Introducing clients to a neuroscience based explanation of addiction

Transcription

1 Introducing clients to a neuroscience based explanation of addiction Philip Townshend Problem Gambling Foundation Mathew McMillan Te Kahui Hauora o Ngati Koata Trust

2 Moral weakness God s punishment Psychodynamic Oral fixation Separation anxiety Psychological Learned behaviour Public health Addiction Models Focus on the agent Disease Altered metabolism of drugs

3 Since the advent of brain scans the brain has been in the addiction frame This sheds some light on gambling as an addiction and how it works Hi

4 Brain Function We think thinking is what makes us special We think we think with our brains Ouch We tend to think we are rational beings

5 Economics-the Chicago School Rational Choice Theory: when people make choices they exercise near-perfect rationality logically weighing up incentives such as price, taxes etc to maximise their own economic interests This is the foundation for neoliberalism and picked up Nobel prizes as well as contributing to the 2008 Global Economic Collapse

6 Behavioural Economics The Science of Choice Daniel Kahneman Nobel Prize in Economics 2002 System 1 Fast, automatic and emotional Dosn't stop to think Reacts Jumps to conclusions habitual System 2 Slow effortful and logical Solves complex tasks Thinker not a doer Requires attention and reasoning

7 Localisation Brain Stem- Life Functions Homeostasis Breathing Digestion Heart beat Blood pressure System 1 Most everyday tasks are left to System 1. This may be why we are so biased and illogical, and such creatures of habit

8 Localisation Frontal Lobe Thinking Personality Executive Function Combines information from other areas and initiates actions System 2 Generally produces better decisions and outcomes but attention, concentration and reasoning are finite resources

9 Why is System 1 the used most? This year 2013 is the first in human existence where more people will die from the effects of overeating than starvation Global Burdon of Disease Study Lancet November 2013 The cerebral cortex is 2-3% of a person s body mass but uses 25-30% of all the Oxygen and Sucrose available It should come as no surprise we are good at turning off our thinking- its too expensive to run

10 Talking Therapies have often targeted System 2 This should improve understanding and insight but may not change behaviour How often have you come across this with clients? Don t know what happened just found myself with a drink in my hand In front of a pokie machine I didn't intent to. When I went in there

11 Its possible for the thinking parts (frontal lobe) and other brain areas to be at odds I ll just hold my breath till I die Detects low O2 and reactsbreathes Anyone can hold their breath- right eg when under water- But Frontal lobes are huge O2 users O2 becomes depleted Thinking/ frontal lobes become less influential The brainstem detects stress (low O2) and acts And the person breathes Autopsy reveals most drowning victims have inhaled water

12 Remember the 12 Step Acronym HALT H - Hungry A - Angry L - Lonely T - Tired These are all things that make the frontal lobes less dominant and let the brainstem do what it does Or- engage System 1 behaviour Usually this means doing what we are used to doing, doing what we are trained to do For our clients- Trained by tens of thousands of button presses and thousands of little rewards

13 Addiction has a lot to do with the reward pathway The Reward Pathway is mostly a dopamine system Dopamine is produced in the brain stem The reward pathway takes dopamine from the brain stem forwards and upwards in the brain Brain Stem- probably means it s a System 1 driven event

14 The Reward Pathway A human thing Probably goes back to being a huntinggathering species

15 This Means:- Addiction May be a brainstem- System 1 phenomena Not not driven by logic and not something we have good conscious control over Who would have thought that

16 The Reward Pathway can be Activated by Association This includes triggers associated with dopamine release The anticipation of rewards can set of the reward pathway Think of Pavlov's dogs and the ringing bell or a Pokie Machine

17 Matt is going to describe how we use this as a road map for treatment

18 We have developed a way of explaining this efficiently and easily to clients and do this on a White Board in in most first sessions Explaining how we do this takes more time than we have today but Matt and I are happy to do this at your place in a staff training day

19 When we present this to our clients We do this with almost all new clients We use their language We use other information from the assessment We find they really love it

20 Here is the whole thing on the white board

21 Thinking of Addiction as a System 1 Issue has altered our treatment approach We think of this as an Ecological Approach to treatment Disulfiram Self exclusion from Pokies Emphasis on changing mental habits Desensitisation Naltrexone Its not necessarily doing anything different its about understanding how what we already do works and changing emphasis

22 If our brains were simple enough for us to understand We would be too simple to understand them