Two Pillars of Recovery

Reflect How Nature Works

Geoff Kane, MD, MPHBrattleboro, VT

February 6, 2013

Kane, MD 2013

Kane, MD 2013

Overview

• Nature (never takes time off)

• Neurobiology Behavior Addiction Powerlessness Recovery

• The Two Pillars of Recovery

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“Addiction is like gravity— governed by laws of nature and never takes time off.”

-Kane

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“…the essence of addiction: uncontrollable, compulsive drug seeking and use, even

in the face of negative health and social consequences.”

- Alan Leshner, PhD

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Addiction

• Subjective: Powerlessness

• Objective: Persistent use despite adverse consequences

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There is more to who we are and more to why we do the

things we do than what meets our own minds.

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Lower centers of the Central Nervous System can act independently of higher

centers.

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“New research shows that emotions have a separate system of nerve pathways,

through the limbic system to the cortex, allowing emotional

signals to avoid conscious control.”

-Robert Ornstein, 1991

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-Robert Ornstein

“…unconscious decisions for action go on constantly inside the head.”

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-Robert Ornstein

“We’re worse off than Freud thought, because many actions proceed

without our knowing anything about them.”

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“Our limbic system sets the mind’semotional tone and stores our

highly charged emotional memories.”

- Tian Dayton, PhD

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Addictive chemical substances change the brain and change

behavior.

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“I have a passion for alcohol.”

- 25 year old female

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“Any addict knows, you’ll do anything to get it.”

- 23 year old male

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• Violate their own rules for behavior/values when under the influence?

• Break promises to themselves about use?

• Pay an emotional price for using (shame, guilt, fear, remorse, anger at self)?

• See a different version of their own drinking/drugging than other witnesses?

• Would become defensive or lie if asked these questions?

- John and Pat O’Neillin Help to Get Help

Are they really hooked?

RELAPSE RATE OVER TIMEA

bsta

iner

s (%

)

Time (Months)

0 1 2 3 4 5 6 7 8 9 10 11 12

2 Weeks

100

90

80

70

60

50

40

30

20

10

0

Heroin

Smoking

Alcohol

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Two Pillars of Addiction Recovery

• Keep your distance!• Ask for help!

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“The treatment of addiction is [still] people.”

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“Suggestions” Made in Addiction Treatment

• 90 meetings in 90 days• Obtain and use sponsor• Do some Step work• Participate in an aftercare group• Participate in counseling/ psychotherapy

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Counseling Tips

• Be Empathic, Nonconfrontational• Offer Choices• Emphasize Patient’s Responsibility• Convey Confidence In Patient’s

Ability To Change

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Determinants of Client “Change”

• Client factors 40%• Relationship factors 30%• Expectancy & Hope 15%• Model/technique 15%

- Michael Clark, MSW

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Positive interpersonal relationships change the brain

and change behavior.

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“Neural repatterning comes as we enter into and sustain new types of relationships that allow us to reregulate

our sense impressionsslowly and over time.”

- Tian Dayton, PhD

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“Interpersonal experience shapes the mind as it continues to develop

throughout the lifespan…

Interactions with the environment, especially relationships with other

people, directly shape the development of the brain’s structure and function.”

- Daniel J. Siegel, MD

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“ …the amygdala, along with related areas…, plays a crucial role in

coordinating perceptions with memory and behavior. These regions are

especially sensitive to social interactions.”

- Daniel J. Siegel, MD

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Some Recovery Skills/Tips• Be honest• Embrace your pain• Mistrust yourself• Keep your distance• Seek people, not chemicals• Pay attention!

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Treatment/Recovery EssentialsPatient• Understand & accept “laws”• Avoid or manage “triggers”• Use supports, human

& spiritual• Avoid abusive

relationships• Take meds when

appropriate

Community• Understand “laws”• Reduce drug

availability• Make professional and

other positive relationships available continuously

• Protect people from abusive relationships

• Make appropriate meds available

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Abstinence results from Skill Power

not Will Power

CRAVING

WITHDRAWAL

HABIT COPINGDocherty’s Craving Triangle

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SpiritualityInvolves Relationships With:

• Self• Other Human Beings• Nature• Creator, God, Higher Power

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A Model for Recovery

• Emotional Arousal

• Sense of Hope

• Sense of Mastery

• Love and Humor

- Modified from Jerome Frank, MD