Research in neuroscience provides an evidence-based and comprehensive understanding of addiction that fits well with the experiences of people needing, seeking, and in recovery. There are several insightful and well-articulated arguments challenging the disease conceptualization of addiction, but two important areas of research – epigenetics and psychoneuroimmunology – greatly advance awareness of how environmental stress creates vulnerability to addiction.
This lecture reviews the most up-to-date science of addiction, the current arguments for and against addiction’s conceptualization as a disease, and how the principles of recovery management counter the pathophysiology of addiction and improve a recovering person’s chances of achieving long-term recovery.
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Manual - Addiction and Recovery Update 2020
Kevin McCauley, MD is a Senior Fellow at Meadows Behavioral Healthcare. He first became interested in the treatment of substance use disorders while serving as a Naval Flight Surgeon where he observed the US Navy’s policy of treating addiction as a safety (not a moral) issue, returning treated pilots to flight status under careful monitoring. Dr. McCauley wrote and directed two films: Memo to Self, exploring the concepts of recovery management, and Pleasure Unwoven, on neuroscience of addiction. He won the 2010 Michael Q. Ford Award for Journalism from the National Association of Addiction Treatment Providers.
As a person in long-term recovery himself, Dr. McCauley is grateful for the many benefits he received to establish his sobriety and strives to make sure that people have access to the same benefits and opportunities. He is committed to understanding how addiction plays out in the lives of people from diverse races and different cultures, genders, and orientations, and hearing their unique perspectives of recovery. Although addiction can be a debilitating disease personally and spiritually, Dr. McCauley joins with his colleagues to treat people seeking sobriety with respect, preserve their dignity, and accompany them as they find their own path into recovery.
Financial: Kevin McCauley is director of program services at New Roads Treatment Center. He is the co-founder of the Institute for Addiction Study. Dr. McCauley receives a speaking honorarium from PESI, Inc.
Non-financial: Kevin McCauley is no relevant nonfinancial relationship to disclose.
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Appraise the latest neuroscientific explanations of substance use disorder pathophysiology and interpret Substance Use Disorder symptomology in light of this research.
Investigate and analyze the arguments for and against the conceptualization of addiction as a brain disease.
Analyze elements and evaluate examples of Recovery Management, post-treatment support/aftercare, and Recovery-Oriented Systems of Care.
Utilize the principles of Safety Culture and Chronic Disease Management to solve common problems in early sobriety
I. Addiction: a disorder of reward learning, decision-making and self-awareness
Definitions of Addiction
The American Society of Addiction Medicine’s Definition of Addiction
The DSM-5 Symptomology of Addiction (Substance Use Disorder)
The Five Current, Leading Neuroscientific Explanations of Addiction
Genetic Vulnerability (Blum)
Incentive-Sensitization (Robinson and Berridge)
Pathology of Memory and Learning (Kalivas)
Stress-induced Allostasis (Koob and LeMoal)
Pathology of Motivation and Choice (Volkow, Goldstein)
The Debate about Addiction’s Definition as a Disease
II. Recent Advances in the Pathophysiology of Addiction
Epigenetics: a new understanding of heritability of addiction & recovery
The Overkalix Study and transgenerational trauma transmission
Nicotine primes cocaine use (Kandel and Kandel)
Psychoneuroimmunology: the Gut-Brain-Immune Loop
Inflammation and Psychiatric Disorders
The Role of Microglia in brain disease and repair
Implications for the Disease Argument
III. Recovery Management: a Safety-based approach to sobriety
Altering Health Disparities by Improving the Social Determinants of Health
Professional Health Programs: What Makes a Good Aftercare Plan
Treatment and “Recovery Literacy”
Recovery Management Check-Ups
Active Linkage to Recovery-Oriented System of Care (ROSC)
Peer-based Sobriety Support (Kelly, Kaskutas)
Relapse Safety Planning
Urine Drug Testing (Monitoring)
Vocational Rehabilitation and The Collegiate Recovery Movement
Addiction Medicine Specialists
How Recovery Management informs Medication-Assisted Treatment