1. NeuroScience and the Dynamics
of Addiction

2. • “Life breaks everyone, and a few are strong in
the broken places.” Ernest Hemingway

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. • 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. • 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. The areas depicted contain the circuits that underlie feelings of reward, learning and memory, motivation and drive, and inhibitory control. Each of these
brain 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. 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 much
of its inhibitory power over the circuits that drive responses to stimuli deemed salient.
All of this creates: GIMME

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. Scans Show Effects of Craving Regulation in the Brain. When study participants thought of the long-term negative
consequences 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 region
critical to setting goals, planning, and controlling behavior—which, in turn, inhibited the ventral striatum, part of the
reward pathway that generates craving.

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. Cognitive Distortion: Addiction Definition of
FREEDOM: Choice without Consequences
Do whatever I want, WITHOUT any
consequences

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. • 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. True Definition of Freedom: Choice with Consequences
Ability 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. • 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. • 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. 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. Cognitive Transformation Theory
• Desistance as a conversion process
• Four key elements in the desistance process
a. Openness to change
b. Exposure to circumstances, or “hooks,” that
may help motivate and move toward change.
Both internal and external
c. Replacement self – Erase and Replace
d. Reinterpretation of previous illegal behavior

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. • 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