we're going to go ahead and get started. My name is Chelsea Kimura, and I am a technical specialist for the Opioid Response Network. Most of you are probably familiar with the Opioid Response Network by now, but for those of you who may not be, we are grant-funded by SAMHSA to provide free training and technical assistance to tribal opioid response grantees and other Native communities across the country. Today, we will be doing our third session in the series, and we'll be talking about brain science and addiction. The session is being recorded and will be available for you and your teammates to review in about two weeks. Before I turn it over to Stephanie Stilwell, our presenter for today, I want to share our land acknowledgement to open our session in a good way. Our work intends to reach the addiction workforce in the Northwest Toro region. This includes Alaska, Idaho, Oregon, and Washington. This region rests on the ancestral homelands of the Indigenous peoples who have lived on this land since time immemorial. Please join us in support of efforts to affirm tribal sovereignty and in displaying respect and gratitude for our Indigenous neighbors. We respectfully acknowledge and honor all Indigenous communities, past, present, and future. And with that, I would like to introduce Stephanie Stilwell, our presenter for today's session. Stephanie is a registered nurse with a diverse background in the healthcare industry, including addiction treatment and healthcare consulting. Her passion is promoting community health and wellness and disease prevention. Stephanie works creatively to bridge the gap between the healthcare systems, individuals, and the community. She has facilitated multiple local and statewide coalitions throughout the state of Alaska. Stephanie is an Anishinaabe woman from Lac La Croix First Nation in Ontario, Canada. And I will go ahead and pass it over to you, Stephanie. Thanks for being here with us. Awesome, thank you. All right, I am going to share my screen and we will get going here. So today, we are going to talk about the brain science and touch on brain science of addiction and substance use disorder. And we're going to touch on some risk and prevention factors as well. And I'm going to pass through some of these slides there. So today, again, we're going to talk mostly about the neurobiological foundations, the brain science of addiction, touching on some of the things that lead up to what makes people more at risk for developing a substance use disorder, and what we can do to prevent that as well. So of course, the first thing we want to really talk about is what is substance use disorder. So substance use disorders are diagnosed medically by something that we call the DSM-5, which is a diagnostic manual that's used by healthcare providers to identify different mental health conditions. So one of the differences in identifying mental health or substance use disorders is that typically, traditional diagnostic methods, healthcare providers often use things like lab tests or urine screenings, whereas substance use disorders are often evaluated and diagnosed based on observable behaviors. So the DSM-5, this manual categorizes substance use disorders into kind of four key domains. And then there's a total of 11 different criteria that are used. So the main domains are impaired control, social problems, risky use, and then physical dependence. So the impaired control is using more of a substance or more often than they are intending to. Somebody is wanting to cut down or stop using but can't do so. They are spending a great deal of time obtaining or using or recovering from the effects of a substance and experiencing cravings or a pressing desire to use the substance. Under social problems, we see things like neglecting responsibilities and relationships, giving up activities that they once cared about to use the substance, or an inability to complete tasks at home. And then we see risky use, meaning these are folks that are using the substance in risky situations or settings or continuing to use despite knowing the problems. And then only two of these symptoms are actually physically, physical symptoms, which means one is needing more of the substance to get the same effect, which we call tolerance, and or having a withdrawal symptom when the substance is not used. So when we're diagnosing somebody with a substance use disorder, there's mild, moderate, and severe levels of presence of two to three symptoms considers a mild substance use disorder, whereas four to five symptoms are a moderate, and then six or more is a severe substance use disorder. So also what's really interesting, because of how substance use disorders are diagnosed, it's really, you know, since it's based on these behaviors, right? So if a provider or somebody is treating a patient for a condition other than their substance use disorder or their substance use disorder, and the patient or the provider chooses to maybe dismiss somebody as a patient solely based on their behavior that's problematic, like not showing up to appointments, that's actually really should be looked at as a symptom of their disease rather than like a reason for them to be dismissed from their treatment, because it is an actual one of the diagnostic criteria for their substance use disorder in particular. So substance