The Addictive Brain as taught by Professor Thad A. Polk

I recently purchased some courses from The Great Courses. The subjects were intended to help me in being a better SMART facilitator. The subjects are:

The Addictive Brain taught by Professor Thad A. Polk

Cognitive Behavioral Therapy taught by Professor Jason M. Satterfield

The Science of Mindfulness: A Research Based Path to Well Being taught by Professor Ronald Siegel and

Practicing Mindfulness: An Introduction to Meditation taught by Professor Mark W. Muesse

In learning, I always do better when I take notes, do outlines, highlight important parts and try to communicate what I’ve learned to others. I’ve decided to do blogs on these subjects as I am learning them. So hopefully my readers, which number in the single digits, can learn this material without having to buy the courses. To learn more go to http://www.thegreatcourses.com You can put any of these courses in their search.

The first course I’ll do is The Addictive Brain. It’s a course given in 12 lectures. The first lecture is titled: Addiction 101.

Lecture 1: Addiction 101 is basically an introduction to the subject along with some definitions. Polk uses the term “addiction” with the meaning that you have pathological abuse of psychoactive substances. He notes that the DSM 5 now uses the term Substance Use Disorder instead of addiction. The new DSM also has 11 criteria now used to define the disorder. When 2 to 3 criteria met there is a Mild disorder, 4 to 5 is Moderate and 6 or more is Severe Substance Use Disorder. Although the 11 criteria weren’t in the lecture I post them here. You can substitute any drug for alcohol in this example.

The Eleven Symptoms of Alcohol Use Disorder

1.Alcohol is often taken in larger amounts or over a longer period than was intended.

2.  There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.

3. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects.

4. Craving, or a strong desire or urge to use alcohol.

5. Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home.

6. Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol.

7. Important social, occupational, or recreational activities are given up or reduced because of alcohol use.

8. Recurrent alcohol use in situations in which it is physically hazardous.

9. Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol.

10. Tolerance, as defined by either of the following: a) A need for markedly increased amounts of alcohol to achieve intoxication or desired effect b) A markedly diminished effect with continued use of the same amount of alcohol.

11. Withdrawal, as manifested by either of the following: a) The characteristic withdrawal syndrome for alcohol, b) Alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms.

The teacher then briefly discusses behavioral addictions such as gambling and the parallels with substance abuse. The last two lectures in this series covers those issues.

Lecture 2: The Psychology and Neuroscience of Reward

Dr Polk makes the claim that addictions “hijack” the brain’s reward system. The lecture breaks down the reward system into 2 factors one is the Psychology of Reward Processing and next the Neuroscience of Reward Processing.

For psychology he starts with basic Pavlovian conditioning then adds the concept that learning is based on “prediction error”. As long as Pavlof’s dog knew food was coming with the bell ringing the dog didn’t need to learn anything new in order to eat. Prediction error learning leads to changing our behavior to achieve a reward. He then talks about Reinforcement Learning, or figuring out how to behave in order to maximize short and long term rewards. He mentions a technique used in Artificial Intelligence programing called Temporal Difference Learning. Temporal difference learning is simply a series of learned behavior based on prediction error learning that can result in rewards such as winning a chess match. He also talks about the phenomenon of “backing up”. In the case of Pavlov’s dog anticipating the reward of eating is “backed up” to the sound of a bell. Has important implications for triggering urges.

Next he discusses some early neuroscience studies which show an area of the brain called the septal area gives people pleasure when stimulated. He notes how both people and rats will forgo basic survival like eating in order to stimulate these areas electrically.

He states there are 3 major brain areas associated with reward processing. The Nucleus Accumbens, the Prefrontal Cortex and the Ventral Tegmental Area.

Nucleus Accumbens – The Pleasure Center. What was stimulated in the early experiments. Major center involved in pleasure from drug stimulation. The Pleasure Center constantly urges us to seek rewards such as food, sex etc.

Prefrontal Cortex – Plays central role in controlling urges arising from reward center. Used to plan and make decisions about future behavior. Central role in controlling addiction. Can exert self control and considers the consequences of continued indulgence of the Pleasure Center.

