Post on 12-Jun-2020
Understanding+Addiction+and+Recovery
Jennifer'Riha,'BASc,'MAC8/19/2019
Working(with(communities(to(address(the(opioid(crisis.
! SAMHSA’s'State'Targeted'Response'Technical'Assistance'(STR8TA)'grant'created'the'Opioid&Response&Network to'assist'STR'grantees,'individuals'and'other'organizations'by'providing'the'resources'and'technical'assistance'they'need'locally'to'address'the'opioid'crisis'.
! Technical'assistance'is'available'to'support'the'evidence8based'prevention,'treatment,'and'recovery'of'opioid'use'disorders.'
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Funding(for(this(initiative(was(made(possible((in(part)(by(grant(no.(6H79TI080816(from(SAMHSA.(The(views(expressed(in(written(conference(materials(or(publications(and(by(speakers(and(moderators(do(not(necessarily(reflect(the(official(policies(of(the(Department(of(Health(and(Human(Services;(nor(does(mention(of(trade(names,(commercial(practices,(or(organizations(imply(endorsement(by(the(U.S.(Government.
Working(with(communities(to(address(the(opioid(crisis.
! The$Opioid$Response$Network$(ORN)$provides$local,$experienced$consultants$in$prevention,$treatment$and$recovery$to$communities$and$organizations$to$help$address$this$opioid$crisis.$
! The$ORN$accepts$requests$for$education$and$training.$! Each$state/territory$has$a$designated$team,$led$by$a$
regional$Technology$Transfer$Specialist$(TTS),$who$is$an$expert$in$implementing$evidenceFbased$practices.$
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Contact'the'Opioid'Response'Network
! To#ask#questions#or#submit#a#request#for#technical#assistance:#
• Visit#www.OpioidResponseNetwork.org• Email#orn@aaap.org#• Call#401E270E5900
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Introduction
Goal%of%this%training%series:%
To%prepare%participants%to%be%well5prepared%and%well5informed%as%they%go%into%their%communities%to%provide%peer%to%peer%support%to%family%members%of%people%with%addiction.%We%are%calling%this%“Family%Recovery%Support.”
We%will%focus%on:%
1. Understanding%addiction%and%recovery
2. Core%values%and%framework%for%providing%Family%Recovery%Support
3. Tools%and%methods%for%“how”%to%provide%Family%Recovery%Support
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The$Science$of$the$Disease$of$Addiction
Myths&vs.&Facts
Myths
! Addiction,is,a,bad,habit.,It’s,the,result,of,moral,weakness,and,overindulgence.
! If,an,individual,has,enough,willpower,,they,can,stop,using,alcohol,or,other,drugs.
! Many,people,relapse,,so,treatment,obviously,doesn't,work.
Myths&vs.&Facts
Facts
! Addiction+is+a+chronic,+life2threatening+condition— like+atherosclerosis,+hypertension,+or+diabetes.
! Due+to+physical+changes+within+the+brain+itself,+most+people+simply+can’t+stop+using,+no+matter+how+strong+their+inner+resolve.
! Like+virtually+any+other+medical+treatment,+addiction+treatment+cannot+guarantee+lifelong+health.++
Disease&Model
A"New$England$Journal$of$Medicine$article"refers"to"addiction"as"a"disease,"like""other"medical"
conditions"in"which"voluntary,"unhealthful"
behaviors"contribute"to"disease"progression"(e.g.,"
heart"disease,"diabetes,"chronic"pain,"and"lung"
cancer).”
Volkow,"N.D.,"Koob,"G.F.,"and"McLellan,"A.T."(2016)."Neurobiologic Advances"from"the"
Brain"Disease"Model"of"Addiction."New$England$Journal$of$Medicine,$374(4),"363O371."https://www.nejm.org/doi/full/10.1056/NEJMra1511480
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Participant)Poll
Have%you%ever%heard%any%of%the%myths%mentioned?
! Yes
! No%
Feel%free%to%share%other%myths%or%stigmatizing%beliefs%regarding%addiction%that%you’ve%heard%in%the%chat%box.
