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The Basic Neuroscience of Addiction: Debunking the
“Choice” MythJESSICA HOLTON, MSW, LCSW, LCAS
Disclosures
• Not affiliated /paid by suggested resources
• LAMP Slides
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LAMP Disclosure Statement
“This product was produced by the Trauma Center at Justice Resource Institute and supported by grant number 2015-VF-GX-K020, awarded by the Office for Victims of Crime, Office of Justice Programs, U.S. Department of Justice. The opinions, findings, and conclusions or recommendations expressed in this product are those of the contributors and do not necessarily represent the official position of the U.S. Department of Justice.”
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Housekeeping
Comments
Ethical obligation to remain attentive
Handouts
Kind, thoughtful feedback is appreciated
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Learning Objectives
Participants will:1. Discover predisposing factors to addiction and basic
neuroscience of addiction.
2. Identify underlying currents and contributing considerations of addiction.
3. Learn about the basic neuroscience of toxic stress and trauma, and survival emotional states.
4. Gain adaptive coping skills and techniques based on basic neuroscience.
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Language Matters
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“By using accurate, non-stigmatizing language, we can help break the stigma surrounding this disease so people can
more easily access treatment, reach recovery, and live healthier lives.”
- Michael Botticelli, Former Director of the White House Office of National Drug Control Policy
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“Words have power. When we use clinically accurate, person-first language, we begin to dismantle stigma-driven attitudes and build effective systems of care. Our families and
friends are more likely to seek help and that help is more likely to be accessible and adequate.”
-Donald McDonald, MSW, LCAS
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The term addiction is derived from the Latin addīcō meaning “enslaved by” or “bound to.
Society today often also characterizes individuals who participate in repetitive
behaviors as being addicted. Thus, the term addiction currently applies to the misuse of alcohol, other drugs, and substances and to a
large number of behavior patterns.
Smith, R., 2015
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Addiction Concepts:A Chronic Brain Disease
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NIDA: Addiction is defined as a chronic, relapsing [reoccurring] brain disease that is characterized by compulsive drug seeking and
use, despite harmful consequences. It is considered a brain disease because drugs change
the brain; they change its structure and how it works. These brain changes can be long lasting
and can lead to many harmful, often self-destructive, behaviors.
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Addiction is a brain disease that begins in childhood.
It is a pediatric disease and needs to be treated as such through
prevention, treatment and recovery.
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Addiction, unlike other chronic diseases, has stigmas and negative perceptions
attached to it.
The stigmas and perception must change from providers, to communities, to families to the individual served.
Language Matters!
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Neuroscience of Addiction
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The brain weighs approximately three pounds, uses about 33% of the bodies energy, is
efficient with energy (30w lightbulb) and needs 500 nutrient rich calories per day for basic functions. The brain experiences over
75,000 thoughts occur each day.
Developing & Pruning
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The Brain
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The Brain
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Survival Center
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The limbic system is responsible for emotions.Hypothalamus - “Master Gland” or “Thermostat” – Regulates hormones
Hippocampus – Functions after 2 yr. old; Short and Long Term Memory.
Amygdala - Functions at birth. ‘Fight or Flight’; Automatic (Auto-pilot); Makes a decision in a split second; Stores past experiences; Reacts (depending on the past experience(s), it may over react); Relief and Reward
The Brain
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The Brain
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Information enters through the hind-brain. It travels through the mid-brain (VTA), the limbic
system, then finally reaches the forebrain.
The hind-brain is responsible for basic body functions.
The forebrain is responsible for decision making, logic, self-awareness, insight.
The brain is, essentially, placed on “hold” at the age chronic chemical use (or behavioral addictions)
began!