Ventral Tegmental Area (VTA). The function of the VTA is more difficult to understand but I’ll try me best to convey what this does. This area of the brain is more primitive than the Nucleus Accumbent and the Prefrontal Cortex. The VTA has neural connections to both and is mainly involved in learning. The VTA neurons start firing when a prediction error occurs and results in a reward. Monkeys had their VTAs monitored when they were exposed to a lever that delivered a reward. However, the lever would only deliver a reward if a light was also on. When the monkey would randomly press the lever with the light on a reward would be delivered and the VTA would be activated. Once the monkey learned the association with the light and lever the VTA would not fire when a reward was delivered. In short the VTA is very effective in helping us learn new ways to seek rewards. Also now the light is backed up to the learned behavior.

Lecture 3: How Addiction Hijacks the Brain

The lecturer pointed out 3 ways the brain is altered as addiction progresses. 1) Numbed pleasure response. 2)  increased cravings as associations between drug use and cues evolve and 3) reduced self control.

1) In drug use the Nucleus Accumbens gets repeated overstimulation. Drugs stimulate the Nucleus Accumbens much more than normal activities. Your brain compensates by suppressing the Nucleus Accumbens. Hence more drugs are needed for the same effect. This is the mechanism of tolerance for drugs. This suppression also results in the addict not being able to get pleasure from activities that used to satisfy the pleasure center. The addict may reach a point where they need the drug just to feel normal.

2) Increased associations and cravings. This is a little more abstract and difficult to understand. I think it can help answer the question of why addicts use when they claim they no longer get pleasure from using – a common complaint. The Nucleus Accumbens pleasure activation is mediated by endorphins. They way it compensates by overstimulation is by making dynorphin, which makes it more resistant to endorphins, and opiates in general. For cravings, and satisfaction from indulging them, the neurotransmitter dopamine is involved. Dopamine has been described as the “addiction molecule”. The lecturer makes the distinction between wanting and liking. Wanting is craving the drug. Liking is enjoying the effects of the drug. Addicts always want the drug, even when the drug gives little pleasure.

We need to turn to the Ventral Tegmental Area (VTA). The VTA is responsible for the associations between drug use and drug related cues resulting in increased cravings. The VTA releases dopamine in response to associations such as the light with the monkeys in lecture 2. Thus dopamine is linked to craving or wanting the drug. Neuroscientists believe that as addiction progresses we develop “incentive sensitization”. We become more sensitive to the cravings induced by dopamine. Sort of the opposite of tolerance. Also, scientists believe, the dopamine itself is that “reward prediction error” and it produces learning, or in the case of addiction, increasing obsession with the drug.

3) Reduced Self Control. Remember that the Prefrontal Cortex is involved in inhibiting undesirable behavior. The rational brain center. Chronic drug use leads to abnormalities of the prefrontal cortex. Neuroimaging studies show diminished function and animal studies show neural damage to the prefrontal area. All this results in lessened ability to suppress the self destructive behaviors of drug abusers.

That’s it for the blog today. I’ll listen to these lectures and blog about them as the days go on.

Updated list on Non 12 Step Meetings in Orange County CA

Non 12 Step Recovery Meetings in Orange County, California

SMART Recovery Meetings:

Sunday, Women’s Meeting. 11 am to 12:30 pm. 1954 Placentia Ave, Costa Mesa, CA 92627. Meeting is in the cafeteria, room 104. mollie.waring@solidlandings.com

Sundays, 5:30 pm to 7 pm. Kaiser Irvine Medical Center, 6640 Alton Parkway, Irvine, CA 92618 Conference Room 6 (5th Floor) in Medical Office Building 2 (MOB2) Enter the office building that’s contiguous with the hospital. Take the elevators to the 5th floor. Follow the signs to Conference Room 6. You’ll see a sign: C6. steve.smart@cox.net

Monday 6:30 PM – 8:00 PM Stevens Square, 250 W. Main Street, Suite #101, Tustin 92602 lisadpearson@cox.net

Tuesday 7:30 PM 2165 Harbor Blvd., Costa Mesa CA 92626 peterpeterpeter2006@hotmail.com

Friday, Men’s Meeting. 7 pm to 8:30 pm. 1954 Placentia Ave, Costa Mesa, CA 92627. Meeting is in the cafeteria, room 104. mollie.waring@solidlandings.com

Life Ring Meeting :

Thursdays, 7 to 8 pm.

