Brain neuroscience and the dynamics of addiction2012


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  • Chronic chemical poisoning every time the person uses the drug: Nucleus Accumbens, ventral tegmental area or pallidum are the earliest reward in the pleasure center of the brain. However there is more at play than sensation.
  • Pleasure construct includes emotion/ memory/ learning/ motivation. Drug/alcohol use changes the structure and function of the areas of brain involved in developing a pleasurable experience.
  • The reason area of the brain (prefrontal cortex) completes the process of responding to a pleasurable construct with a rational choice
  • Summarize the process addiction impact on the brain.
  • What does this mean: The foundation of the phenomenon of addiction is found in the neuroadaptation of the pleasure/learning parts of the brain that compromise the reason based control of choice/judgement.
  • Research study on the impact of CBT on the craving symptom of nicotine addiction.
  • Strategic Thinking!
  • What does all of that neurological research have to do with addiction treatment? If the structure /function of the brain changes, it will have an impact on what the brain does. In psychological terms, the brain thinks/feels. Addiction essentially changes a person from the inside out.
  • Carving new neural pathways to replace the default pathways created by addiction that lead to relapse
  • Much of the research on recidivism focuses on environmental change factors. Others focus on the subjective change process ie CBT to change criminal thinking errors, self defeating behaviors, etc. Reality is you need to do both and then some.
  • OUT Program in the Utah County Jail uses Cognitive Transformation Theory. Operate on the premise that it is not enough to change how you think…. Must change who you are.
  • Maruna, S. (2001). Making good: How ex-convicts reform and rebuild their lives. Washington, Similar to recovering from addiction-AA/NADC: American Psychological Association.Maruna, S., Immarigeon, R., & LeBel, T. P. (2004). Ex-offender reintegration: Theory and
  • Brain neuroscience and the dynamics of addiction2012

    1. 1. NeuroScience and the Dynamics of Addiction
    2. 2. • “Life breaks everyone, and a few are strong in the broken places.” Ernest Hemingway
    3. 3. • Substance dependence on alcohol, or alcoholism, is defined by neuroplasticity that is responsible for phenomena such as sensitization, tolerance, and withdrawal as well as for neuron survival, all of which contribute to the development and maintenance of the disorder. In addition to the extant literature on the importance of brain reward circuits in the development of alcohol dependence, recent research has focused on a new contingent of neural systems that play central roles in the regulation of stress and anxiety as well as mediate executive functions. Neuroscience: Pathways to Alcohol Dependence Part 1 — Overview of the Neurobiology of Dependence Volume 31, Number 3, 2008 Neurobiology of Alcohol Dependence :Focus on Motivational Mechanisms Nicholas W. Gilpin, Ph.D., and George F. Koob, Ph.D.
    4. 4. • Recent work on the role of overlapping cerebral networks in action selection and habit formation has important implications for alcohol addiction research. As reviewed below, (1) these networks, which all involve a group of deep-brain structures called the basal ganglia, are associated with distinct behavioral control processes, such as reward- guided Pavlovian conditional responses, goal-directed instrumental actions, and stimulus-driven habits; (2) different stages of action learning are associated with different networks, which have the ability to change (i.e., plasticity); and (3) exposure to alcohol and other addictive drugs can have profound effects on these networks by influencing the mechanisms underlying neural plasticity. Key words: Addiction; alcohol and other drug (AOD) dependence; AOD use behavior; brain; neuroadaptation; cerebral networks; neural pathways; basal ganglia; neural plasticity “From Actions to Habits Neuroadaptations Leading to Dependence, Henry H. Yin, Ph.D. National Institute on Alcohol Abuse and Alcoholism
    5. 5. • Imaging studies also have revealed substantial reductions in the volumes of many brain structures in human alcoholics, particularly the prefrontal cortex and cerebellum, although prolonged periods of abstinence appear to promote at least partial recovery of these structural deficits (for a review, see Sullivan and Pfefferbaum 2005). The prefrontal cortex and, particularly, the orbitofrontal cortex7 (7The prefrontal cortex is the outer layer of the brain at the front of the head. It can be divided into several regions, one of which is the orbitofrontal cortex. The prefrontal cortex is involved in high-level cognitive and executive functions, such as planning complex cognitive behaviors, decisionmaking, and moderating correct social behavior.) have central roles in executive functions, such as decisionmaking. Accordingly, deficits in these brain areas may impact motivational circuits, impairing the ability of the organism to inhibit impulsive behavior and thereby further contributing to pathological drug-seeking behavior (Jentsch and Taylor 1999). More recently, imaging techniques were used to show that alcohol-dependent humans have smaller amygdala volumes than nondependent individuals and that smaller amygdala volume in alcohol-dependent humans is predictive of subsequent alcohol relapse (Wrase et al. 2008). Neuroscience: Pathways to Alcohol Dependence Part 1 — Overview of the Neurobiology of Dependence Volume 31, Number 3, 2008 Neurobiology of Alcohol Dependence :Focus on Motivational Mechanisms Nicholas W. Gilpin, Ph.D., and George F. Koob, Ph.D.
