Tips for New Facilitators

·       You can’t be all things to all people

·       You can’t cover everyone/everything even in a modest sized meeting 

·       People relapse in spite of your best efforts – it’s them and not you

·       Keep it simple

·       Remember that SMART Recovery® is solution focused, not problem focused as in AA

·       Let the group decide on the meeting’s direction unless it gets counterproductive or totally off topic

·       Avoid AA bashing. It works for some, it doesn’t work for others, we encourage participants to do what works for them

·       Avoid most discussion on medication

·       Avoid debate on the disease vs. bad habit issue. Whether you believe addiction is a disease or not SMART has tools that can help

·       Try to use at least one SR tool at every meeting... on the white board if possible

·       You don’t (can’t) know everything… If there is something you don’t know say so and that you will try to find out

·       Be in Motivation Enhancement mode at all times

·       Don’t be dogmatic, authoritarian, pedantic or “coercive”. Be open-minded, allow participants to come to their own conclusions, use common language, communicate SMART tools and information and meet the participant where they are in their process

·       Don’t ever tell people what they NEED to do; let them figure it out

·       Remember, the only really important thing about someone’s first meeting is that they want to and will come back for their second meeting!

Mindfulness; a personal perspective and experience 5

A different look.

Alas, it’s been a long time since I’ve posted on this topic of mindfulness. Bogged down with the struggles over the science piece partly -- also been busy getting active in the SR online community. Parenthetically, I invite you all to join me there -- it’s become a very active and interesting place at: http://www.smartrecovery.org/community/#.U5spNY1dXw8

This post was prompted by a TED Talk I saw -- a link to which is at the end of this post. The talk is by an interfaith monk, Brother David Steindl, in a presentation about gratitude. This phrasing sounds somewhat interesting but what it’s really about is capturing reality in the present moment or presence, otherwise known as Mindful Awareness, but without ever calling it that.

Brother Steindl offers an opportunity to experience emotions, both good and bad, to be grateful for the ability to do that and to feel happiness.  This is because when you allow yourself to experience gratefulness in the moment positive emotions are almost automatic.

Steindl clearly points out that a universal wish or desire in all humans is to be happy -- we share that. How we attain happiness differs of course. For one path, Steindl introduces the idea that gratefulness leads to happiness, not vice versa.

This happens because you have received something of value that is freely given – and that can lead you to feeling grateful and hence to happiness. This doesn’t happen just once in a while -- you can have it all the time. This is because you have the opportunity for this all the time, in the present moment, hence Mindful Awareness.

Every moment that we have is a valuable gift and it’s freely given – no strings attached. It’s just there to experience and to enjoy.

Steindl’s simple formula to do this: Stop… Look… Go!!  Like crossing a street.

This reminds me of the concepts of Pause so prevalent in similar approaches.

This is a short and very powerful message. I recommend that you spend the time (less than 15 minutes) to view the video.

The talk presents a different look at this concept and never once mentions faith, mindfulness or psychology.

Cheers. 

http://www.ted.com/talks/david_steindl_rast_want_to_be_happy_be_grateful.html?utm_source=newsletter_weekly_2013-11-29&utm_campaign=newsletter_weekly&utm_medium=email&utm_content=talk_of_the_week_button

I have not posted on the mindfulness subject in quite awhile. I plan on beginning again now that its summer . And first off is a list of books I recommend for those in the early stages. To follow will come a list for more advanced “ practioners”

 

Reading list for Mindful Awareness 

For those early in practice 

“Mindfulness “  by Ellen Langer ..classic text 

“ The Mindfulness Solution “ by Ronald Siegal … a good starter book 

“ Mindfulness “  by Mark Williams .. new and recommended relates to CBT 

“ Fully Present “  by Diana Winston and Susan Smalley.. theory and practice 

“Mindfulness in Plain Engish”  by Bhante Gunaratana .. classic book on Buddhist origins of practice 

“Recover”  by Stanton Peale .. recent book using MAPs in recovery 

“The Power of Now” by Echart Tolle ..classic best seller – a bit far out but good 

The Emotional Life of your Brain by Richard Davidson –the best Ive read overview of the neuroscience