St. Joachim’s Annex, 1943 Orange Ave, Costa Mesa, CA 02627

Saint Joachim Church is on the corner of Orange Ave and Walnut. The Annex is on the opposite corner of the church. Take the walkway to the back of the Annex and the meeting will be the door on the left. jmars4@sbcglobal.net

Women for Sobriety:

Women for Sobriety do have a local meeting. For information go to

http://www.womenforsobriety.org and request information by clicking on the contact link on the upper right of the web page.

Refuge Recovery:

Monday 7pm. New Directions for Women Outpatient Offices, 3001 Redhill Ave., Bldg 4 Suite 109, Costa Mesa, CA92626 ekbarbour@gmail.com

Tuesday – 7:30 pm – Harmony HB Yoga and Wellness Center, 16907 Algonquin St., Huntington Beach, CA 9264 kkovacks@yahoo.com

Fridays at 7pm – 1040 West 17th St., Costa Mesa, CA  92627 klhuberty@gmail.com

 

SOS (Secular Oriented Sobriety or Save OurSelves}

Monday 7:30 at 5691 Vonnie Lane, Cypress 90630, “In the garage”.

For secular oriented AA meetings agnosticaanyc.org keeps an up to date list of meetings.

(Meeting information accurate as of November, 2015. To verify please use listed emails. To learn more about these approaches to recovery check out smartrecovery.org and lifering.org.)

Brain Connections

Brain Connections

I’m a fan of Steven Novella. He’s a Professor of Neurology at Yale School of Medicine. He’s also a founder of The Skeptics Guide to the Universe. He’s also the co President of the New England Skeptics Society. He also frequently contributes to his Neurologica blog. I don’t know when he has time to sleep.

He has a blog entry on a recent study of neural connections. The study hi lights how brain connectivity changes when you learn and that reading and study can literally make you smarter. The converse is also true. Although addictions are not mentioned in the article the implications are clear. That learning negative habits increases the connections for negative behaviors. I suggest you read the blog.

http://theness.com/neurologicablog/index.php/study-correlates-brain-connections-to-intelligence/

Original article is here. Link shows abstract only. You hit a paywall if you want to read the whole thing.

http://www.nature.com/neuro/journal/vaop/ncurrent/full/nn.4125.html

Think about the pattern of neural development as addiction progresses. At first the connections aren’t strongly embedded and the stimulus to drink or use doesn’t have much effect on you. You may be as likely to deal with stress by dealing with the stress as opposed to drinking or using over it. As the neural connections progress it becomes second nature to deal with urges and stress by repeating your learned behavior of using. Another way to explain it is think of someone learning the piano. At first the playing is awkward and not very musical. As your brain connections improve with practice the music improves. Studies have shown that piano players have increased brain mass in the areas that control hand muscles and coordination. Their brain has literally changed to become piano players. With addiction your brain also changes, unfortunately in ways to make it more likely to get you to resort to your drug of choice for reward or coping in general.

Once an addiction develops your brain is changed, probably forever. If our theoretical pianist stops playing the piano the areas of the brain controlling his hands will shrink but probably never to pre piano lesson levels. He can never “unlearn” the piano completely. He could resume playing after years of not playing. At first he may not play well but he could probably get up to his former level of skill very quickly. I’m of the opinion that moderation is a poor choice for most everyone with an addiction. Those connections are very easy to restore to addiction level dysfunction.

