Healing The Addicted Brain


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Information and overview of important content of Harold Urschel's book: Healing the Addicted Brain: The Revolutionary, Science-Based Alcoholism and Addiction Recovery Program

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Healing The Addicted Brain

  1. 1. 1 Healing the Addicted Brain A book By: Harold C. Urschel, M.D.
  2. 2. 2 Overview  Excellent reference book for our clients  Easy to read  Probably too basic for most clinicians  Excellent checklists, worksheets (Maybe helpful for ERG and IOP)  Excellent website www.enterhealth.com/healingtheaddictedbrain
  3. 3. 3 Contents 1. It’s a Disease! 2. Changing Your Thoughts from Pro- Addiction to Pro-Recovery 3. Combating Triggers and Cravings 4. Medications to Initiate Recovery and Help Maintain Sobriety 5. Your 12-Step Recovery Program 6. Dealing with Difficult Emotions
  4. 4. 4 Contents 7. Dealing with Dual Diagnosis 8. The Recovering Family 9. Lapse and Relapse 10. Health and Nutrition in Recovery 11. Regaining Enjoyment and Pleasure 12. True Recovery – Maintaining Your Goals
  5. 5. 5 It’s a Disease!  A long-term illness caused by measurable physical damage to the brain  Nice graphic of a damaged brain  Suggests that it takes 6-10 months of sobriety before significant brain repair  Talk therapy helps correct problems caused in the prefrontal cortex (planning, reasoning, regulating drives)
  6. 6. 6 It’s a Disease!  Need medication to correct problems in the limbic system (emotional drive, and memory pathways and urges/cravings)  The new anti-addiction medicines are designed to rebalance the brain’s biochemistry  Use of these medicines enhance ability to focus on and benefit from therapy and 12-step programs
  7. 7. 7 Changing Thoughts from Pro-Addiction to Pro-Recovery  The addicted brain is full of distorted and irrational thoughts  Harmful thoughts trigger negative emotions which trigger pro-addiction behaviors  List of pro-addiction thoughts (e.g., “I can’t get through this without a drink.”)  Worksheets to assess one’s pro-addiction thoughts and substitute healthy thoughts
  8. 8. 8 Changing Thoughts from Pro-Addiction to Pro-Recovery The six-question test of thought accuracy: 1. What concrete factual evidence supports this thought? 2. Are there other ways I could view this situation? 3. What is the worst thing that could happen? 4. What is the best thing that could happen? 5. What is most likely to happen? 6. Is this thought inaccurate?
  9. 9. 9 Combating Triggers and Cravings  The trick is learning to identify and deactivate triggers and to have a plan in place to handle cravings  A nice quiz to see how much one knows about cravings  Cravings are hardwired to the brain. When exposed to a trigger, memory and dopamine circuits are activated leading to a craving.
  10. 10. 10 Combating Triggers and Cravings  A worksheet to identify personalized triggers (i.e., people, places, times of day, activities)  A worksheet called a “Daily Trigger Chart” of situations, thoughts/feelings, behavior, pos/neg consequences
  11. 11. 11 Combating Triggers and Cravings Strategies for handling triggers Good suggestions for avoiding triggers; extinguishing triggers by not using; and crushing cravings by talking, distracting self, using flash cards, stress management techniques, and visualizing
  12. 12. 12 Addictions Medicines  Vivitrol and Campral encourages the addict to cut back on alcohol intake  Campral helps accelerate repairs to brain systems
  13. 13. 13 Addictions Medicines Vivitrol  The active ingredient is naltrexone  Naltrexone is an opiate antagonist used to treat both alcohol and opiate dependence  Works by “plugging in” to opioid receptors in brain cells thus preventing alcohol and opiate molecules from getting in.  It “jams the lock”.
  14. 14. 14 Addictions Medicines Vivitrol  Alcohol molecules cannot activate pleasure pathways and cannot trigger a high  Weakness of naltrexone is that it must be taken daily  Vivitrol is a monthly injection eliminating non-compliance
  15. 15. 15 Addictions Medicines Vivitrol’s Benefits 1. Decreases cravings for alcohol (and opiates) by up to 90% compared to those without the medication 2. If pt. does use, it blocks the high you normally get 3. It prevents the first drink from becoming many
