the science of recovery: an advanced seminar

THE SCIENCE OF RECOVERY: AN ADVANCED SEMINAR

CARDWELL C. NUCKOLS, PhD

[email protected]

WWW.CNUCKOLS.COM

THE SCIENCE OF RECOVERY

“…this business of resentment is infinitely grave. We found that it is fatal. For when harboring such feeling we shut ourselves off from the sunlight of the Spirit. The insanity of alcohol returns and we drink again. And with us, to drink is to die.” Big Book page 66


GRATITUDE (LOVE)

A CHANGE IN WORLDVIEW

GRANDIOSITY(CHARACTER DEFECTS)

GRATITUDE

UNCONDITIONAL LOVE

HUMILITY

ACCEPTANCE

FORGIVENESS

SURRENDER

COURAGE AND HONESTY

GRANDIOSITY AND HUMAN SUFFERING

WHAT DO YOU SEE?

NUCLEUS BASALIS

THE SCIENCE OF RECOVERY: NEUROPLASTICITY

THE NUCLEUS BASALIS IS…

THE MODULATORY CONTROL CENTER FOR PLASTICITY

NOVELTY

THE SCIENCE OF RECOVERY: NEUROPLASTICITY

YOU ARE NEUROPLASTICIANS!

WHAT ENHANCES PLASTICITY?• NOVELTY

• THERAPEUTIC RELATIONSHIPS• PHYSICAL EXERCISE

• MINDFULNESS

NEUROPLASTICITY

• BRAIN AT ALL AGES IS RESPONSIVE TO ENVIRONMENTAL STIMULI

• SYNAPSES CAN CHANGE IN MINUTES WHEN STIMULATED

• NEUROPLASTICITY IS MODULATED BY– GENETIC FORCES – EPIGENETIC FORCES

ADDICTION AND RECOVERY

RECOVERY

ADDICTION

ACUTE ABSTINENCE

• PREFRONTAL CORTEX

• MIDBRAIN• LIMBIC

• BRAIN STEM• LOCUS

COERULEUS

THE SCIENCE OF RECOVERY:GENETICS• GENETICS

–A1 ALLELE OF THE DOPAMINE D2 RECEPTOR GENE

–FOUND IN ONE-THIRD OF POPULATION

–LOW DOPAMINE TONE

THE SCIENCE OF RECOVERY:GENETICS• TWIN STUDIES SUGGEST GENES AND

ENVIRONMENTAL FACTORS EACH INFLUENCE THE VULNERABILITY TO DEVELOPING ADDICTION

• STRESS IS ONE, IF NOT THE PRINCIPLE, ENVIRONMENTAL FACTOR THAT INCREASES ADDICTION POTENTIAL

• IN BOYS WITH THE A1 ALLELE STRESS WAS SIGNIFICANTLY CORRELATED WITH COGNITIVE FUNCTIONAL PROBLEMS

NOBLE AND BENTON. THE D2 DOPAMINE RECEPTOR GENE AND FAMILY STRESS. INTERACTIVE EFFECTS ON COGNITIVE FUNCTIONING IN CHILDREN. BEHAV GENET, 1997; 27:33-43.

THE SCIENCE OF RECOVERY:GENETICS

• GENETIC VULNERABILITY– SONS OF ALCOHOLICS HAVE

DECREASED SENSITIVITY TO ALCOHOL• ENORMOUS AMOUNT OF

DEVELOPMENTAL STRESS• EITHER CAN CAUSE IRREGULARITIES

IN BRAIN CHEMISTRY SUCH AS DOPAMINE BLUNTING


• Treatment dropout linked to elevated stress response (Drug and Alcohol Depd. 105 (3):202-208, 2009)– Salivary cortisol can predict how long a drug

user will remain in treatment– Cortisol measured at base for both men and

women in a residential treatment center before giving them stressful tasks

– Prior to the stressors cortisol levels were similar for the 21 participants who dropped out as compared to the 81 who completed treatment

THE SCIENCE OF RECOVERY:GENETICS• Treatment dropout linked to elevated

stress response (Drug and Alcohol Depd. 105 (3):202-208, 2009) (continued) – The patients who dropped out had cortisol

levels 3-5 times higher than those patients who remained in treatment

– For each unit of increase in cortisol after the stressful tasks, there was a four-fold increase in risk of dropping out


