Midterm Flashcards
Study for Midterm
Addiction is:
A chronic, incurable, often progressive disease characterized by the “loss of control” over the use of drug, behavior, or process
Loss of Control
Use beyond intent and/or use despite negative consequences - leads inevitably to violation of values
Is addiction Physical Dependency
No - you can have physical dependency without loss of control.
How are drug and behavioral addictions related:
All can stimulate reward pathway in the brain
What is addiction transfer with example
Commonly observed phenomena where an individual stops one addictive behavior and then starts another. Cocaine binges replaced by food binges.
Observing addiction transfer
Try to increase consciousness without judgement or certainty of how to respond to it.
What is quicker, conscious or unconscious mind
Unconscious
How can unconscious mind affect our perceptions of reality
Lots of ways - swinging paper clip was good example
When does primary programing of the unconscious mind occur
Pre-verbal - mainly 1 - 2 years
Insecure attachment and addiction
With no attachment, child can’t learn that environment is safe.
Rationalizing addictive behavior
I drink because…
Scapegoating example
He made me drink…
Example of minimizing addictive behavior
If I’m an alcoholic, how do I have a career
Example of prevaricating/lying to explain addictive behavior
creating co-dependency/gaslighting. In time, people will believe their own stories.
Emotional consequence when denial erodes
hopelessness/despair
Danger in premature disintegration of denial system
Suicide/Overdose
What is closest to 12-step powerlessness?
Loss of control
Is high tolerance sign of loss of control
No
Is addictive disease a curable
Propensity for loss of control appears to remain for life but sustained remission is possible
What is recovery position
Laying someone on their side with arms extended and their head position to maintain their airway in the event of vomiting.
Difference between someone with addictive disease and an abuser of alcohol
Person with addictive disease gets drunk even when they didn’t plan to, while alcohol abuser plans to get drunk.
How many paper are required for 12-step paper requirement
1
What is attunement?
Describes how reactive a person is to another’s emotional needs and moods. A person who is well attuned will respond with appropriate language and behaviors based on another person’s emotional state.
Relation to attunement and bonding.
Good attunement creates bonding between child and caregiver.
Relation to attachment/bonding with reward system.
Touch/attuenment release oxytocin (trust drug)
What is neuroception?
describes how neural circuits distin- guish whether situations or people are safe, danger- ous, or life threatening.
How does neuroception show in child behavior?
Neuroception explains why a baby coos at a care- giver but cries at a stranger, or why a toddler enjoys a parent’s embrace but views a hug from a stranger as an assault. Also attachment and self-soothing.
What is Adverse Childhood Experience Survey (ACES)
10 item questionairre done by Kaiser study and natural center for disease control.
What does an ACEs schore predict
Higher ACEs score, negative health, negative mental, social, and physical outcomes.
What is epigenetics?
the study of changes in organisms caused by modification of gene expression rather than alteration of the genetic code itself. [environmental influence on genetic expression]
Lessons of Rat Park
It appears that addiction is primarily an epigenetic disorder.
How does Universal Precautions relate to addiction treatment in terms of childhood trauma.
One should assume for everyone a high ACEs score.
Mirror Neuron
A mirror neuron is a neuron that fires both when an animal acts and when the animal observes the same action performed by another. Thus, the neuron “mirrors” the behavior of the other, as though the observer were itself acting.
What are risks of mirror neurons for counselor.
May be traumatized by someone’s trauma.
How to help a trauma activated person.
You be calm. ask them to breath, hear suffering but don’t be reactive.
Social Engagement - Scientific Name
Parasympathetic Nervous System - Ventral Vagal
Social Engagement - General Terms
Safety, Peace, Joy, Groundedness, Love, Happiness, Curiosity, Connection, Openness, Interest
Ventral Vagal Increases
Digestion, Intestinal Motility, Resistance to Infection, Rest and Recuperation, Circulation to Shin, extremities, Immune Response, Oxytocin
Ventral Vagal decreases
Defensive Responses
Freeze - Scientific Name
Parasympathetic Nervous System - Dorsal Vagal
Freeze - General Terms
“I can’t” Helplessness, Hopelessness, Preparation for Death, Numbness, Suicidality, Conservation of Energy, Trapped, Shame, Dissociation Body Collapse/Immobility
Dorsal Vagal Increases
Fuel Storage, Insulin Activity, Endorphins
Dorsal Vagal Decreases
Heart Rate, Blood Pressure, Temperature, Muscle Tone, Social Behaviors, Immune Response
Fight of Flight - Scientific Name
Sympathetic Nervous System
Fight or Flight - General Terms
“I can” Anxiety, Concern, Worry, Irritation, Frustration, Depression, Fear, Anger, Panic, Rage, Movement Towards
Sympathetic Nervous System Increases
Blood Pressure, Heart Rate, Fuel Availability, Adrenaline, Oxygen Circulation, Blood Clotting, Pupil Size
Sympathetic Nervous System Decreases
Fuel Storage, Insulin Activity, Digestion/Salivation, Sexual Response, Immune Response
Polyvagal Theory
The Polyvagal theory specifies two functionally distinct branches of the vagus, or tenth cranial nerve. It serves to identify the relationship between visceral experiences and the vagus nerve’s parasympathetic control of the heart, lungs, and digestive tract
Polyvagal Threat Levels
Safety - Social Engagement
Danger - Fight or Flight
LifeThreat - Freeze
How is Social Engagement (and eventual self-regulation) wired in individual
Primary Caregiver offers consistent (but not perfect!) opportunities for the child to become regulated from attention/responsiveness.