The Brain
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National Institute of Drug Abuse (NIDA)
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Ventral Tegmental Area (VTA): part of the midbrain, it is rich in dopamine and serotonin neurons and is part of two major dopamine pathways:
◦ one pathway connects the VTA to the nucleus Accumbens (a structure in the Basil Ganglia -reward and reinforcement, addictive behaviors and habit formation)
◦ the other pathway connects the VTA to the cortical areas in the frontal lobes
The Brain
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Default Mode Network (DMN)
•Mind wandering; responding to “Tell me about yourself; Self-reflecting; Empathy; Time travel (future & past); Deactivates with mindfulness & connection
Posterior Cingulate Cortex (PCC)
•Raw signal from eyes, feeding information to front, craving, wanting
Medial Prefrontal Cortex (mPFC)
•Notices passage of time in the present
Orbitofrontal Cortex (OFC)
•Looks for reward
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National Institute of Drug Abuse (NIDA)
Brain Metaphors
◦ Toddler/Teenager & Nurturing Adult
◦ Cartoon Character
◦ Others?
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Substance use can be divided into thirds.
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What about process addictions?
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Addiction Concepts:Survival Pathways
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Relief/Reward
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Long-Term & Short-Term survival
* Trigger* Behavior* Reward & Relief* Consequences
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Activity:Basic Needs
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1. Take in a deep breath.
2. Hold your breath.
3. While holding your breath, not your thoughts, emotions and physiological response.
4. Continue to hold your breath as long as you can.
5. Continue to note your thoughts, emotions and physiological responses.
6. When the urgency to inhale is intense, take a breath and breathe normally.
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Addiction Concepts:Genetics & Environment
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Meme
◦ Noun - a humorous image, video, piece of text, etc., that is copied (often with slight variations) and spread rapidly by Internet users.
◦Noun - an element of a culture or system of behavior that may be considered to be passed from one individual to another by nongenetic means, especially imitation.
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Three Type of Aces –10 Yes/NO Questions
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Source: Centers for Disease Control and Prevention
Credit: Robert Wood Johnson Foundation
ACEs Increase Health Risks
According to the Adverse Childhood Experiences study, the tougher your childhood, the higher your score is likely to be, thus the higher your risk for various health problems later.Behavioral, physical and mental health conditions
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Source: Centers for Disease Control and Prevention
Credit: Robert Wood Johnson Foundation
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Activity:
Finding Your ACE Score
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Original ACE Screening Tool
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CWY ACE-Q: Child and Teen
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Genetics & Epigenetics
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Genetic factors are believed to account for 50% of an individual’s vulnerability to an addiction.
DNA is made up of genes that are nearly identical for 99.9% of individuals.
It is believed that the 0.1% variation contributes to a person’s vulnerability to an addiction, as well as
to other diseases such as diabetes, heart problems, and stroke.
(NIDA, 2008; Smith, R., 2015,;Volkow, 2011).
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When one identical twin was addicted to alcohol, the other twin had a high probability of having the same addiction◦ This was not true for nonidentical (fraternal) twins
Children of individuals who struggled with addiction (to alcohol or other drugs) are 8 times more likely to develop an addiction
There is speculation that genetics also plays a role in behavioral addictions, despite insufficient research, finding that gambling, sex, work, exercise, shopping, and other process addictions to one’s genetic makeup.
(NIDA, 2008; Smith, R., 2015,;Volkow, 2011).
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Epigenetics◦ Greek επι- means “in addition to”
◦ Since 2004 research in the emerging science of Behavioral Epigenetics indicates that nurture wins over nature, to the degree that early experience permanently alters behavior and physiology
(Meaney and Szyf, 2005)
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Methylation ◦ A methyl group is an organic compound which can chemically attach to genes, altering their expression
◦ These methylated attachments can be lifelong, permanently altering the gene activity, including creating changes in behavioral traits associated with the gene
◦ These methylated patterns can be passed on to offspring
◦ Methylation can be changed by life experiences
(Hurley, 2013, Hackett, 2013; Weaver, et al., 2004)
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Historical Trauma
Intergenerational Trauma
Institutional Trauma/Betrayal
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Remember:
Addiction is a brain disease that begins in childhood.
It is a pediatric disease and needs to be treated as such through
prevention, treatment and recovery.
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Quick Sidebar:
Screening Tools
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Assessment Vs Screening tools
Screening Tools are brief questionnaires that assist professionals in getting a snapshot of information
to determine whether additional treatment referrals are needed.
An Assessment Measurement Tool is usually entails questions and the tools will take more time to
administer.
