The Basic Neuroscience of Addiction: Debunking the “Choice” Myth · 2020. 6. 11. · 169 For more information, feel free to contact: Jessica Holton MSW, LCSW, LCAS Jessica Holton,

6/10/2020

McLeod 2020 - Choice Myth 1

The Basic Neuroscience of Addiction: Debunking the

“Choice” MythJESSICA HOLTON, MSW, LCSW, LCAS

Disclosures

• Not affiliated /paid by suggested resources

• LAMP Slides

COPYRIGHT © 2020 JESSICA HOLTON, PLLC 2

LAMP Disclosure Statement

“This product was produced by the Trauma Center at Justice Resource Institute and supported by grant number 2015-VF-GX-K020, awarded by the Office for Victims of Crime, Office of Justice Programs, U.S. Department of Justice. The opinions, findings, and conclusions or recommendations expressed in this product are those of the contributors and do not necessarily represent the official position of the U.S. Department of Justice.”


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Housekeeping

Comments

Ethical obligation to remain attentive

Handouts

Kind, thoughtful feedback is appreciated


Learning Objectives

Participants will:1. Discover predisposing factors to addiction and basic

neuroscience of addiction.

2. Identify underlying currents and contributing considerations of addiction.

3. Learn about the basic neuroscience of toxic stress and trauma, and survival emotional states.

4. Gain adaptive coping skills and techniques based on basic neuroscience.



Language Matters

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“By using accurate, non-stigmatizing language, we can help break the stigma surrounding this disease so people can

more easily access treatment, reach recovery, and live healthier lives.”

- Michael Botticelli, Former Director of the White House Office of National Drug Control Policy


“Words have power. When we use clinically accurate, person-first language, we begin to dismantle stigma-driven attitudes and build effective systems of care. Our families and

friends are more likely to seek help and that help is more likely to be accessible and adequate.”

-Donald McDonald, MSW, LCAS


The term addiction is derived from the Latin addīcō meaning “enslaved by” or “bound to.

Society today often also characterizes individuals who participate in repetitive

behaviors as being addicted. Thus, the term addiction currently applies to the misuse of alcohol, other drugs, and substances and to a

large number of behavior patterns.

Smith, R., 2015

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Addiction Concepts:A Chronic Brain Disease


NIDA: Addiction is defined as a chronic, relapsing [reoccurring] brain disease that is characterized by compulsive drug seeking and

use, despite harmful consequences. It is considered a brain disease because drugs change

the brain; they change its structure and how it works. These brain changes can be long lasting

and can lead to many harmful, often self-destructive, behaviors.


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Addiction is a brain disease that begins in childhood.

It is a pediatric disease and needs to be treated as such through

prevention, treatment and recovery.


Addiction, unlike other chronic diseases, has stigmas and negative perceptions

attached to it.

The stigmas and perception must change from providers, to communities, to families to the individual served.

Language Matters!


Neuroscience of Addiction

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The brain weighs approximately three pounds, uses about 33% of the bodies energy, is

efficient with energy (30w lightbulb) and needs 500 nutrient rich calories per day for basic functions. The brain experiences over

75,000 thoughts occur each day.

Developing & Pruning


The Brain


The Brain

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Survival Center

COPYRIGHT © 2020 JESSICA HOLTON, PLLC19

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The limbic system is responsible for emotions.Hypothalamus - “Master Gland” or “Thermostat” – Regulates hormones

Hippocampus – Functions after 2 yr. old; Short and Long Term Memory.

Amygdala - Functions at birth. ‘Fight or Flight’; Automatic (Auto-pilot); Makes a decision in a split second; Stores past experiences; Reacts (depending on the past experience(s), it may over react); Relief and Reward

The Brain


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The Brain



Information enters through the hind-brain. It travels through the mid-brain (VTA), the limbic

system, then finally reaches the forebrain.

The hind-brain is responsible for basic body functions.

The forebrain is responsible for decision making, logic, self-awareness, insight.

The brain is, essentially, placed on “hold” at the age chronic chemical use (or behavioral addictions)

began!