If social engagement not wired into individual…
No internal means of self-regulation and will tend to spike into fight/flight/freeze. Tend to reach for external means of self soothing (substances and or behaviors for temporary relief) and prone to developing addictive relationship to substances or behavior.
How adverse childhood experiences influence health and well-being throughout the lifespan…
Disrupted Neurodevelopment Social, Emotional, and Cognitive Impairment Adoption of Health-risk Behaviors Disease, disability, and social problems Early Death
Rules of responding to Trauma
1 - Use Universal Precaution approach
2 - Take care of yourself first, breathe, offer yourself as relaxing resonance
3 - Don’t take anything person says personally
4 - Don not argue, respond aggressively, or defensively. Are you okay, Did something happen that’s bothering you? Do you want to talk?
5 - Always prioritize safety (yours and theirs). Don’t push them into a corner, Empower, support, nurture, consistent responses.
How much does an adult human brain weigh.
About 3 pounds.
How much does a baby’s brain weigh?
3/4 of a pound.
How many neurons do we have at birth
About 100 billion - the most we’ll have.
What is Nuerogenesis?
The creation of new neurons
Does Neurogenesis occur throughout life?
Yes, but involves a relatively small number of neurons.
How many connections a second does the brain make in the first few years of life?
1 million.
How does the brain wire itself?
From the result of genetic information and in response to the environment.
What is neuroplasticity?
The ability of the brain to form and recognize synaptic connections, especially in response to learning, experience, or following injury.
What is a neuron?
The basic building block of the nervous system.
What are the parts of the neuron?
Dendrites Receptor sites Cell Body (Soma) Axon Axon Terminal Synapse Reuptake Pump
What are dendrites?
Collectors of incoming chemical messages (neurotransmitters) via receptor sites
What are neurotranmitters?
Chemical messages
What are receptor sites?
Receivers of incoming messages via the lock and key principle
What is an agonist?
A neurotransmitter that activates a receptor site
What are the messages and agonist sends to cell body (soma)?
Go or don’t go.
What is an antagonist?
A neurotransmitter that blocks the receptor site from being activated.
What is the Cell Body (Soma)?
An area of neuron that collects incoming go and don’t go messages. (Accountant of cell)
What happens if Soma collects sufficient go messages?
The neuron fires.
What happens when neuron fires?
A one way electrical message travels down neuron to the axon terminal.
What happens if Some collects insufficient go messages or many no go messages.
The neuron remains in a resting state.
What is the Axon?
Part of neuron that carries electrical discharge to the Axon Terminal.
What is the Axon Terminal?
Place that has vesicles which contain neurochemicals that are released into the synapse as a result of electrical discharge.
What is a synapse?
Space between neurons.
What happens in synapse?
Neurotranmitters move across this space to interact with the dendrites/receptor sites on adjacent neurons.
What is the reuptake pump?
Part of the axon terminal that serves to recycle neurotranmitters from the synapse.
What makes up the Triune Brain?
The Reptillian Brain, The Mammalian Brain, and the Cerebral Cortex.
How does the Triune Brain work when calm?
The three regions of the brain work harmoniously together.
What does addiction and trauma do to the Triune Brain?
They can hijack the brain and over-ride the Cerebral Cortex in order to have a “survival response.”
What is the Reptilian Brain?
The “body brain.” Supports our most basic survival needs. Connects brain to spinal cord and controls functions of the body.
What are the parts of the reptilian brain?
Brain Stem, Cerebellum, and Basal Ganglia.
What does the brain stem do?
Regulates basic bodily functions such as sleep, respiratory rate, heart rate, digestion, reflexes such as grasping and sucking.
What does the cerebellum do?
Coordinates posture, balance, and voluntary movements.
What can activating the cerebellum with rhythmic movements do?
Help calm and balance the nervous system.