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Assessment Vs Screening tools
Assessment Tools and Screening Tools are measurement tools that have differences and similarities, in which the terms are often used
interchangeably.
Using the term Assessment Tool for Screening Tools could not only be considered incorrect, but
also confusing, especially for students, newer clinicians or clinicians becoming familiar with the
benefits of using Screening Tools.
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Original ACE Screening Tool
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Assessment Vs Screening tools
There are hundreds of Screening Tools for a variety of disorders, from mental to physical.
It is crucial to implement evidenced-based Screening Tools and/or valid Assessment
Tools, within one’s scope of practice.
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Assessment Vs Screening tools
It is also imperative to implement Screening Tools that are culturally
applicable. If there is not a specific tool that is culturally specific or accounts for cultural differences, the professional would need to consider the effectiveness of the tool before
proceeding with that tool.
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Assessment Vs Screening tools
Furthermore, it is important to understand that Screening Tools and Assessment Tools do not
replace a thorough clinical biopsychosocial-spiritual assessment. Rather, the
measurement tools could assist in navigating the direction of treatment and/or treatment
referrals.
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Addiction Concept:Stress, Anxiety & Trauma
Law Enforcement
Advocates
Mental Health Workers
Prosecutors
The Impact of Trauma
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What are examples of experiences of traumatic
events?
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COMBAT/WAR ZONE
VIOLENT ENVIRONMENT
MOTOR VEHICLE ACCIDENT
EXPERIENCING/WITNESSING ABUSE (PHYSICAL, SEXUAL VIOLATION, VERBAL, EMOTIONAL, SPIRITUAL)
MEDICAL TRAUMA
WITNESSING DEATH
NATURAL DISASTERS
REPEATED EXPOSURE TO TRAUMAS/ADVERSE DETAILS OF TRAUMAS
OTHERS?
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Make sure the body survives.
Brain fundamentals:
Role of the brain
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Prefrontal cortex
Brain fundamentals: Overview
HippocampusDefense
Circuitry
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Brain fundamentals: Pre-frontal cortex
Prefrontal
cortex
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Brain fundamentals: Defense circuitry
Defense
Circuitry
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Brain fundamentals: Hippocampus
Hippocampus
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Autonomic Nervous System
▪ Controls automatic unconscious bodily functions:
▪ Heart and respiration rate.
▪ GI functions.
▪ Energy output.
The nervous system: Fundamentals
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Brain and Body Reactions to Trauma:
Survival Response
During traumatic event:
▪ Prefrontal cortex impaired.
▪ Defense circuitry in control.
▪ Brain’s automatic survival response takes over.
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Brain and body reactions to trauma:
The survival response, 2
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Brain and body reactions:
Autonomic nervous system
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Brain and body reactions:
Freeze
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Brain and body reactions:
Fight and flight
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Habit is a learned response that worked before:
▪ “It’s late, I need to get home.”
▪ “I have a boyfriend / you have a girlfriend.”
▪ “I don’t feel well.”
...but habits don’t work when there is an actual or perceived threat
Brain and body reactions:
Habits
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…even less conventional responses meant to:
▪ Minimize physical harm,
▪ Reduce pain
…but may render the victim more vulnerable.
Brain and body reactions:
Extreme survival reflexes
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Brain and body reactions:
Tonic and collapsed immobility
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Brain and body reactions:
Dissociation
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Brain and body reactions:
Process flow
THREAT
InitialFREEZE
FIGHT
FLIGHT
Tonic or CollapsedIMMOBILITY
DISSOCIATION
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Impact of trauma on memory
Memory can be enhanced or impaired by trauma:
▪ Encoding: what is attended to during the event.
▪ Storage: what gets filed away.
▪ Retrieval: what can be recalled.
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Impact of trauma on memory:
Enhanced aspects of memory
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Activity:Memory
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Impact of trauma on memory:
Impaired aspects of memory
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Activity:Sabretooth Tigers
Survival Center
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Mobilization -Fight/Flight
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HOLTON, PLLC
9494
Immobilization with Fear -Shutdown
(~2 Minutes)
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Dr. Seigel Hand-Brain Model
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Addiction Concepts:Avoidance, Shame & Isolation
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Secrets, Shame & Isolation
Addiction
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Society teaches us that ifsomething hurts, take a pill for it.
