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Addictions and the sciences


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Emotional and Behavioral self management, behavioral self control, mindfulness, mental illness and addiction, co-morbidity

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Addictions and the sciences

  1. 1. The Sciences & Recovery A Whirlwind Tour of the Research and Strategies October 7-9, 2011 David O. Saenz, PhD, EdM, LLC Clinical and Consulting Psychologist (412) 853-2000
  2. 2. Learning outcomes-participants will…. 1. How I got here 2. Have knowledge of basic statistics surrounding addiction, and addiction & mental illness 3.Understand the research behind self control 4.Understand the basics of “mindfulness”, the research behind it, and how it applies to improving emotional and behavioral self control 5.Be able to apply a few Dialectical Behavior Therapy skills (e.g., radical acceptance, emergency coping plan, self control skills building) to improve self management
  3. 3. 4 VULNERABILITY to ADDICTIONS • 40% - 50% Genetics • 50% - 60% Environment Early Onset Chemical Environment Poor Nutrition Emotional Stress Poor Coping Skills Chronic Physical Illness Grief & Loss Mental illness
  4. 4. Comparison of Relapse Rates Between Drug Dependence and Other Chronic Illnesses 0 10 20 30 40 50 60 70 80 90 100 Drug Dependence Type I Diabetes Hypertension Asthma 40to60% 30to50% 50to70% 50to70% Source: McLellan, A.T. et al., JAMA, Vol 284(13), October 4, 2000. PercentofPatientsWhoRelapse
  5. 5. 6 Treatment Admissions by Primary Substance 0 200,000 400,000 600,000 800,000 1,000,000 1,200,000 1,400,000 1,600,000 1,800,000 2,000,000 1992 1994 1996 1998 2000 2002 2004 Alcohol Opiates Cocaine Marijuana/hashish Methamphetamine Source: Treatment Episode Data Set (TEDS) – Highlights 2004
  6. 6. Drug abuse costs in increased health care costs, crime, and lost productivity.
  7. 7. EmotionalandBehavioral Self-Control
  8. 8. Self-Control (SC) as a deplete-able Resource • Self-control isn’t a characteristic or trait that we either have or don’t have- it’s on a continuum. • It is typically a set of skills that people develop through experience (like a muscle). • Not everyone’s experiences facilitate the development of self- control. (SC vs. self esteem) • People exhibit self-control skills to differing degrees in different situations; it is not an all-or-none phenomenon. RoyF.Baumeister,etalstudeies
  9. 9. Does making decisions deplete self control? • Simple (?) choices & decisions in the last 35 years: • Average American supermarket in 1960 carried <3000 unique items: in 1976 it carried 9,000 different, unique products • By 1980–30,000 (Waldman, 1992) • By 2005–1 million & the average supermarket carried 40,000 of them (Trout, 2005) • Starbucks boasted in 2003 that it offered each customer 19,000 beverage possibilities • TV in the 1950’s - <13 stations (NBC, ABC, CBS), today >600
  10. 10. • Iyengar and Lepper (2000) found that consumers who faced 24 options, as opposed to 6 options, were less willing to decide to buy anything at all. • Those who did buy were less satisfied with their purchase. The more decision-making required in choosing/deciding, the greater the burden and the less able people are to decide w/o anxiety and stress. Does making decisions deplete self control?
  11. 11. • When people have exerted some of their self- regulatory strength on a moderately to highly difficult task they: – Drink more alcohol even when anticipating a driving test (Muraven, Collins,& Nienhaus, 2002), – Are more prone to make impulsive purchases (Vohs & Faber, 2004), – Show higher levels of aggressive responding (Stucke & Baumeister, 2006), – Dieters are more prone to over-eat fattening foods (Vohs & Heatherton, 2000) Does making decisions deplete self control?
  12. 12. – Perform inappropriate or under-controlled sexual behaviors (i.e., willing to have more affairs when depleted) (Gailliot & Baumeister, 2005) – Present themselves in ways less likely to make a good impression (Vohs, Baumeister, & Ciarocco, 2005) Self-Control as a deplete-able Resource
  13. 13. • Self-regulation consumes resources - the self must override one response and then substitute a different response, and energy is required to perform these interrupt and initiate functions. Imagine all of the decisions you have to make by the end of the day! • “ Men and their caves” • Some choices are more depleting than others. Pleasantness likely reduces the stress level of choosing, therefore there might be less depletion. Self-Control as a deplete-able Resource
  14. 14. Drains on Self Control • Making repeated choices/decisions over time or 1-2 difficult decisions (Vohs et al., 2004) • Interacting with people about whom one has a prejudice, e.g., minorities, obese people, LGBT’s, (Richeson & Shelton, 2003) • Being in a situation requiring much impression management (Vohs et al., 2005) (Shakespeare & Goffman) • Suppressing stereotypes is emotionally depleting (Gordijn, Hindriks, Koomen, Dijksterhuis, & Van Knippenberg, 2004), Anagram studies: George Bush = He bugs Gore; Madonna Louise Ciccone = Occasional nude income
  15. 15. Replenishing Self Control
  16. 16. What is Mindfulness??? The practice of becoming focused and aware of the present moment, rather than ruminating on the past or projecting into the future. Rumination/ worrisome projecting into the future (or from the past) significantly increases the struggle and weakens resolve, problem solving, decision-making, logical- rational thinking and emotional availability. It’s about being "in the now” w/o judgment or trying to change things–acceptance is key (it is what it is).
