healing the addicted brain

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Healing the Addicted Brain

A book By:Harold C. Urschel, M.D.

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Overview

Excellent reference book for our clients Easy to read Probably too basic for most clinicians Excellent checklists, worksheets (Maybe

helpful for ERG and IOP) Excellent website

www.enterhealth.com/healingtheaddictedbrain

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Contents

1. It’s a Disease!2. Changing Your Thoughts from Pro-

Addiction to Pro-Recovery3. Combating Triggers and Cravings4. Medications to Initiate Recovery

and Help Maintain Sobriety5. Your 12-Step Recovery Program6. Dealing with Difficult Emotions

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Contents

7. Dealing with Dual Diagnosis8. The Recovering Family9. Lapse and Relapse10. Health and Nutrition in Recovery11. Regaining Enjoyment and

Pleasure12. True Recovery – Maintaining Your

Goals

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It’s a Disease!

A long-term illness caused by measurable physical damage to the brain

Nice graphic of a damaged brain Suggests that it takes 6-10 months of

sobriety before significant brain repair Talk therapy helps correct problems

caused in the prefrontal cortex (planning, reasoning, regulating drives)

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It’s a Disease!

Need medication to correct problems in the limbic system (emotional drive, and memory pathways and urges/cravings)

The new anti-addiction medicines are designed to rebalance the brain’s biochemistry

Use of these medicines enhance ability to focus on and benefit from therapy and 12-step programs

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Changing Thoughts from Pro-Addiction to Pro-Recovery

The addicted brain is full of distorted and irrational thoughts

Harmful thoughts trigger negative emotions which trigger pro-addiction behaviors

List of pro-addiction thoughts (e.g., “I can’t get through this without a drink.”)

Worksheets to assess one’s pro-addiction thoughts and substitute healthy thoughts

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Changing Thoughts from Pro-Addiction to Pro-Recovery

The six-question test of thought accuracy:1. What concrete factual evidence supports

this thought?2. Are there other ways I could view this

situation?3. What is the worst thing that could

happen?4. What is the best thing that could happen?5. What is most likely to happen?6. Is this thought inaccurate?

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Combating Triggers and Cravings

The trick is learning to identify and deactivate triggers and to have a plan in place to handle cravings

A nice quiz to see how much one knows about cravings

Cravings are hardwired to the brain. When exposed to a trigger, memory and dopamine circuits are activated leading to a craving.

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Combating Triggers and Cravings

A worksheet to identify personalized triggers (i.e., people, places, times of day, activities)

A worksheet called a “Daily Trigger Chart” of situations, thoughts/feelings, behavior, pos/neg consequences

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Combating Triggers and Cravings

Strategies for handling triggers Good suggestions for avoiding

triggers; extinguishing triggers by not using; and crushing cravings by talking, distracting self, using flash cards, stress management techniques, and visualizing

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Addictions Medicines

Vivitrol and Campral encourages the addict to cut back on alcohol intake

Campral helps accelerate repairs to brain systems

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Addictions Medicines

Vivitrol The active ingredient is naltrexone Naltrexone is an opiate antagonist used to

treat both alcohol and opiate dependence Works by “plugging in” to opioid receptors

in brain cells thus preventing alcohol and opiate molecules from getting in.

It “jams the lock”.

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Addictions Medicines

Vivitrol Alcohol molecules cannot activate

pleasure pathways and cannot trigger a high

Weakness of naltrexone is that it must be taken daily

Vivitrol is a monthly injection eliminating non-compliance

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Addictions Medicines

Vivitrol’s Benefits1. Decreases cravings for alcohol (and

opiates) by up to 90% compared to those without the medication

2. If pt. does use, it blocks the high you normally get

3. It prevents the first drink from becoming many

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Addictions Medicines

Vivitrol Side Effects Safe, well-tolerated, and non-

addicting Occasional headache, feeling of

sedation, or tenderness at site of injection

Normal dose is 380 mg (daily dose of naltrexone is 50 mg), 70% less than dosage of monthly pills

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Addictions Medicines

Campral Generic name is acamprosate Helps the brain heal more quickly,

thus, reducing cravings and the risk of relapse.

