Addiction Management Blog

Posts Tagged ‘trauma’

The College on Problems of Drug Dependence 2013 – my update

Sunday, June 23rd, 2013

For the past half-dozen years, I have been attending The College on Problems of Drug Dependence, better known as CPDD. The conference has been in existence since 1929 and this year is celebrating 75 years! It is the longest running conference on drug addiction problems in the US and is attended by the brightest minds in the field from all over the world (it even has its own blog). This year it was held in San Diego and included poster sessions, oral presentations, and plenty of networking. Usually I go it alone, but this year decided to drag my family along to make up for the year I brought them to the same conference in Reno where, ironically, gambling, drinking and smoking permeated the hotel and conference (yuck!).

There was a lot of great stuff this year as usual, so I thought I would highlight just a few things that really caught my attention.

  • traumafiveAdverse childhood experiences predict later substance abuse and addiction. We have known for a long time that 80-90 percent of those who go down the path of addiction start their journey early in life – during teenage-age years – most often as an adaptive response to coping with one or more adverse childhood experiences. I have written about the ACE study on this site, but what is new are studies that continue to evolve these findings in more detail, and help us really understand just how complex, pervasive, and critical it is to evaluate and treat underlying traumas in those who struggle with addiction. Current stats on abuse and neglect are frightening, and sadly addiction is not the only outcome of these cases. The British Journal of Psychiatry recently published a paper linking childhood adversity to all classes of mental health disorders. At the conference Cathy Spatz Widom presented some of her work that has involved following 1,575 kids from childhood through adulthood. This amazing study included 908 substantiated cases of childhood abuse and neglect processed by the courts from 1967 through 1971, and then matched this group with a control group of 667 children with no official record of abuse/neglect. The results from interviews over multiple decades provides strong evidence that early life experiences make a difference in the trajectories of our lives. Bottom line for those who struggle with addiction: intervention must involve addressing unresolved issues from the past that perpetuate addictive behavior.
  • Legalization of marijuana. I have not written about this topic on this site before, largely because I continue to struggle with exactly how I feel about it. While it is now legal in two states (Colorado and Washington) many other states are moving to legalize recreational use as well. On many fronts I agree that legalization makes sense, as the drug war has been a miserable failure. At the same time, Nora Volkow, the Director of NIDA, in cannabisher keynote address pointed out that marijuana use among teens is at an all-time high, while research findings are absolutely clear about the dangers of THC in young developing brains. This year the public policy forum was dedicated to this topic, and two great speakers from the RAND Drug Policy Research Center – Beau Kilmer and Rosalie Pacula – provided a lot of food for thought. Beau reviewed his seven P’s and Rosalie addressed the four primary public health goals: 1) prevent youth access, 2) prevent drugged driving, 3) regulate product content and form (potency), and 4) minimize concurrent use with alcohol. The “how” of accomplishing these goals is beyond this post, but if you dig into the RAND site you will find a recent publication that provides all the details.
  • Abuse of prescription drugs. If the 80′s were about cocaine, the 90′s about meth, we are now deeply entrenched in a time where “the” object of addiction are prescription drugs. In the past decade there has been a five-fold increase in treatment admissions for abuse of opioids, and overdose deaths related to pills have tripled in the past two decades. In some states more people die of pill overdoses than motor vehicle accidents. It is a problem that has gained national attention by many government agencies (and non-government groups), and was a hot topic this year at CPDD. Much of the focus was on abuse-deterrent formulations, which studies have shown have reduced abuse and diversion. This is a good thing, but at the same time such formulations are not necessarily reducing the number of people who struggle with abuse/addiction – they are just pushing them in another direction to other more easily abusable products or illicit drugs (what we call the “balloon effect”). The key point goes back to my first bullet point. We need to invest far more resources into prevention and early intervention since this is really the origin of the problem for most who struggle.
  • psilocybinPsilocybin and quantum change. Of all the cool things I learned this year, the one that surprised me the most was a workshop focused on the treatment benefits of psilocybin, a hallucinogenic compound from mushrooms that operates mostly on 5-HT-2a/c serotonin receptors. The session, led by Roland Griffiths and Herb Kleber, reviewed studies where psilocybin produced some remarkable mystical experiences for participants that rated among the most important events in their life! Here is a video clip describing one of the studies. The hope for those who struggle with addiction is that psilocybin may be an accelerated way to induce spiritual experiences that result in profound and lasting behavioral changes. The compound, when used appropriately in controlled conditions, appears to be non-physically toxic and virtually non-addictive. While the early findings are intriguing, I am not so sure we will see it on the list of evidence-based practices any time soon.