  17. 17. • Acceptance is about not avoiding or fighting for control, but about allowing things to be as they are. • The aim is to try and change reactions to the emotions or thoughts, while being careful not to reject, challenge or minimize the emotion itself. What is Mindfulness???
  18. 18.
  19. 19. • 1979 Dr. Jon Kabat-Zinn founded the Mindfulness- Based Stress Reduction program at UMass to treat the chronically, physically ill. Now used as a primary treatment for pain, stress, anxiety, anger issues, explosive disorders, histrionic and avoidant personality disorder, paranoid personality disorder, major depression, eating disorders, addiction, etc. • Police officers in Los Angeles and in Madison, Wisconsin, have received mindfulness training • Many law firms offer mindfulness classes. Replenishing Self Control
  20. 20. Who Uses Mindfulness • Mindfulness is used in prisons, reducing hostility and mood disturbance among inmates, and improving their self control • There are >300 mindfulness programs in hospitals and clinics throughout the U. S. • Many government organizations offer mindfulness training, including parts of the Armed Services • AYD program in Pittsburgh teaches mindfulness to at risk inner city middle schoolers.
  21. 21. Outcomes Research on Mindfulness • Jain and Shapiro (2007)–mindfulness is specific in its ability to “reduce distractive and ruminative thoughts and behaviors”. Reduces emotional reactivity to stressors. • Garland (2009)—found declines in stress after mindfulness interventions, which were potentially due to the positive re-appraisals of what were at first appraised as stressors. • Arch (2006)–Mindfulness provided positive responses to emotionally neutral visual slides, while "unfocused attention and worry" control groups responded significantly more negatively to neutral slides.
  22. 22. Outcomes Research on Mindfulness • Davidson (2003)—found that mindfulness exercises decreased anxiety and "negative" affect and increased positive affect long after the exercises had ended. • Brown (2009)—found that a large discrepancy between financial desires and financial reality correlated with low subjective well-being, but that the accumulation of wealth did not tend to close the gap. After mindfulness training, there was a lower financial-desire discrepancy and thus higher subjective well-being (mindfulness may promote the perception of “having enough”).
  23. 23. • Enable people to better notice, observe, and attend to sensations and perceptions and not allow strong visceral sensations to drive behavior. • Increase awareness and recognition of the effects of decisions and thoughts. • Increase the ability to describe experiences in words and less in senses followed by action/decisions. • Decrease closed judgmental thinking and the spiral of critical and self defeating cognitions & mood. What mindfulness can do….
  24. 24. • From street bride to valedictory speech • Nostril to nostril breathing • Consciously sit up straight and improve posture • Research shows that when sticking to a mild exercise program, participants: – Became more successful at reducing cigarette smoking, alcohol use, and caffeine consumption – Ate less junk food and ate more healthy food – Reported improvements in emotional control and a reduction in impulsive spending – Reported studying more and watching less television. – Improved domestic habits (e.g., washing dishes instead of leaving them in the sink) Oaten & Cheng, 2004, Pylyshyn & Storm, 1988; Scholl, Pylyshyn, & Feldman, 2001). The Art of Replenishing Self Control/Willpower
  25. 25. • Researchers found that self-regulation training in money management (simply keeping close track of spending on a daily basis and making small spending decisions) resulted in the following positive changes: –Significant decreases in psychoactive substance use, including smoking, caffeine, and alcohol consumption. These reductions were not just significant but also substantial (mean reductions of 15 cigarettes, 2 cups of coffee, and 2 alcohol drinks per day!). The Art of Replenishing Self control
  26. 26. • Cont.: –Decreased expression of negative emotional reactivity –Higher maintenance of household chores –Improved study habits –Shift to healthier foods even if such foods cost 3- 4 times more than unhealthy foods PSS: Cohen, Kamarck, & Mermelstein, 1983, GHQ: Goldberg, 1972), The Art of Replenishing Self Control/Willpower
  27. 27. Comorbidity: Addiction and Mental Illness
  28. 28. Comorbidity: Addiction and Mental Illness
  29. 29. Comorbidity: Addiction and Mental Illness
  30. 30. Comorbidity: Addiction and Mental Illness
  31. 31. Mental Illness and Alcohol Dependence • 35% of women with ED have AD • 30-40% with schizophrenia have AD • 30-50% with Major Depression have AD • 60% with Borderline Personality have AD • 28-30% with Bipolar Disorder have AD • If you have alcoholism, or an anxiety disorder, you are 3 times as likely to have the other. Between 22 percent and 69 percent of alcohol-dependent patients have comorbid anxiety disorders. • Extras: 40% of tobacco is sold to those with MI • 85% of those experiencing schizophrenia smoke
  32. 32. A large majority of people who are addicted to illegal drugs have a concurrent alcohol disorder: Cocaine 89 percent Amphetamine 78 percent Opioid 74 percent Cannabis 68 percent Most people who have alcohol use disorders do not have drug use disorders, but >50% people with drug use disorders also have an alcohol use disorder.