The Brain


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National Institute of Drug Abuse (NIDA)


Ventral Tegmental Area (VTA): part of the midbrain, it is rich in dopamine and serotonin neurons and is part of two major dopamine pathways:

◦ one pathway connects the VTA to the nucleus Accumbens (a structure in the Basil Ganglia -reward and reinforcement, addictive behaviors and habit formation)

◦ the other pathway connects the VTA to the cortical areas in the frontal lobes

The Brain


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Default Mode Network (DMN)

•Mind wandering; responding to “Tell me about yourself; Self-reflecting; Empathy; Time travel (future & past); Deactivates with mindfulness & connection

Posterior Cingulate Cortex (PCC)

•Raw signal from eyes, feeding information to front, craving, wanting

Medial Prefrontal Cortex (mPFC)

•Notices passage of time in the present

Orbitofrontal Cortex (OFC)

•Looks for reward


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Brain Metaphors

◦ Toddler/Teenager & Nurturing Adult

◦ Cartoon Character

◦ Others?



Substance use can be divided into thirds.

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What about process addictions?


Addiction Concepts:Survival Pathways

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Relief/Reward


Long-Term & Short-Term survival

* Trigger* Behavior* Reward & Relief* Consequences


Activity:Basic Needs

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1. Take in a deep breath.

2. Hold your breath.

3. While holding your breath, not your thoughts, emotions and physiological response.

4. Continue to hold your breath as long as you can.

5. Continue to note your thoughts, emotions and physiological responses.

6. When the urgency to inhale is intense, take a breath and breathe normally.


Addiction Concepts:Genetics & Environment


Meme

◦ Noun - a humorous image, video, piece of text, etc., that is copied (often with slight variations) and spread rapidly by Internet users.

◦Noun - an element of a culture or system of behavior that may be considered to be passed from one individual to another by nongenetic means, especially imitation.

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Three Type of Aces –10 Yes/NO Questions


Source: Centers for Disease Control and Prevention

Credit: Robert Wood Johnson Foundation

ACEs Increase Health Risks

According to the Adverse Childhood Experiences study, the tougher your childhood, the higher your score is likely to be, thus the higher your risk for various health problems later.Behavioral, physical and mental health conditions


Source: Centers for Disease Control and Prevention

Credit: Robert Wood Johnson Foundation

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Activity:

Finding Your ACE Score


Original ACE Screening Tool


CWY ACE-Q: Child and Teen

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Genetics & Epigenetics

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Genetic factors are believed to account for 50% of an individual’s vulnerability to an addiction.

DNA is made up of genes that are nearly identical for 99.9% of individuals.

It is believed that the 0.1% variation contributes to a person’s vulnerability to an addiction, as well as

to other diseases such as diabetes, heart problems, and stroke.

(NIDA, 2008; Smith, R., 2015,;Volkow, 2011).


When one identical twin was addicted to alcohol, the other twin had a high probability of having the same addiction◦ This was not true for nonidentical (fraternal) twins

Children of individuals who struggled with addiction (to alcohol or other drugs) are 8 times more likely to develop an addiction

There is speculation that genetics also plays a role in behavioral addictions, despite insufficient research, finding that gambling, sex, work, exercise, shopping, and other process addictions to one’s genetic makeup.

(NIDA, 2008; Smith, R., 2015,;Volkow, 2011).


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Epigenetics◦ Greek επι- means “in addition to”

◦ Since 2004 research in the emerging science of Behavioral Epigenetics indicates that nurture wins over nature, to the degree that early experience permanently alters behavior and physiology

(Meaney and Szyf, 2005)


Methylation ◦ A methyl group is an organic compound which can chemically attach to genes, altering their expression

◦ These methylated attachments can be lifelong, permanently altering the gene activity, including creating changes in behavioral traits associated with the gene

◦ These methylated patterns can be passed on to offspring

◦ Methylation can be changed by life experiences

(Hurley, 2013, Hackett, 2013; Weaver, et al., 2004)


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Historical Trauma

Intergenerational Trauma

Institutional Trauma/Betrayal



Remember:

Addiction is a brain disease that begins in childhood.

It is a pediatric disease and needs to be treated as such through

prevention, treatment and recovery.

