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Session 1:Triggers and Cravings
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Changes in the Brain
Limbic System
Prefrontal Cortex
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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 Medicine
A 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
PositivesRelief from
DepressionAnxietyLonelinessInsomnia
EuphoriaIncreased statusIncreased energyIncreased sexual/social confidenceIncreased work outputIncreased thinking ability
METHAMPHETAMINE(METH)
NegativesMay be illegal
May be expensiveMay cause missing work
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Conditioning Process During AddictionIntroductory Phase
Triggers• Parties• Special occasions
• Other events
Responses
• Pleasant thoughts about meth
• Infrequent use
Strength of Conditioned Connection:
Mild
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Development of Obsessive ThinkingIntroductory Phase
Sports
FoodSchool
TV
Girlfriend HobbiesJob
MethFamily
ExerciseParties
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Development of Craving ResponseIntroductory Phase
Entering Using Site
Use of Meth
Heart/pulse rate
Respiration
Adrenaline
Energy
Meth taste
Meth Effects
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PositivesDepression reliefConfidence boostBoredom reliefSexual enhancementSocial lubricant
NegativesEmployment/school
disruptionsRelationship concerns
Financial problemsBeginnings of physiological
dependence
Addictive ProcessMaintenance Phase
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Strength of Conditioned Connection:
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
Moderate
Conditioning Process During AddictionMaintenance Phase
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Meth
FoodSchool
TV
Girlfriend HobbiesJob
MethFamily
ExerciseParties
Development of Obsessive ThinkingMaintenance Phase
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Entering Using Site
Physiolog-ical Response
Use of Meth
Meth Effects
Heart Breathing Adrenaline effects Energy Meth taste
Heart Blood
pressure
Energy
Development of Craving ResponseMaintenance Phase
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PositivesSociabilityOccasional euphoriaRelief from fatigueRelief from stress
NegativesWithdrawal depression
ParanoiaTweaking
Relationship disruptionsFamily distress
Impending job loss
Addictive ProcessDisenchantment Phase
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Strength of Conditioned Connection:
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
STRONG
Conditioning Process During AddictionDisenchantment Phase
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Meth
FoodMeth
TV
Girlfriend MethJob
MethFamily
MethParties
Meth
Development of Obsessive ThinkingDisenchantment Phase
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Thinking of Using
Mild Physiological Response
Entering Using Site
Heart rate Breathing rate Energy Adrenaline effects
Powerful Physiological
Response
Use of Meth Meth Effects
Heart rate Breathing rate Energy Adrenaline effects
Heart Blood
pressure Energy
Development of Craving ResponseDisenchantment Phase
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PositivesRelief from fatigueRelief from stressRelief from depression
NegativesWeight loss
ParanoiaLoss of family
SeizuresSevere depression
UnemploymentBankruptcy
Addictive Process Disaster Phase
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Strength of Conditioned Connection:
Triggers• Any emotion• Day• Night• Work• Free time
Responses• Obsessive thoughts
about meth• Powerful autonomic
response• Powerful physiological
dependence• Automatic use• Persistent paranoia
OVERPOWERING
Conditioning Process During AddictionDisaster Phase
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Meth
Meth
Meth
Meth Meth
Meth MethMeth
MethMeth
Meth
Development of Obsessive ThinkingDisaster Phase
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Thoughts of Meth- Using Place
Powerful Physiological Response
Heart rate Breathing rate Energy Adrenaline
effects
Development of Craving ResponseDisaster Phase
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Trigger
Thought
Craving
Use
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Interruption
Trigger
Thought
Craving
Use
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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