    6. 6. The areas depicted contain the circuits that underlie feelings of reward, learning and memory, motivation and drive, and inhibitory control. Each of thesebrain areas and the behaviors they control must be considered when developing strategies to treat drug addiction.Key:PFC – prefrontal cortex;ACG – anterior cingulate gyrus;OFC – orbitofrontal cortex;SCC – subcallosal cortex;NAc – nucleus accumbens;VP – ventral pallidum;Hipp – hippocampus;Amyg – amygdala.
    7. 7. In the non-addicted brain, control mechanisms constantly assess the value of stimuli and the appropriateness of the planned response.Inhibitory control is then applied as needed. In the addicted brain, this control circuit becomes impaired because of drug use and loses muchof its inhibitory power over the circuits that drive responses to stimuli deemed salient.All of this creates: GIMME
    8. 8. THE GOOD NEWS• Research shows that neuroadaptation flows both ways: change your mind, change your brain!• Using Cognitive/Behavior Therapy techniques, the power of thinking about negative effects of using tobacco proved to be considerable. The participants reported 34 percent less intense urges to smoke and 30 percent less intense food cravings after the LATER instruction compared with the NOW instruction.• Brain scans taken during the experiment showed how concentrating on long-term negative consequences alters brain activity to reduce craving. Functional magnetic resonance imaging (fMRI) of the participants’ whole brain revealed increased activity levels in areas—the dorsomedial, dorsolateral, and ventrolateral regions of the prefrontal cortex (PFC)—that support cognitive control functions, such as focusing, shifting attention, and controlling emotions. Activity decreased in regions that previous studies have linked with craving; these areas include the ventral striatum and ventral tegmental area, which are parts of the reward circuit; the amygdala; and the subgenual cingulate. Individual participants who reported larger reductions in craving exhibited these changes to a more marked degree. A specialized mediation analysis of the images found that the increase in PFC activity drove the decrease in ventral striatum activity, which, in turn, fully accounted for the reduction in craving.“These results show that a craving-control technique from behavioral treatment influences a particular brain circuit, just as medications affect other pathways,” says Dr. Steven Grant of NIDA’s Division of Clinical Neuroscience and Behavioral Research. Whitten, Lori Cognitive Strategy Reduces Craving by Altering Brain Activity” NIDA NOTES, April 19, 2012
    9. 9. Scans Show Effects of Craving Regulation in the Brain. When study participants thought of the long-term negativeconsequences of cigarette consumption (after receiving the instruction "LATER"), rather than short-term pleasures("NOW"), they reduced their craving. Brain scans showed increased activity in the dorsolateral prefrontal cortex—a regioncritical to setting goals, planning, and controlling behavior—which, in turn, inhibited the ventral striatum, part of thereward pathway that generates craving.
    10. 10. • Neuroscience research has identified that bio-chemistry of the brain influences and produces changes in cognition, emotion and behavior. This is beginning to lend an understanding of the neurobiological basis of psychological changes in decision making, cognitive distortions, impulsiveness and poor judgment that many recovering persons have described as the “insanity of addiction”. A common example of this is a psychological condition called cognitive dissonance.• Cognitive dissonance is the result of competing or conflicting thoughts or desires. The need of saving for college but wanting to buy a new car is an example of a situation that can create cognitive dissonance. In the case of addiction, there is a veritable war between the pleasure/reward center of the brain (limbic system) and the reason/ rational part of the brain (frontal cortex). Over time, the reason/rational part of the brain attempts to resolve the cognitive dissonance by creating new ways of thinking and perception.• This results in a condition called cognitive distortion, thinking errors, denial, etc.