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Quick Sidebar:

Screening Tools


Assessment Vs Screening tools

Screening Tools are brief questionnaires that assist professionals in getting a snapshot of information

to determine whether additional treatment referrals are needed.

An Assessment Measurement Tool is usually entails questions and the tools will take more time to

administer.



Assessment Tools and Screening Tools are measurement tools that have differences and similarities, in which the terms are often used

interchangeably.

Using the term Assessment Tool for Screening Tools could not only be considered incorrect, but

also confusing, especially for students, newer clinicians or clinicians becoming familiar with the

benefits of using Screening Tools.

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Original ACE Screening Tool



There are hundreds of Screening Tools for a variety of disorders, from mental to physical.

It is crucial to implement evidenced-based Screening Tools and/or valid Assessment

Tools, within one’s scope of practice.



It is also imperative to implement Screening Tools that are culturally

applicable. If there is not a specific tool that is culturally specific or accounts for cultural differences, the professional would need to consider the effectiveness of the tool before

proceeding with that tool.

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Furthermore, it is important to understand that Screening Tools and Assessment Tools do not

replace a thorough clinical biopsychosocial-spiritual assessment. Rather, the

measurement tools could assist in navigating the direction of treatment and/or treatment

referrals.


Addiction Concept:Stress, Anxiety & Trauma

Law Enforcement

Advocates

Mental Health Workers

Prosecutors

The Impact of Trauma


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What are examples of experiences of traumatic

events?



COMBAT/WAR ZONE

VIOLENT ENVIRONMENT

MOTOR VEHICLE ACCIDENT

EXPERIENCING/WITNESSING ABUSE (PHYSICAL, SEXUAL VIOLATION, VERBAL, EMOTIONAL, SPIRITUAL)

MEDICAL TRAUMA

WITNESSING DEATH

NATURAL DISASTERS

REPEATED EXPOSURE TO TRAUMAS/ADVERSE DETAILS OF TRAUMAS

OTHERS?


Make sure the body survives.

Brain fundamentals:

Role of the brain

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Prefrontal cortex

Brain fundamentals: Overview

HippocampusDefense

Circuitry


Brain fundamentals: Pre-frontal cortex

Prefrontal

cortex


Brain fundamentals: Defense circuitry

Defense

Circuitry

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Brain fundamentals: Hippocampus

Hippocampus


Autonomic Nervous System

▪ Controls automatic unconscious bodily functions:

▪ Heart and respiration rate.

▪ GI functions.

▪ Energy output.

The nervous system: Fundamentals


Brain and Body Reactions to Trauma:

Survival Response

During traumatic event:

▪ Prefrontal cortex impaired.

▪ Defense circuitry in control.

▪ Brain’s automatic survival response takes over.

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Brain and body reactions to trauma:

The survival response, 2



Brain and body reactions:

Autonomic nervous system



Freeze

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Fight and flight


Habit is a learned response that worked before:

▪ “It’s late, I need to get home.”

▪ “I have a boyfriend / you have a girlfriend.”

▪ “I don’t feel well.”

...but habits don’t work when there is an actual or perceived threat


Habits


…even less conventional responses meant to:

▪ Minimize physical harm,

▪ Reduce pain

…but may render the victim more vulnerable.


Extreme survival reflexes

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Tonic and collapsed immobility



Dissociation



Process flow

THREAT

InitialFREEZE

FIGHT

FLIGHT

Tonic or CollapsedIMMOBILITY

DISSOCIATION

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Impact of trauma on memory

Memory can be enhanced or impaired by trauma:

▪ Encoding: what is attended to during the event.

▪ Storage: what gets filed away.

▪ Retrieval: what can be recalled.


Impact of trauma on memory:

Enhanced aspects of memory


Activity:Memory

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Impact of trauma on memory:

Impaired aspects of memory


Activity:Sabretooth Tigers

Survival Center


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Mobilization -Fight/Flight

COPYRIGHT © 2020 JESSICA

HOLTON, PLLC

9494

Immobilization with Fear -Shutdown

(~2 Minutes)


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Dr. Seigel Hand-Brain Model



Addiction Concepts:Avoidance, Shame & Isolation


Secrets, Shame & Isolation

Addiction

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Society teaches us that ifsomething hurts, take a pill for it.