If you want to read more about the conference, check out the CPDD Blog.

Lastly, I know many of you won’t believe this, but CPDD has workshops that go from 8pm until 10pm at night, even Sunday – on Father’s Day! My wife never believed me until she saw it for herself. This is a dedicated group of people! So, after one of these very long evenings, I ventured out into the evening and did a little picture taking. Here are two of my favorites:



Hitting Rock Bottom: New docu-drama about addiction needs your help!

Monday, June 3rd, 2013

I don’t think I have ever done this before on a post, but here goes. I need your help.

Not long ago I was contacted by some folks who have been working hard on a show called Hitting Rock Bottom. It tells the real stories of people who have struggled with addiction, hit rock bottom, and found a way out. Unlike reality television that often turns tragic stories about addiction into entertainment, this show has a far more noble and broader reaching aim. The creater and Director, Corey Snyder, who has been in recovery for the past five years and also happens to be a very talented film maker, wants to instill hope (and action) in those who still struggle. He portrays challenges with addiction through docu-drama storytelling that utilizes actors to dramatize real stories. He and his team have already completed the first four episodes of season one which you can watch right now for free on the Hitting Rock Bottom homepage. Each episode is a few minutes, so watching them all will not take you that long.

HRBThe first season tells the story of Daryl Brown, a very likable young man who sets out in life with no idea of what is ahead for him. The show is more than engaging, and realistically captures the underlying risk factors that contribute to going down a path of addiction. It is real, scary, and unfortunately a story that plays out far too often.

Fortunately, the story of Daryl has a positive ending, but that is where I need your help!

The show is need of funding to finish filming the first season and complete the story of how Daryl overcomes addiction. It’s the best part of the story and has the potential to motivate many struggling souls to seek help. To complete the season, the crew are presently running a fund-raising campaign on Indiegogo. The goal is $57,500 which will cover all costs to finalize filming the remaining episodes. Even with these funds, many involved in this project are giving their time and energy to see this project to its successful completion. By contributing whatever you can, be assured that your donation will go towards a project that has the potential to transform how we understand, treat, and address addiction in this country. Also, there are only 13 days left in the campaign, so please contribute now. And be sure to check out some of the cool perks at various donation levels.

Thank you.

All you need is love, love, love is all you need.

Tuesday, August 30th, 2011

At a training not long ago on CRAFT, the presenter, Dr. Robert Meyers, told a story that I want to pass on to you. But first, if you have never heard of CRAFT, it stands for Community Reinforcement and Family Training which is an evidence-based approach that family members (or friends) can use to facilitate getting an unmotivated loved one struggling with addiction into treatment. I am most fond of this approach because, unlike traditional interventions that rely upon coercing a person into treatment through harsh group feedback, CRAFT relies upon using basic behavioral strategies to rearrange the world of the addict so he or she internally reaches the decision that treatment is necessary. We have known for a long time that external motivation gets the job done; interventions do often lead to treatment. But unfortunately, once there, the person we so badly care about does not engage in treatment, does not really want to be there, and often drops out. We are back to square one and saying that treatment does not work. It is a vicious cycle.

In these situations, treatment fails because of a lack of internal motivation. Those who need to change their behavior have to want to change their behavior, which is why CRAFT is so powerful. It works to increase internal motivation for change by eliminating the positive reinforcement for acting out in an addiction, and enhancing positive reinforcement for non-acting out behaviors. If you don’t understand basic behavioral approaches to change using reinforcement, then it is time for Dr. Meyers’ story.

A woman who had been admitted to a psychiatric ward was driving the staff crazy. From the time she woke up until the time she went to bed in the evening she would scream her head off. The staff tried everything they could think of to get her to stop screaming, but nothing worked. She had to be placed in a room alone, away from the other residents, and restrained at times. Although medications could have been used to sedate her (and probably were at times), they were not the answer. After many frustrating weeks of listening to her loud cries, a doctor was brought in to see if he could help. His name was Nathan Azrin.