While this may sound depressing I prefer the optimistic view that your brain has the capacity to normalize after you abstain from your drug of choice. You can’t “unlearn” your addiction but the connections that formed during your using years do weaken with time. Cravings lesson. Using dreams diminish. Urges get farther apart in time and are weaker. With time you may feel comfortable being in social events involving alcohol like weddings while these may be very challenging for the newcomer and often have to be avoided.

Hopefully you will replace the negative behaviors with positive ones. Good behavior can be learned and positive connections can be made. You can learn to cope with stress by responding in positive ways. Positive connections in your brain lead to positive connections with other people.

Childhood trauma and Addiction

Childhood trauma and Addiction

In my blog post dated 8/27/15 I briefly mentioned a book about childhood trauma. Having been involved in recovery for about 25 years I’ve noticed that many people in recovery from addiction have histories of childhood trauma or growing up in a dysfunctional family. One time I mentioned in a meeting that I had never heard of someone who got into addiction trouble who said “I had a happy life, I just started drinking too much.” Of course, when I said that someone had to disagree and stated that was their history. I have reasons to be suspicious of that person’s claim but I won’t get into that now. Since this was my anecdotal experience I decided to look further into the possible correlation between childhood trauma and substance abuse.

It turns out my suspicions were correct. There is indeed an extensive body of research showing a strong positive correlation between Adverse Childhood Experiences (ACE) and problems with addiction. There is also a positive correlation with many other medical and psychiatric conditions. One of the best studies evaluated over 17,000 adults and rated them on an ACE scale. There was a relation to multiple adverse health and psychiatric disorders with high ACE scores.(1). I don’t want to get into too much detail, but several adverse brain changes have been correlated with ACE. I think it’s safe to say that the more screwed you were as a kid, the harder time you will have as an adult. Those hard times may include a tendency to addiction. A brief article by Maia Szalavitz in Time magazine discusses a couple of these changes and how they interfere with thought processes. (2). Thought processes that may keep us from abusing substances.

As an aside, these are some of the reasons I am really bothered by the stigmatization and prejudice directed towards addicts. They’ve almost universally struggled with abuse and adversity. Further rejection and discrimination is not helpful. The idea that addicts are just weak willed people who want to indulge their desires to party is about 180 degrees wrong.

It’s often said that drinking or using are symptoms of a deeper problem. Often people use substances for self treating their psychological maladies. This research seems to confirm that.

It’s more therapeutic to approach addicted people with empathy and compassion. Even with ACE and psychic scars people can triumph over the adversity. You can have a good life even with your past scars. A nice article in the Fix expounds on these ideas. (3)

1) The enduring effects of abuse and related adverse experiences in childhood, Anda et.al. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3232061/

2) How Childhood Trauma May Make the Brain Vulnerable to Addiction, Depression, By Maia Szalavitz http://healthland.time.com/2012/08/01/how-childhood-trauma-may-make-the-brain-vulnerable-to-addiction-depression/

3) How Childhood Trauma Creates Life-long Adult Addicts, By Maia Szalavitz, https://www.thefix.com/content/trauma-and-addiction9180

Odds and Ends:

Latest webinar just posted as podcast. Check it out.

http://www.smartrecovery.libsyn.com

Exclusive screening of The Business of Recovery

Exclusive screening of The Business of Recovery

This is a documentary worth checking out. When it comes to shopping for rehabs “let the buyer beware.”

Sponsored by: Practical Recovery

Location: Triangle Cinemas, 1870 Harbor Blvd Costa Mesa, CA 92627

Date: Sunday, August 30th

Time: 2:00 pm

Tickets: $12

Contact: info@thebusinessofrecovery.com

PLEASE NOTE: Advance Tickets only. You cannot purchase tickets at the screening. You can order tickets here.

http://thebusinessofrecovery.com/screenings/

Odds and Ends:

Nice recent post on the SMART site:

Recovery Story: Am I “Powerless”? Or “Powerful”? Jean Greer McCarthy on the “power of choice.” http://ow.ly/R2JPt

First SMART Meeting:

An AA veteran goes to her first SMART meeting.

http://rehabreviews.com/like-go-smart-recovery-eight-years-aa/

Kid Stuff:

