Session 1: Triggers and Cravings

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Session 1Triggers and Cravings
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Changes in the Brain
Prefrontal Cortex
Limbic System
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Conditioning
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I.P. Pavlov (18491936)
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Pavlovs Dog
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A Definition of AddictionAmerican Society of
Addiction Medicine
A primary, chronic, neurobiologic disease with
genetic, psychosocial, and environmental factors
influencing its development and manifestations.
Addiction is characterized by behaviors that
include one or more of the following impaired
control over drug use, compulsive use, continued
use despite harm, and craving.
Graham, A.W. Schultz, T.K. Mayo-Smith, M.F.
Ries, R.K. and Wilford, B.B. eds. Principles of
Addiction Medicine, Third Edition. Chevy Chase,
MD American Society of Addiction Medicine, Inc.,
2003.
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The Addictive Process

• Introductory phase
• Maintenance phase
• Disenchantment phase
• Disaster phase

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Addictive ProcessIntroductory Phase
Positives Relief from Depression Anxiety Loneli
ness Insomnia Euphoria Increased
status Increased energy Increased sexual/social
confidence Increased work output Increased
thinking ability
METHAMPHETAMINE (METH)
Negatives May be illegal May be expensive May
cause missing work

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Conditioning Process During AddictionIntroductory
Phase
Strength of Conditioned Connection
Mild

• Responses
• Pleasant thoughts about meth
• Infrequent use

• Triggers
• Parties
• Special occasions
• Other events

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Development of Obsessive ThinkingIntroductory
Phase
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Development of Craving ResponseIntroductory Phase
Entering Using Site
Use of Meth
Meth Effects
? Heart/pulse rate ? Respiration ? Adrenaline
? Energy ? Meth taste
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Addictive ProcessMaintenance Phase
Negatives Employment/school disruptions Relationsh
ip concerns Financial problems Beginnings of
physiological dependence
Positives Depression relief Confidence
boost Boredom relief Sexual enhancement Social
lubricant
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Conditioning Process During AddictionMaintenance
Phase
Strength of Conditioned Connection
Moderate

• Triggers
• Parties
• Friday nights
• Friends
• Alcohol
• Good times
• Sexual situations

• Responses
• Thoughts of meth
• Eager anticipation of meth use
• Mild physiological arousal
• Cravings occur as use approaches
• Occasional use

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Development of Obsessive ThinkingMaintenance
Phase
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Development of Craving ResponseMaintenance Phase
Physiolog- ical Response
Meth Effects
Entering Using Site
Use of Meth
? Heart ? Breathing ? Adrenaline effects ?
Energy ? Meth taste

• Heart
• Blood pressure
• Energy

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Addictive ProcessDisenchantment Phase
Negatives Withdrawal depression Paranoia Tweaking
Relationship disruptions Family
distress Impending job loss
Positives Sociability Occasional euphoria Relief
from fatigue Relief from stress
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Conditioning Process During AddictionDisenchantme
nt Phase
Strength of Conditioned Connection
STRONG

• Triggers
• Fatigue
• All friends
• Stress
• Boredom
• Anxiety
• Free time
• Sexual arousal
• Loneliness

• Responses
• Continual thoughts of meth
• Strong physiological arousal
• Psychological dependency
• Strong cravings
• Frequent use

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Development of Obsessive ThinkingDisenchantment
Phase
Meth
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Development of Craving ResponseDisenchantment
Phase
Mild Physiological Response
Thinking of Using
Entering Using Site
? Heart rate ? Breathing rate ? Energy ?
Adrenaline effects
Powerful Physiological Response
Meth Effects
Use of Meth
? Heart ? Blood pressure ? Energy
? Heart rate ? Breathing rate ? Energy ?
Adrenaline effects
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Addictive Process Disaster Phase
Negatives Weight loss Paranoia Loss of
family Seizures Severe depression Unemployment Ban
kruptcy
Positives Relief from fatigue Relief from
stress Relief from depression
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Conditioning Process During AddictionDisaster
Phase
Strength of Conditioned Connection
OVERPOWERING

• Triggers
• Any emotion
• Day
• Night
• Work
• Free time

• Responses
• Obsessive thoughts about meth
• Powerful autonomic response
• Powerful physiological dependence
• Automatic use
• Persistent paranoia

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Development of Obsessive ThinkingDisaster Phase
Meth
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Development of Craving ResponseDisaster Phase
Thoughts of Meth- Using Place
Powerful Physiological Response
? Heart rate ? Breathing rate ? Energy ?
Adrenaline effects
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Trigger
Thought
Craving
Use
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Trigger
Thought
Craving
Interruption
Use
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Thought Stopping

• Visualization
• Rubberband snap
• Relaxation
• Calling someone

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Thought Stopping

• Visualization

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Thought Stopping
Rubberband Snap
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Thought Stopping

• Relaxation

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Thought Stopping
Calling Someone