Heal the Addicted Brain

You Don’t Have to Live with Addiction

Healing the addicted brain is possible with a multifaceted approach.

Heal the Addicted Brain

You Don’t Have to Live with Addiction

Healing the addicted brain is possible with a multifaceted approach.

The information presented on this page is a general overview and is offered here as a comprehensive resource. At Ampelis Recovery, our programs are customized and tailored to the individual’s needs. Specific details below that cover treatment protocols may not reflect the protocols used for our clients.

If you would like to learn more about Ampelis Recovery and our customized programs for professional men, please do not hesitate to reach out.

WE WELCOME ANY QUESTIONS YOU HAVE: (801) 477-7493

Are You Ready for Your Recovery Journey?

When you struggle with an addiction you live in a constant state of denial.1  People in your life may be frustrated and confused about your actions. Some of these people may believe addiction is a choice; that you could simply choose to stop. This type of misinformation is a deterrent to addiction treatment and contributes to the low self-esteem and self-loathing that medical professionals see too often at the start of recovery.2

Acknowledging You Need Help

The first step on your recovery journey is your willingness to begin treatment.​​​3 Many times, this requires a traumatic event to shock you into accepting there is a problem. The shocking event may be an auto accident, arrest, divorce, a nearly lethal overdose, or many other traumas. Ideally, you will acknowledge treatment is needed before experiencing any of these traumas.

Beginning Recovery

Once you have made the brave step to begin recovery, you must choose the right addiction treatment program. Do you need a residential or outpatient environment? Do you prefer a holistic or more traditional approach? What is important to you?

This article will explore how an advanced treatment program may treat your addiction and help you achieve sobriety. You do not have to resign yourself to being an “addict” for the rest of your life to recover. This article will also explore this revolutionary paradigm. First, let’s learn about your brain chemistry and addiction.

Learn More About Healing the Brain


  • Holistic Approach
  • Brain Chemistry
  • Positive Psychology

Brain Chemistry of Addiction

Addiction is a curable disease of the brain. Modern treatments make it possible to stop addictive cravings, repair psychological trauma, create flourishing relationships, and provide a life full of meaning. But it takes the coordination of many different types of treatment to reach the cure.

How Does Your Brain Work?

The brain is an extraordinarily complex control center for all your body’s systems. The brain is made up of billions of neurons that organize and connect to form the circuits you need to survive.4

Communications in the Brain

Neurons send messages to each other by releasing neurotransmitters that cross a gap, or synapse, between them. The message causes the receiving cell to change and then different molecules recycle the neurotransmitter used to bridge the synapse.5  This is an extremely simplified explanation of one of nature’s most amazing systems.

Building Blocks of Neurotransmitters

Neurotransmitters are created, in large part, by amino acids.6 Addiction depletes your brain’s access to amino acids. Recovery will be more successful if you add amino acids to your systems to correct the depletion.7

How Does Drug Use Affect Neurotransmitters?

Drugs interfere with the neuron’s ability to send, receive, and process communication with neurotransmitters. Some drugs detrimentally activate neurons. Other drugs increase or decrease the number of neurotransmitters produced, flooding or starving your brain’s systems.

Your brain’s store of amino acids and neurotransmitters are impacted either way.

Medical Paradigms Used to Heal the Addicted Brain

There are many new medical paradigms that are used to heal the addicted brain. Some of these paradigms are:

  • Functional Medicine Approach
  • Amino Acids
  • Ketamine Therapy
  • Positive Psychology
  • Healthy Habits
  • Holistic Healing
  • Neuroplasticity

The first part of healing we need to discuss is the clinical philosophy and approach needed to cure, rather than treat, your addiction. Functional medicine gives us a framework to begin.