    11. 11. Cognitive Distortion: Addiction Definition ofFREEDOM: Choice without ConsequencesDo whatever I want, WITHOUT anyconsequences
    12. 12. • Rationalizations:• I ain’t hurtin nobody but myself• It’s my life, I’ll do what I want• Nobody has the right to tell me what to do• I didnt mean to.........(bad thing)• I meant to do it........(good thing)• Im special, unique and different• I was just kidding, having fun, etc.• “It’s not that bad”• “ I’m not as bad as…….”• I’ll quit tomorrow• Results: Win/Lose. Social conflict. Someone always gets hurt. Creates a “Dark Mirror” identity. I define myself by what I’m against rather than what I’m for.
    13. 13. • Cognitive Behavior Therapy is a model of change based in the observation that behavior (and subsequent consequences) stem from thought, attitudes and belief. Therapy is geared toward changing behavior by changing the cognitive distortions that produced it. Counseling is focused on an exploration or “functional analysis” with the client of thought and behavior that is problematic and learning and practicing more positive alternatives through skills training, generalization, repetition/practice and mastery.
    14. 14. True Definition of Freedom: Choice with ConsequencesAbility to make a rational choice in my own and others best interest.• a. Rational thinking:• Think it through• Look at all angles• Ahimsa- to do no harm• Save the dime to gain a dollar- delayed gratification• Stay the Course• Be comfortable living in my own skin• Step Up and do the responsible thing• b. Results: Win/Win. No one gets hurt. Creates a positive self. I define myself by what I’m for rather than what I’m against.•• 3. Assignment: Pick one of the above and “act as if..” you have that characteristic. Practice applying it in behavior for one week and report to the group on what you learned.
    15. 15. • The result of adopting these positive rationalizations is the development of cognitive abilities to reduce conflict, support realistic perception/judgement and behavior with corresponding positive consequences. In short, it reinforces recovery and helps motivate and facilitate abstinence from drug use and its’ attending problems. These cognitions can be further operationalized into values/principles/behaviors that can be taught, practiced, integrated and mastered.
    16. 16. • In the long run, as research is discovering, changing the mind not only changes behavior, but also changes the brain as well. The future of addictions treatment may well involve strategically applying neurological evidence based counseling therapies to carve new neural pathways to heal the addiction damaged brain• Recovery is a solution to make many stronger in the broken places.
    17. 17. Desistance• The basic question underlying all offender intervention programs is, What will help offenders desist from future criminal behavior?• Despite the existence of extensive research on recidivism, desistance is not well understood (Bottoms, Shapland, Costello,Holmes, & Muir, 2004; Bushway, Piquero, Broidy, Cauffman, & Mazerolle, 2001).• Desistance is a process rather than a discrete event
    18. 18. Cognitive Transformation Theory• Desistance as a conversion process• Four key elements in the desistance processa. Openness to changeb. Exposure to circumstances, or “hooks,” that may help motivate and move toward change. Both internal and externalc. Replacement self – Erase and Replaced. Reinterpretation of previous illegal behavior
    19. 19. Desistance requires a reformulation of one’s identity• Desisters tended to describe redemption narratives in which they viewed their “real selves” as noncriminals. They differentiated themselves from their previous mistakes, crafted a moral tale from their experiences, and expressed a desire to use their experiences to help others (Maruna, 2001).• Recovery is a solution to make many stronger in the broken places.
    20. 20. • References• Neuroscience: Pathways to Alcohol Dependence Part 1 — Overview of the Neurobiology of Dependence Volume 31, Number 3, 2008 Neurobiology of Alcohol Dependence :Focus on Motivational Mechanisms Nicholas W. Gilpin, Ph.D., and George F. Koob, Ph.D.• “From Actions to Habits Neuroadaptations Leading to Dependence, Henry H. Yin, Ph.D. National Institute on Alcohol Abuse and Alcoholism• Whitten, Lori Cognitive Strategy Reduces Craving by Altering Brain Activity” NIDA NOTES, April 19, 2012• Maruna, S. (2001). Making good: How ex-convicts reform and rebuild their lives. Washington, DC: American Psychological Association• Follow-Up: An Evaluation of the RealVictory Program, Bert O. Burraston, David J. Cherrington and Stephen J. Bahr Int J Offender Ther Comp Criminol published online 2 December 2010 Bahr, Stephen J. Ph.D., Harris, Paul E. (Lish), Hobson, Janalee “A Way Out In Utah County “ American Jails MARCH | APRIL 2011