“Fix it.”

We live in a shamed based society.

If one has cancer, treatment takes place and everyone is proud.

If one has an addiction, or mental illness, society places stigmas.

Georgi, J. M., 2004


Shame has been defined as, “pain in the soul that can not be tolerated,” thus one tends to find

their own ‘medicine.’

Georgi, J. M., 2004


“Shame is a stain on my soul…”

Vietnam Vet

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Suffering x Resistance = Pain

(10 x 10 = 100)Or

(10 x 0 = 0)


Isolation: Rat Park


Polyvagal Theory

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Remember: The brain’s job is to survive/live.




Psychological statesPolyvagal Theory

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Safety (trust, vulnerability, rest & digest)

Mobilize (fight, flight)

Immobilize (avoidance, disassociate, freeze)


Grief, Loss & Change


Grieving Process:

1) Shock/Denial

2) Anger (Projection)

3) Bargaining (“What ifs”)

4) Depression (Introspection)

5) AcceptanceMarrone, 1997

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Grieving: Dual Model



Revised Healing Process/Stages of Change:

1) Denial

2) Bargaining

3) Anger (Projection)

4) Depression (Introspection)

5) Acceptance

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Other Potential Undercurrents:

Mood Disorders

Psychotic Disorders

Medical Conditions (Chronic Pain)

Grief & Loss


Providing Effective Treatment Interventions

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TYPES OF COPING –

Obtaining Wellness &

Recovery


Recovery

The Substance Abuse and Mental Health Services Administration (SAMHSA)

defines recovery as:

“A process of change through which individuals improve their health and

wellness, live a self-directed life, and strive to reach their full potential.”


Working Definition of Recovery

Recovery from addiction (chemical or process) is a voluntarily maintained lifestyle characterized by: ◦ Sobriety Vs MAT Vs Harm Reduction

◦ Personal Health - A state of complete physical, mental, and social well-being (not merely absence of disease)

◦ Citizenship - Effort and commitment to improving one’s community. It is often captured in the traditional recovery terms “giving back” or “service work”

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Depth of Recovery

Partial Recovery

Full Recovery

Enriched Recovery


Further definitions of Recovery

Recovery is the process through which severe alcohol and other drug problems are resolved

along with the development of:

Physical, emotional, spiritual, relational and occupational health

(White & Kurtz, 2005)


Recovery pathwaysAbstinence-based

Moderation-based

Medication-assisted

Solo (natural) recovery

Peer-assisted

Treatment-assisted

(less than 10% of people with a SUD in the U.S. seek professional treatment in a given year; only 25% of individuals with such disorders will receive treatment in their lifetimes)

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Recovery CapitalExamples of greater “recovery capital” include:

Employment

Higher socioeconomic status

Higher social supports and stability

Positive marital and work relationships

Greater sense of self-efficacy

Social supports


Relief/Reward


Coping Skills

Noun: Any characteristic or behavioral pattern that enhances a person's adaptation. Coping skills include a stable value or religious belief system, problem solving, social skills, health-energy, and commitment to a social network.

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Types of Coping

Action-based coping

Emotional-based coping

Harmful coping

http://hopecalls.org/m_coping.html



The Brain After Drugs…….


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Volkow, et al, 2001


Developing trust and rapport with a Client becomes more feasible when a provider: shows empathy, communicates well, has a thorough

grasp of the realities of the Client’s life, draws on effective counseling strategies, uses a non-

judgmental approach and understands the legal issues regarding the safety of the Client.


A practitioner’s communication style will affect how a Client responds to his or her

advice. Even subtle perceived negative attitudes can undermine a Client’s trust in

his/her provider. When compassion is evident in a provider’s choice of words,

demeanor and attention, it is often easier for a Client to listen, communicate, and

act on the new knowledge.

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Source: Hubble, M., Duncan, B., & Miller, S. (1999)


Properly addressing avoidance/immobilization is essential

when treating addiction.


Interventions to Stabilize the Nervous System

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Pathways for Habits or Patterns (Coping): Must reframe the issue or concern, not just

talk about it.