What is the Basal Ganglia?
A collection of structures that link up the midbrain regions and contains reward center.
What does the Basal Ganglia do?
Encodes procedural memories and habitual behaviors.
What are procedural memories?
Part of the long term memory that is responsible for knowing how to do things like walking, talking, and riding a bike.
What is another name for procedural memories?
Motor Skills.
What is the mammalian brain?
The “emotional brain” or limbic system. Place of emotional response and attachment instincts. Also involved with procedural learning, motivation, and memory.
What makes up the Mammalian Brain
Thalamus, Hypothalamus, and Amygdala
What is the thalamus?
Spot on top of brain stem that received sensory input from the external world and our bodies. Filters what sensory information is relevant. Connects and communicates with all three levels of the brain.
Does that Thalamus communicate quicker with emotion region or higher cortical area?
The emotions region, so our thinking brain is always a half-second behind when it comes to processing emotional responses.
What does the Hypothalamus do?
Controls our automatic nervous system and regulates body temperature, sleep/wake cycles, food intake, and thirst.
What does the Amygdala do?
Involved in emotional learning including the fear response. It receives information from the Thalamus, assesses the emotional significance of a stimulus and prompts the nervous system if we should approach or avoid it based on past experiences.
What are the responses of the Amygdala?
Safety Response or Activating Response
What is the Safety Response
If the Amygdala perceives the stimulus as safe, it prompts the hypothalamus to release oxytocin.
What is oxytocin?
A stress reducing hormone that promotes bonding
What is the Activating Response?
If the Amygdala perceives the stimulus as potentially dangerous, it prompts the hypothalamus to activate hormones like adrenaline and cortisol to mobilize the fight/flight/freeze/fawn response.
What is the fawn response?
A sub response of the activating response, it is an often overlooked survival mechanism to a traumatic experience or circumstance. Fawn according to Webster’s Dictionary means “to act servilely; cringe, and flatter.
What does the Hippocampus do?
Organizes emotional experience into time, context, and space then transfers this information up the medial prefrontal cortex to form explicit , conscious memories.
What is the difference between Hippocampus and Amygdala roles?
The amygdala generalizes the meaning of a stimulus, the hippocampus helps to differentiate the nuances. (Amygdala - fire is hot and can hurt you. Hippocampus - fire in the safety of a fireplace makes you warm and comfortable.
What is the Cerebral Cortex?
The frontal lobe and topmost outer layer of the human brain. Facilitates higher-order thinking, language, conscious and emotional regulation. Divided into two hemispheres.
What are the parts of the Cerebral Cortex?
Right Hemisphere
Left Hemisphere
Prefrontal Cortex
What does the right hemisphere do?
It is more directly connected to the emotional brain and specializes in spatial reasoning, metaphorical thinking, nonverbal communication and processing negative emotions.
What does the left hemisphere do?
Has more connections to the Prefrontal Cotrex and specializes in logical analysis, verbal communication, integrating positive emotions, and organizing our experiences in a coherent narrative of our lives.
What does the Prefrontal Cortex do?
Gives us the ability to use abstract thought, make conscious decisions, regulate emotions, and use verbal reasoning.
What are the parts of the Prefrontal Cortex?
Dorsolateral Regions PFC (tops and sides)
Medial Regions PFC (middle and bottom)
What does the Dorsolateral Regions do?
Involved in working memory, planning, decision making, intellectual insight, and your relationship to your external surroundings. It has no connections to the amygdala, so it can’t properly regulate emotional responses so it sends stimulus to the Medial Regions..
What does the Medial Regions do?
Primary region we use to regulate emotions and impulses. Works with hippocampus to form explicit memories. Emotion and reasoning processes compete for resources in the MRFPC.
What can happen if emotional arousal is high in the MRFPC?
It can be overwhelmed with neurochemicals from the emotional brain and temporarily hinder its ability to access the brain’s executive functions in the DRFPC. This is why we may lash out when we’re stressed and not able to use more adaptive responses until we calm down.
What is an explicit memory?
Made in the Medial Regions, an explicit memory involves conscious recollection compared with implicit memories which are an unconscious, unintentional form of memory . Remembering a specific driving lesson is an explicit memory, while improved driving skills as a result of the lesson is an implicit memory.
What brain areas are involved in a Trauma Response?
Amygdala, Hypothalamus, and Pituitary Gland
What does Amygdala do in trauma response
It perceives a threat and sends signal to the hypothalamus
What does the Hypothalamus do in a Trauma Response?
Releases hormones that activate the 4F response via the pituitary gland.
What does the pituitary gland do in the Trauma response?
Release endogenous opiates to dull pain and tell the adrenal glands to release adrenaline, noradrenaline, and cortisol.