Transcript

Part of what makes our brains so deliciously amazing, is that they’ve evolved to reward us and encourage us
00:04
when we do stuff that helps us survive and spread our genes all over the place.
00:09
I’m talking about eating and sex having and running from danger.
00:12
Stuff like that.
00:12
For hundreds of thousands of years, this system served us well. But in a way, our brains have
00:17
since gotten too smart for their own good.
00:19
We’ve figured out how to make ourselves experience this pleasure when we’re not even doing any of those things.
00:25
By inventing drugs.
00:27
And we’ve also figured out how we could do those things.
00:29
Eating, sex having, getting an adrenaline rush.
00:33
Recreationally.
00:34
Instead of for our survival. And sometimes the craving for that feeling can take on a life of its own.
00:39
And so, by doing these things, we have basically invented addiction.
00:44
Nice move, brains.
00:45
But this is why addiction isn’t limited to drugs; behaviors can be addictive too.
00:49
The compulsive urge to use cocaine again and again, the compulsive urge to eat candy bars again and again,
00:55
are both produced from the same brain circuitry.
00:58
Same goes for addictions to gambling, sex, eating, even…Reddit.
01:03
Addiction: it’s all in our brains. Mo’ synapses, mo’ problems.
01:09
[Intro Jingle]
01:20
The chemistry of addiction takes place mostly in the brain’s limbic system, the set of structures at the center
01:24
of the brain that controls our emotional and behavioral responses to the information we receive.
01:28
It’s often referred to as the brain’s “reward center.”
01:31
And it responds to new information from the nervous system by releasing chemical messengers called neurotransmitters
01:36
that pass signals from one neuron to the next or to another kind of cell it wants to activate.
01:42
Your brain produces at least 100 different neurotransmitters and we’re finding new ones all the time.
01:47
But the most important neurotransmitters, when it comes to addiction, are the ones that are released
01:51
when we do something that’s key to our survival and success.
01:55
Once they’re done getting the word out, they’re usually re-absorbed back into whatever neurons they originated from.
02:00
There are two major kinds of neurotransmitters and in a healthy brain they’re pretty much in balance.
02:05
There’s excitatory neurotransmitters, which get their target cells all fired up with chemical energy
02:10
and there’s inhibitory neurotransmitters which keep their target cells calm and mellow.
02:15
Serotonin is an inhibitory neurotransmitter that you’ve probably heard of; it helps regulate your mood, your
02:20
your appetite and your sleep cycle.
02:22
But it’s the excitatory ones that you really gotta watch out for.
02:25
Endorphin, for instance, is released when we exercise, are really stressed or in a lot of physical pain,
02:30
and it helps with coping and painkilling.
02:32
And, by far, the most important reward chemical is dopamine.
02:35
It’s released whenever our brain believes we should take strong note of our current behavior, to remember it.
02:40
It’s levels rise in response to pleasurable experience like eating or baby-making.
02:46
But it’s also released when, like, a bull moose is charging us.
02:49
PAY ATTENTION TO THIS MOMENT! DO NOT FORGET IT!
02:52
So, yes, the exciting sensation you feel when your dopamine levels are up reminds our brains to do things
02:57
that are important to our survival.
02:59
But it’s also a large part of what drives addiction.
03:02
Because addictive drugs are really good at not only messing with our levels of dopamine and other neurotransmitters,
03:08
they also exploit the brain’s ability to vividly remember unnatural highs and motivate itself to find more of them in the future.
03:16
Scientists have recently started to debate whether dopamine actually makes you feel good,
03:21
or if it just exists to make you want things more.
03:24
We’ve always based the assumption that dopamine makes you feel good on the fact that it makes people
03:29
and, more commonly, rats repeat activities that increase dopamine levels.
03:34
But while dopamine definitely has a pleasure component, it may be much more important
03:39
in simply creating desire, whether or not there’s a pleasurable outcome, which is why, maybe, so many
03:45
addictions continue long after any actual pleasure is gone.
03:48
Another important factor in addiction is that when the brain is met with the intense stimuli that drugs can cause,
03:53
it has all kinds of defenses that it desperately uses to restore balance.
03:56
So after using a certain drug over the long-term, your brain will reduce the number of neurotransmitters
04:01
or receptors available to it to try to moderate it’s effects.
04:05
This leads to what’s known as a hypo-functioning reward system, which makes artifical and natural highs harder to come by.
04:11
So while your brain on drugs is not technically a fried egg, it is a significantly altered egg.
04:16
This is why we develop tolerance to certain drugs and why addicts often end up with shiny new psychological
04:21
disorders they didn’t have before their addictions.
04:23
Now, with all this in mind, drugs that cause addiction screw with your brain activity in two major ways:
04:28
One, they imitate one of your natural neurotransmitters or two, they artificially change the levels of your
04:34
neurotransmitters, either by overstimulating their release or inhibiting their re-absorption.
04:39
So, for instance, heroin and other opiates like codeine and morphine are some of the most addictive substances on Earth,
04:46
because their structure is very similar to endorphin.
04:49
They bind to nerve cell receptors reserved for endorphin in huge numbers which magnifies endorphin’s painkilling
04:55
effect, creating a feeling of euphoria.
04:57
Opiates create far more powerful reactions than any natural stimulus.
05:02
So once the artificial high is experienced, the brain craves to return to that feeling.
05:07
Nicotine, meanwhile, takes a different attack vector; first, it mimics a neurotransmitter called acetylcholine
05:12
which triggers the release of large amounts of dopamine.
05:15
Then it also sets off the release of other chemicals that leverage it’s effect, like glutamate, which plays an
05:20
important role in memory formation.
05:22
So, in addition to dopamine being all, “Remember this and do it more!”, glutamate is also firing memos
05:28
off to surrounding neurons, creating what some scientists think is a memory loop that reinforces the habit.
05:34
Finally, a third way for it to act, nicotine also sets off a flood of an inhibitory neurotransmitter called GABA,
05:41
which ordinarily calms neurons down, but after 20 minutes the GABA receptors are so desensitized
05:47
that there’s nothing left to get in dopamine’s way.
05:49
Then there’s alcohol, which upsets that balance of neurotransmitters that allow body and brain to function as one.
05:57
It binds to a number of different receptors, including those for acetylcholine and serotonin,
06:02
which explains it’s initially pleasing and, later, sedative effects.
06:06
More alcohol means slower communication between neurons, but here’s the thing:
06:10
as the brain grows used to alcohol over long-term use it tries to compensate by releasing excitatory neurotransmitters
06:16
to speed up signal transmission.
06:18
So, after heavy regular drinking, if the flow of alcohol stops, the brain is left with out of control synaptic
06:24
firing with nothing to calm it down.
06:26
Now, you’ve heard of a drunk getting the shakes when they stop drinking. This is where that comes from.
06:30
Now, some drugs don’t even bother imitating a neurotransmitter. Instead, they just screw with the levels
06:35
of natural neurotransmitters.
06:37
We’re talking here about things like cocaine and methamphetamine and other amphetamines
06:41
like ecstasy and bath salts.
06:43
Cocaine is such an effective stimulant because it interrupts the reabsorption of dopamine and another
06:47
important excitatory chemical: norepinephrine.
06:50
By creating extremely high concentrations of them floating around in the synapses, nerve cells are
06:55
overstimulated and the user will feel pleasure from the dopamine and energy thanks to the norepinephrine.
07:00
But because it creates such a flood of these neurotransmitters the cocaine ends up depleting them,
07:05
and more and more cocaine is needed to produce the same high.
07:08
Now, the effects of smoking meth can last up to twelve hours versus one hour to cocaine and is vicious in it’s
07:15
ability to create addiction.
07:17
Instead of blocking the re-absorption of dopamine, like cocaine does, meth causes the release of excess amounts of dopamine.
07:24
It’s a nasty drug made worse by the fact that over time an addicts brain, in an effort of self-defense,
07:29
will eventually force neurons to release an enzyme that destroys all that extra dopamine,
07:33
as well as the brain’s ability to produce more.
07:36
As a result, users will continue upping the dosage, seeking a high that they can’t achieve.
07:41
Other new amphetamines bursting onto the scene including bath salts, which are so fascinatingly awful
07:46
that we did a separate episode just on them.
07:48
Bath salts contain a group of synthetic stimulants called substituted cathinones which combine the effects of
07:53
both cocaine and meth at the same time.
07:56
What scientists are now discovering is that these same chemical reactions brought about by substance abuse
08:01
are similar to those brought about by a number of behaviors, causing behavioral addiction.
08:06
Let’s take gambling: the neural circuits manipulated by wagering money on blackjack, horse racing and other games of chance
08:12
are actually the same ones that originally evolved to help animals assess reward versus risk.
08:16
Like, you’re living on the savannah and you haven’t eaten in two days,
08:20
you don’t want to be like, “I forget, is it the black berries that kill you or the red ones?”
08:24
But what researchers have discovered with gambling is that it’s not only winning that enhances dopamine
08:28
transmission in the limbic system but it’s also the near misses; it’s the 4-out-of-5 jackpot symbols on the slot machine
08:34
or being one number off on the roulette wheel.
08:36
Those things actually have a larger effect on the brain than winning the jackpot.
08:40
Almost getting the reward causes strange things to happen to the ways in which your brain anticipates future rewards.
08:46
Our brains love to find and predict patterns. But, when it becomes fixed on predicting patterns in something
08:51
that’s inherently unpredictable, like a slot machine, it leads to compulsive gambling.
08:57
And, in fact, in 2012, the Diagnostic Statistical Manual for Mental Disorders, which is pretty much the go-to
09:02
book for psychiatric illness professionals announced that it’s going to add a new category for behavioral addictions
09:07
beginning with pathological gambling.
09:10
It’s also adding references to internet and sex addiction for the first time and many would like to see food addiction added as well.
09:17
Food and sex addiction are controversial topics, partly because of the stigmas associated with them.
09:23
The release of dopamine as a response to eating fatty foods is completely natural and makes perfect sense evolutionarily.
09:29
However, even this natural release of dopamine can be exploited.
09:33
Studies of rats have shown that, when given easy access to high sugary and fatty foods like bacon and chocolate and cheesecake…
09:41
Ooh-mmm. Bacon chocolate cheesecake.
09:43
Those rats not only ignored their normal food but continued to eat the unhealthy snacks even when they were shocked in the process.
09:50
Over time, the rat’s brains developed tolerance to the chemical response to junk food by desensitizing their
09:56
dopamine receptors, exactly like the hypo-functioning reward circuitry caused by drug addiction.
10:01
Findings like this have actually led to a theory that some people might have fewer dopamine receptors than
10:05
others, which may make them more predisposed to food and other addictions.
10:09
Like sex, for instance. This shouldn’t come as a surprise, given that brain scans taken during orgasm closely
10:15
resemble those of heroin users after shooting up.
10:17
Like food addiction, sex addiction is linked to low dopamine levels in the brain which can lead to
10:22
post-sex hangovers that leave the addict in despair and on a quest to find his or her next fix.
10:28
It’s a craving, both biologically and psychologically.
10:31
Even here on the internet our dopamine receptors are spoiled full of fun and stimulating distractions that activate our pleasure chemicals.
10:40
And like other addictive behaviors, it’s often the anticipation that’s greater than the reward.
10:45
I mean really, how many times did you check your email in the last hour and how many important emails did you actually have?
10:51
Meanwhile, studies of video gamers are showing that players will continue their gaming, even when multiple
10:56
distractions are placed in front of them.
10:57
Not that I would know anything about that.
11:00
We’re living in kind of a golden age of brain research right now, which means that we’re learning more about
11:04
the causes of addiction and possible cures every day.
11:07
And while there pretty much is no way to avoid overstimulating your dopamine receptors in this world of instant pleasures,
11:13
the rush of finding a particularly adorable cat on Reddit is likely going to remain my drug of choice,
11:19
at least for the near future.
11:20
Thanks for watching this episode of SciShow Infusion.
11:23
Don’t do drugs.
11:25
If you have any ideas for future episodes of SciShow or questions or comments you can leave them for us
11:29
on Facebook or Twitter or in the comments below,
11:31
and if you want to keep getting smarter with us here at SciShow, go to YouTube.com/SciShow and subscribe.
11:36
We’ll see you next time.
11:38
[Outro Jingle]

Functional Medicine for Addiction

Functional medicine is rooted in recognizing that each disease or illness has many different causes.8  When functional medicine is biology-based, it explores things like low amino acids, poor nutrition, vitamin deficiencies, and more. But functional medicine can also account for mind-based causes like depression, stress, bad habits, and more.

The human experience is complex and is made up of many different influences – physical health, mental health, interpersonal connections, living conditions, and spirituality. Each of these elements is distinct but interrelated. Our physical health is affected by our thoughts, relationships, and spirituality. Physical exercise and diet affect your mind. The eight dimensions of wellness is a good roadmap for functional medicine.9

Treating Each Dimension of Wellness in Recovery

The Substance Abuse and Mental Health Services Administration (SAMHSA) defines the eight dimensions of wellness as follows:10

  1. Emotional: Coping effectively with life and creating satisfying relationships
  2. Spiritual: Expanding your sense of purpose and meaning in life
  3. Intellectual: Recognizing creative abilities and finding ways to expand your knowledge and skills
  4. Physical: Recognizing your need for physical activity, diet, sleep, and nutrition
  5. Environmental: Good health by occupying pleasant, stimulating environments that support your well-being
  6. Financial: Satisfaction with your current and future financial situations
  7. Occupational: Personal satisfaction and enrichment derived from your work
  8. Social: Developing a sense of connection, belonging, and a well-developed support system

Why Are They All Important?

All of the aspects of your wellness are connected and impact each other. When one dimension suffers, other dimensions suffer. When you thrive in one area, other areas will also thrive. To be healthy, happy, and fulfilled, it is important to identify your wellness needs and work towards making sure that those needs are met. When in recovery, the entirety of your wellness must be taken care of so you can get the most out of your treatment. Addressing these areas together creates lasting healing.11 Brain functions can be restored, resulting in positive emotions and eliminated addictive cravings.

We now have a framework to explore modern treatment modalities. We will discuss amino acid infusions next.

Amino Acid Infusion to Add Building Blocks During Recovery

How Do Amino Acid’s Work in the Brain?

Neurotransmitters are brain chemicals that send information to your body. Neurotransmitters produce different effects on your brain; some make you feel energized while others make you feel calm.12

When you eat proteins, they break down into amino acids during digestion, and these amino acids help neurons in your brain create neurotransmitters.13 The amino acids tyrosine and tryptophan are two amino acids that support the production of dopamine and serotonin, chemicals that control how you feel.

How Does Addiction Affect Your Brain’s Amino Acids?

Tyrosine and Dopamine

The amino acid tyrosine plays a critical role in the production of dopamine because enzymes in the body can turn tyrosine into dopamine.14 Dopamine is a pleasure molecule that is linked to the reward center of the brain. Activities that we find enjoyable, such as eating or spending time with friends, releases dopamine that creates a pleasurable and happy feeling. Our brain interprets that activity as a reward, making us want to repeat the activity to feel the positive effects of dopamine again.

