Science of Unmanageability

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T Roland Reeves, MD, FACS, FASAM
Kelly Reeves, RN
Medical Director

Executive Director
Clinical Director

Best Nurse in the World Sue
Minnick COO Chief Enabler
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Disclosure I am a trainer for Braeburn
Pharmaceuticals for Buprenorphine implants
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The Science of Unmanageability
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What is Addiction? Addiction is A Brain Disease

• Characterized by
• Compulsive Behavior
• Continued abuse of drugs despite negative
  consequences
• Persistent changes in the brains structure and
  function

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Unmanageability
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naw, I got this.
Hey buddy, need some help?
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ok, ok
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Therefore, the main problem of the alcoholic
centers in his mind, rather than in his body. If
you ask him why he started on that last bender,
the chances are he will offer you any one of a
hundred alibis. Sometimes these excuses have a
certain plausibility, but none of them really
makes sense BB pg 23 The word mind is used
over 40 times in first 164 pages of BB, The word
body occurs 10 times
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Brain Disease?

• If you can
• Sit quietly after difficult news
• Never complain, blame or be a victim
• Happily eat whatever is put in front of you
• Fall asleep easily without a drink or pill after
  an active day of running around doing all
  that is needed to do
• You always find contentment wherever you are

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Then you are probably a dog!!
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I think, therefore I am
Rene Descartes
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three ounce words
health needs money ambition
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My
health needs money ambition
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Thinking

• Where does thinking come from?
• All of subconscious neural areas become
  integrated into consciousness.
• There is a hierarchy of power of these inputs.
  More basic (instinct) more power
  survival
• I may consciously choose one thing, then I do
  another. Subconscious drive trumps conscious
  decisions resulting in subconscious driven actions

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• Brainstem Active brain. Regulates basic
  processes, states of arousal, fight-flight-freeze.
  
• Limbic System Ractive brain. Emotions,
  evaluation of good vs bad, forming relationships
  and emotional attachment, salience, memory
• Cerebral cortex Responsive brain. Think,
  imagine, combine facts and experiences, create.

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Middle Prefrontal Cortex- the real control center

• Body Regulation 5. Empathy
• Attunement 6. Insight
• Emotional Balance 7. Fear extinction
• Response Flexibility 8. Intuition

prenatal stress, lack of nurturing, trauma,
stress, pain, depression, anxiety, craving,
substance use, etc Prefrontal cortex goes OFF
LINE
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All of these pathways route input to be modified,
judged, reacted upon, and remembered implicitly
and explicitly.
Energy via our senses becomes information via
experience The information directs growth,
development, function, integration of the brain.
Seven senses, maybe eight, provide the
information that determines our identity.
1-5 see, tasted, hear, smell, feel 6
perceive our internal states 7 perceive our
inner mind, reflect on experience 8
perceive the energy of another
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10 consciousness 90 subconscious
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REACTION
OVERTHINKING
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I think, therefore I am
Rene Descartes
Restless, irritable, annoyed, angry, lonely,
depressed, bored, anxious, discontented,
frustrated, afraid, hurt..
I think, therefore I am______________________
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I Need RELIEF!!!
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EVERYONE is seeking relief
Around 12 find a reliable, reproducible, end of
all my problems answer..
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ADDICTION
A Compulsion for Relief and Numbness

• Biological Fate or Conscious Choice?
• I thought it was a disease?
• If it is a disease, why do people talk about
  behavior and spirituality?

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•  impairment of the normal state of the living
  animal or plant body or one of its parts
  that interrupts or modifies the performance of
  the vital functions, is typically manifested by
  distinguishing signs and symptoms, and is a
  response to environmental factors (as
  malnutrition, industrial hazards, or climate), to
  specific infective agents (as worms, bacteria, or
  viruses), to inherent defects of the organism (as
  genetic anomalies), or a combinations of these
  factors 

D I S E A S E
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Hijacked!!!
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R I G I D I T Y
C H A O S
Unmanageability
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Unmanageability
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I would rather be drunk and miserable, than
just miserable.
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What I have What I do What people think about
me EGO Limitations,
scarcity, pessimism, expectations,
disappointment, doubt, fear
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Sugar
Oreos vs Cocaine facebook, tv remote, eat, shop,
gamble, love.
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DOPAMINE tells the brain All sytems go and
that was good for the system DOPAMINE
Determines Motivation Dopamine is how the brain
LEARNS
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Natural Rewards Elevate Dopamine Levels
Sex
Food
200
200
NAc shell
150
150
DA Concentration ( Baseline)
of Basal DA Output
100
100
Empty
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Box Feeding
Female Present
0
Sample Number
0
60
120
180
Time (min)
Di Chiara et al., Neuroscience, 1999.,Fiorino and
Phillips, J. Neuroscience, 1997.
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Effects of Drugs on Dopamine Release
Amphetamine
Cocaine
Morphine
Nicotine
Time After Drug
Di Chiara and Imperato, PNAS, 1988
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CONNECTED
Normal Dopamine Level___________________________
Low Dopamine- something amiss
No Dopamine- Anhedonism
ALONE
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Default Mode Network (DMN)
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Overlap between DMN and Self-referential
processing
Whitfield-Gabrieli Neuroimage (2011)
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End Result- ADDICTION There is a compulsion to
do something that the brain now perceives to be
imperative to SURVIVAL, it is biologically and
neurologically entrenched. Recovery MUST be
real changes in the reward/learning/drive
pathways fixed in the brain.
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POWERLESS
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ACTIONS/REACTIONS
Addiction- Automatic pathways laid down from
birth, guided by instincts to avoid pain and seek
reward.
SUBCONSCIOUS
BIOLOGY
Rigidity or Chaos based on bottom up
reactivity, or paralysis of
analysis stemming from top down dominance.
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If addiction results in a primary abnormality of
chemistry, function, integration and wiring in
the brain,
How do we change the BRAIN?
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NEUROPLASTICITY

