AnnouncementsSecond exam is Thursday, November 6Similar format as first examExam is not cumulativeStudy guide will be posted by Friday eveningOverarching issues addressed by addiction treatmentSkills to handle cravings (calm down the GO! System)Skills to better control impulses, prevent relapse (build up the STOP! System)Alter neurochemistry to deal with withdrawal, cravingsEnhance desire and motivation to quitAddress practical, psychological, and spiritual needs that contribute to stress, feelings of isolation, and useOnly about 10% of people who have an addiction actually receive treatmentAbout half of members in treatment have come because of a family member or from a court orderBut there are people who want to be thereIn treatment first thing that is done is to start to boast motivation for people to be thereOne way to reduce cravings is recognize them as cravings and then talk yourself out of using. That would be building up the STOP! System. This is what the cognitive-behavioral treatment is all about.All of these things though are worked on when people come to treatment.Cognitive-behavioral therapyBuild up the STOP! System and reduce the GO! System.Environment that we experience day to day. Could be going to a party where there could be alcohol or drugs there. The theory says the environment and the outcome, which is what happens, is all determined by things that are going on for us. This can include our thoughts, feelings, and behavior. These three things mediate the relationship between the environment and the outcome.Environment Thoughts, Feelings, Behavior  OutcomeCognitive-behavioral therapy say lets change thoughts, feelings, and behavior. If we can change any one of those things, better outcomes can occur.All of these things are interrelated. It’s a reciprocal determinism, which is that our thoughts influence our feelings and our feelings influence our behavior. Whatever behavior you act out can influence your thoughts.The outcome can be that you use substances and maybe you feel guilty so the outcome can influence your feelings. One behavior is going to a party, which is a high-risk situation, and you choose to leave the party, then you are changing your environment.If you intervene at any point on here, it has the likelihood to reduce substance use.Environmental triggersBoth the brains reward/reinforcement system and pain systems shape our behavior via the conditioned responsee.g., Pavlov’s dogs, food poisoningAnything we come to associate with the reward or pain system such as smells, sights, sounds can “trigger” the conditioned responseThe conditioned response bypasses conscious thought and leads to powerful reactions in our brain and bodyWhen persons with addiction are exposed to images associated with drug use – even those too fast for the conscious brain to notice - the GO! system is “triggered”If you see a pipe or something like that you will think about using. Because so many times you have compared the two things.Pavlov’s dogs: A bell ringing that was associated with food. This shows us things in the environment can also be associated with drug use. If we encounter certain objects we have cravings. Anything can become associated with substance use and thus can become a trigger. Trigger is really just anything that sparks a craving to use.Biological evidence of triggersfMRI signal- craving associated with cocaine-related cueHuge spike in the reward system when person who was addicted to cocaine sees an image of someone snorting cocaineTriggers/cues are idiosyncratic– unique to the individualIn treatment a main goal is to help people identify what their triggers are. For everyone this is going to be different. There will be common things across people like seeing paraphernaliaSome people though may have triggers that are just to the individual, not experienced by others.Cognitive-behavioral interventionsCognitiveChange thoughts, expectancies, and emotions that contribute to substance use behaviorBehavioralChange the things that we do that contribute to substance usePlaces we go, people we hang with, patterns we have throughout the day that lead to increased tendency to useIClicker questionWhich of the following cognitive-behavioral approaches incorporates positive incentives for abstinence?Contingency managementCue exposureCoping skills trainingResolving childhood issuesMost addiction treatments focus on the here and now. There is a recognition of the past maybe someone has a history of trauma. But really all the evidence-based therapies focused on here is not related to resolving childhood issues.Cue exposure is what causes trigger to happen. Environmental cues are what triggers cravings.In treatment try to identify what are the most triggering situations for a certain individual the most triggering situation may be a fight with a significant other. And then the next one may be the fridge of full of beer. Then maybe hanging out with a friend who is a big drinker. And then reading a magazine that features weed. This is a hierarchy of cues, the top is the most stressful thing that every time it happens you use. Most of the time for the 2nd thing. Half the time you will use. And the last thing maybe every few times you read it end up smoking. When you identify someone with this hierarchy of cues you then work with the individual to disassociate the cue with substance use.Hope is that when people encounter cue in environment they won’t want to use. The therapist can ask the person to bring in the magazine many times and disassociate it with substance use.Contingency management is most often used in opiate treatment programs. When they don’t use they are given rewards.One way also is to give people money for staying clean.After a little more time giving people money less often.Positive reinforcement for not using is seen to be very effective.Example treatment program that uses cognitive-behavioral therapy (video)MATRIX Institute on AddictionsSan Bernardino, CAIncorporates motivational and cognitive-behavioral approaches for treating addictionWatch and listen for: cognitive and behavioral strategiesPeople cannot control when triggers will occur. It is not an intelligence issue it’s a biological issue.Care more about why people stay rather then why people went to treatment in the first place.Key is whether or not people change their behavior.Cognitive interventions in the video? Things that worked to change people’s