  33. 33. Comorbidity increases complexity of alcoholism…
  34. 34. Teens: Comorbidity can mean more conditions…
  35. 35. Radical Acceptance: Acceptance is about turning your mind toward the acceptance road and away from the “rejecting reality” road. It minimizes the struggle and does not deplete self control b/c emotional resources are targeted into managing emotions and problem resolution. A Few Dialectical Behavior Therapy Strategies
  36. 36. Dialectical Behavior Therapy
  37. 37. A Few Dialectical Behavior Therapy Strategies Radical Acceptance Coping Statements: • It is what it is, this is how it has to be • All the events have led to this • I can’t change what has happened (Poker hand) • Fighting the past only eats up limited energy • This too will pass • Even if I don’t like what’s happening right now, it’s perfect.
  38. 38. • Make an inner COMMITMENT to accept things as they are, akin to working with the hand your dealt as opposed to sweating it (what happens if you sweat it out in a poker game?). • The COMMITMENT 1st turns person toward a path. • Turn the mind to commit to acceptance repeatedly. Sometimes, one has to make the commitment several times in the space of a few minutes • Commitment binds one to a course of action, which research indicates increases performance in that direction. A Few Dialectical Behavior Therapy Strategies
  39. 39. Distraction plan: develop a detailed plan for distracting yourself during stressful periods: • Hold an ice cube in your hand • Do chores • Call someone • Volunteer at the Humane Society • Go for a bike ride or a walk • Watch a movie • Learn self soothing skills • Safe place visualization: My safe space is_____ • The reason I feel safe here is________. A Few Dialectical Behavior Therapy Strategies
  40. 40. • Obstacles to improving on self control: • Desire: The desire that things were different right now. A wish that reality was not as it is. A desire to be someone different, to feel better, to be happier. • Aversion: Being angry, afraid, anxious, or ruminating at what is happening now. A negative judgment about what is now is an expression of aversion. • Tired/sleepy/dull/heavy: Not actual but brought on by the sensation of yet another crisis, issue or concern. • Restlessness: An overwhelming storm of thoughts, sensations, demands and distractions. • Doubt: Inner voice of “I can’t do this any more… I can’t handle it… What good is this… How can this happen to me?” A Few Dialectical Behavior Therapy Strategies
  41. 41. • Simple strategies to Overcoming Obstacles: • Desire: Notice and name desire for what it is (keep feelings cards). Recognize that getting what you want is never enough. Realize that desire w/o preparation is like bench pressing 400lbs 10 times on your 1st day at the gym. • Aversion: Name the feeling. Recognize it’s teaching potential– why anger now? What is its function/purpose? • Tired/sleepy/dull/heavy: Sit up straight… water on your face. Take a break and be active- walk, jog, vacuum. • Restlessness: Narrow your focus. Wandering minds result from this, focus on a body part (nose), count your breaths, deep breath slowly, be mindful. • Doubt: Focus only on present moment. Bring nothing from the past to the moment. A Few Dialectical Behavior Therapy Strategies
  42. 42. • Create an emergency coping plan: • When I’m upset with myself, someone else or a situation, • First I’ll do_________________________ • Next, I’ll do ________________________ • Then I’ll___________________________ • Finally, I’ll__________________________ Copy the plan and keep one in your wallet or purse, another one on the fridge, and still another one on your restroom and bedroom door. These are reminders and keep you from stressing over what you’re determined to do. A Few Dialectical Behavior Therapy Strategies
  43. 43. Why do women live longer than men?
  44. 44. What No One Will Ever Tell You…. But I Will Sooo… why do women live longer than men?....