Other things that operate in the same reward system are drugs, alcohol, and gambling; however, these activities tend to over-stimulate dopamine production. This causes an even greater feeling of pleasure that can’t be experienced through natural dopamine-releasing activities. When stopping the use of the addictive substance, withdrawal symptoms will begin as the high levels of dopamine come down, resulting in increased cravings.14

When seeking treatment for substance use, tyrosine, which can be found in high-protein food such as chicken, turkey, cheese, milk, nuts, and seeds, can help balance out dopamine levels that are left diminished when substance use ceases.14 Low levels of dopamine can result in a low mood, fatigue, and cravings for the substance. Eating more protein during recovery, and therefore having more amino acids in our bodies, can help regulate dopamine levels during detox and recovery.14

Tryptophan and Serotonin

Tryptophan is an amino acid that is a precursor to the production of serotonin.14 Serotonin is a neurotransmitter that is responsible for feelings of happiness, optimism, regulation of mood, sleep, and appetite. Our mood, sleep schedule, and appetite are often thrown off balance by substance use disorders, which can be linked to lower serotonin levels. Low levels of serotonin are also linked to depression and other mental health disorders.

Just like tyrosine, tryptophan can be found in high-protein foods, which is why a healthy diet high in protein is recommended for people recovering from addiction. During withdrawal, low serotonin levels can contribute to low mood, sleep problems, lack of appetite, and cravings for sweet foods. Tryptophan, while not a cure for substance use or depression, can help to balance levels of serotonin and lessen symptoms of depression and withdrawal.

How Can an Amino Acid Infusion Help You Recover from Addiction?

Although more clinical evidence is needed, the use of amino acid infusions is an effective treatment for addiction.15 Because substance use disorders cause an imbalance among neurotransmitters, an amino acid infusion can help to restore the balance of neurotransmitters, restoring the brain to its normal state at a faster rate than simply changing your daily diet. This can help to reduce cravings and help alleviate the discomfort of withdrawal symptoms.16

One method of accelerating recovery is by detoxing with intravenous amino acid therapy, which includes a combination of amino acids, vitamins, and minerals injected straight into the bloodstream. They travel to the brain where they begin to balance neurotransmitters quickly. Intravenous amino acid therapy is typically completed in ten days. After that, you would continue with substance use treatment such as counseling, nutrition, exercise, etc.

Now that you replenished your amino acids, it is time for therapy to reach lasting sobriety. But there is an option that enhances the effectiveness of traditional therapy – ketamine-assisted psychotherapy.

How Does Ketamine Help the Brain Heal?

Ketamine is traditionally known as a party drug and as an anesthetic that has been used for soldiers since the Vietnam War. Ketamine was approved as a treatment for depression and other mental health disorders by the Food and Drug Administration in 2019.17 Unlike traditional antidepressants that affect one of the monoamine neurotransmitters (serotonin, norepinephrine, and dopamine), ketamine acts on glutamate, the most common chemical messenger in the brain.18

Using the Chemical Messenger Glutamate

Glutamate plays a role in the changes that synapses go through in response to experiences relating to learning and memory.17 Ketamine can help your brain to produce glutamate, which stimulates new neural connections in your brain. Strengthening these connections helps your brain regulate and process cognitive thoughts and emotions, impacting how you learn, remember, and respond to experiences.

Balancing Gamma-Aminobutyric Acid

Glutamate also plays a role in producing and balancing gamma-aminobutyric acid (GABA), which is a calming neurotransmitter.18 High levels of glutamate and low levels of GABA can result in symptoms of anxiety. Low levels of both glutamate and GABA can result in symptoms of depression. Ketamine helps to regulate these levels and promote calmness.

Increasing Resilience to Stress

Ketamine can also help to reduce stress by increasing your body’s resilience. Stress can cause structural changes in the brain, which ketamine can counterbalance by promoting synaptic growth in the prefrontal cortex and hippocampus, regulating your behavior, mood, personality development, and memory.18

Ketamine’s Enhancement of Therapy Sessions

Ketamine-assisted psychotherapy is a new approach to traditional psychotherapy where ketamine is taken during an hour-long psychotherapy session. Using ketamine during a therapy session can help with temporary relief from mental health symptoms to make the therapy more productive and effective.

Low doses of ketamine can produce changes in consciousness, expand your awareness, and provide you with a fresh lens through which to view your life, worry, anxiety, and problems.19

Studies About Ketamine in Treatment

There are many ongoing studies of how ketamine improves a wide range of mental health problems. Ketamine’s effectiveness in treating depression is supported by many peer-reviewed studies, while studies supporting the use of ketamine for other conditions like addiction are now beginning to emerge.

Ketamine and Depression

A study conducted in 2019 of 25 men with severe depression showed that ketamine-assisted psychotherapy:

  • Reduced depression
  • Improved emotional attitudes
  • Provided Positive changes in life values and purposes
  • Gave insights into the meaning of life
  • Increased level of spiritual development
  • Supported a sober lifestyle

Each patient received six doses of ketamine over two weeks. Patients were assessed before receiving ketamine, an hour after their dosage, and one month after the final dosage. Results showed that there was a significant improvement in symptoms of anxiety and depression after the 2-week treatment and one month after the final treatment.20