• WHEN YOU DISCONTINUE TO DRINK CIRCUITS ARE STILL PRESENT– CORTICOTROPIN RELEASING FACTOR

(CRF) SYSTEM PRODUCES A CHRONIC STRESS RESPONSE THAT IS A SET-UP FOR RELAPSE

– 60-70% OF RELAPSE OCCUR UNDER CONDITIONS OF NEGATIVE EMOTIONAL STATE

THE SCIENCE OF RECOVERY:GENETICS• A shortage of D2 receptors, some researchers

surmise, could predispose a person to addiction.

• Nora Volkow, NIDA Director, led two studies that involved artificially increasing the number of D2 receptors in rats by administering adenoviral vectors directly into their brains. Viral vectors transmit their genetic material and makeup into foreign cells, in this case increasing the number of D2 receptors in the new cells to match their own.

THE SCIENCE OF RECOVERY:GENETICS• In one study involving rats and alcohol,

the increased number of D2 receptors led the rodents to consume less alcohol, compared with their baseline intake.

• In the other study, the D2-receptor increase caused rats to significantly reduce their intake of cocaine.


• Association between DA D2 receptor numbers and drug self-administration (PET)– Increased D2 receptors reduced alcohol

consumption– Decreased D2 receptors higher risk

• DA D2 receptor levels influenced by stress and social hierarchy

THE SCIENCE OF RECOVERY:GENETICS• Michael Nader, a researcher at Wake Forest

School of Medicine, is investigating ways to raise D2-receptor levels naturally.

• One experiment he helped conduct focused on five separate groups of four monkeys. Each had been self-administering cocaine to the point of habit and were then deprived of the drug for an eight-month period. To create a picture of D2-receptor availability, the monkeys were given a radioactive tracer that competes with dopamine for receptors.

THE SCIENCE OF RECOVERY:GENETICS• The monkeys were then randomly put in social

groups of four and given the opportunity to self-administer the drug again.

• Positron emission tomography (PET) imaging of the monkeys over time showed fluctuations in dopamine levels, which allowed the researchers to estimate the changing numbers of available D2 receptors.

• After only three months, the socially dominant monkeys in each group had naturally increased their numbers of D2 receptors.

THE SCIENCE OF RECOVERY:GENETICS• There was no increase in the subordinate

monkeys. Further, the subordinate monkeys reverted to using cocaine at much higher levels than the dominant monkeys.

• "There is an interesting relationship between D2-receptor numbers and vulnerability to drug addiction," Nader said. "It appears that individuals with low D2 measures are more vulnerable compared to individuals with high D2-receptor numbers."

THE SCIENCE OF RECOVERY:GENETICS• Why did the socially dominant monkeys

show D2-receptor increases?• One hypothesis is environmental

enrichment. For the monkeys, it seems, being dominant was the enriching trigger.

• One physiological consequence of involvement in 12-step meetings, therefore, could be an increase in the natural production of D2 receptors.


• Social interventions can change neurobiology– Increased DA D2 receptors– Reduced self-administration

• Behavioral interventions could counteract the aversive effects of drug abuse and reinforce the power of group approaches

THE STRIATUM• The basal ganglia are nestled inside cortex,

surrounding the thalamus (see image above). The striatum (part of the basal ganglia circuitry) is composed of the putamen, caudate, and nucleus accumbens. Other important parts of the basal ganglia are the globus pallidus (which has an internal and an external segment, GPi and GPe respectively) and the subthalamic nucleus (STN).

NEURAL PATHWAYS

CORTICOSTRIATAL CIRCUITRY• This impairment could arise from two general

pathologies in corticostriatal circuitry: addicts could have pathologically strengthened drug-seeking behaviors, or they could have pathological impairments in the capacity to control drug-seeking behaviors. These two possibilities are not mutually exclusive.

• Corticostriatal circuitry has two subcircuits: the limbic subcircuit, which comprises brain regions such as the prefrontal cortex, the amygdala, the nucleus accumbens (NAc) and the ventral tegmental area (VTA); and the motor subcircuit, which contains the motor cortex, the dorsal striatum and the substantia nigra.