 

Some suggested summer reading for those who might be interested in some recent more " advanced " topics

·  Neuroscience of emotion ... " The emotional life of your brain " by Richie Davidson 

·  Neuroscience of Addiction ... " Memoirs of an Addicted Brain " by Marc Lewis 

·  Excellent explanation of CRAFT ..  " Beyond Addiction " by Jeff Foote

·  Conflict resolution :  " Im rignt, youre wrong, now what " by Xavier Amador

·  HOw the mind works  " Thinking; Fast and Slow " by Daniel Kahneman

·  Topical approach to Mindfulness .. " Mindfulness ..." by Mark williams

·  And a classic I recently reread with much better understanding and relevance to Smart ... " Man's Search for Meaning "  by Viktor Frankl 

 

I often get asked in meetings about the possible passing of the addictive behavior by the attendees to their offspring via genetics.  This is a complex issue and the field has now progressed nicely in the understanding of this issue – with rapidly developing understanding of epigenetics . a different form of inheritance .  This is nicely described in this recent article from “ The Fix” by Jeanne Swanson which I have copied here. Its pretty self explanatory so here it is in its entirety for your interest . It surely is to me.

__________________________________________________________________________________________________________________________________________________________

In biology class, most of us were taught to believe that specific traits are passed on through our genes: if I have the “Alzheimer’s gene” or the “breast cancer gene,” there’s a probable chance that my son or daughter will carry that gene. However, what about more “complex” diseases like depression, or alcoholism? While alcoholism does tend to run in families—and has a genetic component—how exactly is it passed on?

In recent years, more and more studies are showing that there is another level of inheritance at work: epigenetics. Literally “above the genome,” epigenetic marks are chemical “tags” that can be put on or taken off DNA, and their purpose is to control the expression of genes. Some tags turn genes on, while others turn genes off. These tags come in the form of molecules called methyl groups or acetyl groups, and they can also appear on the outside of the DNA strand. In the nucleus of every cell, the very long strands of DNA coil around proteins called histones; these histones can be more “open” or “closed,” depending on what tags reside on the surface.

These “tags” can be helpful and are very important for many biological processes. For example, in the development of an embryo into a baby, epigenetics plays a huge role in making sure embryonic cells differentiate at the right time and place. Ever wonder how a small handful of cells become heart and lung and brain cells, and all the other cells in our bodies? Since every single cell contains all of our DNA, some genes have to be turned off, while others left on, in order for there to be different types of cells.

However, the epigenome is ever changing; marks can come, and marks can go. In fact, the epigenome is highly sensitive to the environment. Environmental Factors such as diet, stress, and exposure to environmental toxins can alter the arrangement of these tags and cause disease. And, it’s being increasingly shown, disease in not just us, but in our kids, and our grandkids. Groundbreaking—and controversial—studies by epigenetics researcher Michael Skinner at Washington State University have not only brought to the forefront the idea of endocrine disruptors, but that these environmentally harmful chemicals can leave marks on the genome that can be passed on through germ cells—sperm and egg—to next generations. This new field has become known as transgenerational epigenetic inheritance. 

And while there are examples of traits that have been inherited across multiple generations in everything from seeds to rodents to humans—DNA methylation patterns in response to environmental toxins, for instance—“no one has looked in terms of drugs of abuse,” says Ghazaleh Sadri-Vakili, an assistant professor at Harvard Medical School and the director of the neuroepigenetics laboratory of the MassGeneral Institute for Neurodegenerative Disease. That is, until now.

Building off this previous work, several recent studies in rodents have, indeed, delved into how drug and alcohol use affects the epigenome of the offspring. While mothers can harm the baby in utero, as well as subject it to stress and abuse as a child, researchers are beginning to ask the question: Can the effects of parents’ substance abuse be felt by their children, even if they stopped using years before? 

These new findings suggest that if a parent uses drugs, he or she could pass on that DNA “damage” in the form of inherited epigenetic changes. What’s more, these epigenetic changes can predispose the offspring to not only becoming addicts, but to having to grapple with the behavioral traits that make it so hard to resist the pull of using, like impulsivity and heightened sensitivity to drugs.