Transcript

00:06
so research is all about team
01:46
[Music]
02:33
[Music]
03:14
so this has been a because the FDA
03:46
and then I’m going to talk about some of
03:49
the brain mechanisms underlying creative
03:51
mechanisms that seem to be implicated in
03:54
our Kennedy but I think it’s useful to
04:03
take a step back and talk about just how
04:07
bad depression is a group like this
04:09
probably knows first the end by the
04:12
personal experiences family members or
04:14
friends how bad depression can be but I
04:18
find when I talk to groups of people
04:19
they often think that being depressed is
04:22
like having a bad day and I want to
04:25
highlight that that it’s really much
04:28
bigger than that first it’s very common
04:31
the reason most of us know someone who’s
04:34
been depressed or have been depressed
04:36
ourselves because so many people
04:38
struggle with depression depression is
04:46
the most disabling
05:01
get the kind of treatment they need
05:02
either access to the treatment or when
05:05
they get access to the treatments aren’t
05:07
as effective as they need to be lastly
05:10
depression is more useful so we know
05:15
that it has a measurable the the salmon
06:04
troubling part is that the generations
06:06
of standard cancer depressant
06:08
medications which no help so many many
06:11
people they still are not
06:53
they want me to sing into the microphone
06:56
I feel like Frank Sinatra
06:59
anyway anyway so even even at the end of
07:04
at the end of year thirty percent of
07:08
people in that study had not responded
07:10
and if you are one of the people who
07:12
were lucky enough to respond to to to a
07:16
regular antidepressant on average it
07:19
took two months to get remission so
07:24
that’s a long time to wait when you’re
07:27
when you’re depressed and in my clinical
07:30
practice well I can I feel like I can
07:33
almost always get somebody better but we
07:36
have this terrible problem which we
07:38
don’t address adequately in the field
07:40
which is relapse a return of depression
07:43
in someone who you’ve got gotten better
07:46
for a period of time in the star D trial
07:49
again if you fell into the group of
07:52
treatment resistant patients which meant
07:54
that you went to the third or fourth
07:55
step the chances of having a return of
07:58
your depression over the following years
08:00
is about 75% that’s very discouraging so
08:09
following up with doctor trainee
08:11
presented this morning it was a whole
08:14
generation of research that that he
08:17
conducted before he started doing the
08:20
ketamine work that really laid the
08:21
conceptual framework that that
08:25
that was important for discovering
08:27
ketamine and that was that there was
08:29
good reason to think that serotonin and
08:31
norepinephrine systems were implicated
08:33
in the antidepressant actions of
08:38
antidepressants that Denis and George
08:41
Henninger and Pedro Delgado others at
08:44
Yale found that if you depleted the body
08:46
of serotonin
08:47
it could transiently reverse the effects
08:50
of SSRI antidepressants
08:52
if you depleted the body of
08:54
norepinephrine it could transiently
08:56
reverse the antidepressant effects of
08:59
nora norepinephrine targeting
09:01
antidepressants and if you took the
09:03
heroic step of depleting the body of
09:06
both serotonin and norepinephrine at the
09:08
same time you could generally reverse
09:10
the effects of most antidepressants and
09:13
so but people confuse this with the
09:17
notion that serotonin and depression
09:19
were actually causing major depression
09:23
or disturbances in serotonin and
09:25
norepinephrine were causing
09:27
antidepressant and dr. Charney led the
09:29
this group of investigators to conduct
09:33
another set of studies which found that
09:37
if you give healthy people if you
09:40
deplete serotonin in healthy people you
09:43
didn’t necessarily cause depression or
09:46
if you depleted the body of
09:48
norepinephrine and dopamine you didn’t
09:51
cause depression and there was even a
09:53
study where you depleted both serotonin
09:56
norepinephrine and dopamine in healthy
09:59
people at the same time and still didn’t
10:04
produce depression and and this was kind
10:08
of like a conceptual crisis and and as I
10:12
was preparing that talk today I was
10:14
reminded of a quote from Ernest
10:16
Rutherford who was called the father of
10:18
nuclear physicist and Nobel laureate one
10:21
of the smartest men who who ever lived
10:25
and and and there’s a quote of him he
10:28
says gentlemen we’ve run out of money
10:30
it’s time to start thinking and and this
10:33
is what what you know you come to a
10:36
conceptual crisis
10:38
and sometimes that’s the most exciting
10:40
and creative moment out of all the
10:43
research and so I used to go up at the
10:46
end of the as Dennis said this morning I
10:48
used to go up to his office at the end
10:49
of the day and we toss a toss up you
10:53
know ideas for research studies and deal
10:55
with issues that were coming up why did
10:57
I go up to his office because because
10:59
his office was much nicer than my office
11:01
so so that was it was a good place to go
11:04
so so we would we said we simplified the
11:12
problem into a very simple idea and the
11:16
idea was that that almost all of the
11:21
research on depression at that time
11:23
believed that the pathology of
11:25
depression lay in the cells that release
11:29
norepinephrine or serotonin these are
11:31
cells that live in primitive parts of
11:33
the brain and and have a role in tuning
11:37
the activity of the higher centers of
11:39
the brain the higher centers that
11:41
actually generate and regulate mood the
11:44
cortex and the limbic system we said
11:47
well what if we turn that problem on its
11:49
head what if the pathology doesn’t lie
11:52
in the nora nephron and serotonin
11:54
systems but that these are systems that
11:57
can be recruited to try to treat
11:59
depression what if the primary pathology
12:02
actually lives in the cortex and limbic
12:04
system cells themselves what if it lives
12:07
there one profound implication of this
12:11
simple shift in perspective is that it
12:15
made us think about different
12:17
neurotransmitter systems in depression
12:19
in other words the cortex and limbic
12:22
system used glutamate in gaba
12:24
as their primary signaling mechanisms
12:27
not system not chemicals like serotonin
12:30
and norepinephrine so we thought well
12:33
what what would be the best way to probe
12:36
the role of glutamate in depression and
12:39
it just so happens that it was sort of
12:43
like Reese’s Peanut Butter Cup
12:44
commercial Dennis brought his depression
12:47
issue and I put my ketamine my glutamate
12:51
into his
12:52
depression because I had been working on
12:56
on glutamate psychopharmacology and
12:59
studying the drug ketamine in relation
13:02
to the biology of higher cognitive
13:04
functions and psychosis and and we had
13:08
found dose related effects of ketamine
13:11
and we had used a dose primarily as dr.
13:16
Charney mentioned earlier of 0.5
13:19
milligrams per kilogram over 40 minutes
13:21
this was a dose that had robust
13:26
cognitive and behavioral effects but
13:28
didn’t impair people from performing a
13:31
variety of tasks when we gave that same
13:34
dose to people with depression we got
13:38
these results which is this within our
13:41
some alleviation of depression and was
13:44
within 24 hours there are actually some
13:47
people who said oh my depressions all
13:50
better and one of the most important
13:53
things that you should take away from
13:54
this figure is that the the
13:58
antidepressant effects are not
14:01
overlapping with and not in any way
14:03
related to the euphoric effects there is
14:07
no persistent euphoria that accounts for
14:10
the antidepressant effects of ketamine
14:12
in fact all of those effects go away
14:15
long before the antidepressant effects
14:17
emerge so in a way and I’m gonna come
14:21
back to this later the antidepressant
14:24
effects of ketamine are a brains
14:26
reaction to having been exposed to
14:29
ketamine and it does not produce
14:32
elevated mood and everybody it is not a
14:35
drug that you give to healthy people to
14:38
improve their moods
14:39
because if healthy people get ketamine
14:42
mostly what they experience during this
14:45
window when people with depression are
14:47
feeling better most healthy people are
14:49
feeling hungover
14:56
most healthy people are feeling hungover
15:00
like they have they’ve had too much to
15:02
drink the night before okay okay so I’m
15:06
gonna have I’m gonna have someone who’s
15:08
actually gone through it tell you a
15:10
little bit about what it’s like to have
15:11
ketamine as a treatment I’ve been in
15:15
treatment pretty consistently since I
15:17
was in middle school a combination of
15:20
different styles of therapy as well as
15:22
different medications and my functioning
15:24
was pretty high but I tended to still
15:29
really struggle with these feelings of
15:31
just profound Alumnus and despair and
15:38
about three years ago I kind of slipped
15:41
into what I would consider a very severe
15:43
depression in receiving intravenous
15:46
ketamine and the day after I received my
15:51
first treatment I felt like myself but
15:55
what was strange was it’s like immediate
15:57
the next day I woke up and I felt I
16:00
could internalize good things about
16:03
myself I could feel positive feelings I
16:07
could feel feelings in general the
16:09
gratitude I have for this treatment and
16:13
so thankful I live in an area where
16:16
there’s such innovation happening I
16:18
didn’t even know this
16:21
it wasn’t intended to be a commercial
16:24
here but but but you get a feeling that
16:27
this is a remarkably transformative
16:29
experience for many people it’s not just
16:31
a lightening of their depression but but
16:34
in some fundamental way in alleviation
16:37
of the suffering that they’ve had with
16:39
with depression and it is generally
16:42
sustained by periodic administration of
16:45
ketamine or now s ketamine in order to
16:50
maintain the benefit on a longer-term
16:52
basis as is dr. Charney noted one of the
16:57
most striking things about the rapid
16:59
antidepressant effects of ketamine is
17:01
the ability to reduce suicidal ideation
17:04
and the possibility that ketamine may
17:07
play a role in helping to manage
17:10
severely depressed people who have not
17:13
responded to other kinds of treatments
17:15
and who have prominent suicide present
17:19
prominent suicide risk lastly as I
17:24
mentioned oftentimes in psychiatry you
17:28
can get somebody better but only to find
17:31
that their symptoms return over time and
17:33
one of the striking D PSA’s of data from
17:36
the development of s ketamine or privado
17:38
the Janssen drug was that people who
17:42
responded to the combination of a new
17:44
antidepressant and ketamine were
17:47
randomized to either stay on ketamine or
17:49
to stop taking the ketamine and if they
17:52
stop taking their ketamine over a year
17:55
they had almost a you know 58% chance of
17:59
relapse whereas if they stayed on the
18:01
ketamine that risk was substantially
18:04
reduced this is a very low rate of
18:07
relapse for patients and treatment for
18:09
treatment-resistant depression remember
18:11
in the star DS study people who were had
18:15
had remitted there had a 75% chance of
18:20
relapsing over a year here if they stay
18:24
on a new antidepressant it was about 60%
18:27
and about less than half if they stayed
18:32
on their cat
18:35
so so this is an exciting time ketamine
18:39
and maybe other drugs that will follow
18:42
it like ketamine s ketamine and other
18:45
drugs that may follow it may produce
18:46
rapid relief may have some value for
18:49
treatment-resistant symptoms of
18:51
depression and protection against
18:54
relapse so how does ketamine work and
18:57
and I think when when Time magazine did
19:01
its article about ketamine they called
19:03
it the anti antidepressant and I think
19:06
that’s really a kind of a neat way to
19:09
think about how ketamine works in the
19:12
brain in order to tell you a little bit
19:15
about how ketamine works I want to
19:17
introduce you to the cerebral cortex in
19:20
particular you can start the movie in
19:25
particular this is a slice of the brain
19:27
and you’re looking at the glutamate
19:28
neurons in the brain and and this is
19:30
from the work of Jeff Lichtman at
19:33
Harvard University and if you zoom in
19:36
close on a glutamate neurons you’ll see
19:39
these very interesting structures these
19:43
blebs
19:44
sticking out here these blobs are called
19:47
dendritic spines and they are the sites
19:50
where glutamate cells communicate with
19:52
each other in the brain in other words
19:54
the inputs attach themselves to the
19:58
dendritic spines in order to make
20:01
synaptic connections right two minutes
20:05
okay now I’m gonna speak incredibly fast
20:09
because I have two minutes
20:11
now I we can get the the basic ideas
20:15
apart so here you see the dendritic
20:18
spines like the like in the pictures
20:20
that you just saw in under stress and
20:23
animals those dendritic spines are
20:25
depleted but rapidly after a single dose
20:27
of ketamine those spines grow grow back
20:30
and make new synaptic connections in
20:33
animals is that relevant to patients
20:35
with depression well the first question
20:37
is are there reduced and are there
20:40
reduced synapses synaptic connections in
20:43
the brains of people with depression now
20:45
in Rina Esther lists and Sofie homes in
20:47
our collaborative group did a study
20:50
using a pet tracer that binds to the the
20:53
nerve protein in the nerve endings of of
20:56
nerve cells and showed that in patients
20:59
with severe depression and even some
21:01
with comorbid post-traumatic stress
21:03
disorder that there are in fact
21:05
reductions in this pet marker for
21:08
synaptic density associated with
21:10
depression equally important was that
21:13
those reductions in synaptic density
21:15
were associated with poor communication
21:18
between areas and the brain involved in
21:21
the regulation of mood so what is the
21:24
relationship between that and the
21:26
antidepressant effects Academy here you
21:29
see a study that actually came from
21:30
doctors Charney’s group but it was
21:32
written by led the analysis was led by
21:36
someone in our group chatty abdullah and
21:38
and this is a study showing that there
21:40
are reductions in cortical communication
21:44
or what’s called functional connectivity
21:45
in patients with treatment resistant
21:48
major depression but 24 hours after a
21:51
single dose of ketamine the those
21:53
reductions go away
21:55
so in animals you have deficits in
21:59
synaptic connectivity that are restored
22:01
by ketamine in patients with depression
22:03
you have deficits in synaptic density
22:06
that are associated with impaired
22:09
functional connectivity and that
22:10
impaired functional connectivity is
22:13
alleviated by a single dose Academy
22:16
so in summary summary what I’ve shown
22:20
you some evidence that ketamine
22:21
constitutes a kind of fundamentally new
22:23
way to think about the tree
22:25
of depression particularly
22:27
treatment-resistant symptoms of
22:29
depression given its rapid
22:31
antidepressant effects and the fact that
22:33
it’s given very intermittent ly as
22:35
opposed to a kind of a drug you take
22:37
daily I’ve shown you some evidence that
22:40
it works through some fundamentally new
22:42
mechanisms for affecting brain structure
22:46
and plasticity and that although I
22:50
didn’t go into today as we unravel the
22:54
biology about how ketamine works we’re
22:56
learning new things that might point to
22:58
other types of treatments for depression
23:00
as well so again this has been a really
23:04
exciting story to be a part of a thrill
23:07
to share with with from the early days
23:10
of this work with Dennis Charney and and
23:12
even more exciting to see it amplified
23:16
in society so thank you very much
23:19
[Applause]
23:24
you did it great yes sir
23:28
I’m yeah yeah yes sir Oh rather than
23:38
looking at it for depression with
23:41
bipolar and mental illness depression
23:44
why are you limiting it to just I don’t
23:47
know the the treatment-resistant okay so
23:51
that so so the question is why are we
23:53
limiting why has the fda limited the
23:57
approval of ketamine to people with
24:01
treatment resistant depression and the
24:02
answer that study is that the studies
24:06
that were conducted by Janssen with
24:08
spray bottle were of patients with
24:11
treatment resistant depression not the
24:12
other subgroups of depression however
24:14
the academic investigators have in fact
24:17
studied the efficacy of ketamine for
24:22
other forms of depression like bipolar
24:24
depression and found evidence of
24:27
efficacy so Carlos Zarate in particular
24:30
working in Dennis’s pod and I imagine
24:33
and then continuing on has found that it
24:36
is helpful for bipolar depression there
24:39
in patients who have bipolar one
24:41
manic-depressive illness there’s a there
24:43
is some concern about stimulating
24:46
hypomania so it’s recommended that
24:49
people stay on mood stabilizing
24:51
medications but but it has been tested
24:55
in bipolar depression
24:59
how long is ketamine been around you
25:02
said in one of your slides it was
25:04
originally an anesthetic brand and and
25:07
at what point did you say why don’t we
25:10
try this at old anesthetic and street
25:13
drug how did you happen to move to that
25:16
right so yeah so for us detroiters
25:21
ketamine was discovered in the early
25:24
1960s in Ann Arbor and first tested by
25:28
Edie Domino who was an investigator at
25:32
the University of Michigan and
25:33
collaborated with the group at Lafayette
25:34
Clinic
25:35
Detroit and but when it was discovered
25:40
people had no idea how it affected the
25:42
brain
25:43
it wasn’t until 1983 that it was figured
25:47
out that ketamine blocked a receptor for
25:50
the transmitter glutamate and it was not
25:52
that far after that time that in in
25:55
around 1989 where I wanted to once we
25:59
knew how it worked where we wanted to
26:01
employ it as a pharmacologic tool in
26:04
research and from 1989 it was only until
26:08
1995 where we started to depression but
26:11
I think your your question raises an
26:13
important important important point we
26:16
first reported the antidepressant
26:19
effects of ketamine in 1997 at the
26:21
Society of Biological Psychiatry meaning
26:24
and it didn’t get approved as a
26:25
treatment for depression until 2019
26:30
right so it gives you some idea how long
26:34
and slow the research process is and how
26:37
initial research in this program in a
26:41
way started out as a psychosis research
26:44
program around 1990 right so 30 years so
26:49
so research you have to be in it for the
26:54
long game because even when you think
26:57
you aren’t to something really big it
26:59
can take a really long time to to to
27:02
develop into real treatment one more
27:05
unfortunately yes sir yeah oh well maybe
27:09
we’ll give it to both of you get go
27:11
ahead go ahead teachers at the same time
27:17
and this happily if I can process that I
27:19
see that there’s been research done and
27:22
ongoing with psilocybin for depression
27:25
and I wanted to know if you’re involved
27:27
with that at all and most importantly or
27:29
importantly what the sense is at this
27:32
stage between how psilocybin compares to
27:35
ketamine yeah so we can’t so there is
27:39
research on going to look at whether
27:41
psilocybin has antidepressant effect I
27:43
don’t think we know the answer to that
27:45
yet it is there have been some
27:47
preliminary report
27:48
but they don’t meet our standard of
27:50
evidence yet to say that it’s an
27:52
antidepressant there is an a psilocybin
27:56
study for depression ongoing in our
27:59
medical center test testing it we don’t
28:03
know what the results of that study will
28:05
be yet
28:06
and I but and so we can’t really compare
28:10
ketamine where we know what it’s
28:11
antidepressant effects are to something
28:15
that we don’t yet know whether it’s even
28:16
antidepressant yet but I will say that I
28:20
think that that the path that we went
28:23
through ketamine to test ketamine was
28:25
one to where we challenged the status
28:28
quo and and we’re willing to rigorously
28:33
carefully evaluate a novel treatment
28:35
mechanism so I am I I think that
28:39
psilocybin is a treatment that needs the
28:43
same kind of rigorous careful evaluation
28:47
and and there are there are you know
28:50
this is a contentious area so there are
28:52
ways that it could go awry on both sides
28:54
one that there are advocates who want to
28:57
see it used before it’s a validated
28:59
treatment I don’t support that there are
29:01
people who think it’s a terrible drug
29:03
and should never be study I don’t
29:04
support that either I’m I’m more of a
29:07
cautious okay last question yes sir
29:12
oh well I guess not okay no but well he
29:16
had been waiting patiently back here yep
29:20
it’s nice to see this what she
29:23
enthusiastically answer
29:29
so the the studies you showed people are
29:34
taking as scattered me but they’re still
29:36
taking their traditional tricyclic yeah
29:38
it’s a person so it’s not so much I
29:41
don’t know it’s not like you’ve turned
29:42
this thing on its head or it’s Time
29:44
magazine the anti antidepressant you’re
29:46
still using these traditional methods
29:49
that are related to dopamine and
29:51
serotonin and norepinephrine in
29:54
combination with s ketamine right except
29:57
I don’t think that the SSRI is necessary
30:00
the only reason people are staying on
30:02
the SSRIs in these studies is because
30:05
it’s almost impossible to get people to
30:08
go off their antidepressant medications
30:10
to try a new medication it’s really hard
30:13
and so the answer is we are now there
30:16
are now studies being initiated to test
30:19
ketamine without the SSRIs in order to
30:22
determine whether the SSRIs play in so
30:24
we’re gonna have to stop it’s really
30:26
really nice to see the kind of
30:29
enthusiasm that we’ve got here