What does Adrenaline and Noradrenaline do?
elevate heart rate, mobilize increased blood flow (more alert), give us energy, strengthen our muscles.
What does Cortisol do?
Promotes release of glucose into bloodstream. Inhibits body activities (reproduction, growth, immune system functions). Inhibits activity of Hippocampus and PFC. This inhibition conservers energy and focus to what is needed for immediate survival.
What is Freeze Response.
If fight or flight doesn’t work to eliminate threat, the freeze response is activated via the Parasympathetic Nervous System (Dorsal Vagal). Muscles can become limp as we collapse or become immobilized.
What happens with endogenous opiates during freeze response?
They are released at even high levels. Extra Opiates can help protect us from pain, cause us to dissociate, faint, or even cause us to have little recollection of a traumatic event.
Explain how trauma is a disorder of memory?
During emotionally stressful events, the amygdala encodes all the involved memory into an implicit (felt, experiential) memory. This encoded memory can be triggered by an aspect of the original event. It is very difficult to overcome this implicit memory by creating a new explicit memory related to the stimulus.
What is memory reconsolidation?
Healing from trauma can happen not from retelling the memory of a trauma, but by filling in the missing secure attachment first in the form of a trusting, attuned, therapeutic relationship.
What occurs in the greatest number in a neuron?
Receptor Sites
What part of the neuron serves as the lock in the lock and key mechanism
Receptor Sites
What part of the neuron stores neurotranitters
Vesicles
Where are vesicles stored?
Axon Terminals
Are synapses part of the neuron?
No
What removes neurotranmitters from the space synapses?
Reuptake Pump.
Who has the most neurons? 3 month old 3 year old 30 year old 60 year old
3 month old
What serves as the key in lock and key principle?
Neurotranmitters
Which direction does electrical impulse flow in neuron
Uni-directional from the cell body to the axon terminal.
What neurotranmitter gives a go get it message?
Dopamine
Which neurotransmitter gives a “that’s enough” message?
Serotonin
What neurotransmitter is involved in the main pleasurable aspect of mood altering drugs?
Endorphin
What neurotranmitter makes people miserable after quitting mood altering drugs?
Dynorphin
Which is an agonist for the opiate receptor site? Morphine Methadone Heroin Vicodain All of the above
All of the above
Which of the following acts as an antagonist for alcohol? Suboxone Methadone Amphetamine Methylsoberate None of the above
Methadone
What would happen is you gave an opiate antagonist to someone physically dependent to heroin?
It would make them overdose
It would make them susceptible to infection
It would put them in immediate withdrawal
None of the above
All of the above
It would put them in immediate withdrawal
What is the ventral tegmental area?
Part of the midbrain, rewarding stimulus cause it to release dopamine.
What is the Nucleus Accumbens?
An area of the midbrain that appears to be responsible for the sensation of pleasure.
What is the prefrontal cortex normally?
Normally would serve as a mechanism to control impulses that create conflict with values.
What areas of prefrontal cortex are hijacked by addiction?
Orbital Frontal Cortex and Anterior Cingulate Cortex, critical for attachment and decision making – they become major players in compulsive seeking of drugs.
What happens to Amygdala under drugs –
Overlearns cues for drugs and becomes major player in craving.
What neruortransmitors are involved in the reward system?
Dopamine, Serotonin, Endorphins, and glutamate.
What is the message of dopamine?
Wanting, go get it.
What is the message of serotonin?
Satiation, that’s enough
What is the message of endorphone?
Pleasure, that’s good.
What happens to endorphine with overuse?
It becomes depleted.
What is the message of glutamate?
I will remember. Go get it.
What happens with glutamate in periods of withdrawl or non-use?
Is overproduced and causes anxiety.
What is neuroplasticity’s role in addiction?
Builds drug hypermemories in the brain that might become permanent.
What is the dopamine hypothesis?
All drugs and behaviors have the ability to release dopamine in the pleasure center of the brain.
What is the brain stress system?
It is the anti-reward system.
What happens in the brain stress system?
Dopamine surge causes an increase in Corticotrophin Releasing Factor (CRF) and in Dynorphin levels. Both of these create unpleasant emotional states that are then relieved by consumption of the addictive drug.
What happens if brain stress system is chronic?
The brain will reset the pleasure set point. Normal pleasures will no longer register in the pleasure center. Anhedonia is the result and more and more drugs are required to have a sense of pleasure.
What is Anhedonia?
An inability to feel pleasure.
What is thought to happen in hypofrontality?
Addiction causes the top down (prefrontal cortext) management of the midbrain to fail. Craving is an intense emotional experience. Connection of the drug to survival has been carved into the brain.
