Session 1:

Triggers and Cravings

1-1
 Changes in the Brain

Prefrontal Cortex
Limbic System

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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 Addiction
American 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 Process
Introductory Phase

Positives
Relief from METHAMPHETAMINE
Depression (METH)
Anxiety Negatives
Loneliness May be illegal
Insomnia May be expensive
Euphoria May cause missing work
Increased status
Increased energy
Increased sexual/social confidence
Increased work output
Increased thinking ability

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 Conditioning Process During Addiction
Introductory Phase

Strength of Conditioned Connection:

Mild
Triggers Responses
• Parties
• Pleasant thoughts
• Special occasions about meth
• Other events • Infrequent use

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Development of Obsessive Thinking
Introductory Phase

Food
Sports School
TV
Hobbies
Girlfriend
Job
Family Meth
Parties
Exercise

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 Development of Craving Response
Introductory Phase

Entering Use of Meth Meth Effects

Using Site
 Heart/pulse rate
 Respiration
 Adrenaline
 Energy
 Meth taste

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 Addictive Process
Maintenance Phase
Negatives
Employment/school
disruptions
Positives Relationship concerns
Depression relief Financial problems
Confidence boost Beginnings of physiological
Boredom relief dependence
Sexual enhancement
Social lubricant

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Conditioning Process During Addiction
Maintenance Phase

Strength of Conditioned Connection:

Moderate
Triggers Responses
• Parties • Thoughts of meth
• Friday nights • Eager anticipation
• Friends of meth use
• Alcohol • Mild physiological
• “Good times” arousal
• Sexual situations • Cravings occur as use
approaches
• Occasional use
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Development of Obsessive Thinking
Maintenance Phase

Food
Meth School
TV
Hobbies
Girlfriend
Job
Family Meth
Parties
Exercise

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 Development of Craving Response
Maintenance Phase

Physiolog-
Entering Use of Meth
ical
Using Site Meth Effects
Response
 Heart
 Heart
 Blood
 Breathing
 Adrenaline
effects pressure
 Energy
 Energy
 Meth taste

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 Addictive Process
Disenchantment Phase

Negatives
Positives
Withdrawal depression
Sociability
Paranoia
Occasional euphoria
Tweaking
Relief from fatigue
Relationship disruptions
Relief from stress
Family distress
Impending job loss

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 Conditioning Process During Addiction
Disenchantment Phase

Strength of Conditioned Connection:

STRONG
Triggers Responses
• Fatigue • Continual thoughts
• All friends of meth
• Stress • Strong physiological
• Boredom arousal
• Anxiety • Psychological
• Free time dependency
• Sexual arousal • Strong cravings
• Loneliness • Frequent use
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 Development of Obsessive Thinking
Disenchantment Phase

Food
Meth Meth
TV
Meth
Girlfriend
Job
Family Meth
Parties
Meth

Meth

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 Development of Craving Response
Disenchantment Phase
Thinking of Mild Physiological Entering Using
Using Response Site
 Heart rate
 Breathing rate
 Energy
 Adrenaline effects

Powerful
Physiological Use of Meth Meth Effects
Response  Heart
 Heart rate  Blood
 Breathing rate pressure
 Energy  Energy
 Adrenaline effects
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 Addictive Process
Disaster Phase

Positives Negatives
Relief from fatigue Weight loss
Relief from stress Paranoia
Relief from depression Loss of family
Seizures
Severe depression
Unemployment
Bankruptcy

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 Conditioning Process During Addiction
Disaster Phase
Strength of Conditioned Connection:
OVERPOWERING
Triggers Responses
• Any emotion • Obsessive thoughts
• Day
about meth
• Night • Powerful autonomic
• Work
response
• Free time • Powerful physiological
dependence
• Automatic use
• Persistent paranoia
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 Development of Obsessive Thinking
Disaster Phase

Meth
Meth Meth
Meth
Meth
Meth
Meth
Meth Meth
Meth
Meth

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 Development of Craving Response
Disaster Phase

Thoughts of Meth- Powerful Physiological

Using Place Response

 Heart rate
 Breathing rate
 Energy
 Adrenaline
effects

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Trigger

Thought

Craving

Use
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Trigger

Thought

Craving
Interruption
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

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