THE EPIGENETICS OF ADDICTION

The hallmarks of addiction are tolerance and then, sensitization. Sensitization happens when a user becomes overly sensitive to a drug’s high or rewarding effect; accompanied by intense cravings and often, relapse. Eric Nestler, a leading figure in studying the epigenetic changes associated with addiction, discovered two key transcription factors that remain turned on after using drugs, thereby leading to symptoms of tolerance. (A transcription factor is a protein that parks itself next to a gene and turns it on.)

However, what was keeping the transcription factors around, they themselves being proteins from active genes? “The heightened sensitivity, it turns out, stems from epigenetic modifications of the genes,” Nestler, who is the director of the Friedman Brain Institute at the Mount Sinai School of Medicine, wrote in an article for Scientific American magazine in 2011. 

In recent years, Nestler’s lab has conducted a series of studies on rodents that show how cocaine use can affect the genetic activity in certain parts of the brain. In one, he found that chronic cocaine use changes the pattern of acetyl and methyl tags on hundreds of genes within the brain’s reward center; and these changes make these genes more active when subsequently exposed to cocaine. In another paper, they found that chronic cocaine administration dials down the activity of certain molecules that remove acetyl groups, and of certain molecules that add methyl groups—in both cases making the genes more active with more cocaine. Epigenetic modifications have been observed in rats that use alcohol, nicotine, cocaine, amphetamines, and opiates. 

Many of these changes are transient, lasting only a few hours after the animal receives the drug. Some last much longer, however; Nestler’s group has seen changes last as long as a month, and they’re looking into even longer times. In fact, if Skinner and others are right, it’s the very long-lasting nature of these epigenetic changes that make them heritable.

INHERITING EXPERIENCE?

In the mid-1800s, the theory of natural selection replaced the idea initially proposed by biologist Jean-Baptiste Lamarck, who believed that acquired characteristics could be inherited. Now, study after study is showing that by some mechanism, acquired traits—like sensitivity to drug exposure—can, in fact, be passed from parent to offspring. While several well-cited studies have shown epigenetic inheritance of disease, studying transgenerational effects in drug addiction is in its infancy.

Yasmin Hurd, a professor at the Mount Sinai School of Medicine, published a study early this year showing that adolescent rats that were exposed to THC had first-generation (F1) offspring who were, among other telltale behaviors of addiction, more likely to use heroin compulsively. On a molecular level, parental THC exposure was associated with gene expression changes in the cannabinoid, dopamine, and glutamatergic receptors in the dorsal striatum of the F1 offspring—this area of the brain is important for compulsivity and reward-seeking behavior.

“I wasn’t really expecting this significant of an effect,” Hurd says. “We thought that most of the epigenetic things that happened to you are erased, and basically you don’t pass on those epigenetics marks to your children.” Sperm and egg cells are believed to lose most of their acquired epigenetic marks during a “reprogramming” process when the two meet. “Now, we realize that that’s not true, so what are the mechanisms?”   

Hurd’s lab is busy exploring this. Next, she plans to scour the epigenome of the pups, to see what their patterns of marks show. She also plans to see how this might play out in a second generation.

Other groups have found startling proof that past drug-taking behavior affects offspring. In January of 2013, Chris Pierce, a professor at the University of Pennsylvania Perelman School of Medicine, found that male offspring of rats who had been exposed to cocaine showed less addictive behavior toward cocaine. They then measured and found that levels of a certain protein, BDNF, were increased in the medial prefrontal cortex of the male pups.

Fair Vassoler, a co-author who was working in Pierce’s lab at the time, believes that this decreased susceptibility is not that surprising in that it is a protective effect. The study built on their earlier work that showed that in rats exposed to cocaine and then followed by a period of abstinence, levels of BDNF were increased in the prefrontal cortex, the decision-making center of the brain. BDNF, or brain-derived neurotrophic factor, is involved in the health of neurons, “a fertilizer of the brain,” Vassoler says. “This might be a compensatory mechanism,” in that in response to cocaine, the brain makes more BDNF “to prevent rats from taking more.” They hypothesize that the pups of cocaine-using rats have inherited the increased levels of BDNF to protect them from becoming addicts themselves. Females don’t share the protective effect, and Vassoler does not know why. Next steps are seeing how the next generation, F2, responds to cocaine, and if the protective effect is passed on to a third generation.