use can also be viewed kind of on a spectrum, like I said. Previously, if we have two to three symptoms, this is a mild substance use disorder, all the way up to severe substance use disorder. We can also look at the substance use kind of spectrum as well. So there's non-use, which is somebody who completely is abstinent from all substances, and all the way into like a severe substance use disorder. There is, you know, kind of a category with the caveat of beneficial use is that, you know, this is an example of like, in a lot of indigenous communities, tobacco is a sacred medicine, and is used in ceremony and other contexts like that. But so even though that it is used as a medicinal purpose and is, you know, sacred, it can still lead to a nicotine use disorder and can be habit forming. So there is the spectrum, but it's important to recognize that even though some may be labeled as beneficial, there is a risk for developing a substance use disorder at any point along the spectrum as well. And also note, when we talk about something called harm reduction, that can be applied at any point throughout this continuum of care as well, or a substance use spectrum. So when we talk about our brains, especially as it relates to substance use disorder and addiction, it's pretty complex. The brain itself is a really complex organ, and the science behind how our brain works is super detailed and intricate. And I'm not going to get into everything, and I don't expect anybody to be a brain expert in brain science after today. But what I do want to do is talk about, give you enough information for you to walk away from here today with a bit more understanding of what's actually happening in our brains in addiction and in substance use disorders, so that you can possibly describe to somebody else what's happening in our brains, or at least you can understand when you're talking to your clients about what's going on in their brains and their bodies. And we're going to do this by watching a few minutes of this video. This guy does a really great job explaining the process. And so we're going to take a few minutes and watch this video together. I'm going to make sure I have shared my sound. Share computer sound. There we go. Okay, so here we go. Hopefully. You need three things to survive. You need food, you need water, you need dopamine. Now, some of the people who get a little antsy say, we also need oxygen. Yes, well, we also need skin, but I'm not going to really talk about that today. We're going to talk about the three things we absolutely need to survive as a human in today's world. And that is food, water, and dopamine. We need dopamine because it's the chemical responsible for motivation. It's this thing that's responsible for us going and making a friend, having a mother have a bond with a baby. It's the thing that motivates us when we do good to do better. When somebody pats you on the back and says, good job, and you go to do something more than what you're supposed to do, and you go to do something more significant, that's because your dopamine has gotten pinged, and it's just something pushing you, this invisible chemical that's pushing you along the path. On a normal day, we even know how much dopamine we're supposed to have. So on Monday morning, when I wake up and I have to get up and I go to work, I live in the range of about 50 nanograms per deciliter of dopamine. That sits in the central part of my brain, and that's required for me to get out of bed and go get that first cup of coffee. The worst day, the really bad day, the day you call your office and you fake vomit in the phone and you decide not to go in. You're like, I just can't make it. That's about 40 nanograms per deciliter. So not much lower, but low enough to where you just want to sit around in your pajamas all day and do nothing. What about the best day ever? The day where all at once you win the lottery, you have 2% body fat, and you're living on the beach. All of those things happen at the exact same time. We even know that one. That's 100 nanograms per deciliter. Our brain is meant to go all the way to there. It's not really meant to go above. And we can look at things like your favorite food, which is like 94 nanograms per deciliter. And sex, 92 nanograms per deciliter. Bummer, right? Couldn't have predicted that. Maybe they need to redo that research. But at the same time, we know that we're supposed to live within this relative normal state between 40 on a horrible day and 100 on our best day. So what happens when we add a chemical into the brain like methamphetamine? This chemical is really important because it pushes us way past that 100 nanograms per deciliter. In fact, it actually pushes up to 1,100 nanograms per deciliter, more than 10 times the amount of dopamine that our brain should be making. And then if we look at things like marijuana or alcohol or heroin, these are things that push it up into the high hundreds. This is not what we're supposed to be doing. As we look at this, we have the normal that we're supposed to be. We have this large jump for something like methamphetamine. And then we have these other drugs that drive that dopamine up. And when that happens, it starts to take over that part of the brain. And no longer does going to your child's birthday make you happy. It's not happening. The