ourselves when we make mistakes, we also need to be kind to ourselves by enjoying life when we can…. Seeking joy after adversity is taking back what was stolen from you…. But happiness is the frequency of positive experiences, not the intensity.”

1. Joy NotesWrite down three moments of joy each day! Typically these are momentary flashes. So as you go through your day, recognize them and say to yourself, “this will go in today’s Joy Notes!”

Three Exercises for Post-trauma Growth

2. VIA Character Strengths Survey: viacharacter.org

Register, it’s free!

Complete the 240‐question survey, and receive your strengths inventory report – See the good in YOU!

3.WHAM, ???

“The one thing you can’t take away from me is the way I choose to respond to what you

do to me. The last of one’s freedoms is to choose one’s attitude in any given circumstance.”

Viktor Frankl. (1946). Man’s search for meaning.

Recovery Capital &Recovery Community Organizations (RCOs)

People in recovery, family members, friends, peers and allies… National: Faces & Voices of Recovery (2001)

facesandvoicesofrecovery.org

State: Georgia Council on Substance Abuse (2000) gasubstanceabuse.org

Local recovery community organizations: list website, email, phone number, and contact person* *make warm handoffs, not “referrals”

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Closing

Applying the SOAR Identify five aspects of the social model of

recovery;

Explain tolerance, withdrawals, addiction, relapse, and recovery based on current neuroscience;

Counteract three common beliefs that stunt recovery or resilience following setbacks or trauma; and

List five contributors to, and two exercises for, resilience or post-trauma growth.

After this session participants will be able to…

Three Key Takeaways1. Addiction, very much like other

chronic health conditions, affects the brain, mind and behavior

2. Recovery, very much like other chronic health

conditions, requires daily management

The Main Takeaway: Expect recovery!HOPE is

everywhere because over

25 millionAmericans

are inlong-term recovery!

Please write your most significant takeaways from today on Page 2

EXPECTRESILIENCE

The goal: A habit of engaging in

compassionate conversations with

equanimity to promote resilience in oneself and others

Please complete aparticipant feedback form!

“Not My Job”Award Winner

Documents

Applying the SOAR - Expect resilience, not relapse 180206brauchtworks.com/yahoo_site_admin/assets/docs/... · 3 Applying the Science of Addiction Recovery (SOAR): Expect Resilience,