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What%the%disease%does%to%the%brain
• The%brain%is%a%communication%system.%
• Neurons%are%receptors%that%send%and%receive%information%constantly.%
• Addictive%substances,%such%as%opiates,%are%picked%up%by%neurotransmitters%and%are%communicated%in%the%brain.
• They%“trick”%the%brain%into%needingthe%addictive%substance.%
• They%can%be%2–20%times%more%potent%than%naturally%occurring%neurotransmitters.
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What%Addiction%Does%to%the%Brain
With%time,%repeated%overexposure%to%the%neurotransmitters%associated%with%pleasure%cause%the%brain%to%try%to%rebalance%itself%by:
! reducing%the%number%of%receptors%that%can%accept%the%pleasure%message;%or
! producing%fewer%and%fewer%of%the%naturally%occurring%pleasure%neurotransmitters.
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Effect&on&the&Brain
At#this#point,#the#substance#is#rewiring#the#brain’s#messaging#systems#and#may#begin#to#impact:
! Memory
! Experience#of#Pain
! Rational#decision?making
! Self?regulation
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Brain&Studies14
Vulnerability,to,Addiction
• Why$are$some$people$more$vulnerable$to$addiction?• Genetic$predisposition• Developmental$• Chronic$pain$• Dual$diagnosis
Triggers,(Cravings,(and(Relapse(! Even%after%detoxification%and/or%beginning%of%treatment,%individuals%
still%experience%physical%symptoms%of%addiction.%Why?! Unconscious%memory%systems
– Example:%“Pavlov’s%dogs”—The%dog%likely%doesn’t%know%“why”%he%salivates%and%fixates%on%eating%when%he%hears%a%bell,%but%the%two%unrelated%things%have%been%physically%linked%in%the%dog’s%brain%messaging%system.%The%dog%has%a%“trigger.”
– Without%conscious%“unlearning”%(the%dog’s%brain%disconnecting%the%bell%from%food),%the%dog%is%likely%to%have%this%same%response%years%later,%even%if%he%doesn’t%hear%the%bell%for%years.%
– This%physiological%response%happens%whether%or%not%the%dog%is%actually%hungry%or%needs food.
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Cravings)and)Relapse
Post%Acute%Withdrawal%Syndrome%(PAWS)
! Happens'after'detoxification'has'ended
! Can'persist'for'many'months'after'detox
! Is'a'result'of'the'brain’s'decreased'ability'to'function
! Associated'with'a'very'high'risk'of'relapse''
! Associated'with'a'very'high'risk'of'death'from'overdose'due'to'decreased'physical'tolerance
! Can'last'for'years'with'opioid'use'disorder''
PAWS%Symptoms
! Low'energy
! Low'concentration/'poor'attention'span
! Poor'memory
! Poor'sleep
! Poor'appetite
! Anxiety
! Depression
! High'irritability
! Anger
! Feeling'“restless”
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Healing(and(Brain(Plasticity
! After´&detox,&the&brain&begins&to&restore&its&natural&state&of&communication&or&“plasticity.”
! It’s&a&slow&process:&– At&least&several&months&– Possibly&up&to&2&years&– In&some&cases,¬&all&damage&is&repaired&&– Some&people&may&experience&longDterm&effects&
! In&most&cases,&the&recovery&process&involves&slow&healing&that&can&be&observed&in&brain&scans.
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The$Science$of$Recovery$
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Participant)Poll
Were$you$previously$aware$of$Post$Acute$Withdrawal$Syndrome$and$the$physiological$reasons$for$recurrence$of$symptoms$sometimes$long$after$a$person$had$started$recovery?
! Yes
! Kind$of=$but,$it$makes$more$sense$now
! No
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Recovery
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Laying'the'Foundation
! Addiction(is(a(chronic(disease(and(the(risk(for(recurrence(remains(elevated(even(after(long(periods(without(symptoms.