Ketamine and Substance Use Disorders

A 1997 study into the efficacy of ketamine treatment for a group of people with an alcohol use disorder showed promising results for ketamine treatment.21 A control group received conventional and standard methods of treatment for alcohol dependence whereas the other group received an intramuscular injection of ketamine. After a year, only 24% of the control group were still sober whereas 66% of the ketamine treatment group maintained sobriety.

  • Only 24% of the Control Group Were Still Sober 24% 24%
  • 66% of the Ketamine Treatment Group Maintained Sobriety 66% 66%

Knowing how ketamine can assist and enhance your addiction treatment therapy, let’s look at some forward-thinking takes on psychology that help recovery.

Positive Psychology in Recovery

What is Positive Psychology?

Positive psychology has been accurately defined as the following:

“[P]ositive psychology is a scientific approach to studying human thoughts, feelings, and behavior, with a focus on strengths instead of weaknesses, building the good in life instead of repairing the bad, and taking the lives of average people up to “great” instead of focusing solely on moving those who are struggling up to “normal.”22

For example, our positive psychology approach focuses on 10 Principles of Recovery:

  1. Accountability
  2. Purpose
  3. Hope
  4. Gratitude
  5. Spirituality
  6. Self-Worth
  7. Courage
  8. Forgiveness
  9. Service
  10. Integrity

We will focus our discussion of positive psychology in recovery with the concepts of resiliency and gratitude. Then we will move on to the concepts of self-love and positive reinforcement.

Building Resiliency to Help Recovery

The term ‘resilience’ comes from the Latin word ‘resilio,’ which means to bounce back.23 Resilience is the ability to recover from and push through adversity and difficulty, which is a huge aspect of the recovery process.

How Resiliency Helps in Recovery and Beyond

Resiliency can help in the recovery process to push through treatment even when it gets hard, or when it seems like it will never get better, or when you experience a relapse.

Resilience involves taking a step back, evaluating the situation, and moving forward from it rather than giving up. Building resiliency includes:

  • Learning from the past, including successes and failures
  • Accepting that change will happen and adapting to it
  • Recognizing that having a strong support system is important during the recovery process
  • Focusing on self-care
  • Being grateful
Transcript

