1. Substitutes for the Thumb The thumb is our original coping device- we use it to self-soothe. The chemistry of contentment

2. The goal of self-soothing is satiation.  All the ways a parent meets baby’s needs become associated with comfort, love, bliss.  When all our basic needs are met, we experience satiation.  Any behavior that alters mood in a positive way will be repeated & intensified.  Desire for satiation is ultimately a desire to return to the calm, comfort, & lack of responsibility of the womb.  Psychologically, satiation seekers reduce stress by passive withdrawal from conflict.

3. Chemistry of contentment  Heroin is the ultimate satiation drug.  Other things: –Sedatives –Music –Food –Massage –Cigarettes –TV or Internet use

4. Psychoactive drugs

5. Endorphins- the keys to paradise  Endorphins are opiates produced by the body to reduce pain & produce euphoria. –Endorphins are released by the satiation drugs, slowing mental activity- except in the nucleus accumbens (the brain’s reward center) in the limbic system.  Op-mex (opiate-mediated experience) are drugs that produce pain relief and soothing.  Too much of these drugs can result in all systems of the body shutting down. It also results in cravings.

6. Homeostasis requires a delicate balance of excitation & inhibition of neural firing.  Warm milk contains tryptophan which converts to serotonin & decreases excitatory neurotransmission.  Naloxone blocks endorphin effects, resulting in decrease in eating behavior.

7. Why would alcohol be considered a depressant?  When alcohol is ingested, the inhibitory synapses are first to be depressed- resulting in excitation, lack of inhibitions.  As drinking continues, the excitatory synapses are also depressed, resulting in stupor & slowed reaction time.  Since the drinker no longer can make good decisions, he believes he can drive, but his ability to drive is severely impaired.

8. What is the genetic connection?  50 – 60% of the risk for alcoholism is inherited  Alcoholics metabolize alcohol differently from others- the enzymes needed to process alcohol are less effective  Those who can drink more with less effects send more alcohol to the brain. They don’t experience nausea, which would slow them down.  So the one who can drink you under the table is at highest risk for alcoholism.

9. Dependence  As neuronal activity in the brain decreases in response to a drug, the user needs the drug simply to feel normal.  Withdrawal occurs if drug is discontinued.  Users develop tolerance to a drug, which allows them to use much more of the drug.  Tolerance prevents the user from recreating the original high.

10. Challenges to sobriety  Conditioned desire –Cravings erupt in situations of previous use  Conditioned withdrawal –Someone who is sober, feeling the shakes, cramps, anxiety when considering drinking again- similar to withdrawal from the drug  Acamprosate can reduce effects of conditioned withdrawal by reducing the excitability of glutamate receptors (an excitatory neurotransmitter)  Naltrexone is another drug that reduces relapse by blocking receptors for endorphins & causing a bad taste when drinking.

11. Drug interventions aren’t enough  Other things the sober person needs to manage are: –Staying away from high-risk situations –Replacing peers or friends who use –Learning to control interpersonal conflict –Developing higher self worth through skill-building, management of thoughts –Practicing other responses & thoughts (RET)  Rule violation effect- –the result of cognitive dissonance, self-attribution (I’m a failure for wanting to drink), positive perceived effects of the drug – it all leads to self-justification of drinking  Most people trying to be sober will lapse when they feel frustrated with no ready solution

12. Cognitive strategies for managing cravings

13. Can drinking be therapeutic?  Moderate alcohol intake (2 drinks/ day) is related to lowered CVD (20% lower risk of stroke or heart attack than abstainers) –Alcohol increases good cholesterol- HDL & reduces clotting of the blood  The downside is increased risk of cancer –Risk of colon cancer increases 15% if you drink more than 1 drink a day- 4 drinks/ day and the risk is 40% higher (risk also increases for breast cancer)  Alcohol is the 3 rd biggest cause of preventable death after smoking & obesity