! A(person(who(has(been(asymptomatic(for(a(period(of(time(is(considered(to(be(“in(recovery”.(Sometimes(people(will(use(the(phrase,(“in(long>term(recovery.”(
! There(are(many(paths(to(recovery,(and(we(do(not(invalidate(or(discriminate(against(one(path(to(recovery(versus(another.(
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The$Recovery$Model
! The$Recovery$Model$is$a$concept$that$focuses$on$the$importance$of$building$resilience$and$supporting$an$individual’s$sense$of$identity$and$self:esteem.$
! It$is$a$strength:based$approach$that$does$not$focus$solely$on$symptoms.$It$focuses$on$the$opportunities$an$individual$has$to$$control$(or$control$responses$to)$life’s$challenges.$
! This$model$aims$to$help$people$move$forward,$set$new$goals,$and$take$part$in$relationships$and$activities$that$are$meaningful.
Stages'of'Change
Within&the&construct&of&the&Recovery&Model&and&the&focus&on&strengths&and&resiliency,&it&is&also&helpful&to&understand&how,&why,&and&when&people&change.&
This&can&be&especially&helpful&in&helping&family&members&of&individuals&with&addiction&understand&their&loved&one’s&behavior.&
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The$Stages$of$Change
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Stages'of'change
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Precontemplation/(no/intent/or/desire/to/change)
Contemplation/(intend/to/change)
Preparation/(small/steps/toward/change)
Action/(have/made/changes/and/intend/to/continue)
Maintenance/(sustained/change/and/intend/to/continue,/haves/plan/to/avoid/relapse//recurrence)
Termination/(no/desire/to/return/to/previous/state,/certain/will/not/have/recurrence)
Putting'it'all'Together
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Using(the(Recovery(Model(as(a(foundation(for(providing(support(increases(the(likelihood(of(a(successful(outcome.
As(with(all(other(medical(conditions(in(which(voluntary,(unhealthful(behaviors(contribute(to(disease(progression,(the(
individual’s(stage(of(change(is(critical(to(the(outcome(of(treatment(and(prevention(of(recurrence(of(symptoms(of(addiction.(
Next%Session
! Cultural'humility'and'awareness
! Trauma'&'grief'informed'approach'to'support
! Person/'family'centered'care
! Important'boundaries'and'ethical'considerations'
! Supervision'and'oversight'of'support'providers
! Proper'self>care
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Questions)&)Discussion
Please&type&your&questions&or&comments&in&the&chat&box.&
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References
Bonney, S., & Stickley, T. (2008). Recovery and mental health: A review of the British literature..Journal of Psychiatric and Mental Health Nursing, 15(1), 140D153.
Davidson, L. (2005). Recovery, selfDmanagement and the expert patient: changing the culture ofmental health from a UK perspective. Journal of Mental Health, 14(1), 25D35.
Flynn, P., Joe, G., Broome, K., Simpson, D., & Brown, B. (2003). Looking back on cocainedependence: Reasons for recovery. American Journal on Addictions, 12(5), 398–411.
Kakko, J., Svanbourg, K.D., Kreek, M.J., & Heilig, M. (2003). 1Dyear retention and social function afterbuprenorphineDassisted relapse prevention treatment for heroin dependence in Sweden: arandomized, placeboDcontrolled trial. Lancet, 361(9358), 662D8.
Prochaska, J. O., & Norcross, J. C. (2001). Stages of change. Psychotherapy: Theory, Research,Practice, Training, 38(4), 443D448.
Rosenbloom, M.J. & Pfefferbaum, A. (2008). Magnetic Resonance Imaging of the Living BrainDEvidence for Brain Degeneration Among Alcoholics and Recovery with Abstinence. National Institutesof Health, 31(4), 362D376.
Suckling, J. & Nestor, L.J. (2016). The neurobiology of addiction: the perspective from magneticresonance imaging present and future. Addiction, 112(2), 360D369.
Volkow, N.D., Koob, G.F., and McLellan, A.T. (2016). Neurobiologic Advances from the Brain DiseaseModel of Addiction. New England Journal of Medicine, 374(4), 363D371.
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