Nate walked down the hall to the woman’s room as staff likely snickered about how he possibly could make a difference given all that had been tried. When he arrived, the woman was sitting on the edge of the bed rocking back and forth screaming like she did throughout the day. He stood at the doorway for quite some time. He may have thought about why she was screaming, but also knew that whatever the driving reason, she could not speak and exploring the why would likely be a long journey. Instead, being a behavioral psychologist, he considered her behavior and what he wanted her to do instead of screaming. Well, this was easy, he wanted her to stop screaming. Then, he considered the times when she was doing what he wanted her to do: eating, sleeping, and breathing. During these activities she did not scream. As he stood in the doorway, he began to focus more on the immediate moment to moment rhythm of her screaming and breathing. Then he got an idea…

Right at the moment when she stopped screaming to take a breath, he walked over to her and gently stroked her hair. After she inhaled and began screaming again, he slowly moved back to the door and waited until she had to take another breath. He then repeated the movements with every breath: move close to her, look her in the eyes, gently stroke her hair, and then move away as she screamed. Nate knew, that at our core, we all have one unifying need: love. And he believed that by reinforcing the moments when she was not screaming, even though they were just seconds, with loving touch, that just maybe…maybe, he could alter her behavior. While staff had isolated her, restrained her, and stayed clear of her, he moved closer to her. And his approach worked. By that evening, he was sitting next to her on the bed, gently stroking her hair, and the screaming had stopped. He told the staff that when she woke up the next morning and started to scream, someone was to sit next to her and gently comfort her. In fact, anytime she began to scream, the antidote was the same.

I love this story because so often when we are challenged in life we tend to overlook the obvious. We seek out expensive treatments, elaborate self-help strategies, or engage in complex change regiments only to become frustrated when change eludes us. Dr. Azrin is among the most cited psychologists of all time, and although he may go down in history for his popular read, Toilet Training in Less Than a Day, for me, he will go down as an individual who taught me about love.

Mark Girard, LCSW & Certified Jungian Analyst: Working with Altered States

Tuesday, December 7th, 2010

For the past few years I have taught a foundations course on addiction treatment to graduate students. An important aspect of the course is helping students understand that longterm successful outcomes  necessitate resolving underlying drivers of addictive behavior, namely, adverse childhood experiences. In an effort to illustrate concretely how this may be done, I enlisted the help of a good friend and colleague, Mark Girard, who is a master at knowing how to help people heal from deep, traumatic wounds. As a Licensed Clinical Social Worker and certified Jungian Analyst with years of experience, he is incredibly skilled at working with a wide range of altered states, or emotional constrictions due to trauma. What impresses me most about Mark is how he uses himself as a tool in therapy. He walks his talk and maintains a presence with patients that is the essence of what a good therapeutic relationship is all about. During his recent visit to my class he agreed to have me videotape his lecture. The approximate 35 minute presentation is a gift to us all. I encourage you to take the time – quiet, focused time – to sit and hear what he has to say.

In the presentation, Mark mentions an article by Dr. Bruce Perry from the ChildTrauma Academy that was required reading in class. The article is titled Applying Principles of Neurodevelopment to Clinical Work with Maltreated and Traumatized children and is a nice adjunct to his lecture. He also makes reference to Babette Rothschild’s wonderful book on trauma, The Body Remembers: The Psychophysiology of Trauma and Trauma Treatment, and the classic article on trauma by Bessel van der Kolk, The Body Keeps Score – both among the very best reads on the topic of trauma.

Uncovering the pervasive roots of addiction: Part 1

Wednesday, July 7th, 2010

“For every thousand hacking at the leaves of evil, there is one striking at the root.”  – Thoreau

In my life there have been many times when I felt isolated, lonely, disconnected, and alone. These times have never  been pleasant, and in the absence of nurturing relationships, close friends to call on a dime, or a tribe of my own, I coped by engaging in substitute relationships with work, money, entertainment, food, hobbies, and exercise (just to name a few). For years I felt shame about many of my behaviors, and my inability to connect in deep ways with others. Now I understand that so much of my adaptive behaviors were a response to underlying root problems, problems that needed resolving and hampered in significant ways my ability to intiate, develop, and maintain intimate and nurturing relationships with people. I also believe that now, more than ever, those who struggle with addiction share similar root causes that need to be addressed if successful longterm outcomes are to materialize.

The roots of addiction go much deeper than the adaptive behaviors that so often are the focus of intervention efforts. This is because dealing with the symptoms (addictions) are easier than dealing with the root causes. I have long believed that addiction is a problem best managed over time like other chronic illnesses. But successful management necessitates addressing what drives the addictive behavior in the first place. It requires knowing how to turn down the flame, dig out the roots, and resolve problems that are solvable. These underlying roots come in many shapes and sizes, but there are two forms that I believe are the primary drivers of addiction today. This post will address the first form: adverse childhood experiences.