“Fix it.”
We live in a shamed based society.
If one has cancer, treatment takes place and everyone is proud.
If one has an addiction, or mental illness, society places stigmas.
Georgi, J. M., 2004
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Shame has been defined as, “pain in the soul that can not be tolerated,” thus one tends to find
their own ‘medicine.’
Georgi, J. M., 2004
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“Shame is a stain on my soul…”
Vietnam Vet
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Suffering x Resistance = Pain
(10 x 10 = 100)Or
(10 x 0 = 0)
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Isolation: Rat Park
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Polyvagal Theory
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Remember: The brain’s job is to survive/live.
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Psychological statesPolyvagal Theory
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Safety (trust, vulnerability, rest & digest)
Mobilize (fight, flight)
Immobilize (avoidance, disassociate, freeze)
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Grief, Loss & Change
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Grieving Process:
1) Shock/Denial
2) Anger (Projection)
3) Bargaining (“What ifs”)
4) Depression (Introspection)
5) AcceptanceMarrone, 1997
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Grieving: Dual Model
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Revised Healing Process/Stages of Change:
1) Denial
2) Bargaining
3) Anger (Projection)
4) Depression (Introspection)
5) Acceptance
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Other Potential Undercurrents:
Mood Disorders
Psychotic Disorders
Medical Conditions (Chronic Pain)
Grief & Loss
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Providing Effective Treatment Interventions
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TYPES OF COPING –
Obtaining Wellness &
Recovery
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Recovery
The Substance Abuse and Mental Health Services Administration (SAMHSA)
defines recovery as:
“A process of change through which individuals improve their health and
wellness, live a self-directed life, and strive to reach their full potential.”
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Working Definition of Recovery
Recovery from addiction (chemical or process) is a voluntarily maintained lifestyle characterized by: ◦ Sobriety Vs MAT Vs Harm Reduction
◦ Personal Health - A state of complete physical, mental, and social well-being (not merely absence of disease)
◦ Citizenship - Effort and commitment to improving one’s community. It is often captured in the traditional recovery terms “giving back” or “service work”
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Depth of Recovery
Partial Recovery
Full Recovery
Enriched Recovery
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Further definitions of Recovery
Recovery is the process through which severe alcohol and other drug problems are resolved
along with the development of:
Physical, emotional, spiritual, relational and occupational health
(White & Kurtz, 2005)
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Recovery pathwaysAbstinence-based
Moderation-based
Medication-assisted
Solo (natural) recovery
Peer-assisted
Treatment-assisted
(less than 10% of people with a SUD in the U.S. seek professional treatment in a given year; only 25% of individuals with such disorders will receive treatment in their lifetimes)
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Recovery CapitalExamples of greater “recovery capital” include:
Employment
Higher socioeconomic status
Higher social supports and stability
Positive marital and work relationships
Greater sense of self-efficacy
Social supports
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Relief/Reward
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Coping Skills
Noun: Any characteristic or behavioral pattern that enhances a person's adaptation. Coping skills include a stable value or religious belief system, problem solving, social skills, health-energy, and commitment to a social network.
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Types of Coping
Action-based coping
Emotional-based coping
Harmful coping
http://hopecalls.org/m_coping.html
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The Brain After Drugs…….
National Institute of Drug Abuse (NIDA)
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Volkow, et al, 2001
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Developing trust and rapport with a Client becomes more feasible when a provider: shows empathy, communicates well, has a thorough
grasp of the realities of the Client’s life, draws on effective counseling strategies, uses a non-
judgmental approach and understands the legal issues regarding the safety of the Client.
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A practitioner’s communication style will affect how a Client responds to his or her
advice. Even subtle perceived negative attitudes can undermine a Client’s trust in
his/her provider. When compassion is evident in a provider’s choice of words,
demeanor and attention, it is often easier for a Client to listen, communicate, and
act on the new knowledge.
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Source: Hubble, M., Duncan, B., & Miller, S. (1999)
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Properly addressing avoidance/immobilization is essential
when treating addiction.