Improves the alcoholic’s cognitive skills, and ability to learn new skills

Accelerates the recovery process

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Addictions Medicines

Campral Talk therapy helps with problems

governed by the cortex, Campral repairs damage to the deeper limbic system

This reduces cravings and makes it easier for the brain to concentrate of talk therapy

It’s believed to restore the GABA and glutamate systems

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Addictions Medicines

Campral

Pts. report after taking it for 4-6 weeks to feel calmer, handle stress more effectively, concentrate and focus better and have fewer cravings

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Addictions Medicines

Campral Need about 200 mg per day to

rebalance GABA and glutamate systems

2-3 tablets daily Suggests taking it for at least a year Nontoxic and nonaddicting Possible side effects – diarrhea,

nausea, itching, intestinal gas

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Addictions Medicines

Other Medicines for Alcoholism Antabuse – acts as a deterrent.

Most effective when administered by a monitor. Standard dose is 250 mg. daily.

Topirimate (Topamax) – Not FDA approved. May reduce alcohol cravings and anxiety

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Addictions Medicines

Medication for Opioids- Suboxone Suboxone (Buprenorphine) – a

partial-agonist. Removes the craving without the “high”.

Blocks the effects of opioids, decreases cravings, and suppresses the major symptoms of withdrawal

Side effects – sweating, headache, pain, nausea, constipation, and insomnia

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Addictions Medicines

Medications for Stimulants Modafinil (Provigil) – shows promise

to reduce cocaine withdrawal Propranolol (Inderal) – decreases

symptoms of cocaine withdrawal Buproprion (Wellbutrin) – seems to

help reduce relapse in Meth addicts Showing promise – topamax,

antabuse, neurontin, lioresal

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Addictions Medicines

Treatment for Sedatives – neurontin, trileptal, seroquel, risperdal, lexapro, and zoloft for symptoms of anxiety;

Treatment for marijuana – seroquel, lexapro, zoloft for anxiety and depression

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Your 12-Step Recovery Program

Basic concepts of AA Importance of Sponsorship 12-Step tips Types of AA meetings Finding AA meetings On average, try 4-6 different

meetings to find the right fit

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Dealing with Difficult Emotions

Focuses on depression, anxiety, and anger

Checklists to determine if you are depressed or suffer from anxiety and suggestions for managing depression, anxiety or anger.

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Dealing with Dual-Diagnosis

53% of drug abusers and 37% of alcohol abusers have at least one serious mental illness

Considers benzos as not an option for pts. with dual diagnosis. Suggests vistaril or trazodone for anxiety.

Dual Recovery Anonymous (DRA) Importance of proper sleep and avoiding

caffeine

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The Recovering Family

Anyone living in the same household of the addict is considered family

Family members unwittingly become enablers

A Lapse/Relapse Consequences Agreement – spells out consequences of returning to substance use

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Lapse and Relapse

9 Warning Signs1. Elevated life stress2. Loss of daily structure3. Neglecting healthy coping skills4. Behavior changes5. Social isolation and withdrawal6. Loss of judgment, loss of control7. A change in attitude8. Reactivation of denial9. Recurrence of physical withdrawal

symptoms

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Lapse and Relapse

A Relapse Prediction Scale

A Lapse/Relapse Prevention Plan worksheet

A Lapse/Relapse Action Plan worksheet

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Health and Nutrition in Recovery

Elements of a healthy diet

Exercise: the world’s best stress reliever

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Regaining Enjoyment and Pleasure

An extensive list of recreational activities to consider

A Pro-Addiction Thoughts checklist A Pro-Recovery Thoughts worksheet Suggestions to brighten your day