CORTICOSTRIATAL CIRCUITRY

CORTICOSTRIATAL CIRCUITRY• Corticostriatal projections are

responsible not only for generating learnt, well-established behaviors such as in drug taking, but also for changing behaviors in response to a variable environment, and thereby generating new adaptive behaviors

• Addicts have difficulty modulating drug-seeking behaviors with information that should suppress the behavior

CORTICOSTRIATAL CIRCUITRY• The NAc serves as a gateway through which

information that has been processed in the limbic subcircuit gains access to the motor subcircuit.

• Relapse to compulsive drug seeking arises from an impaired ability of the limbic subcircuit to effectively process and/or use the negative environmental contingencies associated with relapse. The result is that behavior is dominated by the previously learnt, well-established drug-seeking strategies.

Nucleus Accumbens

Ventral TegmentalArea

DopamineDopamine

Opioid PeptidesOpioid Peptides

NaltrexoneNaltrexone

ArcuateNucleus

THE SCIENCE OF RECOVERY: DOPAMINE (DA) TONE


• TWO TYPES OF LOW DA TONE (CONTINUED)• SYMPTOMS WILL BE THOSE OF REDUCED

DA TONE AT NAc REGARDLESS OF THE LOCATION OF FEEDBACK PROBLEM

• FROM TREATMENT PERSPECTIVE WHAT DIFFERENTIATES WHETHER DA OR OPIOID CAUSATION OF LOW DA TONE IS….– HISTORY OF DRUG USAGE AND EFFECTS THAT

USER EXPERIENCES


• SUFFICIENT– DA TONE IN REWARD CIRCUITRY YIELDS

ADEQUATE• ATTENTION• MOTIVATION• ATTACHMENT• HEDONIC TONE


• REDUCED OR LOW DA TONE– ANHEDONIC RELATIVE TO THOSE

AROUND THE INDIVIDUAL– SENSE OF NOT FITTING IN– POOR ATTENTION– POOR LEVEL OF MOTIVATION– RESTLESS– IRRITABLE– DISCONTENTED

PREFRONTAL CORTICAL DOPAMINE

• Optimal levels of prefrontal cortical dopamine are critical to various executive functions such as working memory, attention, inhibitory control, and risk/reward decisions, all of which are impaired in addictive disorders such as alcoholism.

• Imaging studies of alcoholics have demonstrated less dopamine in the striatum

Volkow ND; Wang GJ; Telang F; Fowler JS; Logan J; Jayne M; Ma Y; Pradhan K; Wong C: Profound decreases in dopamine release in striatum in detoxified alcoholics: possible orbitofrontal involvement. J Neurosci 2007; 27:12700–12706


• Less dopamine in the prefrontal cortex, which governs executive functions, is important because it could impair the addicted person’s ability to learn and utilize informational/behavioral strategies critical to relapse prevention. This is supported by literature that links prefrontal cortical dopamine with executive functions, such as attention, working memory, behavioral flexibility, and risk/reward decision making, all of which are impaired in addictive disorders such as alcoholism.

Floresco SB; Magyar O: Mesocortical dopamine modulation of executive functions: beyond working memory. Psychopharmacology (Berl) 2006; 188:567–585


• It is tempting to speculate that the failure to incorporate past negative consequences in a decision to drink alcohol during abstinence is related to decreased prefrontal cortical dopamine in alcoholism.

• Unclear whether decreased dopamine transmission in alcoholism represents a premorbid trait or alcohol-induced state

Narendran, et al. Decreased Prefrontal Cortical Dopamine Transmission in Alcoholism. Am J Pscyhiatry. 2014;171:881-888. doi:10.1176/appi.ajp.2014.13121581


• INCREASING DA TONE AT NAc– THREE POSSIBLE APPROACHES

• INCREASE AMOUNT OF DA RELEASED-CURRENTLY HAVE MEDS LIKE SUBOXONE THAT WILL DO THIS

• INCREASE NUMBER OF RECEPTORS-MEDS NOT AVAILABLE FOR THIS

• REDUCING REUPTAKE OF DA-HAVE MEDS THAT WILL DO THIS (PROVIGIL)

THE SCIENCE OF RECOVERY: THE OPIATE EXPERIENCE

HIGH

ABNORMALLY NORMAL

SUBJECTIVE W/DRAWAL

ACUTE ABSTINENCE SYN.