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Interventions to Stabilize the Nervous System
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Pathways for Habits or Patterns (Coping): Must reframe the issue or concern, not just
talk about it.
Instant Reward and Relief
VS
Long-term Reward and Relief
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Time perception
Anniversaries
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Brain Tricks/Resets:Less Is Better
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Deep Breathing
Breathe in and out from your diaphragm (not chest).
Breathe in for four (4) seconds
Hold for five (5) seconds
Breathe out for eight (8) seconds
This is one (1) cycle.
Complete at least six (6) to twelve (12) cycles
This changes the blood flow from your chest (heart and lungs = preparing for Survival/Fight and Flight) to your extremities (arms and
hands), which cues the brain that it is no longer in Survival/Fight or Flight mode.
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Cook’s Hook UpBrain ButtonsCook’s Posture
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Activities that Engage Frontal Lobe
(Re-allocate energy from the Limbic System, to Frontal Lobe)
Counting
Adding
Subtracting
Organizing
Alphabetizing
Word Searches
Jigsaw Puzzles
Balancing on one leg
Hopping on one leg
Yoga
*Mindfulness
*Grounding
This type of action based coping pulls energy to the frontal lobe (thought and control center) and away from the Limbic System (intricate Fight and
Flight/Survival Center)
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Drinking Water
Whistling
Humming
Rocking
Weighted Items
Engaging Large Muscle Groups
Pushing/Leaning on Wall
Resourcing
Loving Kindness
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Daily Gratitude List
Successes / Positives
Challenges / Negatives◦ How did you cope?
What are you grateful for?
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Gratitude Counters Fear
Compassion Counters Anger
Mindfulness counters habit
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Mantras
“Feelings and thoughts are not facts. What facts counter or validate my feelings?”
“Anxiety is my fear, linked to the future, linked to my imagination. What is happening in the here and now?”
“What are the facts that counter my fear/anxiety/stress responses?”
“Anger is a reaction that stems from fear or sadness. What am I feeling?”
“What you focus on grows.”
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Mantras
“Energy flows where attention goes.”
“I choose to befriend myself.”
“Focus on micro moments of success.”
“Whether it is a good day or a bad day, it is the same day. You get to choose.”
“Compassion counters anger. Anger and compassion cannot be experienced at the same time.”
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Progressive Relaxation
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Journal Writing&
Narratives
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Letters(Purging to ‘Business’)
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Metaphors
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Danger Sequence
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Danger Sequence
1) Name the stressor or trigger.
2) Am I in danger? Fear is not real. Danger is. 95-99% of the time, there is not actual danger.
The answer is NO.
3) Are past traumas (real saber tooth tigers behind you) being triggered?
If yes, counter with facts: Age, location, year, individuals involved, actions, et cetera.
If no, move to #4.
4) Are past negative life (mutated saber tooth tigers off to the side of you) events being triggered?
If yes, counter with facts: Age, location, year, individuals involved, actions, et cetera.
If no, move to #5
5) What are the specific stressors (hologram saber tooth tigers in front of you)?
6) What are the tangible solutions (not anxiety or fear based) that you will implement?
Follow sequence, without adaptions. Repeat often. Practice on small stressors in order to build “muscle memory” for the larger stressors, trauma triggers, and/or crisis that might occur.
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Recommended Resources
Safe and Sound Protocol™
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Unyte Biofeedback
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Social Media – Vagus Nerve
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California Evidence-Based Clearinghouse for Child Welfare
https://www.cebc4cw.org/
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CEBC Evidence-Based Practice
The CEBC has adopted the Institute of Medicine's definition for evidence-based practice with a slight variation that incorporates child welfare language:
Best Research Evidence
Best Clinical Experience
Consistent with Family/Client Values
This definition builds on a foundation of scientific research while honoring the clinical experience of child welfare practitioners and being fully cognizant of the values of the families we serve.
Adapted from Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington,DC: National Academy Press.
