Healing The Addicted Brain

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Healing the Addicted Brain
A book By:
Harold C. Urschel, M.D.

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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

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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

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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

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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)

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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

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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

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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?

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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.

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 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

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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

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Addictions Medicines
 Vivitrol and Campral encourages
the addict to cut back on alcohol
intake
 Campral helps accelerate repairs to
brain systems

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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”.

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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 Treatment for Sedatives –
neurontin, trileptal, seroquel,
risperdal, lexapro, and zoloft for
symptoms of anxiety;
 Treatment for marijuana – seroquel,
lexapro, zoloft for anxiety and
depression

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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

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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.

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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

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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

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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

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Lapse and Relapse
 A Relapse Prediction Scale
 A Lapse/Relapse Prevention Plan
worksheet
 A Lapse/Relapse Action Plan
worksheet

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Health and Nutrition in Recovery
 Elements of a healthy diet
 Exercise: the world’s best stress
reliever

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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

Healing The Addicted Brain

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