• SUBUTEX-Buprenorphine. sublingual (SL)– 2mg and 8mg tablets

• SUBOXONE-Buprenorphine/Naloxone SL tablets AND FILM

• Zubsolv SL• PARTIAL AGONIST

– Increasing dose does not increase effect like a full agonist


• BUPRENORPHINE-Very high affinity for mu opioid receptor

• Mu receptor will choose buprenorphine over other opioids

• Buprenorphine will displace other opioids• Slow dissolution from mu receptor

– Half-life on receptor is 34-36 hrs– Heroin on and off receptor in millisecond– At Buprenorphine dose of 16mg almost no

binding to other opioids

PHARMACOLOGICAL

• NALTREXONE (Revia, Vivitrol)• Pure antagonist• Poor compliance

– Less than 10% for street addicts

• Better compliance– Healthcare professionals– Parole/Probation

• New suspension with q30d administration should dramatically increase compliance and reliability of drug

VIVITROL Carton Components

47

VIVITROL

Important Safety Information

• VIVITROL is contraindicated in patients receiving opioid analgesics or with current physiologic opioid dependence,patients in acute opiate withdrawal, any individual who has failed the naloxone challenge test or has a positive urine screen for opioids, or in patients who have previously exhibited hypersensitivity to naltrexone, PLG, carboxymethylcellulose or any other components of the diluent.

• VIVITROL patients must be opioid free for a minimum of 7-10 days before treatment.

• Attempts to overcome opioid blockade due to VIVITROL may result in a fatal overdose.

• In prior opioid users, use of opioids after discontinuing VIVITROL may result in a fatal overdose because patients may be more sensitive to lower doses of opioids.

VIVITROL[full prescribing information]. Cambridge, MA: Alkermes, Inc; May 2009. 53

THE SCIENCE OF RECOVERY:GLUTAMATE• NOTION THAT ADDICTION EQUALS TOO MUCH

DOPAMINE IS A GROSS OVERSIMPLIFICATION• IN ANIMAL STUDIES

– EVEN WHEN DA RECEPTORS ARE BLOCKED SOME DRUG-SEEKING BEHAVIOR PERSISTS• EXTERNAL CUE DRIVEN

– DRUGS AFFECTING DA DIRECTLY HAVE BEEN INEFFECTIVE

– INDIRECT APPROACHS SUCH AS INCREASING GABA EFFECT AND REDUCING GLUTAMATE EFFECT SEEM MORE PROMISING (EXAMPLE-TOPIRIMATE)

BRAIN WORKS. VOL 18, NO 5, SEPT/OCT 2008, PGS 1 AND 2.

THE SCIENCE OF RECOVERY: GLUTAMATE• TWO STAGE MODEL OF ADDICTION

– STAGE 1-OCCASIONAL DRUG USE BECOMES INCREASINGLY CHRONIC AND UNCONTROLLED. THE NEUROBIOLOGICAL SOURCE OF THESE SYMPTOMS IS DRUG-INDUCED DEREGULATION OF THE BRAIN’S REWARD CENTER• DOPAMINE

– STAGE2-ADDITIONAL FEATURES INCLUDE WITHDRAWAL SYMPTOMS, PERSISTENT VULNERABILITY TO RELAPSE WITH ALTERATIONS IN DECISION MAKING AND OTHER COGNITIVE PROCESSES• DRUG-INDUCED SIGNALS BY NEUROTRANSMITTER

GLUTAMATE FROM BRAIN AREAS PRIMARILY ASSOCIATED WITH JUDGMENT

THE SCIENCE OF RECOVERY: GLUTAMATE

• CHANGES IN BRAIN GLUTAMATE SIGNALING INDUCED BY CHRONIC DRUG EXPOSURE HAS A WIDE VARIETY OF NEUROBIOLOGICAL EFFECTS INSTRUMENTAL IN THE TRANSITION FROM DRUG ABUSE TO ADDICTION (KAVALIS,2009)