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Applications (a.k.a Apps)Breathe2Relax
Prana Breath
Virtual Hope Box
T2 Mood Tracker
Guided Meditat(e)
Headspace
Smiling Mind
Addicaid
Ginger.10
Sober Grid
Cassava
Sober Tool
Hazelton Betty Ford
Cope Notes
Insight
Calm
Others?
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SUCCESS
To laugh often and much; to win the respect of intelligent people and the affection of children; to earn
the appreciation of honest critics and endure the betrayal of false friends; to appreciate beauty; to find
the best in others; to leave the world a bit better, whether by a healthy child, a garden patch, or a
redeemed social condition; to know even one life has breathed easier because you lived; this is to have
succeeded.
-- an adaptation of a poem published in 1905 by Bessie Stanley
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Thank you!!!!
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For more information, feel free to contact:
Jessica Holton
MSW, LCSW, LCAS
Jessica Holton, PLLC
3491 Evans Street
Suite D
Greenville, NC 27834
252-987-3039
www.jessicaholton.com
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Referencesde Shazer, S. (1997). Radical Acceptance. Family Systems and Health, 15, 375-378.
Georgi, J. M. (2004). Treatment issues for dual diagnosis: Post traumatic stress disorder and substance abuse. Presentation sponsored by Eastern AHEC. Greenville, NC.
Hester, R.K. & Miller, W.R. (2003). Handbook of alcoholism treatment approaches (3rd ed). Boston: Allyn and Bacon.
Marrone, R. (1997). Death, Mourning, and Caring. Dying and the near-death experience.(pp. 71-78). Pacific Grove, CA: Brooks/Cole Publishing Company.
Meaney, M. J., & Szyf, M. (2005). Environmental programming of stress responses through DNA methylation: life at the interface between a dynamic environment and a fixed genome. Dialogues in Clinical Neuroscience, 7(2), 103-123.
Miller, W. (1998). Toward a motivational definition and understanding of addiction. Motiverande Samtal. Retrieved from http://www.motiverandesamtal.org/miwiki/Toward%20a%20Motivational%20Definition
Reid, K.E. (2002). Clinical social work with groups. In A.R. Roberts & G.J. Greene (Eds.), Social workers’ desk reference. New York, New York: Oxford University Press.
Sidbury, L. & Owens, C. (2005). Critical incident stress and emergency response. Presentation sponsored by Pitt Community College. Greenville, NC.
Valasquez, M.M., Gaylyn, G.M., Crouch, C. & DiClemente, C.C. (2001). Group treatment for substance abuse: A stages-of-change therapy manual. New York: The Guilford Press.
Yalom, I.D. (1995). The theory and practice of group psychotherapy (4th ed.). New York: Basic Books.
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ReferencesBusch, N.B. & Valentine, D. (2000). Empowerment Practice: A Focus on Battered Women. AFFILIA,
15(1), p. 82-95.
Food, Nutrition and Health Program - Dietetics Major. (n.d.). Critical thinking flow chart. Retrieved
from http://dietetics.landfood.ubc.ca/year-5-interns/student_created_resources/professional-
development/critical-thinking/
Gutierrez, L.M., Parsons, R.J., & Cox E.O. (1998). Empowerment in Social Work Practice: A Sourcebook. Pacific Grove, California: Brooks/Cole Publishing Company.
Lee, J.A.B. (2001). The Empowerment Approach to Social Work Practice: Building a Beloved Community(2nded.). New York: Columbia University Press.
National Association of Social Workers Association of Social Work Boards (2013). Best practice standards in social work supervision. Washington, DC: NASW Press.
Rieck, T., & Callahan, J. L. (2013). Emotional intelligence and psychotherapy outcomes in the training clinic. Training And Education In Professional Psychology, 7(1), 42-52.
Rieck, T., Callahan, J. L., & Watkins, C. J. (2015). Clinical supervision: An exploration of possible mechanisms of action. Training And Education In Professional Psychology, 9(2), 187-194.
Robbins, S.P., Chatterjee, P., & Canda, E.R. (1998). Contemporary Human Behavior Theory. Boston: Allyn& Bacon.
Turner, F.J (ed.). (1996). Social Work Treatment: Interlocking Theoretical Approaches (4thed.). New York: Free Press.
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