Beyond Sobriety

1. Beyond Sobriety Susan J Campling, RN, Psy.D CSAT-S, CMAT, CSOT, CDVT, TT Pine Grove Behavioral Health

2. Objectives • Identify that addiction is fundamentally a disease of self aversion and attachment failure • Examine how attachment failure and neurology predispose some people to the disease of addiction • Review the elements of sexual, relational addiction and how shame and lack of intimacy are the underpinnings of the addiction process • Develop tools to assist people with addiction to create a new self love story as a healing intervention • Discuss how 12 Step becomes part of the love story

3. The Golden Buddha

4. Recovery is a Story Alchemy Miracle Mystery based Outcome is essentially unknown- powerlessness Journey is the goal Intuition and introspection has meaning Can not be consistently measured- requires surrendering control • Science based • Outcome focused • Goal directed • Positivism- science as ideology • Quantitative research- replicable, reliability, validity

5. All addiction is about escape and seeking pleasure in a place where eventually the apple will be seen as poisoned. Until then, it exerts great control.

6. Issues with the SelfRoot problems Trauma including neglect, physical and sexual abuse… Addiction as a means of dissociation Attachment Psychology-spirituality Biological

7. Trauma “No passion so effectively robs the mind of all its powers of acting and reasoning as fear.” Edmund Burke

8. Cycle of Trauma and Addiction Cortical failure Trauma can be both an event and a process. For some people the event is highly traumatic. For others chronic subtle trauma has the greatest impact resulting in feelings of helplessness, shame and despair.

9. Addiction Continued use despite negative consequences and the lie. DuPont “A chronic, relapsing disease characterized by compulsive drug seeking and use—despite serious, even devastating consequences—and by long-lasting chemical changes in the brain.” NIDA

10. ASAM Definition Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors. Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.

11. O'Brien C P Phil. Trans. R. Soc. B 2008;363:3277-3286

12. Attachment NeurobiologyLicking • Increased synaptic density, longer dendrite branching, and increased neuronal survival • Increased MPFC DA in response to stress and increased startle inhibition • Increased NMSA and BDNF expression and increased cholinergic neuronal survival • Increased levels of oxytocin and estrogen receptors in medial pre-optic areas (Cozolino)

13. Impact of Maternal Separation Decreased exploratory behavior, avoidance of novelty, greater vulnerability to addiction Greater cortisol secretion, increased colonic motility (IBS), decreased glial density, increased neuronal and glial death, decreased GABA receptor maturity, increased anxiety, fearfulness, and response to stress, reduced gene expression, decreased synaptic density in the MPFC (Cozolino)

14. Default Mode Network • Before age 9 years old children have poor anterior/ posterior integration • In adults with histories of severe childhood trauma, processes are similar to children at age 9. • Decreased myelination in fiber tracts in the middle and posterior corpus callosum due to elevated stress hormones damaging glial cells. • Adults with PTSD demonstrate deficiencies in functions reliant upon self referential processing, such as emotional awareness and emotional recognition. • Dissociation is noted on fMRI as disruption of this system.

15. Theory of Mind • Definition- the cognitive ability to put one’s self in another person’s mental state: mind blindness is normal until about age 5-6. • Research • Addiction- impaired in alcoholics at week 10 of abstinence. PFC hypothesis. chicken or egg? • PDD- autism and Asperger's- impaired. Observable at age 5 80% with Smarty's test • PTSD- impaired ability to apply TOM to others • Other Mood Disorders- impaired social cognition in Bipolar DO • Personality disorders- impaired in BPD- few other studies Gender Differences • Imaging studies- women and men use different brain regions during TOM tasks. Women use the right temporal parietal region while men use the left. Women have better other directed TOM and access the amygdala while men show no differences between self and other TOM tasks

16. “It is axiomatic (self evident) that one cannot sustain intimacy without the capacity for self esteem.” Terrence Real

17. Biology Trauma and addiction fragment the brain resulting in numerous biological systemic breakdowns. Recovery is about the healing the body system and restoring whole brain integration.