things that normally make us feel happy start to pale in comparison. This is because the brain is built to survive. In fact, we know that this is a survival issue for the brain, mainly because dopamine is what drives us to procreate, to get food, to get water, like we talked about. And we know so much about addiction and all of these things that are going on in that part of the brain that we actually know the parts of the brain responsible for this motivation and this dopamine release. It's places like the anterior cingulate gyrus, the lateral bed nuclei of the amygdala, the nucleus accumbens, the ventral tegmental area, the periaqueductal gray. We know this. And by the end of all of these videos on this site, you're going to know exactly what each of those parts do. But for now, you should understand that this area of the brain called the limbic system, which includes, but it's not limited to, the ventral tegmental area and the nucleus accumbens are responsible for reward. And the fact that we can look on an MRI and see these parts of the brain working, and we can see them working in a patient who is not on any drugs and those that have been on illicit substances for a long time and see major differences in how these structures work is really important because it allows us to start to understand things like behavior. We can see that all of the focus is on the dopamine part of the brain. Remember that nucleus accumbens and ventral tegmental area that we talked about. In that part of the brain, when you've been taking things like methamphetamine for a long time, every time that you take the methamphetamine, it goes from 1,100. Then the next time, maybe it's 900, then 600, then 500, then 200, then 100. Then you're required to take that drug even to get you up to that normal level of 50 nanograms per deciliter. Let's say we found this person, we get them into treatment and we remove that drug. Now we have people whose dopamine goes all the way down to as low as 10 nanograms per deciliter. On their best day ever, it's only 20 nanograms per deciliter. These are numbers that matter. We're going to keep hammering on these because when you have 10 nanograms per deciliter, you can't get out of bed. You can't get up to put your clothes on and go to a job interview or to even take care of yourself or your family. When we lack dopamine, the body craves it. When you crave dopamine, you get into survival mode. That leads to primal action. That primal action is a lot of times the behavior that we see. How can they take grandma's jewelry? How can they steal a credit card? How can they pawn something that they own? Their brain is telling them that they are not going to survive if they don't get dopamine. The main factor in our brain and substance use disorders, as he talked about, this is a chart of the dopamine levels in our brains. On a normal day, we need at least 50 nanograms to survive, to get through our day. When we're eating food, it spikes to 100, 150 nanograms. Then with additional substances, we're seeing these initial increases and spikes in the amount of dopamine that our brain is releasing. However, of course, he used an example of methamphetamine. For all substances that we're putting in our body causes an increase in this dopamine here as well. The methamphetamine initially, we get over a thousand nanograms. Then for each additional use over time, we're really not, it's not, our brain is not producing the normal levels of dopamine anymore. We're fully relying on this substance to give us that dopamine, but we create this tolerance over time. Therefore, it decreases the amount of dopamine in our bodies, in our brains. And so we need to have this, we need to put some sort of substance in our body in order to get our levels of dopamine back to just a functioning level. But once somebody stops using that substance, then over time, our brains recover. Here's an example of how somebody who is using, let's say the repeated use of cocaine, reducing the levels of dopamine receptors in our brain. This is our normal, typical, what we're seeing in our brains for our dopamine. And this is somebody who is using cocaine. And as you can see, there's lower levels of dopamine activity in our brain. However, here's an example of somebody who is in the process of recovering. So this is our normal control, a brain that is not being, somebody is not using any substances or methamphetamine. This is somebody who has been using methamphetamine, but has been without methamphetamine in their system for 30 days. And after 14 months, as you can see, the dopamine activity has regained. So over the course of time, our brains do recover. So this is with somebody who has been abstinent. So if we're talking about other ways for treatment, when we're talking about medications for addiction treatment and things like that, we'll get into in another session. But there are other ways to help increase the amount of dopamine in our brains in the meantime. But we're going to switch gears just a little bit here and dive into kind of some of those risk factors. What are the things that lead to substance use disorders? So there's a number of factors that contribute significantly to an individual's likelihood of developing a mental health or a substance use disorder. And there's a lot of different prevention strategies also that