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reality of relapse by benbenzhou

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reality of relapse

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									                                                                                  Word Association

                                                                                     Relapse
             The Reality of                                        •   Drug abuse
               Relapse                                             •   Diabetes
                                                                   •   Asthma
                                                                   •   Heart Attack




                                                              Why Does Treatment
             “It’s easy to give up smoking.
           I have done it a thousand times.”                  Seem So Ineffective?


                                    Mark Twain




           Outcome In Hypertension                                        Outcome In Addiction
10
                                                              10
8
                                                              8
6                                                             6
4                                                             4
2                                                             2
0                                                             0
          Pre         During         During   During   Post             Pre         During        During   During   Post

     Treatment Research Institute                                  Treatment Research Institute
                                                                                        Relapse Rates for Drug Addiction
Is CD Treatment Effective?                                                             are Similar to Other Chronic Medical
                                                                                                     Conditions




                                                 Percentage of Patients who Relapse
                                                                                      100
•   Many patients don’t comply                                                         90
                                                                                       80
•   Many patients relapse                                                              70
                                                                                       60
•   Treatment doesn’t cure people                                                      50
                                                                                       40
•   Compliance and relapse rates similar                                               30
    to those rates for treatment of: heart                                             20
                                                                                       10
    disease, asthma, diabetes, obesity,                                                 0
    gingivitis.                                                                                  Drug         Type I Diabetes    Hypertension         Asthma
                                                                                              Dependence

                                                                                            Source: McLellan, A.T., et. al., JAMA 234(13), October 4, 2000.




                                                                                                       Addiction is like…
                                                                                                             A dog with a bone
                                                                                                                              • The dog does not want
                                                                                                                                to let go of the bone
    What is Addiction?                                                                                                          (addiction/ denial).
                                                                                                                              • It gets excited when it
                                                                                                                                thinks its going to get its
                                                                                                                                bone (craving)
                                                                                                                              • It always wants more
                                                                                                                                bones (loss of control)
                                                                                                                              • Sometimes the dog
                                                                                                                                takes you for a walk.




        Treatment is like…                                                                    What Boomer is Thinking
      Obedience School for the Dog                                                                                                             What can I get
                                                                      They won’t test me                                                        away with?
                       • You teach the dog’s                          for another week.
                         owner to control the
                         dog.
                       • You develop a variety
                         of tools (relapse
                         prevention) to help                                          Try the second-
                                                                                       hand smoke                                                    We can talk
                         the dog be obedient.                                              excuse.                                                   our way out
                       • Some dogs are                                                                                                               of this.
                                                                                                                 I want to get high
                         harder to train.                                                                        I want to get high
                                                                                                                 I WANT TO GET
                                                                                                                      HIGH!!!
Changing People Places & Things                                            Why do people relapse?
                                                                 •   Poor recovery skills
                                                                 •   Loss of motivation
                                                                 •   Powerful cravings
                                                                 •   Lapse in Judgement
                                                                 •   Poor Brain Function
                                                 HEY GUYS!!
                                                 THERE GOES
  I can hang out                                 THE FOX!!
With my old friends                              LET’S GET’EM!
And not chase the
        fox




      UNDERSTANDING RELAPSE                                                RELAPSE CLASSIFICATION

 RELAPSE IS A PERSISTENT FEATURE                                     DRUG INVOLVED OFFENDERS CAN BE
 OF ADDICTION.                                                       CATEGORIZED ACCODING TO THEIR
                                                                     RELAPSE/RECOVERY HISTORY.
 Relapse not an isolated event. It is part of a process of
                                                                     Recovery prone – continuous abstinence
 being unable to cope with living life on life’s terms. The
 process may be marked by renewed return to active                   Brief relapse prone – brief interruption of
 drug use, criminal behavior, physical or emotional                  recovery process
 collapse, or suicide. The relapse process is marked by              Chronic relapse prone – despite their efforts to
 predictable and identifiable warning signs that are                 change, these individuals maintain dysfunctions
 evident long before use or collapse occurs.                         that prevent continuous abstinence




            RELAPSE WARNING SIGNS                                             SITUATIONS OF RELAPSE
    CHANGE IN ATTITUDE- recovery no longer a                           •   Relapse as response to drug hunger
     priority                                                          •   Relapse as impulse
    CHANGE IN BEHAVIOR- old survivor skills                            •   Relapse as a cognitive test
     return                                                            •   Relapse as flight
    CHANGE IN SITUATION- a return to old                               •   Relapse or go crazy
     people, places and things which support self                      •   Relapse and loss
     defeating lifestyle                                               •   Relapse as rage
                                                                       •   Relapse as self loathing
                                                                       •   Relapse as vacation
      How Relapse Happens                                The Ride Downhill

• The Steady Ride Downhill                                            • Miss meetings
                                                                      • Stop caring
• The Catastrophe                                                       about stuff
• The Surprise                                                        • Hang out with
                                                                        wrong people
• Craving                                                             • Hang out in
                                                                        wrong places
                                                                      • Use




           The Catastrophe                                  The Surprise
• Something bad                              • You’re trying to
  happens                                      stay sober
• Intense feelings                           • Someone asks if
• Hard to handle                               you want
• Using will “help”                            some___.
  deal with the pain.
                                             • Before you can
• Life owes me this
                                               think, your mouth
  one
                                               (the dog) says
                                               “YES!!”