00:01
[Music]
00:07
you
00:08
[Music]
00:19
in 1997 my hometown Nashua New Hampshire
00:24
was labeled the best place to live in
00:26
the United States it’s a small beautiful
00:29
city of cultures from all around the
00:32
world a melting pot of hopeful
00:34
immigrants raising new families and
00:37
natives who have called New Hampshire
00:39
home for centuries if you were to visit
00:42
today you could enjoy our beautiful
00:44
parks get a bagel on Main Street or
00:47
everyone’s favorite part
00:48
enjoying our no sales tax shopping
00:51
visitors are usually mesmerised by its
00:55
incredible beauty which is why it’s
00:58
difficult for people to believe that
01:00
such a kind place is America’s ground
01:04
zero for the opioid epidemic it’s true
01:11
and the beautiful layer the visitors get
01:15
to enjoy is a dark truth of substance
01:18
abuse and addiction tearing apart
01:21
communities and families in 2015 over
01:25
400 people died of overdose related
01:28
deaths a 250 percent increase from 2011
01:32
but that it’s just a surface of the
01:36
effect and the opioid epidemic has had
01:39
underneath the layer of overdose rates
01:41
that is caught the world’s attention is
01:43
a community of youth that have been
01:46
neglected and forgotten children are
01:51
losing family members seeing addiction
01:54
and drugs in their own homes and
01:56
negligence of the issues they face has
02:00
allowed a culture of teen drug abuse to
02:03
breathe as a National Institute of
02:06
changing drug abuse reports New
02:08
Hampshire you to consistently rank in
02:11
the top five US states so the highest
02:13
teen cocaine heroin and prescription
02:16
drug abuse the question
02:20
the people from New Hampshire have been
02:23
asking themselves for years is why us
02:28
and unfortunately it’s impossible to
02:33
answer this question accurately for the
02:36
Dartmouth Center for technology and
02:38
behavior Health’s points the three that
02:39
contribute significantly the first
02:42
prescription medical institutions in New
02:46
Hampshire prescribe opioids
02:48
at a much higher rate than the national
02:50
average while having the least funded
02:53
per capita treatment facilities to give
02:55
care to those who need rehabilitation
02:58
the second is accessibility the ease of
03:01
access to drugs is so incredibly high
03:04
and only getting worse as dr. Lisa Marsh
03:07
at Dartmouth reports a new drug fentanyl
03:10
which can be made in homes and be sold
03:12
for less than a six-pack of beer is
03:14
making the prevention of a distribution
03:17
nearly impossible but surprisingly it’s
03:21
a third one social that contributes the
03:24
most to New Hampshire’s vulnerability
03:28
Dartmouth C tbh finds that the rural
03:31
nature of New Hampshire towns combined
03:33
with the reclusive culture has created
03:36
an environment where people don’t really
03:38
build large social groups and don’t
03:41
really build long-lasting healthy
03:43
relationships with the people around
03:45
them to understand why this contributes
03:48
so significantly to new hampshire’s
03:50
vulnerability we have to understand how
03:52
addiction itself really works an amazing
03:57
exemplification of this is an experiment
04:00
done by psychologist Bruce Alexander
04:01
called the rat Park and this he creates
04:04
two cages one the first one were just
04:08
one rat nothing to do no one else and
04:11
given two water bottles one normal and
04:16
one laced with morphine consistently
04:20
this rat would become addicted to the
04:23
morphine water and dive in overdose but
04:28
Alexander extended his experiment and
04:29
created a rat Park
04:31
a community of rats that could played
04:32
together toys that they could use and
04:35
the same to water models normal and one
04:39
lay some morphine in this rat cage
04:42
rarely would a rat become addicted to
04:45
the morphine water this experiment shows
04:49
us that of social environment or a lack
04:53
of can contribute significantly to
04:55
addiction as Johann Harry a journalist
05:00
put said the opposite of addiction is
05:01
not sobriety but connection with
05:06
Dartmouth Ct BHS findings about the lack
05:08
of social environment New Hampshire
05:10
tells us combined from what we learned
05:12
from the rat Park experiment is that the
05:14
rural nature’s of New Hampshire towns
05:17
literally makes it just like the first
05:19
rat cage so how do we solve that how do
05:24
we make people connect more a possible
05:29
solution positive psychology positive
05:34
psychology is defined as a study of what
05:37
makes life worth living
05:38
what keeps a person ticking is it
05:41
friends family goals a sense of
05:44
belonging its objective on each person
05:46
and it varies but using positive
05:48
psychology a person can help a patient
05:50
understand what keeps them going and a
05:53
large part of it is mindfulness be
05:56
mindful to yourself to the people around
05:58
you your environment which is basically
06:01
understanding things for the way they
06:02
are and appreciating them rather than
06:05
judging them negatively so what does
06:08
that mean well before we delve in
06:11
further to the applications of positive
06:13
psychology in New Hampshire let’s do a
06:16
brief demonstration so I ask everyone to
06:19
close their eyes and I want you to slow
06:25
down your breath and count your breasts
06:27
with me 1 2 3 1 2 3
06:36
and on your mind I want you to imagine I
06:39
think or a person or place that you’re
06:45
thankful and in your mind I want you to
06:49
tell that think that you’re appreciative
06:51
of it and that you are so blessed to
06:55
have it in your life and once you’ve
06:58
done that open your eyes
07:03
that is a very brief demonstration or
07:06
what a positive psychology session would
07:08
look like essentially the goal of
07:11
positive psychology is to integrate a
07:13
mentality of positive thinking and
07:15
appreciation into a person’s life and
07:18
this is done mostly by looking into five
07:21
main methods the first deliberate
07:23
breathing that we just did the
07:25
meditation mind and mental games
07:27
communication and practicing gratitude
07:29
and through these five methods we focus
07:33
on six main pillars of positive
07:35
psychology the first is self-awareness
07:38
understanding who you are what your
07:40
needs are the things you value and the
07:43
things you’re thankful for in
07:45
self-regulation are you taking care of
07:48
yourself
07:48
are you eating three meals a day have
07:51
you sleeping enough are you meeting your
07:52
daily goals and your long-term goals
07:55
the next is optimism taking the people
07:59
around you the events around you
08:00
interpreting the good out of it fourth
08:03
mental agility keeping your mind quick
08:04
focused and coordinated fifth strength
08:07
of character taking the characteristics
08:10
you want to see in your own life and
08:11
practicing them like confidence kindness
08:14
temperance the sixth is connection the
08:17
most important in the foundation
08:18
building long lasting relationships with
08:21
the people around you whether they’re
08:22
peers co-workers friends family and if
08:27
you can practice these six things in
08:29
your life you’ll reap the benefits of
08:31
resilience and building connection
08:33
because positive psychology has been
08:36
proven to be able to do both of those
08:37
things but often the positive psychology
08:41
is misunderstood to be a pseudoscience
08:44
how could such a thing work and it
08:46
really isn’t
08:48
for many years it has been used to treat
08:50
ADHD and clinical depression and anxiety
08:53
studies by the University of
08:56
Pennsylvania show that it reduces
08:58
symptoms of depression and anxiety
08:59
improves mental health and reduces
09:01
addiction and dependency on substances
09:03
and everyone who went through positive
09:07
psychology training reported being able
09:09
to build healthier and longer lasting
09:11
relationships with the people around
09:12
them but when applied to children upends
09:17
adolescent training program found that
09:19
young students were also able to build
09:21
much larger in healthier social groups
09:23
and it cut in half the rate of moderate
09:27
to severe depression and anxiety
09:28
symptoms and dr. Himelstein or the
09:32
center of behavioral health found that
09:35
in youth there was a decrease in
09:37
impulsivity and substance craving but
09:43
the most fascinating thing was that when
09:45
tested two years after all the benefits
09:49
were proven to continue showing that
09:51
it’s long lasting effects
09:55
so does this mean we know the benefits
09:59
of positive psychology we know the
10:02
characteristics of places like New
10:04
Hampshire and what makes them vulnerable
10:05
to opioid epidemics so could a possible
10:10
long term preventive strategy to the
10:13
opioid epidemic be the Train youth at
10:17
risk cities like Nashua and positive
10:20
psychology the answer is we don’t know
10:26
what we do know is that positive
10:29
psychology has been used for years
10:30
to treat addiction it improves mental
10:33
health and helps build healthy
10:35
relationship in small quantities but
10:37
never hasn’t been used as a tool to
10:41
fight the opioid epidemic at the city
10:43
level but the research is there and
10:47
professors agree that such a program
10:49
could work so that’s exactly what we
10:52
tried to do this year I wrote a few
10:55
organizations a group of high school
10:57
students and we trained high school
10:58
volunteers in positive psychology
11:00
and then once a week for an hour a day
11:03
they will go to elementary schools the
11:05
middle schools and teach young students
11:07
elementary middle school students in
11:09
positive psychology they do the sessions
11:11
like we just did the delivery breathing
11:14
they have ample time to play group
11:17
activities and to socialize and we have
11:19
two volunteers to focus on five main
11:21
principles during the meetings the first
11:23
is mindful self the belief that a
11:26
volunteer cannot be an effective teacher
11:28
the first embracing the ideas the
11:30
positive psychology into their own life
11:33
second is mindful system using the ideas
11:36
of positivity and appreciation to create
11:38
a welcoming environment for all the
11:39
students
11:41
third is mindful awareness instruction
11:43
taking those elements of positivity and
11:46
appreciation and bringing it to their
11:48
interactions with the students mindful
11:51
integration is teaching the students
11:54
positive psychology to the sessions
11:56
teaching them how to be positive how to
11:58
be appreciative how to be mindful which
12:01
leads us to the last one mindful living
12:02
how do you bring that mentality a
12:04
positive thinking appreciation into
12:06
their daily lives the essential goal of
12:08
positive psychology so they do this once
12:12
a week for a full year but how do we
12:14
know what’s working to find out we
12:18
created a series of six benchmark
12:19
assessments self-esteem goals optimistic
12:24
view of the world independence from
12:26
social influences strength of character
12:28
and optimistic view of people and each
12:30
one corresponds to an activity that the
12:34
volunteers will run with the students
12:35
and then we teach him how to evaluate
12:37
their responses on a scale of one to
12:39
five and if they’re able to show
12:42
progress in our benchmark assessments
12:43
versus the group of students who didn’t
12:45
go through the training that means that
12:47
the training is effective and since the
12:50
benchmark assessments correspond
12:52
directly to the six pillars of positive
12:54
psychology we went through earlier this
12:57
means that showing progress and the
12:58
benchmark assessments means progress in
13:01
integrating positive psychology into
13:04
their own lives meaning that the
13:06
training if progress has shown would it
13:09
be an effective long-term strategy
13:13
and from there the city can bring this
13:16
into the education system bring the
13:18
training a positive psychology to every
13:20
single student so that every single
13:21
person who graduates from the Nashville
13:23
public school education system would be
13:26
trained in positive psychology it’s an
13:28
innovative and unique approach to make a
13:32
city more resilient from the ground up
13:34
to stop addiction and dependency on
13:37
substances before it starts but there’s
13:41
many things that cause the opiate
13:43
epidemic and this is and could just be a
13:47
drop in the bucket of solutions it’s a
13:51
complex issue with no easy solution and
13:54
the biggest adversity New Hampshire has
13:57
had to face in decades but until we all
14:00
come together and put our drops into the
14:03
bucket our community our friends and our
14:05
families can’t hope for a better future
14:08
in a divided world New Hampshire is a
14:12
unique place it asks us to forget
14:14
religion politics and race and to come
14:18
together to be part of and help
14:20
something bigger than ourselves our
14:22
strength is in our unity and our future
14:25
is in the community we build thank you
14:33
you

 

 

 

Healing from Addiction with Gratitude

Gratitude is the practice of being thankful for the things in your life and showing appreciation for them. Gratitude can be helpful in recovery because it involves a positive and optimistic mindset. Those who practice gratitude are not only more optimistic; they are also better at dealing with challenges, have more energy, feel more in control of their lives, think more clearly, experience less stress, and live longer.24 Suffering from substance use disorders can result in negative mindsets and negative patterns of thinking, which are detrimental to the healing process. Gratitude can help you break out of that negative cycle.