• THESE NEURAL ALTERATIONS LIMIT THE ABILITY TO ADAPT TO NEW INFORMATION (TO STOP TAKING DRUGS IN SPITE OF ADVERSE CONSEQUENCES)AND STRENGHTEN THE POWER OF DRUG LEARNED ASSOCIATIONS


• Addiction as impairment in reversal learningIN ADDICTION…

“WHEN I USE DRUGS I FEEL GOOD”

CHANGES TO

“WHEN I USE DRUGS BAD THINGS HAPPEN”

NEW RULE BUT CANNOT ADAPT


• ADDICTS CAN LEARN A NEW RULE BUT RUN INTO PROBLEMS WHEN THE RULES CHANGE– COCAINE AND ALCOHOL ABUSERS WERE ASKED

TO PRESS KEY EACH TIME THEY SAW A GREEN RECTANGLE ON THE SCREEN

– AFTER 500 REPETITIONS TOLD NOT TO PRESS KEY WHEN SAW GREEN RECTANGLE

– CONTROLS EASILY ADAPTED WHILE ADDICTS KEPT PUSHING THE KEY EVEN AFTER GIVEN FEEDBACK• IMPAIRED REVERSAL LEARNING DUE TO DRUG USE

AND NOT GENETICS

THE SCIENCE OF RECOVERY: COGNITIVE FUNCTION

• Addiction is a disorder of altered cognition• Addiction impacts…

– LEARNING– MEMORY– ATTENTION– REASON– IMPULSE CONTROL

• Effects are particularly disruptive when exposed during brain development and in the co-occurring population


• Cognitive deficits in chronic drug abuse– Withdrawal produces cognitive symptoms

• Cocaine-deficits in cognitive flexibility• Amphetamine-deficits in attention and impulse

control• Opioids-deficits in cognitive flexibility• Ethanol-deficits in working memory and attention• Cannabis-deficits in cognitive flexibility and

attention• Nicotine-deficits in working memory and

declarative learning

THE SCIENCE OF RECOVERY: COGNITIVE FUNCTION• Why give an alcoholic or addict a 60

minute didactic or video?• A new format

– 15-20 minute simple didactic• How to participate in treatment

– 10 minute questionnaire– 30 minute discussion group


I THINK………..

I FEEL…………..

I LEARNED……

MY FUTURE BEHAVIOR WILL CHANGE…


• RELAPSE FALLS ALONG A SPECTRUM

• COMPULSIVE RELAPSE• PREFRONTAL CORTEX OFF-LINE

• REGULATED RELAPSE• SOME PREFRONTAL AVAILABILITY

• LITTLE OR NO RELAPSE• PREFRONTAL CORTEX AVAILABLE

THE SCIENCE OF RECOVERY CRAVING MANAGEMENT

• Though some relapse triggers can be consciously avoided, such as people, places and things related to drug use, other subconscious triggers related to the brain's reward system may be impossible to avoid -- they can gain entry to the unconscious brain, setting the stage for relapse.

• Baclofen, commonly used to prevent spasms in patients with spinal cord injuries and neurological disorders, can help block the impact of the brain's response to "unconscious" drug triggers well before conscious craving occurs.

THE SCIENCE OF RECOVERY CRAVING MANAGEMENT• Subliminal drug "reminder cues" (the sights,

sounds, smells, and memories of the drug) could activate the brain's reward circuit.

• 23 cocaine-dependent men, ages 18 to 55. Each reported using cocaine on at least eight of 30 days before screening. Inclusion in the study required that they stay for up to 10 days in a supervised inpatient drug treatment facility, be drug-free for the duration, not be on any medication affecting dopamine or neurotransmitter response, and have no history of psychosis, seizures, or brain syndromes unrelated to cocaine use.

THE SCIENCE OF RECOVERY CRAVING MANAGEMENT• Upon admission, patients were randomized to receive baclofen or placebo. Over the first six days, patients in the baclofen group received the medication in increasing dosage to 60 mg. While on the full 60 mg dose of baclofen, patients were placed in an fMRI and shown a series of images, to measure their neural responses to "ultra-brief" pictures of cocaine or other comparison pictures. Each of the ultra-brief 33 msec "target" pictures was immediately followed by longer picture of non-drug objects or scenes. Under these conditions, the participants are aware of the longer pictures, but the ultra-brief target pictures remain completely outside conscious awareness -- they are "backward-masked."