we can implement that help reduce those risks while also enhancing protective factors for the actual problem or challenge that they're facing at that time. So there's risk factors that can be found at different levels, such as our biological factors, our genetics, our psychological factors, our family, the family we are a part of, the community we live in, the culture we are a part of. A lot of these factors have correlations with either a higher probability of developing a substance use disorder or have negative outcomes. Whereas also, on the other hand, there's protective factors at each of those levels as well. So there's kind of like this teeter-totter, these positive counterbalances associated with like that's a decreased. So you have this risk factor, but we also will put in this healthy, positive coping skill that will kind of help balance out over time. So some of the risk factors include things like our income level, the people who are around us, our family, our peers. If you've experienced any adverse childhood experiences like ACEs, we'll talk about that shortly here, employment status or employment. Other individual risk factors include, like I said before, the genetic predisposition that we might have, or if you've been exposed to alcohol or substances, you know, prenatally. Conversely, some of those teeter-totters are having positive role models in your family. So there's just this really dynamic interplay between these risk factors and these protective factors and how we can, you know, even though somebody has this risk factor, we can promote positive protection factors to help decrease the likelihood of having negative outcomes later on in life. So when we're working with specifically Indigenous communities, we want to really take a deeper look at some of the risk and protective factors that are specific to Indigenous communities. The United States is home to over 9.7 million individuals from Indigenous communities. We have ties to and affiliated with 500, I think, 74 federally recognized tribes with just within our country. And each of those tribes and individuals and communities have different cultures. But for the most part, most of these people have at some point historically in their lineage faced different issues related to violence or discrimination or trauma. And those still have an impact today, which creates kind of some significant health disparities and social economic disparities, which is a risk factor that can lead to negative outcomes. And if we're looking at like the rates of issues with substance use disorders, Alaska Natives and American Indians have a higher rate of substance use disorders as well. So it's really important to kind of like, OK, these are risk factors. These are the things that, you know, put us more at risk for developing these conditions. However, we also need to recognize that some of these communities, that our communities have extreme positive protective factors and resilience that we can connect, that we can use as that counterbalance. So if we can emphasize, you know, getting grounded into the culture, emphasizing the strength in the community and, you know, the spirituality of the community, that's a really important piece of it. So how can we connect people in Indigenous communities back to traditional activities and games? You know, one of the big positive protective factors is social connectedness, and especially across multi-generations within these communities, speaking Indigenous languages and bringing back the revitalization of languages in many of these communities. Other traditional ceremonies and spiritual ceremonies, relationships with the land and subsistence, life, fishing, hunting, gathering berries, all of that is a huge protective factor and just really reconnecting or connecting in with the cultures, with your culture. So these are all some of the counterbalances to some of the negative risk factors that we have in Indigenous communities. Also this, you know, risk protection factors all kind of fit within, you know, these different contexts. So we just talked a lot about community as that, but there's also, you know, individuals in relationships and in society. So if we're talking about in relationships, we're looking at risk factors that include maybe parents, if you're a child, parents who use drugs and alcohol or have a mental health condition, or if there's been any type of child abuse or maltreatment. Those are some, you know, negative risk factors, but a counter protective factor is having a parent involvement that's positive, a positive role model, or at least having one really solid adult in their life. We talked about communities in Indigenous communities. We also can talk about communities as in like just generally the neighborhood that you live in, whether you're exposed to poverty or violence and or protective factors in a community could be having availability of afterschool programming or faith-based resources or something that is available in the community. And then just as a society risk factors can include sometimes the laws and or like racism or a lack of economic opportunity in your area. And then protective factors kind of conversely would be maybe laws that are for to protect people from hate crimes or discrimination or even laws that prohibit or limit the availability of alcohol in