18. Cortical Development Gogtay N et al. PNAS 2004;101:8174-8179

19. Hypersexuality • Addiction • Trauma Response • Attachment Failure • Disease • Brain Injury • Medication • Illicit Drugs • Theory of Mind • PDD

20. PsychologySpirituality A disciple once complained, “You tell us stories but you never reveal their meaning.” Said the Master, “How would you like it if someone offered you fruit and chewed it up before giving it to you?” “No one can find your meaning for you.” “Not even the Master.”

21. Any spirituality of joy is also a spirituality of tragedy. In order to become a genuine human being the nature of our being-ness requires acceptance of ourselves and our world as both/and rather than either/or. It is in embracing this spirituality that we embrace the world and reality as it is. We discover who we are. (Kurtz & Ketcham)

22. Integrity/ Wholeness Consistency Actions Values Methods Measures Principals Expectations Outcomes

23. The Power of Story • Grounding experience in linear sequential frameworks • Problem solving • Models for emotion, behavior and identity integration • Identifying goals and establishing pattern of goal attainment • Affect regulation when under stress • Context for movement to self definition

24. Sex n RX We can chose to have strong sexual ethics or we can choose to let psychoactive substances, including lust, attraction or love decide for us. Sexually mature people know they are worth the effort to make their boundaries clear to their partners, but most importantly, to themselves.

25. Sexual Boundary Questionnaire • Physical: • What are you comfortable doing? Where are you comfortable being sexual? Do you have condoms? Lube? Are you too caught up in the high? Do they/ you want to be sexual in a safe place? Are your friends pushing you to move too far outside of your comfort zone? Are you ready and able to stop things if you want to? How does your body feel with this person?

26. Date Rape* Drugs • Drug induced Rape Prevention and Punishment Act (1996) • Up to 20 years in prison and fines for anyone who covertly distributes a controlled substance in order to commit a violent crime • Amphetamines • Barbiturates • Opiates • Chloral hydrate • Alcohol • GHB • Rohypnol • Ketamine • Datura

27. Internet and Sexual Development • Mixed opinions •  Sexual uncertainty •  Permissiveness towards non committed sex • Belief that women are sex objects •  Sensation seeking (chicken or egg?) • Among female adolescents, greater sexual experience decreased exposure to SEIM • SEIM may be more problematic for adults for whom the internet is novel and therefor higher in arousal • Can be a tool to foster healthy sexual development

28. WarningThe following slides have pornographic imagesWhat story do they tell?

29. DAFT PORN

30. Urophilia- S+M

31. Furrys

32. OVERSTOCK.com

33. INTERNET BRIDES

34. HANTE/ ANIME

35. HOOK UP SITES

36. GRIND-R PHONE APP

37. Sexual Fantasy Differences When women speak frankly about their sexual fantasies, they are often shockingly “incorrect.” To be swept away by Prince Charming is a longing for the perfect father, youthful, powerful and benevolent.” “...the insatiable market for men is porn. What many women find offensive in the male sexual marketplace is not erotic explicitness per se but pornography’s characteristic lack of mutuality, or even real personhood.” (Real)

38. “People tend to do in the bedroom what they do in every other room.” David Snarch Our sexual ethic is our personal ethic. If we believe that it is okay to fuck, piss on, screw, fuck ‘m up the ass or otherwise assault another in our fantasies or bed, we are more likely to do the same in the boardroom. Sex addiction grossly alters our personal epic and changes our role from hero to villain, Christ to Anti-Christ, Grace to Shame.

39. Recovery is the Hero’s Journey Towards a Reparative Narrative

40. Recovery is the Process of Transforming Shame to Grace • 12 Step- integrates the miracle with the magic • Therapy- narrative, art, psychodrama, experiential and integrative approaches • Stress management skills training- meditation, exercise, play • Confronting the daemon within • Grace- Gratitude- Gravitas