THE SCIENCE OF RECOVERY CRAVING MANAGEMENTNT• What the team found was that the patients

who were treated with baclofen showed a significantly lower response in the reward and motivational circuits to subliminal cocaine cues versus neutral cues, as compared to the placebo-treated control group.

K. A. Young, T. R. Franklin, D. C. S. Roberts, K. Jagannathan, J. J. Suh, R. R. Wetherill, Z. Wang, K. M. Kampman, C. P. O'Brien, A. R. Childress. Nipping Cue Reactivity in the Bud: Baclofen Prevents Limbic Activation Elicited by Subliminal Drug Cues. Journal of Neuroscience, 2014; 34 (14)

ROBIN WILLIAMS

“I realized... you keep going with this, you’ll wake-up in a field with a small animal,” laughed Williams. “If you’re violating your standards faster than you can lower them, time to go away.”

THE SCIENCE OF RECOVERY: HABIT

YOU CANNOT EXTINGUISH A BAD

HABIT; YOU CAN ONLY CHANGE IT

THE SCIENCE OF RECOVERY: HABIT

THE CUE TRIGGERS THE ROUTINE AND

ALSO TRIGGERS THE CRAVING FOR THE REWARD TO COME

THE SCIENCE OF RECOVERY: HABIT• When a habit begins the whole brain is

activated as it actively processes all of the stimuli

• After this phase the higher brain begins to reduce level of activation

• Then even the memory centers reduce activity

• BASAL GANGLIA has now taken control of recalling the patterns and acting on them

BASAL GANGLIA

THE SCIENCE OF RECOVERY: HABIT LOOP

CUE

ROUTINEREWARD

THE SCIENCE OF RECOVERY: HABIT• CUE AND REWARD BECOME

INTERTWINED CREATING A CRAVING (CONDITIONING)

• In a habit the brain reduces emphasis on decision making

• Pattern unfolds automatically unless you find a new routine

• After craving develops, cannot extinguish a bad habit, you can only change it

THE SCIENCE OF RECOVERY: HABIT LOOP

SAME CUE(S)

DIFFERENT ROUTINE

SAME REWARD

THE SCIENCE OF RECOVERY: HABIT• ALMOST ANY HABIT CAN CHANGE IF

YOU KEEP THE SAME CUE(S) AND SAME REWARD

• ALCOHOLICS ANONYMOUS changes the habit loop

• ALCOHOLICS ANONYMOUS succeeds because it helps use the same cues and get the same rewards but shifts the routine

THE SCIENCE OF RECOVERY: HABIT• To change a habit must address the same cues

and rewards as before and feed the craving by inserting a new routine

• WHAT DO ALCOHOLICS AND ADDICTS CRAVE?– It isn’t a craving to be drunk– Physical effects of alcohol are the least rewarding

(the same can be said for cocaine, methamphetamine, etc.)

– Is it connection, reduce anxiety, forget worries?– Meetings and companionship-another bar to

escape to, catharsis, distraction

THE SCIENCE OF RECOVERY: HABIT• What is the pleasure we seek in the first

place?– Is it…

• COMPLETION• RELAXATION• TO FORGET• TO CONNECT• TO REWARD MYSELF• TO GIVE ME COURAGE• TO FEEL LIKE YOU BELONG AS ONE OF THE

GROUP

THE SCIENCE OF RECOVERY: HABIT• ALMOST ANY HABIT CAN CHANGE IF

YOU KEEP THE SAME CUE(S) AND SAME REWARD

• ALCOHOLICS ANONYMOUS changes the habit loop– AA offers…

• Escape• Catharsis• Distraction• Relief via talking

THE SCIENCE OF RECOVERY: HABIT• ALCOHOLICS ANONYMOUS succeeds because it

helps use the same cues and get the same rewards but shifts the routine

• AA forces new routines for what to do each night as opposed to drinking

• To change a habit must address the same cues and rewards as before and feed the craving by inserting a new routine

• WHAT DO WE CRAVE?– Is it connection, reduce anxiety, forget worries?– Meetings and companionship-another bar to escape

to, catharsis, distraction

THE SCIENCE OF RECOVERY: HABIT• What is the thirst behind the thirst?