Instant Reward and Relief

VS

Long-term Reward and Relief


Time perception

Anniversaries

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Brain Tricks/Resets:Less Is Better


Deep Breathing

Breathe in and out from your diaphragm (not chest).

Breathe in for four (4) seconds

Hold for five (5) seconds

Breathe out for eight (8) seconds

This is one (1) cycle.

Complete at least six (6) to twelve (12) cycles

This changes the blood flow from your chest (heart and lungs = preparing for Survival/Fight and Flight) to your extremities (arms and

hands), which cues the brain that it is no longer in Survival/Fight or Flight mode.


Cook’s Hook UpBrain ButtonsCook’s Posture

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Activities that Engage Frontal Lobe

(Re-allocate energy from the Limbic System, to Frontal Lobe)

Counting

Adding

Subtracting

Organizing

Alphabetizing

Word Searches

Jigsaw Puzzles

Balancing on one leg

Hopping on one leg

Yoga

*Mindfulness

*Grounding

This type of action based coping pulls energy to the frontal lobe (thought and control center) and away from the Limbic System (intricate Fight and

Flight/Survival Center)


Drinking Water

Whistling

Humming

Rocking

Weighted Items

Engaging Large Muscle Groups

Pushing/Leaning on Wall

Resourcing

Loving Kindness


Daily Gratitude List

Successes / Positives

Challenges / Negatives◦ How did you cope?

What are you grateful for?

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Gratitude Counters Fear

Compassion Counters Anger

Mindfulness counters habit


Mantras

“Feelings and thoughts are not facts. What facts counter or validate my feelings?”

“Anxiety is my fear, linked to the future, linked to my imagination. What is happening in the here and now?”

“What are the facts that counter my fear/anxiety/stress responses?”

“Anger is a reaction that stems from fear or sadness. What am I feeling?”

“What you focus on grows.”


Mantras

“Energy flows where attention goes.”

“I choose to befriend myself.”

“Focus on micro moments of success.”

“Whether it is a good day or a bad day, it is the same day. You get to choose.”

“Compassion counters anger. Anger and compassion cannot be experienced at the same time.”

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Progressive Relaxation


Journal Writing&

Narratives


Letters(Purging to ‘Business’)

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Metaphors


Danger Sequence


Danger Sequence

1) Name the stressor or trigger.

2) Am I in danger? Fear is not real. Danger is. 95-99% of the time, there is not actual danger.

The answer is NO.

3) Are past traumas (real saber tooth tigers behind you) being triggered?

If yes, counter with facts: Age, location, year, individuals involved, actions, et cetera.

If no, move to #4.

4) Are past negative life (mutated saber tooth tigers off to the side of you) events being triggered?

If yes, counter with facts: Age, location, year, individuals involved, actions, et cetera.

If no, move to #5

5) What are the specific stressors (hologram saber tooth tigers in front of you)?

6) What are the tangible solutions (not anxiety or fear based) that you will implement?

Follow sequence, without adaptions. Repeat often. Practice on small stressors in order to build “muscle memory” for the larger stressors, trauma triggers, and/or crisis that might occur.

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Recommended Resources

Safe and Sound Protocol™


Unyte Biofeedback


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Social Media – Vagus Nerve


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California Evidence-Based Clearinghouse for Child Welfare

https://www.cebc4cw.org/


CEBC Evidence-Based Practice

The CEBC has adopted the Institute of Medicine's definition for evidence-based practice with a slight variation that incorporates child welfare language:

Best Research Evidence

Best Clinical Experience

Consistent with Family/Client Values

This definition builds on a foundation of scientific research while honoring the clinical experience of child welfare practitioners and being fully cognizant of the values of the families we serve.

Adapted from Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington,DC: National Academy Press.

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Applications (a.k.a Apps)Breathe2Relax

Prana Breath

Virtual Hope Box

T2 Mood Tracker

Guided Meditat(e)

Headspace

Smiling Mind

Addicaid

Ginger.10

Sober Grid

Cassava

Sober Tool

Hazelton Betty Ford

Cope Notes

Insight

Calm

Others?