Donna Jackson Nakazawa has published a book titled Childhood Disrupted. A summary of her ideas can be seen in the Psychology Today article. The basic premise is that Adverse Childhood Experiences, (ACE), can lead to later adverse health and psychological conditions. It’s been my experience that most people with substance abuse problems have had more than there share of ACEs. This is not mentioned in the article. I’ve always felt that therapy is useful in most any recovery program.

https://www.psychologytoday.com/blog/the-last-best-cure/201508/7-ways-childhood-adversity-changes-your-brain

Updated list for Non 12 Step Recovery Meetings

Updated list for Non 12 Step Recovery Meetings in Orange County, California

SMART Recovery Meetings:

Sunday,  Women’s Meeting. 11 am to 12:30 pm. 1954 Placentia Ave, Costa Mesa, CA 92627. Meeting is in the cafeteria, room 104. mollie.waring@solidlandings.com

Sundays, 5:30 pm to 7 pm. Kaiser Irvine Medical Center, 6640 Alton Parkway, Irvine, CA 92618 Conference Room 6 (5th Floor) in Medical Office Building 2 (MOB2) Enter the office building that’s contiguous with the hospital. Take the elevators to the 5th floor. Follow the signs to Conference Room 6. You’ll see a sign: C6. steve.smart@cox.net

Tuesday 7:30 PM 2165 Harbor Blvd., Costa Mesa CA 92626 info@smartrecoveryoc.org

Friday,  Men’s Meeting. 7 pm to 8:30 pm. 1954 Placentia Ave, Costa Mesa, CA 92627. Meeting is in the cafeteria, room 104. mollie.waring@solidlandings.com

Life Ring Meeting:

Thursdays, 7 to 8 pm.

St. Joachim’s Annex, 1943 Orange Ave, Costa Mesa, CA 02627

Saint Joachim Church is on the corner of Orange Ave and Walnut. The Annex is on the opposite corner of the church.  Take the walkway to the back of the Annex and the meeting will be the door on the left. jmars4@sbcglobal.net

Women for Sobriety:

Women for Sobriety do have a local meeting. For information go to

http://www.womenforsobriety.org and request information by clicking on the contact link on the upper right of the web page.

Refuge Recovery:

Monday 7pm. New Directions for Women  Outpatient Offices,  3001 Redhill Ave., Bldg 4 Suite 109, Costa Mesa, CA92626 ekbarbour@gmail.com

Tuesday – 7:30 pm – Harmony HB Yoga and Wellness Center, 16907 Algonquin St., Huntington Beach, CA 9264 kkovacks@yahoo.com

Fridays at 7pm – 1040 West 17th St., Costa Mesa, CA  92627 klhuberty@gmail.com

SOS (Secular Oriented Sobriety or Save OurSelves}

Monday  7:30 at 5691 Vonnie Lane, Cypress 90630, “In the garage”.

For secular oriented AA meetings agnosticaanyc.org keeps an up to date list of meetings.

(Meeting information accurate as of  August, 2015. To verify please use listed emails. If you know of an error in this list please notify me at steve.smart@cox.net. To learn more about these approaches to recovery check out smartrecovery.org, refuge recovery.org, and lifering.org.)

Odds and Ends:

Two new SMART meetings are starting soon.

One is starting on the 21st of this month. It is an Men’s SMART meeting from 7 to 8:30pm on Friday’s at 1954 Placentia Avenue, Room 104, Costa Mesa 92627.

The second one is a Woman’s SMART meeting on Sundays 11am to 12:30 pm. Same address as above. First meeting is 8/23.

Thank Mollie for these meetings.

Excuses, excuses, excuses….

Don’t let hard times or other excuses be a justification for relapse.

http://www.thecleanslate.org/victims-of-circumstance-how-to-avoid-being-a-delicate-addict-on-the-edge-of-relapse/

Article by Tom Horvath.

Explains how addiction to destructive behavior is tied into survival behaviors innate to our species.

https://www.practicalrecovery.com/prblog/addiction-and-recovery-an-evolutionary-perspective/