Addiction and Recovery PDF

Addiction and Recovery – what it is, how to detect it and how to make meaningful changes 1. clear goals (strong sense of what one wants to do) [must find out what you want to do] 2. concentration/focus on task-at-hand (complete task focus) [must develop attentional control] 3. sense of control (cont...

Addiction and Recovery – what it is, how to detect it and how to make meaningful changes 1. clear goals (strong sense of what one wants to do) [must find out what you want to do] 2. concentration/focus on task-at-hand (complete task focus) [must develop attentional control] 3. sense of control (control over what one is doing) [staying calm when control seems reduced or slipping) 4. loss of self consciousness (minimal pride & vanity, humility because the ‘doing’ is the reward) 5. challenge-skill balance (competent to meet high situational demands) [must seek & confront challenging situations…they are the most ‘fun’] 6. action-awareness merge (‘doing’ spontaneously without having to think first) [practicing spontaneous ‘doing’] 7. unambiguous feedback (knowing how well one is doing during performance) [unafraid to confront the truth of unambiguous feedback] 8. transformation of time (time passes differently, less tediously and more interestingly) 9. autotelic experience (flow experience is rewarding). (Csikzentmihalyi and Csikzentmihalyi, 1988) One ‘flows’ into addiction: but what kind of flow? 1. clear goals (strong sense of what one wants to do) [must find out what you want to do]…[just want to feel better as one feels bad] 2. concentration/focus on task-at-hand (complete task focus) [must develop attentional control]…[limited context – thinking simply with minimal internal debate] 3. sense of control (control over what one is doing) [staying calm when control seems reduced or slipping) [perception of extreme self control although control is sacrificed to a substance or behaviour] 4. loss of self consciousness (minimal pride & vanity, humility because the ‘doing’ is the reward) [humility becomes secrecy] 5. challenge-skill balance (competent to meet high situational demands) [must seek & confront challenging situations] [the wrong perception is that addiction is a lifestyle of ‘ease’ when it’s a challenging downwards curve largely due to needs for secrecy & stigmatization] 6. action-awareness merge (‘doing’ spontaneously without having to think first) [practicing spontaneous ‘doing’] [distinguishing between spontaneity and impulsivity] 7. unambiguous feedback (knowing how well one is doing during performance) [unafraid to confront the truth of unambiguous feedback] [some addictions are so momentarily satisfying that it feels like unambiguous truthful feedback] 8. transformation of time (time passes differently, less tediously and more interestingly) [‘lost in space’ – no perception of time-passage] 9. autotelic experience (flow experience is rewarding) [so satisfying that one relinquishes other desires & ambitions] Behavioural Addiction – Michael Phelps https://www.youtube.com/watch?v=CDsk9At6aEU Interviewed by Joe Buck Started swimming at 7 yrs & by 10 yrs, he was winning medals ADHD dx (couldn’t sit still) – Ritalin until 6th grade then discontinued…..first world record (8 yrs later) at 15 yrs Most decorated Olympian of all time Behavioural Addiction – Michael Phelps Swimming was ‘escape’ from emotional stress (e.g. parental divorce) If 10,000 hr guideline applies, he swam in 8 years, 1200 hrs per year, 100 hr/month or 25 hrs/wk or 5 hrs/day….it is evident that he was an ‘early achiever’ in the curve But…why two DUI offenses after Olympic triumphs? Was he rebelling against the addictive regimen? At 41:22 he derives insight about an addictive treatment centre…he commits to the program Behavioural Addiction – Michael Phelps He wrote letters to his father and mother…acknowledged needs for fatherly love “Right then and there (in treatment) I began to be ‘who I am’ rather than trying who I was trying to be…” Currently he has four sons with his wife of 8 years The Michael Phelps Foundation uses swimming as a lifestyle discipline for healthy development – special emphasis on mental health Drug Addiction – what is most addictive? Based on the elevation of dopamine levels…habitual use results in decreased expression of dopamine receptors, leading to adverse feelings & withdrawal symptoms 1. Cocaine: adverse side-effects of Cocaine withdrawal and abstinence - depression and fatigue 2. Methamphetamine: increased alertness, talkativeness, hyperactivity. Adverse effects: irregular heartbeat, agitation, increased blood pressure, aggressive behavior 3. Opioids (Heroin and Fentanyl): specifically attach to the GABA neurotransmitter, which controls the brain’s reward & pleasure pathways. When Opioids slow down the actions of GABA neurons, dopamine floods the pleasure circuits, resulting in a wave of pleasure & pain relief Drug Addiction – what is most addictive? 