Loving Yourself in Recovery

For as long as addiction has been identified, there has been a stigma attached to it. Some people still falsely believe that addiction is a choice, and associate it with negative stereotypes like being lazy or a criminal.25

The reality is that substance use disorders can affect anyone.

Whether it is alcohol, drugs, or prescription medicine, no one is immune to substance use. For that reason, it is essential to try to remove the stigma from yourself and others who are struggling with substance use disorders.

Once the stigma is eliminated, you can see yourself as a valuable human being who is struggling with a medical condition. That mindset will increase your self-esteem and lead to the ultimate goal of loving yourself.

Positive Reinforcement for Self-Esteem

Self-esteem refers to your feelings of personal self-worth and value.26 People living with addiction tend to suffer from low self-esteem, as they start to believe that they don’t deserve to be happy and healthy. This is due to experiencing effects of depression and anxiety. Ways that you can focus on positive reinforcement to build up your self-esteem during recovery are:

Writing affirmations: affirmations are simple, positive statements you say or write about yourself

Forgive yourself for your past mistakes, try not to dwell, and move forward

Accept compliments and positivity from others

Do something kind for someone else every day; it will make you feel good

Know that you deserve to recover, and you are worthy of living a happy and healthy life, for yourself and your friends and family

Knowing your end goals is only one step in the healing process; you also need to learn how to reach them. That is where healthy habits assist with your recovery.

Learning Healthy Habits in Recovery

Healthy habits are actions you can learn that improve your life and positively impact your recovery journey. There are many different beliefs on how to learn healthy habits. We will discuss two of the main ways: SMART Goals and Tiny Habits.

SMART Goals

SMART is an acronym for Specific, Measurable, Achievable, Relevant, and Time-bound, and is a way to set achievable goals.27 Planning exactly how you will achieve your goal makes you much more likely to succeed. When it comes to substance use treatment, setting small and achievable goals throughout recovery can help you stay motivated and feel as though you are succeeding in treatment. SMART goals can also be applied to all other aspects of life and the goals you want to achieve.28

The Concept of Tiny Habits

When trying to make changes to our habits and lifestyle, it can be overwhelming to think that we need to make big changes and drastically adjust our lives. This can often deter us from even trying to make changes because we think that we won’t be able to achieve such a change, which leads to disappointment and self-criticism. This is where the concept of tiny habits comes in.

According to BJ Fogg, a behavioral scientist at Stanford University and author of the book: Tiny Habits: The Small Changes That Change Everything, a tiny habit is so simple and tiny as possible so that you have no excuse not to do it.29 For example, if you want to start reading, instead of thinking to yourself, I need to read a whole book, tell yourself you are going to read one paragraph.

This makes it so that even if you’re busy, or tired, or not feeling well, you can still accomplish your tiny task. The next step is to fit your tiny habit into your existing routine. For example, reading a paragraph before bed. The third step is to celebrate your tiny habit so that your brain associates a positive reward to the habit, which will help your tiny habit to become a new lifestyle habit.

We outlined how the eight dimensions of wellness impact your recovery early in the article. Now we will look specifically at three areas that are essential to holistic healing fitness, nutrition, and sleep.

Holistic Healing for Addiction

Physical Fitness During Recovery

Physical exercise is healthy for anyone but can particularly help with the treatment of substance use. For starters, it can help you create a healthy routine and something to structure your day around when balancing recovery and work.

Long-term fitness can also improve cardiovascular health, which lowers your risk of diabetes and cancer and stimulates the immune system.30 Research also shows that regular exercise can improve symptoms of depression and can increase the number of new nerve connections in your brain, which helps to heal the brain from addiction.31

When you exercise, your body releases chemicals called endorphins which reduce pain and trigger feelings of positivity. Regular exercise can also help improve sleep patterns and the quality of your sleep.32

How Do You Improve Physical Fitness in Recovery?

The key to improving your physical fitness during recovery is to start small. You don’t need to suddenly work out five times a week at a gym; even taking a short walk around the block a couple of times a week can make a difference; everyone starts from a different place.

Try to find something you like doing, whether that is walking, swimming, dancing, tennis, fitness classes, or yoga. Any activity where you take time out of your day to focus on movement will make a difference. The best addiction treatment programs will have you work with an exercise physiologist to learn which types of exercise are best for you.

Nutrition During Recovery

Addiction takes a toll on your nutritional health. Substance use often leads to poor nutritional health because many substances affect eating habits and digestive systems. Substances such as stimulants can suppress appetite and disrupt metabolic and neuroendocrine regulation, which leads to incorrect calorie consumption and reduced nutrient processing.33 Other substances may cause an increase in appetite and lead to weight gain, or unhealthy food choices. 34

Substance use also causes vitamin and mineral deficiencies, damage to vital organs and the nervous system, and an impaired immune system. These all contribute to long-term health problems, such as metabolic syndrome, diabetes, hypertension, weight problems, and eating disorders.35

How Proper Nutrition Fuels Your Body and Recovery

Proper nutrition, an overall healthy diet, and a healthy lifestyle help to restore physical and mental health during recovery. Carbohydrates, the body’s main source of energy, help your body and brain to function. Without adequate carbohydrates in your diet, your brain can’t function properly, your blood sugar levels become unstable, and neurotransmitters in the brain become disrupted.36 Carbohydrates also help to produce serotonin which makes us feel happy and optimistic, helps us to sleep, and helps to curb food cravings. Low levels of serotonin can result in depression, irritability, and sleep problems.

Overall, a healthy diet consisting of carbohydrates, amino acids, healthy fats (omega-3 fatty acid), vitamins and nutrients (iron, folate, B6 and B12), adequate hydration, less sugar, and lower levels of caffeine can have a significantly positive impact on physical and mental health, and can drastically support the treatment process.36

Yoga and Meditation During Recovery

Yoga and meditation have been shown to have positive effects on individuals who are in recovery. This is because yoga and meditation can help provide stress relief and help to regulate the stress response system.37 They can also help you observe your feelings and emotions without necessarily acting on them. This can be helpful when trying to resist drug or alcohol cravings. Because substance use can make you feel out of control, yoga and meditation are a way of taking control of your mind and finding more positive ways of thinking.

Sleep Hygiene for Recovery

Healthy sleep habits help you recover from addiction.

What Is Sleep Hygiene?

Sleep hygiene is the practice of having good sleeping habits. This includes:38

  • Consistency going to bed at the same time every night and waking up at the same time every morning
  • Making sure your room is quiet, dark and at a comfortable sleep temperature
  • Not having electronic devices (smartphone, TVs, computers) in the bedroom at night
  • Avoiding large meals, caffeine, and alcohol before bed
  • Exercising during the day to help you fall asleep better at night

How Does Proper Sleep Help You Recover?

Substance use can drastically impact your sleep schedule, which can negatively affect your overall health. According to a study in the Journal of Addiction Medicine, insomnia occurs five times as much in those in early recovery as in the general population.39 Substance disorders can also contribute to circadian rhythm disorders, parasomnias, and sleep apnea. 39

Sleep is critical in recovery because sleep deprivation can lead to a low mood, impulsivity, irritability, and poor emotional regulation; which can increase the risk of relapse.40

Now that you are beginning to understand the importance of exercise, nutrition, and sleep, let’s learn about the brain’s powerful ability to work around any damage caused by substance use. That ability is known as neuroplasticity.

Neuroplasticity and Rewiring the Brain

Neuroplasticity is a newer buzzword that is used in medical treatment. Neuroplasticity helps you recover from addiction; here’s how.

The Concept of Neuroplasticity

Neuroplasticity is the brain’s ability to restructure itself by creating new neural connections throughout our lives.41 Neuroplasticity allows the neurons/nerve cells in the brain to change in reaction to injury and disease and to adjust their activity to accommodate new situations or changes in the environment.