• Synaptogenesis
• Myelinogenesis
• Neurogenesis
• Intention fuels these changes

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Neuroplasticity
Focused Awareness is the scalpel by which we
mold our brain What fires, wires (use it or
lose it)
Richard J. Davidson, Univ of Wis-Madison
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AWARENESS Changes structure (synapses,
pathways, etc.),
function (neurotransmitters, dopamine,
cortisol, etc.)

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Larger brains, faster mental processing, higher
IQ, and increased activity correlating to the
left hand, even if they just imagined playing

Annals of the New York Academy of Science, 999,
485-496
Followed 79 aspiring cab driver trainees required
to memorize a labyrinth of 25,000 streets over 4
years. Only 39 of them passed the exam. They
had significant growth in areas of the
hippocampus related to spatial memory compared to
non-successful trainees.

Scientific American, Dec 8, 2011,
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The embodied BRAIN is the mechanical source of
the MIND
The MIND shapes structure and function of the
BRAIN MIND the energy that becomes information
that shapes and regulates the brain
Dan Siegel, Mindsight
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Changing Pathways
Awareness accomplishes dampening and eventual
dismantling of the associative learning process
of drug usethus deautomating a largely habitual
process. Brewer, Bowen, Smith, Marlatt,
Potenza, 2010 Kabat-Zinn et al., 1985 Teasdale,
Segal, Williams, 1995
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New pathways.
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What can I give Compassion Love
Awareness Restored
potential, Possibilities Connection
ME
Universe
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Dec 2015
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We can not think our brains betterunless we
change how we think.
AWARENESS
We can repair, restore, and create new situations
in our brains. We can fundamentally change our
motivations, drives and instincts
CONCIOUSNESS
SUBCONCIOUS
BIOLOGY
Endeavors that can be termed spiritual actually
change our brains
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Neurotransmitter Changes (Adapted from
Newberg and Iversen, 2003)
ADDICTION
SPIRITUALITY
Dopamine dec inc reward
Serotonin dec inc focus
Melatonin dec inc sleep
Noradrenaline inc dec anxiety
Acetylcholine dec inc parasymp
Glutamate dec inc brain energy
NAAG dec inc cell comm
GABA dec inc calmness
Cortisol, CRF inc dec stress
Endorphins dec inc pain relief
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Substance abuse One year
clean
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Mindfulness practice leads to increases in
regional brain gray matter density Britta K.
Hölzel, James Carmody. Mark Vangel, Christina
Congleton, Sita M. Yerramsetti, Tim Gard, Sara W
Lazar 2011
a controlled longitudinal study to investigate
pre-post gray matter concentration attributable
to participation in an 8 week MBSR program.
Compared to contols (no MBSR and pre-MBSR) there
was increase in hippocampus, post cingulate
cortex, temporo-parietal jct, and the cerebellum
gray matter. The results suggest that
participation in MBSR are associated with
changes in learning and memory processes,
emotional regulation, self-reference and
perspective
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Blood Flow in the brain
Negativity
Appreciation
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Increased dopamine tone during
meditation-induced change of Consciousness
Cognitive Brain Research Volume 13, Issue 2,
Pages 255259
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Frontal Lobes- peace, less separation
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Increased mPFC activation
Brewer et al., Proceedings National Academy of
Sciences, December 13, 2011
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This involves moving from a focus on content to
a focus on process, away from cognitive therapys
emphasis on changing the content of negative
thinking, toward attending to the way all
experience is processed Segal, Williams and
Teasdale
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Why 12 steps?

• Automaticity, Instinct
• Recognize Connections
• Aware, Awake, Committed,
• Victim, blame, fear and disconnection
• (Its all about ME)
• Automatic behaviors
• Conscious reconnection
• Am I disturbed? Recentering
• Practices. Road Maintenance
• Connected. I am a Part-Of, Empathy, compassion,
  attunement, presence.

• Powerless
• Belief in Higher Power
• Turn my will over
• Inventory of past
• Character Defects
• Amends
• Review the events of the day
• Prayer and Meditation
• Spiritual Awakening

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SPIRITUALITY
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Having had a spiritual awakening as the result
of these steps.. Alcoholics Anonymous the "Big
Book"
Spirit or spiritual is used over 120 times in
164 pages of BB
CONNECTED
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Between stimulus and response there is a space.
In that space is our power to choose our
response. In our response lies our growth and our
freedom.
Mans Search For Meaning Victor Frankl
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What was our choice to be? BB p53
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PEACE is a choice
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