         Recovery is A Skill                     What Do They Need to Learn?
• It must Be Learned                         •   Cravings management
• Some people Learn faster than others       •   Refusal skills
• Some people learn better by listening      •   Leisure Recreation activities
• Some people learn better by watching       •   Coping strategies
• Some people learn better by doing          •   Problem solving
• The best learning happens when all 3 are   •   Crisis management
  used                                       •   Doing the responsible thing
• Doing it well takes practice
• People make mistakes
         Dealing with mistakes                  Ambivalence and Motivation
•   Is the person trying?                    • Many participants have mixed feelings
•   Did they get honest about the mistake?     about having to stop using.
                                             • Motivation levels wax and wane
•   What was the nature of the mistake?
                                             • The “expectation” is that everyone will
•   What can be learned by the mistake?        always be motivated.
                                             • The reality is somedays you feel motivated
                                               somedays you don’t
                                             • Motivation drops when people are
                                               frustrated (known as the F***its).




              Motivation:
                                                             Sober Me
         Sober Me vs. Using Me
                                             • Wants to be sober
                                             • Doesn’t want to
                                               relapse
                                             • Likes not having
                                               hangovers
                                             • Wants to stay out of
                                               jail
                                             • Likes keeping a job
                                             • Likes having people
                                               trust them.




                  Using Me
• Likes being high
• Likes hanging out in
  fun places
• Says “One won’t hurt!”
• Doesn’t mind lying to
  people
• Doesn’t really care
  about job (except for
  the $$)
• Doesn’t think they can
  get caught
          Native American Story                                                   The Craving      Why can’t I
                                                                                                   stop thinking
• Inside of me live the Spirits of two wolves,                                                     about gettin’
  a good wolf and a bad wolf. They                                                                 high???
  constantly fight, with the battle raging back
  and forth. Which one will eventually win:
• The one that I feed.
• Feed Sobriety – Meetings, reading,
  talking, etc.




                                                                               Craving and the Brain
    Craving and the Male Brain
                                                                                Gender Differences
                           Amygdala                     Amygdala
                           not lit up                   activated
 Front of Brain




 Back of Brain

            Nature Video                Cocaine Video



                                                                          Female             Male




                 What’s a Craving?                                                   Craving
• A “trigger” causes a reaction.                                                                       Relapse
• The reaction is more emotional than                                 Trigger
  rational
• The intensity of the reaction can reduce                            Memory
                                                                                                    Impaired
  the ability to reason logically                                   Stimulation                     Judgement
• The dog keeps barking louder and louder                           of Nucleus
  – thinking eventually it will get what it                         Accumbens
  wants.                                                            & Amygdala
• We give in – to shut up the dog.
                                                                         Focus on Drug      Anxiety Increases
            Relapse Triggers                                 RelapseTriggers
                                                                     SEEING IT ON TV
                                                MY DEALER
                                                                   GETTING ANGRY
                                                THE SMELL OF MY DRUG
                                                                    SEEING SOMEONE USE
                                                NIGHTTIME
                                                                            BEING BORED
                                                 OLD FRIENDS
                                                                   HAVING MONEY
                                                SEEING IT IN THE STORE
                                                                   FEELING LONELY




Circuits Involved In Drug Abuse and Addiction
                                                                   Go & Stop

     STOP                                       •   Craving elicitsGo!!
                                                •   Powerful
                         GO                     •   Activity in limbic system not frontal cortex
                                                •   Feeling/reacting vs. thinking/planning
                                                • Thinking initiates Stop!!
                                                • Addicts have “bad brakes” – Stop!
       All of these must be considered          • Hard to stop this fast moving car.
          in developing strategies to
           effectively treat addiction




                                                            Preventing relapse
                                                • Develop skills
                                                • Saying no
                                                • Figuring out where not to go who not to
                                                  see
                                                • Support networks
                                                • Emergency plans
                                                • Safe place to live
            Fred Flintstone Brakes
Relapse Risk factor assessment
•   Motivation
•   Environment
•   Impulsivity
•   Stress

								
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