– “I was thirsty because I was feeling incomplete and alcohol helped me feel more connected, more alive.”

– Bill Wilson, “Before A.A. we were trying to drink God out of a bottle.”

– Gerald May- a deep yearning for fulfillment or completion; a longing to love and be loved and a desire for the source of this love-God

THE SCIENCE OF RECOVERY: HABIT• What is the thirst behind the thirst?

– The great analyst Carl J. Jung put it thus, “His craving for alcohol was the equivalent, on a low level, of the spiritual thirst of our being for wholeness, expressed in medieval language: the union with God.”

– An intense, urgent, or abnormal desire or longing. At the time it seems more painful than any other longing. It subsumes us and we are a slave to it…and it seems it will never end. Although not understood in that moment, it is really a powerful thirst to go “home.”

THE SCIENCE OF RECOVERY: HABIT• REPLACEMENT ROUTINES ONLY

BECOME DURABLE NEW BEHAVIORS WHEN SPIRITUALITY IS ADDED (this is what gets you through the major crises in your life)

• PATTERN:– Could only stay sober by habit

replacement until a major crisis hit– Add spiritual element and now can get

through these tough times

DOPAMINE (DA) TONE-GENDER DIFFERENCES

• WOMEN ESCALATE FASTER TO HEAVY USE

• WOMEN MORE READILY SUCCUMB TO SOCIAL AND PHYSICAL DAMAGE

• REPRODUCTIVE HORMONES MAY UNDERLIE THIS SUSCEPTIBILITY– REMOVE OVARIES OF FEMALE RAT (NO

LONGER PRODUCE ESTROGEN) AND REDUCE DRUG SEEKING BEHAVIOR FOR COCAINE AND AMPHETAMINE

DOPAMINE (DA) TONE-GENDER DIFFERENCES• ESTROGEN MAY SPUR ADDICTION BY

STIMULATING BRAINS REWARD PATHWAYS ENHANCING “HIGH” BY INCREASING DA

(ANTHES, EMILY. “SHE’S HOOKED”. SCIENTIFIC AMERICAN MIND. MAY/JUNE 2010, PGS.14-15.)

• PROGESTERONE APPEARS TO OPPOSE ESTROGEN’S ABILITY TO PROMOTE ADDICTION

• GIVE BOTH ESTROGEN AND PROGESTERONE TO RATS WITHOUT OVARIES AND NO ACCELERATION OF ADDICTION


• FEMALE RESPONSE VARIES ACROSS MENSTRUAL CYCLE AS LEVELS OF ESTROGEN AND PROGESTERONE WAX AND WANE (2007, SUZETTE EVANS, COLUMBIA UNIVERSITY)

– STIMULANTS MORE PLEASURABLE TO WOMEN DURING ESTROGEN-DOMINATED FOLLICULAR PHASE WHICH OCCUPIES APPROXIMATELY 2 WEEKS FROM ONSET OF PERIOD UNTIL OVULATION THAN DURING THE LUTEAL PHASE AFTER OVULATION WHEN BOTH ESTROGEN AND PROGESTERONE ARE HIGH


• ASKED ONE-HALF OF 202 FEMALE CIGARETTE SMOKERS TO TRY TO ABSTAIN DURING LUTEAL PHASE AND THE OTHER HALF TO TRY TO ABSTAIN DURING THE ESTROGEN RICH FOLLICULAR PHASE– THIRTY-FOUR (34) PERCENT OF WOMAN IN FIRST

GROUP HAD NOT SMOKED AT 30 DAYS– FOURTEEN (14) PERCENT OF WOMEN IN THE

SECOND GROUP HAD NOT SMOKED AT 30 DAYS(2008, SHARON ALLEN, UNIVERSITY OF MINNESOTA MED SCHOOL)

the science of recovery: an advanced seminar

Documents

science of recoverygratitude

elevated stress response

chronic stress response

family stress

a1 allele stress

dopamine d2 receptor

d2 dopamine receptor

dopamine blunting