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&acute&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,&not&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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