communities. So there is that. And then something that I'm sure most of us have heard is the nature versus nurture kind of dialogue. And that's something that I want to talk about for a quick second, because what does that really mean? So let's kind of talk about that and how that can impact risk factors for addiction. So biological factors that can affect a person's risk for developing a substance use disorder includes things like genetics. It can be the stage of development, for example, at what age does a person first use a drug or an alcohol or some sort of substance, because a teenager is at most risk if they use at a certain stage in their brain development to become to have a substance use disorder later on in life. Sometimes your gender or your even your ethnicity can put you more at risk based on our genetics. And also, there's something called epigenetics. So this means that like a person could be born with a specific gene mutation, but it kind of lies dormant in our body until something at a certain time wakes it up. So that could be somebody, let's use schizophrenia for an example here. Somebody could have a genetic mutation that makes them predisposed to having schizophrenia, but they don't actually display and have the disease, but they have a mutation for it. However, let's say they've experienced some sort of trauma or something triggers in their environment triggers this some stress or something happens. And it basically turns on that gene and wakes it up. So it then kind of becomes active. And that person then displays signs and symptoms of having schizophrenia. And that's the same concept with a substance use disorder as well. There we go. And then again, the early experience of a child really do play a crucial role in a lot of things, but including brain development. And then the genes, of course, provide that basic framework for their life. And then the environment and other influences kind of help play off those genetic components as well. So whereas like everybody needs a healthy level of, let's call it positive stress for healthy development. There's something called chronic stress, uncontrolled stress, toxic stress that kind of conversely is not healthy for us. It actually can be considered a, or it's often in conjunction with adverse childhood experiences or ACEs. So ACEs are things that impact our social, emotional, and cognitive functioning. And it increases the risk of a number of issues later on in life. So not just substance use disorder, but can also impact, you know, obesity, other heart health conditions. And so the stress response system, when it's activated by these childhood, adverse childhood experiences can have long lasting effects on our immune system as well. The functioning of our brains, especially the areas that kind of help regulate and are responsible for complex problem solving, emotional regulation, memory. So it's really important to acknowledge that. So ACEs, some examples of ACEs are physical abuse. Somebody being exposed to having physical abuse, emotional abuse, sexual abuse, physical neglect or emotional neglect. And then the other areas are just living in a house with somebody with domestic violence, living in a house with an adult who has a substance use disorder, living in a house with an adult that has a mental health condition that's untreated, having gone through a separation or a divorce and, or living in a house where somebody has gone to jail. Those are all risk factors or ACEs. And so the number of like ACEs that somebody experiences, the more likely they are to have a negative health outcome later on in life. And something that is kind of called now as a universal ACE is the COVID-19 pandemic, because that's a trauma that we all kind of went through together. It created a lot of social isolation and unemployment, economic stress. There were a lot more higher rates of depression, and we hit some of our record rates of overdose deaths during that time as well. So again, when we're looking at our kind of the, what am I saying? The race and the ethnicity factors, we see that some of the highest numbers of overdose deaths are in the non-Hispanic American Indian or Alaska Native community. The highest rates of drug overdose deaths just disproportionately occur in this population. And this is another example of like how the number of risk factors that increase with the number of ACEs you have. So somebody with no ACEs has a lower number or a lower odds of ever attempting suicide or having an alcohol use disorder. And that increases dramatically with each additional ACE score that we add on. So understanding the link between ACEs and substance use disorder and other significant health outcomes really is helping to prevent and provide treatment strategies. So something that we are going to get into in the next slide is called trauma-informed care is a huge part of helping with this early intervention and providing support to individuals who we know that have a history of trauma and ACEs is super important as we work toward other aspects in recovery and their treatment. So trauma-informed care, you'll be getting, I did a presentation for you all on trauma-informed care, and that will be coming to you in the form of a recording soon. What trauma-informed care really does is kind of changes the perspective from thinking of like