Adverse Childhood Experiences
In the mid 1980s, physicians from Kaiser Permanente’s Department of Preventative Medicine in San Diego made an interesting discovery. Those who were losing the most weight and succeeding in the weight loss program were the ones most likely to drop out and quit. Was it because they no longer needed the program? Nope. Further investigation revealed that the majority of dropouts did not maintain their weight loss and went back to struggling with problems of overeating and obesity. Why did they quit if they were succeeding in the program? A deeper look revealed that overeating and obesity were used as tools to cope with unresolved adverse childhood experiences (ACEs). In most cases, overeating was an unconscious behavior utilized as a protective solution to these unresolved childhood problems.

How was it unconsciously protective? In many cases, the ACEs involved sexual, physical or emotional abuse. Developing a relationship with food was safer than developing intimate or nurturing relationships with people who might abuse again. Being obese unconsciously deterred romantic interests and physically enhanced protection of the body. The finding that most of the participants in the weight loss program had prior ACEs led Kaiser to collaborate with the Centers for Disease Control (CDC) to explore the link between ACEs and general health outcomes.

The study involved over 17,000 middle-class Americans and has produced over 50 scholarly research journal articles. Among the most signficant findings in the study was that two-thirds of the participants reported at least one ACE, and more than one in five reported three or more ACEs. In addition, the higher a person’s ACE score, the more addictive behavior was utilized as a coping response. For example:

Here you can see that as the number of ACE scores increase, so too does the percent who meet criteria for alcoholism. This finding is detailed in an insightful paper titled The Origins of Addiction by the lead researcher of the study, Vincent Felitti. What the ACE study helps us to understand is that the roots of addiction are real, diverse, and if left unaddressed, will continue to fuel the behavior we are so badly trying to manage (or end).

Dr. Gabor Mate, continued…

Monday, July 5th, 2010

The following interview with Dr. Mate provides additional context for his work and beliefs about addiction. One surprising statement he makes is that less than five percent of his patients overcome their addictions - not the best of outcomes. Of course what “overcome” means and how to define outcomes are messy topics, but I am far more optimistic about  the tenacity of the human spirit to change. Addiction is most definitely a challenge, but one reason for poor outcomes has been the lack of understanding about the nature of addiction, and the need for a comprehensive solution like MRC. Watch the interview, and then let me know your thoughts about Dr. Mate’s conclusions.

Living Hero Podcasts: Dr. Gabor Mate Interview

Sunday, May 30th, 2010

I recently learned about the website Living Hero that produces podcasts of “living luminaries and mavericks” hosted by Jari Chevalier. Her most recent interview was with Dr. Gabor Mate, a Canadian physician with a broad range of life experience (and wisdom) on topics including: mind-body medicine, stress and trauma, ADD, and addiction. I first heard about Dr. Mate when a close therapist friend told me about his book, In the Realm of Hungry Ghosts: Close Encounters with Addiction. Shortly thereafter, another friend said he had been to Portland and spoke at a college campus. Then…the podcast interview. Call me slow, but eventually I do pay attention when the universe is attempting to tell me something – like pay attention to this guy!

After listening to the insightful interview by Jari (please go listen now), it is clear that much of what Dr. Mate believes is very much in line with the information on this website and blog. He advocates understanding addiction as a coping response to underlying pathologies, namely adverse childhood experiences. These early events impact brain development, as well as other developmental capacities, resulting in the need for relationships with objects that help regulate stress and emotion cycles. Although much of the discussion focused on addiction as a coping response (feel better), I believe Dr. Mate would also agree that addictive behavior is perpetuated because it feels good – the brain likes it!

I remember a case involving very successful business owner who decided to have lunch with her girlfriends at a local diner that just happened to also have newly installed video poker machines. Having no history of gambling behavior, she thought nothing of putting a buck in the machine to see what would happen. Minutes later she experienced a “big win” – a $600 dopamine rush. So…the following week she told her girlfriends they should meet again for lunch at her lucky restaurant. She put another dollar in the machine and amazingly she won the jackpot again, another $600 big win. That was all it took for her brain chemistry to rearrange some important neurons that led to an out-of-control gambling addiction. Her husband brought her to the clinic because she was unable to stop playing video poker, was blowing thousands of dollars per day, and neglecting her business and family. Although she did love how winning made her feel, in the end, her relationship with video poker machines was just another substitute for the human intimacy she so longed for, but struggled to obtain.

