Motivating Behavioral Change: An Addictions Perspective. Nzinga A. Harrison, M.D. Chief Medical Officer Anka Behavioral Health, Inc.

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1 Motivating Behavioral Change: An Addictions Perspective Nzinga A. Harrison, M.D. Chief Medical Officer Anka Behavioral Health, Inc. Learning Objectives Upon completion of this activity, the learner will be able to: 1. Discuss the definition of addiction 2. Discuss the basic neurobiology of addiction 3. Define the Stages of Change 4. Use the principles of basic neurobiology of addiction and Stages of Change to design practical interventions for motivating behavioral change in individuals with addiction 1

2 Overview Definition of Addiction Neurobiology of Addiction Stages of Change Motivating Behavioral Change Addiction Definition (part I) Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors. 2

3 Addiction Definition (Part II) Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death. Chronic Medical Illnesses ILLNESS Follows Treatment Recommendations RELAPSE RATE (1 YR) Addiction 40-60% 40-60% Asthma Diabetes Hypertension <40% meds <30% lifestyle <60% meds <30% lifestyle <40% meds <30% lifestyle >60% 30-50% 50-70% McClellan. October 4, 2000 Vol 284, No. 13 (1693) 3

4 Functional Anatomy Specific parts of the brain responsible for specific functions Prefrontal Cortex (Voluntary) Deep Brain (Involuntary) Limbic System Dopamine Pathway The Reward Pathway Food Water Sex Nurturing I like it I love it I need it 4

5 The Limbic System Emotions Memory Fight or Flight The Limbic System Olfactory Bulb: Smell Thalamus: The Interpreter Amygdala: Emotional Memory Hippocampus: Factual Memory Frontal Lobe Executive Planning Decision-Making Impulse Control 5

6 Craving Stages of Change 6

7 Decisional Balance The cons of changing outweigh the pros in the Precontemplation stage. The pros surpass the cons in the middle stages. The pros outweigh the cons in the Action stage. 7

8 Motivational Interviewing* What is it? Motivational interviewing is a client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence. *www.motivationalinterview.org Biopsychosocial Model What biopsychosocial factors are contributing to addiction? What biopsychosocial factors could motivate change? 8

9 Stages of Change Stage of Change Sentinel Event Next Stage of Change Precontemplation Considers making a change CONTEMPLATION Contemplation Makes a decision to change PREPARATION Preparation Makes the change ACTION Action The change becomes the new habit MAINTENANCE Stage Appropriate Treatment Planning Stage of Change Example Goal Precontemplation I don t need to change. CONTEMPLATION Contemplation Maybe I should think about changing. PREPARATION Preparation I m ready to change my behavior. ACTION Action I have changed my behavior. MAINTENANCE Maintenance I am maintaining my new behavior. RELAPSE PREVENTION 9

10 Stage Appropriate Treatment Planning Stage of Change Goal Interventions Precontemplation CONTEMPLATION Engagement, education Contemplation PREPARATION Develop discrepancy, pros/cons, identify barriers Preparation ACTION Positive reinforcement, relapse prevention Action MAINTENANCE What s working? Relapse prevention Case 35 year-old woman recently divorced presents with complaints of depression. She s never had any psychiatric treatment or psychotherapy. She wants help dealing with her failed marriage. Her main complaints are depression, fatigue and headaches which are worse in the morning. She admits she used to drink socially, but over the past 5 years, she began drinking nightly after her children go to bed. She averages 8-10 beers per night. 10

11 Case When she awakens in the morning, she s irritable with a headache. She had stopped making breakfast for the children and would have a beer to steady her hands before she picked them up from school. Before her husband left, she had attempted to stop drinking several times, but would get too sick and just found herself drinking more and more. At this point, she doesn t see how she could ever stop drinking because she is so depressed. Case What Stage of Change is she in as related to changing her drinking? What is the goal as related to her drinking? 11

12 Case What biological, psychological and social factors are contributing to her drinking? What biological, psychological and social factors may serve as opportunities for developing intrinsic motivation to change her drinking? Case Based on the Stage of Change she is in, and the biopsychosocial factors, what strategies will you use to motivate behavior change? 12

13 Putting It All Together Limbic system is constantly sending emotional information forward to the frontal cortex Dopamine pathway is constantly reinforcing certain behaviors, not necessarily based on how healthy they are The frontal cortex must be trained not to take Limbic System and Dopamine Pathway information as golden truth The frontal cortex can be trained to make its own decisions Putting It All Together Consequences (Limbic) + Motivation (Dopamine) = Behavioral Change (Prefrontal Cortex) 13

14 Putting It All Together Behavioral change happens in stages The most successful interventions 1. Are stage appropriate 2. Are based on intrinsic motivation Learning Objectives Upon completion of this activity, the learner will be able to: 1. Discuss the definition of addiction 2. Discuss the basic neurobiology of addiction 3. Define the Stages of Change 4. Use the principles of basic neurobiology of addiction and Stages of Change to design practical interventions for motivating behavioral change in individuals with addiction 14

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