4. Alcohol – is a disinhibiting depressant & the most widely used addictive substance with 8.3% qualifying for alcohol use disorder 5. Nicotine - is a stimulant that elevates dopamine levels and causes burst firing of dopamine neurons. It is fast-acting & reaches the brain within seconds, leading to an immediate release of dopamine. Are there anti-addictive drugs? Yes Campral (Acamprosate) for alcohol disorder Buprenorphine/Naloxone (for opioid addiction) Bupropion (Smoking, Cocaine) Wellbutrin (widely prescribed antidepressant) Buspirone (Opioids) – Buspar - anti-anxiety drug that boosts the effects of antidepressants Disulfiram (Alcohol, Cocaine): an alcohol aversion medication that produces immediate & severe reactions when alcohol is consumed Are there anti-addictive drugs? Gabapentin (Alcohol, Generic Substance Abuse): a non-opioid medication prescribed for a variety of conditions, including: neuropathy; fibromyalgia; substance use disorders Methadone (Opioids): used for opioid replacement therapy (ORT) and Methadone Maintenance Therapy (MMT) Naloxone (Opioids): Naloxone is an emergency medication given to reverse opioid overdoses. Naltrexone (Alcohol, Opioids, Cocaine): administered orally (ReVia) or via injection (Vivitrol), naltrexone totally blocks the effects of alcohol or any opioid. Are there anti-addictive drugs? Nicotine isolated from tobacco in 1828: Nicoderm CQ, Nicorette, Nicotrol Inhaler - Nicotine is a stimulant found naturally in tobacco Propranolol (Alcohol, Cocaine) - a beta-blocker used to treat high blood pressure. It also shows promise as a treatment for performance anxiety and PTSD. It can alter the emotional memory of cue-related triggers that drive compulsive drinking or drug-seeking. Pyridoxine (Vitamin B6) – Replenishing helps restore the normal formation of neurotransmitters. Thiamine (Vitamin B1) – Excessive alcohol consumption directly interferes with thiamine uptake within the gastrointestinal tract. Folic Acid (Vitamin B9) - Replenishing helps ease depression during alcohol disorder recovery What new anti-addictive drugs have been discovered? Because H. Osmond believed LSD induced symptoms like delirium tremens, he and A. Hoffer treated 2000 alcoholics under carefully controlled conditions (1954 to 1960). Forty to to 45% of the LSD treated alcoholics remained abstinent after a year’s observation. A meta-analysis (Krebs and Johansen, 2012) of 6 randomized trials of LSD for alcohol dependence that reported drin ing outcomes (Bowen et al., 1970; Hollister et al., 1969;) demonstrated consistent treatment effects favoring LSD. These studies included 325 participants who received active treatment with LSD and 211 who received control treatment. DPT effects - Alcoholism Use of dipropyltryptamine (DPT) in the treatment of alcoholism (Grof et al., 1973; Rhead et al., 1977). DPT is a classic psychedelic (Fantegrossi et al., 2008), structurally similar to DMT, with clinical effects lasting from 1–6 h, depending on dose, when given by intramuscular injection (Rhead et al., 1977). In a single-group pilot study involving 51 participants, Grof et al. reported highly significant improvement in clinical outcomes including abstinence among the 47 participants (92%) who received between 1 and 6 DPT (mean 1.9) sessions and completed follow-up at 6 months (Grof et al., 1973). Psilocybin & Alcohol In a single-group study, 10 volunteers with alcohol dependence received oral psilocybin 0.3 mg/kg or 0.4 mg/kg in 1 or 2 supervised sessions scheduled 4 weeks apart. Psilocybin was administered during a 12-week manualized therapy program which included Motivational Enhancement Therapy and therapy sessions devoted to preparation for and debriefing from the psilocybin sessions. Participants' responses to psilocybin were qualitatively similar to those described in other populations. Drinking did not decrease significantly in the first 4 weeks of treatment (when participants had not yet received psilocybin), but decreased significantly following psilocybin administration. Gains were largely maintained during 36 weeks of follow-up. The intensity of selfreported effects during the first psilocybin session at week 4 was strongly correlated with improvement in drinking during weeks 5–8 (r = 0.76 to r = 0.89), and with decreases in craving and in- creases in abstinence self-efficacy during week 5. Psilocybin & Nicotine A recent pilot study showed a manualized 15-week program of cognitive-behavior therapy incorporating 2 or 3 psilocybin sessions (~0.29 mg/kg or ~0.43 mg/kg, administered on the target quit date and at 2 and 8 weeks post-target quit date) resulted in excellent outcomes N = 12 of the 15 participants (80%) were biologically confirmed as smoke-free at a 6 month follow-up (Johnson et al., 2014). Responses to psilocybin were similar to populations previously studied consisting of mostly non-smokers (Griffiths et al., 2006; Griffiths et al., 2011), with 31% of sessions meeting criteria for a “complete” mystical experience, and 40% of participants experiencing at least one psychologically challenging experience. Drug Interactions Classic psychedelics have effects on brain-derived neurotrophic factor (BDNF) and glial cell line-derived neurotrophic factor (GDNF), both neurotrophic factors relevant to addiction and other psychiatric disorders BDNF and GDNF play critical roles in neurogenesis, synaptic plasticity, learning, and memory (Ghitza et al., 2010) especially through its action at the 5HT2A receptors (Tsuchioka et al., 2008) A Case Study of Effective Treatment No compromise with addictive behaviour Exercise & other exertional activities implemented – hard work is required to reverse addictive ‘imprint’ in brain Consistent review of consequences of addiction Use of anti-addictive medications No personal fault attribution - consequence of life history & parental neglect Adderall – a last concern Adderall is another pharmacological name for equal parts amphetamine and dextroamphetamine Dextroamphetamine has a high potential for misuse in a recreational manner since individuals typically report feeling euphoric, alert, and energetic after taking the drug As of 2019, there is no effective pharmacotherapy for amphetamine addiction