Addiction is a very complex problem with no easy answers. What I like most about Dr. Mate’s approach to healing is that it is humane, sensible, and incorporates harm reduction strategies. More information about his work can be found on his website. But if you can’t wait to read his book, then listen to the podcast byJari, it is well worth your time.

The Sanctuary Model: why you should know about it

Saturday, May 15th, 2010

Dr. Sandra Bloom is a psychiatrist largely responsible for the creation of the Sanctuary Model, which is both a framework for treating trauma, as well as an organizational change model that integrates evidence-based trauma interventions with the benefits of therapuetic communities. The brillance of this model is that it optimizes the safety and healing of all parties involved in social systems of care: patients and clinicians, prisoners and judges, victims and advocates, addicts and counselors. It is a model, in my opinion, that is applicable across all organizations no matter what their purpose, because it provides a roadmap for how humans should treat one another, no matter what position they may find themselves in.

Why do we need it? Because most social/healthcare service organizations are in crisis. U.S. healthcare problems were detailed in a number of publications by the Institute of Medicine, with outcomes indicating that the U.S. has the most expensive healthcare system in the world, yet ranks far down the list in terms of overall quality. But it is not just our healthcare system that is in dire need of overhauling. Our education, criminal justice, mental health, child welfare, and…yes, our addiction treatment system are all struggling to meet the needs of the populations they serve. The Santuary Model suggests that the problems are rooted in unhealthy systems, not individual people. If we understand the system, we then stand a chance of making changes within the system that ultimately translate into better outcomes for all involved.

Across the different social systems, the problems are similar: reduced funding, decreased training and education, more paperwork, more surveillance and  micromanagement, greater staff turnover, and lots of stress across all levels of organizations. These factors then translate into organizations that are chronically stressed, attempting to do more with less, always operating in a reactive/crisis mode, ultimately leading to folks being chronically hyperaroused. In this state, it is like Brian Farraher, CEO of Andrus Children’s Center has said, “Managing like your hair is on fire.”  Stress leads to a loss of basic safety and trust, a breakdown of emotional intelligence, behaviors that result in more conflict, and staff who feel disempowered. As relationships become strained, more autocratic approaches to leadership (counseling/healthcare/justice) emerge, and then folks just stop talking. In essence, organizations stop learning. The outcomes are costly for all involved.

The Santuary Model is the antidote. It acknowledges that stress, trauma…life problems, exist not only in the clients who show up for help (or are mandated for help), but also in the helpers. The served and the servers are mirrors of each other, and both require focus and attention on seven commitments:

Implementing the Sanctuary Model in organizations, and incorporating the commitments into all of our lives, means embracing our responsibility to the common good of all people, to our future, to our planet. The details of the commitments, and how best to implement them are documented on the Sanctuary Website and in Creating Sanctuary: Toward the Evolution of Sane Species.

If we ignore the warning signs so clearly right in front of us, “Human history becomes more and more a race between education and catastrophe.” HG Wells, Outline of History, 1920

Confessions of a (Tiger) sex addict?…helping out CNN and the rest of the media

Tuesday, March 9th, 2010

The media love stories like Tiger Woods and his lady friends. Sex sells, it always has. Unfortunately, the media rarely care whether they are portraying an issue accurately, it is more about soundbites and sales. I know, because I used to get interviewed quite often for addiction-related stories when I worked for a large university teaching hospital. My 20 minute interviews would get slashed to 10 second clips on the nightly news. I have come to realize that it is not their fault, it is the way of news in our soundbite culture. But topics like addiction and what has happened with Tiger deserve more than soundbites. Addiction is an incredibly complex problem with no simple answers. It seems that despite this fact, the media have attempted to reduce Tiger’s problems to a diagnosis of sex addiction. In the clip below they interview a sex addict who provides evidence that sex clearly is an addiction, and that his experiences are similar to Tigers, check it out (and then keep reading):

Here is my own commentary about sex addiction and Tiger’s problems:

