Information and overview of important content of Harold Urschel's book: Healing the Addicted Brain: The Revolutionary, Science-Based Alcoholism and Addiction Recovery Program
2. 2
Overview
Excellent reference book for our clients
Easy to read
Probably too basic for most clinicians
Excellent checklists, worksheets (Maybe
helpful for ERG and IOP)
Excellent website
www.enterhealth.com/healingtheaddictedbrain
3. 3
Contents
1. It’s a Disease!
2. Changing Your Thoughts from Pro-
Addiction to Pro-Recovery
3. Combating Triggers and Cravings
4. Medications to Initiate Recovery
and Help Maintain Sobriety
5. Your 12-Step Recovery Program
6. Dealing with Difficult Emotions
4. 4
Contents
7. Dealing with Dual Diagnosis
8. The Recovering Family
9. Lapse and Relapse
10. Health and Nutrition in Recovery
11. Regaining Enjoyment and
Pleasure
12. True Recovery – Maintaining Your
Goals
5. 5
It’s a Disease!
A long-term illness caused by
measurable physical damage to the
brain
Nice graphic of a damaged brain
Suggests that it takes 6-10 months
of sobriety before significant brain
repair
Talk therapy helps correct problems
caused in the prefrontal cortex
(planning, reasoning, regulating
drives)
6. 6
It’s a Disease!
Need medication to correct
problems in the limbic system
(emotional drive, and memory
pathways and urges/cravings)
The new anti-addiction medicines
are designed to rebalance the
brain’s biochemistry
Use of these medicines enhance
ability to focus on and benefit from
therapy and 12-step programs
7. 7
Changing Thoughts from Pro-Addiction
to Pro-Recovery
The addicted brain is full of distorted and
irrational thoughts
Harmful thoughts trigger negative
emotions which trigger pro-addiction
behaviors
List of pro-addiction thoughts (e.g., “I
can’t get through this without a drink.”)
Worksheets to assess one’s pro-addiction
thoughts and substitute healthy thoughts
8. 8
Changing Thoughts from Pro-Addiction
to Pro-Recovery
The six-question test of thought accuracy:
1. What concrete factual evidence supports
this thought?
2. Are there other ways I could view this
situation?
3. What is the worst thing that could
happen?
4. What is the best thing that could
happen?
5. What is most likely to happen?
6. Is this thought inaccurate?
9. 9
Combating Triggers and Cravings
The trick is learning to identify and
deactivate triggers and to have a
plan in place to handle cravings
A nice quiz to see how much one
knows about cravings
Cravings are hardwired to the brain.
When exposed to a trigger,
memory and dopamine circuits are
activated leading to a craving.
10. 10
Combating Triggers and Cravings
A worksheet to identify personalized
triggers (i.e., people, places, times
of day, activities)
A worksheet called a “Daily Trigger
Chart” of situations,
thoughts/feelings, behavior,
pos/neg consequences
11. 11
Combating Triggers and Cravings
Strategies for handling triggers
Good suggestions for avoiding
triggers;
extinguishing triggers by not
using; and crushing cravings by
talking, distracting self, using flash
cards, stress management
techniques, and visualizing
12. 12
Addictions Medicines
Vivitrol and Campral encourages
the addict to cut back on alcohol
intake
Campral helps accelerate repairs to
brain systems
13. 13
Addictions Medicines
Vivitrol
The active ingredient is naltrexone
Naltrexone is an opiate antagonist
used to treat both alcohol and
opiate dependence
Works by “plugging in” to opioid
receptors in brain cells thus
preventing alcohol and opiate
molecules from getting in.
It “jams the lock”.
14. 14
Addictions Medicines
Vivitrol
Alcohol molecules cannot activate
pleasure pathways and cannot
trigger a high
Weakness of naltrexone is that it
must be taken daily
Vivitrol is a monthly injection
eliminating non-compliance
15. 15
Addictions Medicines
Vivitrol’s Benefits
1. Decreases cravings for alcohol
(and opiates) by up to 90%
compared to those without the
medication
2. If pt. does use, it blocks the high
you normally get
3. It prevents the first drink from
becoming many
16. 16
Addictions Medicines
Vivitrol Side Effects
Safe, well-tolerated, and non-
addicting
Occasional headache, feeling of
sedation, or tenderness at site of
injection
Normal dose is 380 mg (daily dose
of naltrexone is 50 mg), 70% less
than dosage of monthly pills
17. 17
Addictions Medicines
Campral
Generic name is acamprosate
Helps the brain heal more quickly,
thus, reducing cravings and the risk
of relapse.