  16. 16. 16 Addictions Medicines Vivitrol Side Effects  Safe, well-tolerated, and non- addicting  Occasional headache, feeling of sedation, or tenderness at site of injection  Normal dose is 380 mg (daily dose of naltrexone is 50 mg), 70% less than dosage of monthly pills
  17. 17. 17 Addictions Medicines Campral  Generic name is acamprosate  Helps the brain heal more quickly, thus, reducing cravings and the risk of relapse.  Improves the alcoholic’s cognitive skills, and ability to learn new skills  Accelerates the recovery process
  18. 18. 18 Addictions Medicines Campral  Talk therapy helps with problems governed by the cortex, Campral repairs damage to the deeper limbic system  This reduces cravings and makes it easier for the brain to concentrate of talk therapy  It’s believed to restore the GABA and glutamate systems
  19. 19. 19 Addictions Medicines Campral Pts. report after taking it for 4-6 weeks to feel calmer, handle stress more effectively, concentrate and focus better and have fewer cravings
  20. 20. 20 Addictions Medicines Campral  Need about 200 mg per day to rebalance GABA and glutamate systems  2-3 tablets daily  Suggests taking it for at least a year  Nontoxic and nonaddicting  Possible side effects – diarrhea, nausea, itching, intestinal gas
  21. 21. 21 Addictions Medicines Other Medicines for Alcoholism  Antabuse – acts as a deterrent. Most effective when administered by a monitor. Standard dose is 250 mg. daily.  Topirimate (Topamax) – Not FDA approved. May reduce alcohol cravings and anxiety
  22. 22. 22 Addictions Medicines Medication for Opioids- Suboxone  Suboxone (Buprenorphine) – a partial-agonist. Removes the craving without the “high”.  Blocks the effects of opioids, decreases cravings, and suppresses the major symptoms of withdrawal  Side effects – sweating, headache, pain, nausea, constipation, and insomnia
  23. 23. 23 Addictions Medicines Medications for Stimulants  Modafinil (Provigil) – shows promise to reduce cocaine withdrawal  Propranolol (Inderal) – decreases symptoms of cocaine withdrawal  Buproprion (Wellbutrin) – seems to help reduce relapse in Meth addicts  Showing promise – topamax, antabuse, neurontin, lioresal
  24. 24. 24 Addictions Medicines  Treatment for Sedatives – neurontin, trileptal, seroquel, risperdal, lexapro, and zoloft for symptoms of anxiety;  Treatment for marijuana – seroquel, lexapro, zoloft for anxiety and depression
  25. 25. 25 Your 12-Step Recovery Program  Basic concepts of AA  Importance of Sponsorship  12-Step tips  Types of AA meetings  Finding AA meetings  On average, try 4-6 different meetings to find the right fit
  26. 26. 26 Dealing with Difficult Emotions  Focuses on depression, anxiety, and anger  Checklists to determine if you are depressed or suffer from anxiety and suggestions for managing depression, anxiety or anger.
  27. 27. 27 Dealing with Dual-Diagnosis  53% of drug abusers and 37% of alcohol abusers have at least one serious mental illness  Considers benzos as not an option for pts. with dual diagnosis. Suggests vistaril or trazodone for anxiety.  Dual Recovery Anonymous (DRA)  Importance of proper sleep and avoiding caffeine
  28. 28. 28 The Recovering Family  Anyone living in the same household of the addict is considered family  Family members unwittingly become enablers  A Lapse/Relapse Consequences Agreement – spells out consequences of returning to substance use
  29. 29. 29 Lapse and Relapse 9 Warning Signs 1. Elevated life stress 2. Loss of daily structure 3. Neglecting healthy coping skills 4. Behavior changes 5. Social isolation and withdrawal 6. Loss of judgment, loss of control 7. A change in attitude 8. Reactivation of denial 9. Recurrence of physical withdrawal symptoms
  30. 30. 30 Lapse and Relapse  A Relapse Prediction Scale  A Lapse/Relapse Prevention Plan worksheet  A Lapse/Relapse Action Plan worksheet
  31. 31. 31 Health and Nutrition in Recovery  Elements of a healthy diet  Exercise: the world’s best stress reliever
  32. 32. 32 Regaining Enjoyment and Pleasure  An extensive list of recreational activities to consider  A Pro-Addiction Thoughts checklist  A Pro-Recovery Thoughts worksheet  Suggestions to brighten your day