  • Far too much time is spent debating whether specific behaviors should be called addiction. The reporters above point out that many do not consider sex addiction a real psychiatric disorder because it does not exist in the current verision of the Diagnostic and Statistical Manual of Mental Disorders (DSM). But the DSM is a socially-constructed diagnostic guide that is in the process of completely revamping the section dedicated to the diagnosis of addiction. Turns out we got it wrong for the past couple of decades! In my opinion, debates about whether people can be “addicted” to be specific objects (porn, food, internet, cell phone use) get us nowhere. For years therapists have treated patients with significant problems related to all these things, which usually come in packages of behavior. Our focus should be on understanding addiction as a relationship problem, not an object-specific problem.
  • How should we understand Tiger’s behavior? If addiction is about relationships, then we see that his pursuit of women  has been about something other than just sex. Any therapist in the country who has spent time dedicated to the topic of sex addiction (Patrick Carnes, Jennifer Schneider, Robert Weiss) will say that sex addiction is not about sex. It is about intimacy and emotional connection, or the lack thereof. As humans we are wired for relationships, but adverse childhood events (and trauma throughout life) lead to the avoidance of emotional experiences necessary for healthy emotional development. The result is a person like Tiger becomes an adult doing his best to negotiate the complexities of adult relationships with the emotional/relationship/intimacy skills of a child. No wonder he looks like a deer caught in headlights at news conferences.
  • As a person neglects their internal emotional world, very often the emotional energy (which has to go somewhere) gets displaced into academic mental activities or sports. It is not coincidental that many who suffer from addiction and untreated trauma are professional athletes or have professional careers requiring brain power and academic credentials.  A number of news commentators have pointed out that when Tiger came on the pro scene at age 19 his life never was the same. I would add that prior to the age of 19 his life was very different from other kids, how else was he able to go pro at 19? I am not an expert on Tiger Woods and have no knowledge of the events in Tiger’s early life that influenced his present behavior. And in truth, I don’t care, they are not my business. Each person’s past is their own.
  • We need to realize that we (even those who work in the media and are taking shots at him) are not so different from Tiger. On some level, we all struggle with past traumas, maintaining intimate relationships, sex, and developmental constrictions. And at times we all have engaged in excessive behaviors that help us disconnect from the world and our emotional pain (like even watching a bit too much professional sports). Sure, we may not have millions in the bank, be the world’s greatest golfer, or have the ability to act out in the ways he has, but just like Tiger, we all have our own life challenges. The real question is whether we are deepening our awareness of our shadow side, and doing the work necessary to own it, integrate it, and evolve our own mental/emotional health.

One final thing. Understanding why Tiger did what he did is very different then letting him off the hook. Let me be clear, I am not attempting to justify his behavior or say his acting out was not his fault. He needs to take responsibility for what he has done, and realize how his actions have hurt a lot of people. But we in society are so quick to judge others, and in a sick way relish watching those on top take big plunges. Instead of buying into the soundbite entertainment value of Tiger’s pain, we could benefit a lot more by exploring how his fall is a mirror for aspects of our own life.

Where the wild things are

Tuesday, March 2nd, 2010

Last night my wife and I went to a lecture by Joseph LeDoux, the author of The Emotional Brain and the Synaptic Self. His research has primarily focused on understanding the emotions of fear and anxiety through animal models, and how these emotions impact memory. One of my favorite chapters in the Emotional Brain is titled “Where the wild things are”  which describes the link between what he has learned about the amygdala, hippocampus, and common emotional problems. There were many take home gems from his talk, but the ones that have stayed with me the most are:

  • There is evidence that early traumas, even those that occur right after birth, get seared into the amygdala (emotional memory) and stay with us for life. Even though our ability to remember a trauma requires some development of the hippocampus, and likely does not begin until around the age of three, we can still react emotionally to particular triggers that we were exposed to prior to the age of three even if we have no memory of what happened.
  • Trauma changes the physical brain and how it operates, and in so doing, influences the behavior of the person. People respond very differently to trauma, even when exposed to the same traumatic events.
  • We are hard-wired to respond to threatening situations behaviorally before our rational brain evaluates a situation and makes a determination of whether something is dangerous. This is why we jump back when we see someting squiggly on the ground. It is an evolutionary, survival response. And if the squiggly thing is a killer snake, then good thing we jumped before we thought about it.
  • Traditional anatomy and physiology texts teach that our emotions come from the limbic system. LeDoux’s work has shown that emotions like fear involve many parts of the brain that extend beyond how we understand the limbic system. So…he believes we should do away with the limbic system - it does’nt exist.
  • The work of psychotherapy is about our neocortex  learning to exercise control over the evolutionary old emotional systems – over the amygdala.

So, translation for those who struggle with addiction. Addictive behavior can be understood as an unhealthy coping strategy to an amygdala that likely has some emotional wounds. This is why so many relapse prevention programs focus on mindfulness and CBT strategies for behavioral self-regulation. I continue to believe that all who struggle with addiction can benefit from trauma resolution work.