Improves the alcoholic’s cognitive
skills, and ability to learn new skills
Accelerates the recovery process
18. 18
Addictions Medicines
Campral
Talk therapy helps with problems
governed by the cortex, Campral
repairs damage to the deeper limbic
system
This reduces cravings and makes it
easier for the brain to concentrate
of talk therapy
It’s believed to restore the GABA
and glutamate systems
19. 19
Addictions Medicines
Campral
Pts. report after taking it for 4-6
weeks to feel calmer, handle stress
more effectively, concentrate and
focus better and have fewer
cravings
20. 20
Addictions Medicines
Campral
Need about 200 mg per day to
rebalance GABA and glutamate
systems
2-3 tablets daily
Suggests taking it for at least a year
Nontoxic and nonaddicting
Possible side effects – diarrhea,
nausea, itching, intestinal gas
21. 21
Addictions Medicines
Other Medicines for Alcoholism
Antabuse – acts as a deterrent.
Most effective when administered
by a monitor. Standard dose is 250
mg. daily.
Topirimate (Topamax) – Not FDA
approved. May reduce alcohol
cravings and anxiety
22. 22
Addictions Medicines
Medication for Opioids- Suboxone
Suboxone (Buprenorphine) – a
partial-agonist. Removes the
craving without the “high”.
Blocks the effects of opioids,
decreases cravings, and suppresses
the major symptoms of withdrawal
Side effects – sweating, headache,
pain, nausea, constipation, and
insomnia
23. 23
Addictions Medicines
Medications for Stimulants
Modafinil (Provigil) – shows promise
to reduce cocaine withdrawal
Propranolol (Inderal) – decreases
symptoms of cocaine withdrawal
Buproprion (Wellbutrin) – seems to
help reduce relapse in Meth addicts
Showing promise – topamax,
antabuse, neurontin, lioresal
24. 24
Addictions Medicines
Treatment for Sedatives –
neurontin, trileptal, seroquel,
risperdal, lexapro, and zoloft for
symptoms of anxiety;
Treatment for marijuana – seroquel,
lexapro, zoloft for anxiety and
depression
25. 25
Your 12-Step Recovery Program
Basic concepts of AA
Importance of Sponsorship
12-Step tips
Types of AA meetings
Finding AA meetings
On average, try 4-6 different
meetings to find the right fit
26. 26
Dealing with Difficult Emotions
Focuses on depression, anxiety, and
anger
Checklists to determine if you are
depressed or suffer from anxiety
and suggestions for managing
depression, anxiety or anger.
27. 27
Dealing with Dual-Diagnosis
53% of drug abusers and 37% of alcohol
abusers have at least one serious mental
illness
Considers benzos as not an option for pts.
with dual diagnosis. Suggests vistaril or
trazodone for anxiety.
Dual Recovery Anonymous (DRA)
Importance of proper sleep and avoiding
caffeine
28. 28
The Recovering Family
Anyone living in the same
household of the addict is
considered family
Family members unwittingly
become enablers
A Lapse/Relapse Consequences
Agreement – spells out
consequences of returning to
substance use
29. 29
Lapse and Relapse
9 Warning Signs
1. Elevated life stress
2. Loss of daily structure
3. Neglecting healthy coping skills
4. Behavior changes
5. Social isolation and withdrawal
6. Loss of judgment, loss of control
7. A change in attitude
8. Reactivation of denial
9. Recurrence of physical withdrawal
symptoms
30. 30
Lapse and Relapse
A Relapse Prediction Scale
A Lapse/Relapse Prevention Plan
worksheet
A Lapse/Relapse Action Plan
worksheet
31. 31
Health and Nutrition in Recovery
Elements of a healthy diet
Exercise: the world’s best stress
reliever
32. 32
Regaining Enjoyment and Pleasure
An extensive list of recreational
activities to consider
A Pro-Addiction Thoughts checklist
A Pro-Recovery Thoughts worksheet
Suggestions to brighten your day