In a paper from late 2013, Vassoler, then working with Elizabeth Byrnes at Tufts University’s Cummings School of Veterinary Medicine, and her colleagues found that exposing adolescent female rats to cannabinoids enhanced their female pups’ response to morphine. In a most recent paper from April of this year, adolescent females exposed to morphine had male offspring who were more sensitive to morphine.

Considering rates of prescription opioid use and addiction—especially by younger people—Vassoler says the main take-home message of all this research is one of awareness. “Whether you’re male or female, [your behavior] can affect the next generation,” she says. “That’s pretty new, really important. And, it could really help to make people think before they act.”

IS THE DAMAGE REVERSIBLE?

The burning question on many recovering addicts' minds will be, Is there anything I can do to reverse the damage I’ve done before having children? Most interviewed were cautioned about considering epigenetic changes as necessarily bad. And, many of these changes are transient—that is, methyl groups can be tagged on, and they can be tagged off—in response to environmental stimuli. Most importantly, these studies involve rodents; humans are much more complex in their response to stress.

“Some of these changes are reversible,” Harvard’s Sadri-Vakili says, while others are more static. A theory based on environmental enrichment has emerged which says that a stimulating, nurturing environment in recovery can help reverse these changes. Vassoler is a proponent - the last thing she wants is for recovering addicts to believe that they should not have babies. “The work that we’re doing in lab rats is so very far removed from humans,” who are obviously going to live a much more enriched life.

Sadri-Vakili emphasizes getting more exercise, or playing mentally stimulating games like chess, to increase levels of BDNF in the brain. “All these things will help boost BDNF levels,” she says, which is important for synaptic plasticity in improved learning and memory. “It keeps minds plastic, and growing, and healthy.”

 

  

The following is an example of the lousy science I so often criticize in the psychiatry literature. It’s adding complexity over and over again. And to be honest smacks of attempts to create more business for people already hurting in a field that has lost its way. Psychiatrists have given up their real asset- talk therapy in favor of pills. Not to mention a new diagnosis code to justify sending a bill.

I would also be remiss not to mention this will be a boon for big Pharma who will sell all sorts of potions to treat this new “diagnosis “ 

It shows that using the new imaging technologies all sorts of new innovative diagnostic entities can be fashioned using them or interpreting them incorrectly . 

It also brings to mind the discredited entity known as “co-dependency” an idea sponsored and supported by AA and Alanon. 

Where will it all end—sighs

 

 

NEW YORK ― "Love addiction," a condition characterized by severe pervasive and excessive interest toward a romantic partner, may actually be a form of attachment disorder, new research suggests.

A new literature review of studies using the terms "love addiction," "pathological love," and "behavioral addiction" showed possible involvement of the brain reward dopaminergic system as well as attachment-related biological systems.

"We wondered where love, a feeling of well-being, devolves into addiction. And what might be the criteria for love addiction and its destructive and dysfunctional behaviors?" asked Vineeth P. John, MD, associate professor of psychiatry and behavioral health at the University of Texas Health Science Center in Houston, during a press briefing here at the American Psychiatric Association 2014 Annual Meeting.

Still, he told Medscape Medical News that it is important not to musicalize normal, albeit deep, love. Instead, clinicians should be concerned if patients stay in a relationship despite danger or if have severe pining long after a breakup despite knowing the relationship is over.

"There is an urgent need for a better conceptualization of [love addiction] from an oncological and neurobiological perspective," the investigators note.

"This would be the first step in devising controlled studies aiming at properly assessing the efficacy of different psychosocial and pharmacological interventions in the treatment of this intriguing condition."

Lack of Control

Dr. John reported that the researchers wanted to question whether being addicted to love was possible and if so, whether it could be a diagnosable disorder.

Dr. Vineeth John

They defined love addiction as a pattern of maladaptive behaviors and intense interest toward 1 or even more romantic partners at the detriment of other interests and resulting in a lack of control and significant impact on functionality.