SUCCESS

To laugh often and much; to win the respect of intelligent people and the affection of children; to earn

the appreciation of honest critics and endure the betrayal of false friends; to appreciate beauty; to find

the best in others; to leave the world a bit better, whether by a healthy child, a garden patch, or a

redeemed social condition; to know even one life has breathed easier because you lived; this is to have

succeeded.

-- an adaptation of a poem published in 1905 by Bessie Stanley


Thank you!!!!

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For more information, feel free to contact:

Jessica Holton

MSW, LCSW, LCAS

Jessica Holton, PLLC

3491 Evans Street

Suite D

Greenville, NC 27834

252-987-3039

[email protected]

www.jessicaholton.com


Referencesde Shazer, S. (1997). Radical Acceptance. Family Systems and Health, 15, 375-378.

Georgi, J. M. (2004). Treatment issues for dual diagnosis: Post traumatic stress disorder and substance abuse. Presentation sponsored by Eastern AHEC. Greenville, NC.

Hester, R.K. & Miller, W.R. (2003). Handbook of alcoholism treatment approaches (3rd ed). Boston: Allyn and Bacon.

Marrone, R. (1997). Death, Mourning, and Caring. Dying and the near-death experience.(pp. 71-78). Pacific Grove, CA: Brooks/Cole Publishing Company.

Meaney, M. J., & Szyf, M. (2005). Environmental programming of stress responses through DNA methylation: life at the interface between a dynamic environment and a fixed genome. Dialogues in Clinical Neuroscience, 7(2), 103-123.

Miller, W. (1998). Toward a motivational definition and understanding of addiction. Motiverande Samtal. Retrieved from http://www.motiverandesamtal.org/miwiki/Toward%20a%20Motivational%20Definition

Reid, K.E. (2002). Clinical social work with groups. In A.R. Roberts & G.J. Greene (Eds.), Social workers’ desk reference. New York, New York: Oxford University Press.

Sidbury, L. & Owens, C. (2005). Critical incident stress and emergency response. Presentation sponsored by Pitt Community College. Greenville, NC.

Valasquez, M.M., Gaylyn, G.M., Crouch, C. & DiClemente, C.C. (2001). Group treatment for substance abuse: A stages-of-change therapy manual. New York: The Guilford Press.

Yalom, I.D. (1995). The theory and practice of group psychotherapy (4th ed.). New York: Basic Books.


ReferencesBusch, N.B. & Valentine, D. (2000). Empowerment Practice: A Focus on Battered Women. AFFILIA,

15(1), p. 82-95.

Food, Nutrition and Health Program - Dietetics Major. (n.d.). Critical thinking flow chart. Retrieved

from http://dietetics.landfood.ubc.ca/year-5-interns/student_created_resources/professional-

development/critical-thinking/

Gutierrez, L.M., Parsons, R.J., & Cox E.O. (1998). Empowerment in Social Work Practice: A Sourcebook. Pacific Grove, California: Brooks/Cole Publishing Company.

Lee, J.A.B. (2001). The Empowerment Approach to Social Work Practice: Building a Beloved Community(2nded.). New York: Columbia University Press.

National Association of Social Workers Association of Social Work Boards (2013). Best practice standards in social work supervision. Washington, DC: NASW Press.

Rieck, T., & Callahan, J. L. (2013). Emotional intelligence and psychotherapy outcomes in the training clinic. Training And Education In Professional Psychology, 7(1), 42-52.

Rieck, T., Callahan, J. L., & Watkins, C. J. (2015). Clinical supervision: An exploration of possible mechanisms of action. Training And Education In Professional Psychology, 9(2), 187-194.

Robbins, S.P., Chatterjee, P., & Canda, E.R. (1998). Contemporary Human Behavior Theory. Boston: Allyn& Bacon.

Turner, F.J (ed.). (1996). Social Work Treatment: Interlocking Theoretical Approaches (4thed.). New York: Free Press.

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http://www.jessicaholton.com/

Documents

The Basic Neuroscience of Addiction: Debunking the “Choice” Myth · 2020. 6. 11. · 169 For more information, feel free to contact: Jessica Holton MSW, LCSW, LCAS Jessica Holton,