Family Education Session 1: Triggers and Cravings 1-1.

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Session 1:Triggers and Cravings

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Changes in the Brain

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Conditioning

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I.P. Pavlov (1849–1936)

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Pavlov’s Dog

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A Definition of AddictionAmerican Society of Addiction MedicineA primary, chronic, neurobiologic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. Addiction is characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving.

Graham, A.W.; Schultz, T.K.; Mayo-Smith, M.F.; Ries, R.K.; and Wilford, B.B. eds. Principles of Addiction Medicine, Third Edition. Chevy Chase, MD: American Society of Addiction Medicine, Inc., 2003.

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The Addictive Process

Introductory phase Maintenance phase Disenchantment phase Disaster phase

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Addictive ProcessIntroductory Phase

METHAMPHETAMINE (METH)PositivesRelief from

DepressionAnxietyLonelinessInsomnia

EuphoriaIncreased statusIncreased energyIncreased sexual/social confidenceIncreased work outputIncreased thinking ability

Negatives

May be illegal

May be expensive

May cause missing work

Matrix IOP 1-8

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Conditioning Process During AddictionIntroductory PhaseStrength of Conditioned Connection: Mild

Triggers• Parties• Special occasions

• Other events

Responses

• Pleasant thoughts about meth

• Infrequent use

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Development of Obsessive ThinkingIntroductory Phase

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Development of Craving ResponseIntroductory Phase

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Negatives

Employment/school disruptions

Relationship concerns

Financial problems

Beginnings of physiological dependence

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Addictive ProcessMaintenance Phase

Positives

Depression relief

Confidence boost

Boredom relief

Sexual enhancement

Social lubricant

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Triggers• Parties• Friday nights• Friends• Alcohol• “Good times”• Sexual situations

Responses• Thoughts of meth• Eager anticipation

of meth use• Mild physiological

arousal• Cravings occur as use

approaches• Occasional use

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Conditioning Process During AddictionMaintenance Phase

Strength of Conditioned Connection: Moderate

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Development of Obsessive ThinkingMaintenance Phase

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Development of Craving ResponseMaintenance Phase

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Positives Sociability Occasional euphoria Relief from fatigue Relief from stress

Negatives Withdrawal depression

Paranoia Tweaking

Relationship disruptions Family distress

Impending job loss

Addictive ProcessDisenchantment Phase

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Triggers• Fatigue• All friends• Stress• Boredom• Anxiety• Free time• Sexual arousal• Loneliness

Responses• Continual thoughts

of meth• Strong physiological

arousal• Psychological

dependency• Strong cravings• Frequent use

Conditioning Process During AddictionDisenchantment Phase

Strength of Conditioned Connection: Strong

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Development of Obsessive ThinkingDisenchantment Phase

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Development of Craving ResponseDisenchantment Phase

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Positives Relief from fatigue Relief from stress Relief from depression

Negatives Weight loss

Paranoia Loss of family

Seizures Severe depression

Unemployment Bankruptcy

Addictive Process Disaster Phase

Matrix IOP 1-20

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Triggers• Any emotion• Day• Night• Work• Free time

Responses• Obsessive thoughts

about meth• Powerful autonomic

response• Powerful physiological

dependence• Automatic use• Persistent paranoia

Conditioning Process During AddictionDisaster Phase

Strength of Conditioned Connection: OVERPOWERING

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Development of Obsessive ThinkingDisaster Phase

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Development of Craving ResponseDisaster Phase

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All Downhill

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All Downhill, but with Interruption

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Thought Stopping

Visualization Rubberband snap Relaxation Calling someone

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Thought Stopping

Visualization

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Thought Stopping

Rubberband Snap

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Thought Stopping

Relaxation

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Thought Stopping

Calling Someone

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