Brain reorganization occurs when undamaged axons grow new nerve endings to reconnect neurons whose links were injured or severed.42 Healthy axons can also sprout new nerve endings and connect with other healthy nerve cells to form new neural pathways that can improve brain functioning. For example, if one area of the brain is damaged, the healthy parts can take over some of the functions of the damaged portion to compensate for the damage .42

How to Rewire Your Brain

Activities that take advantage of neuroplasticity to help rewire your brain are:

Play Games

Playing board games can help to teach your brain new skills. Board games can help with motor coordination, visual recognition, spatial navigation, memory, reaction time, decision making, problem-solving, and cooperation.43 Board games have experienced a renaissance recently, so there are many options to choose from. Here are examples of top-rated board games and the skills they help you build:

  • Photosynthesis and Kodama are board games that help spatial awareness
  • Pandemic and Mysterium help with cooperation, visual recognition, and problem-solving
  • Azul and Sagrada teach motor coordination and decision making
  • Galaxy Trucker and Telestrations require reaction time to succeed

Learn a New Language

Learning a new language helps increase grey matter density in the brain, which is associated with attention, memory, emotions, and motor skills.44 Learning a new language also increases white matter in the brain which helps with brain connectivity and communication between different brain regions. Learning a new language at any age can promote problem-solving and creative thinking skills, improved vocabulary, and reading comprehension.

Play Music

Music has multiple benefits: it can help improve our moods, increase our ability to learn new information, and help with concentration and focus.45 Music therapy has been shown to slow the decline of cognitive function in older populations. Research shows that music combined with art, dancing, gaming, exercise, listening helps promote neuroplasticity.45 Musicians also tend to have better memory, focus, concentration, motor coordination, and audio and visual perception.45

Create Art

Whether or not you believe that you are good at art, creating something with your hands, whether it is a painting, a sculpture, or a drawing, can help improve cognitive abilities.46 Art enhances creativity and concentration, while also promoting relaxation.46

Travel/Explore

Traveling to new countries and experiencing a new environment and new culture can help enhance your creativity and communication.47 New experiences help your brain to adapt to new things to enhance neuroplasticity.48

Exercise

We already discussed how exercise benefits your physical health, it also has numerous mental benefits. Exercise can help improve learning, memory, fine motor coordination, and brain connectivity.49 Physical exercise also increases blood flow and cell growth in the brain, which can help to reduce symptoms of depression.49

Counselling/Therapy

Psychotherapy, such as cognitive-behavioral therapy, can help not only to rewire thinking patterns, but it also literally rewires our brains. A study conducted by psychologists at King’s College London found that connections between key regions in the brain became stronger after six months of CBT, and led to long-term improvements in symptoms.50

When looking at brain imaging from before and after CBT, brain scans showed increased brain activity and showed “heightened connections between the amygdala, the brain region involved in fear and threat processing, and the prefrontal cortex, which is responsible for reasoning and thinking rationally.”50

You have now learned a pretty detailed framework for recovering from addiction. Now, let’s take a look at one segment of society that experiences high rates of addiction – high achievers.

Addiction and Successful Businesses

What is burnout? Does high-stress work lead to addiction? Is addiction treatment cost-effective for your employees? If you are a business relying on top professionals in your field, you will need to deal with addiction issues quickly, and your bottom line should encourage addiction treatment. First, we will discuss “Burnout Syndrome.”

Treating Burnout Syndromes

What Is Burnout?

Everyone experiences stress from time to time, but people in demanding careers can experience extreme stress and exhaustion to the point of burnout. According to the World Health Organization, burnout is classified as an occupation phenomenon and is included in the 11th Revision of the International Classification of Diseases (ICD-11).51 Burnout is defined in ICD-11 as “a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions:

  • Feelings of energy depletion or exhaustion
  • Increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job
  • Reduced professional efficacy”51

Does Burnout Contribute to Addiction?

Burnout can contribute to addiction. One of the characteristics of burnout is feeling continuously exhausted. This is typically the result of high stress and a lack of sleep from over-working or sleep disturbances. Because of the high stress and exhaustion, individuals experiencing burnout may be more likely to turn to alcohol, illegal substances, or prescription medications, such as benzodiazepines, to combat the stress and to help fall asleep at night.52 Some may also turn to stimulants such as caffeine, cocaine, or amphetamines to stay awake and energized throughout the workday. This can lead to substance dependence that disrupts sleep and impacts health. 52

The Toll Work Stress Takes on Health

How Does Stress Affect High Earners?

Most people think that the more money you earn, the less stressed you are, and the less you earn, the more stressed you are financially. This is not necessarily true, however, research shows that people earning higher incomes tend to face higher levels of stress at work and don’t necessarily feel more satisfied with their work.53

A survey of 1,000 LinkedIn members employed in the U.S. found that people earning between $51,000 – $75,000 a year generally feel less stressed than those making over $200,000 a year, where nearly 70% said they feel stressed.53

Can Stress Lead to Addiction?

Just like burnout, stress can lead to addiction. Not everyone who experiences high levels of stress will end up with a substance use disorder. However, substances like alcohol, drugs, and prescription medications are abused to decrease stress, increase calmness and feelings of euphoria, and help sleep at night, or stay energized during the day. Substances can offer many effects that might seem helpful for people feeling stressed; however, there is a risk of addiction that comes with taking any substance.

Cost-Benefit of Addiction Treatment for Businesses

The Costs of Addiction on US Businesses

According to the National Institute on Drug Abuse:

  • Substance use costs the U.S. over $600 billion ever year54
  • More than 20 million Americans struggle with substance use disorders and 16 million are heavy drinkers55
  • More than 75% of these people are employed full-time55
  • Employees who are heavy drinkers are about 33% less productive than their coworkers and cost their employers about $7,000 a year in lost productivity56
  • Substance use costs American employers about $160 billion per year in accidents, lost productivity, and related problems56
  • Employees who use substances are twice as likely compared with their co-workers to have been fired in the last year, changed employers more than three times in the last year, and missed two or more days of work in the past month due to their use56
  • 75% of People with an Addiction are Employed Full-Time 75% 75%

The Returns for Businesses That Encourage Addiction Treatment

When businesses invest in addiction treatment and encourage employees to seek help as they would for other health issues, they see:57

  • Better overall employee health
  • Lower healthcare costs over time
  • Less absenteeism
  • Improved job performance and efficiency
  • Reduced costs associated with disability claims and workers’ compensation
  • Fewer accidents
  • Less corporate liability

High achievers are subject to increased stress and demanding work. If they end up with a substance abuse problem, it can disrupt your entire company. It pays to look after the wellness of your employees and encourage addiction treatment when necessary.57 Some treatment centers even allow the high achiever to work while in recovery. This creates an even bigger win for a company with a key employee struggling with addiction.

Conclusion

We have discussed many topics, theories, and issues in this article. While extensive, the information provided is just the tip of the iceberg when you are faced with addiction and starting your recovery journey. Don’t try to handle your addiction by yourself; let trained, passionate professionals at an addiction treatment center assist you. If you liked the sound of these advanced treatment techniques, be sure to ask prospective treatment centers if they offer these services.

Addiction can be cured; it just takes work, knowledge, the right support and a willingness to get better.

Resources

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  14. https://www.edgewoodhealthnetwork.com/blog/the-power-of-protein-in-addiction-recovery-part-2/#:~:text=Protein%20and%20Neurotransmitters&text=When%20we%20ingest%20proteins%2C%20they,feel%20the%20way%20we%20do
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  25. https://www.scientificamerican.com/article/fighting-back-against-the-stigma-of-addiction/
  26. https://positivepsychology.com/self-esteem/
  27. https://www.ucop.edu/local-human-resources/_files/performance-appraisal/How%20to%20write%20SMART%20Goals%20v2.pdf
  28. Ibid.
  29. https://www.npr.org/2020/02/25/809256398/tiny-habits-are-the-key-to-behavioral-change
  30. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6557987/
  31. https://www.health.harvard.edu/mind-and-mood/exercise-is-an-all-natural-treatment-to-fight-depression
  32. https://www.webmd.com/depression/guide/exercise-depression#1
  33. https://www.todaysdietitian.com/newarchives/120914p44.shtml#:~:text=Substance%20abuse%20is%20known%20to,and%20changes%20in%20sleep%20patterns
  34. https://drugabuse.com/guides/substance-abuse-and-weight-change/
  35. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4411899/
  36. https://www.edgewoodhealthnetwork.com/blog/the-power-of-protein-in-addiction-recovery-part-2/#:~:text=Protein%20and%20Neurotransmitters&text=When%20we%20ingest%20proteins%2C%20they,feel%20the%20way%20we%20do
  37. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3193654/
  38. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6289280/
  39. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2775419/
  40. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6122651/
  41. https://www.medicinenet.com/neuroplasticity/definition.htm
  42. http://www.columbia.edu/cu/record/archives/vol26/vol26_iss3/2603_Brain_Compensates.html
  43. https://www.healthline.com/health/rewiring-your-brain
  44. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0226525
  45. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3957486/
  46. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2804629/
  47. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6499159/
  48. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3222570/
  49. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3951958/
  50. https://www.huffingtonpost.ca/entry/therapy-brain-changes_n_587e440ce4b07b9dd704c13b
  51. https://www.who.int/news/item/28-05-2019-burn-out-an-occupational-phenomenon-international-classification-of-diseases#:~:text=%E2%80%9CBurn%2Dout%20is%20a%20syndrome,related%20to%20one’s%20job%3B%20and
  52. https://www.ncbi.nlm.nih.gov/books/NBK209050/
  53. https://www.cnbc.com/2018/04/18/more-money-means-more-stress-says-new-study.html
  54. https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/drug-addiction-treatment-worth-its-cost
  55. https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHNationalFindingsReport2018/NSDUHNationalFindingsReport2018.pdf
  56. https://dwiresourcecenter.org/index.php/what-does-alcohol-drug-use-cost-your-business/
  57. https://www5.cbia.com/healthyconnections/article/save-your-company-money-by-assuring-access-to-substance-abuse-treatment