Although it can occur simultaneously with substance dependence or sex or gambling disorders, it can also be considered an addiction behavior itself, a part of a mood or obsessive-compulsive disorder, or even a part of erotomania.

"It is thought that it affects as many as 3% of the population. And in certain subsets of young adults, it may even go up to 25%," said Dr. John.

He added that individuals who are most at risk for the condition include those with an immature concept of love, a maladaptive social environment, or high levels of impulsivity and anxiety; are anxious-ambivalent or "seductive narcissists"; or have structural affective dependence.

Results from the analysis showed that a picture of a participant's "beloved" elicited activation in the brainstem, the right ventral tegmental area (VTA), and the caudate nucleus regions. These areas have been shown to be central to the brain's reward, memory, and learning functions and have been implicated in substance abuse. In addition, addiction and attachment disorders share overlapping neural circuits, through the VTA to the nucleus accumbens.

"So basically, what we might be looking at is an attachment problem," he said.

Love Molecules

He also reported that 4 possible "molecules of love" include dopamine (which incites desire and facilitates repetition of love behavior), oxytocin (which mediates social behavior), the opioid hormone (which activates pleasure sensations), and vasopressin (which affects protective behaviors).

Interestingly, men who carried the "allele 334 for the gene coding for vasopressin receptor (AVP R1A)" showed less stable relationships.

"But the most plausible and practical aspect of love addiction would be to look at how to treat it," said Dr. John.

Because they found few studies examining benefits of psychotherapy and no studies assessing the efficacy of medications for this condition, the investigators came up with hypothetical guidelines for target symptom interventions.

For psychosocial treatments, they suggested self-help groups, cognitive-behavioral therapy, psychodynamic psychotherapy, or enrolling in Sex and Love Addicts Anonymous.

In addition, they suggested using selective serotonin reuptake inhibitors and/or antidepressants to treat obsessive thoughts about a romantic partner; mood stabilizers to treat mood instability or seeking out multiple partners; mood stabilizers, antipsychotics, naltrexone, or buprenorphine for treating impulsive seeking of romantic partners; and oxytocin or vasopressin for treating impaired attachments.

"It might be possible to devise drug-based therapies for the treatment of difficult love, based on neurobiological substrates," said Dr. John.

"But this is clearly a futuristic concept. We cannot medicalize noble human emotions. This particular addiction has to be harmful, disruptive, and destructive and cause significant psychological distress. And the treatment has to be totally voluntary," he added.

"Overall, it's time to think about our patients, or at least a small subset of them who are clearly suffering with what is probably an attachment problem."

 

 

The following was written by Matt Robert who asked me to post it for him. He took over the Mclean Detox visits for me recently , and this is his reflections on the experience.

Every once in a while a story comes along that is totally off topic but gives cause for pause and reflection. This is one about the head of the NIH, Frances Collins, and a young man named Sam Berns.

The occasion is Sam’s death of OLD age at age 17. Sam had Progeria.

He was a remarkable boy with a very rare killer disease that caught a lot of people’s attention and led to some very interesting science of benefit to many more who don’t have the problem.

I can’t tell it any better than the NIH did here:

http://directorsblog.nih.gov/2014/01/12/in-memory-of-sam-berns/

This land of ours with escalating chaos, super-hype and criticism, materialism and stress, is still a great place to be. 

I'm not sure how many people read this thing I write but I enjoy it and it helps organize and crystallize my thinking on some things that I at least think are important.

So I’m going to keep on writing. I hope to get plenty of comments. Sometimes I’m deliberately a bit controversial to invoke some comment.

So coming soon in 2014 you will be seeing some good stuff: 

• Mindfulness in seniors (close to my heart)
• Stigma - the big bugaboo in recovery
• New findings of gender differences in addictions
• Brain changes in addiction
• A primer on meditation methods
• Mindfulness and substance use reduction
• The masks of addiction
• The issue of co-dependency
• Addiction: A disease of the brain or not?

Gasp - that’s a lot of writing. Better get busy!

Stay tuned

Your Science Reporter