what's wrong with you to what's happened to you. So this approach really recognizes that healthcare organizations, teams, healthcare providers, all of us, we really need to understand a patient's life history to be able to provide really effective healing-oriented healthcare. And so additionally, to add some more layers onto that, we really want to make sure that when we're working with indigenous communities that we're also really talking about and taking into consideration some of the historical trauma that's occurred in the communities that still is impacting their lives and access to care today. So adopting some trauma-informed care practices and strategies really can help enhance patient engagement, treatment adherence, and health outcomes for the clients that we're serving. And it also helps to kind of create a better staff environment for us as well. So it really involves around realizing the widespread impact that trauma has, recognizing the signs of trauma, integrating trauma knowledge into our policies and practices, and avoiding re-traumatization of our clients. And so really this is something that needs to be embraced at all levels within an organization, not just solely at a practitioner level, but from the janitor that works, the custodian that works at the clinic, to the front desk staff, to anybody that has any interactions with staff or clients. It's really important to have them understand trauma and how we can really work as a team to make sure that our patients are feeling safe in their treatment. So make sure you take a look at the video that will be coming to you for that presentation. Let's see. Okay, so something is going on with my screen here. Let me see if this is the right slide. I am frozen here. I'm going to stop my share and try this again. Sorry. Sorry, looking through. Okay, so I have another video. Make sure it's going to work here. Make sure I'm sharing my sound. Okay, great. So I have a quick video here. As we're watching this, I want, it's a little bit outdated, so I want to make sure that you all recognize some of the language that's used that might be a little stigmatizing. So pick up on that and in your mind just think about how you would say things differently. But I want to take a few minutes and watch this clip. Our current theory of addiction comes in part from a series of experiments that were carried out earlier in the 20th century. The experiment is simple. You take a rat and put it in a cage with two water bottles. One is just water, the other is water laced with heroin or cocaine. Almost every time you run this experiment, the rat will become obsessed with the drugged water and keep coming back for more and more until it kills itself. But in the 1970s, Bruce Alexander, a professor of psychology, noticed something odd about this experiment. The rat is put in the cage all alone. It has nothing to do but take the drugs. What would happen, he wondered, if we tried this differently? So he built Rat Park, which is basically heaven for rats. It's a lush cage where the rats would have colored balls, tunnels to scamper down, plenty of friends to play with, and they could have loads of sex. Everything a rat about town could want. And they would have the drugged water and the normal water bottles. But here's the fascinating thing. In Rat Park, rats hardly ever use the drugged water. None of them ever use it compulsively. None of them ever overdose. But maybe this is a quirk of rats, right? Well, helpfully, there was a human experiment along the same lines. The Vietnam War. 20% of American troops in Vietnam were using a lot of heroin. People back home were really panicked because they thought there would be hundreds of thousands of junkies on the streets of the United States when the war was over. But a study followed the soldiers home and found something striking. They didn't go to rehab. They didn't even go into withdrawal. 95% of them just stopped after they got home. If you believe the old theory of addiction, that makes no sense. But if you believe Professor Alexander's theory, it makes perfect sense. Because if you're put into a horrific jungle in a foreign country where you don't want to be, and you could be forced to kill or die at any moment, doing heroin is a great way to spend your time. But if you go back to your nice home with your friends and your family, it's the equivalent of being taken out of that first cage and put into a human rat park. It's not the chemicals. It's your cage. We need to think about addiction differently. Human beings have an innate need to bond and connect. When we are happy and healthy, we will bond with the people around us. But when we can't, because we're traumatized, isolated, or beaten down by life, we will bond with something that gives us some sense of relief. It might be endlessly checking a smartphone. It might be pornography, video games, Reddit, gambling, or it might be cocaine. But we will bond with something because that is our human nature. The path out of unhealthy bonds is to form healthy bonds, to be connected to people you want to be present with. Addiction is just one symptom of the crisis of disconnection that's happening all around us. We all feel it. Since the 1950s, the average number of close friends an American has has been steadily declining. At the same time, the amount of floor space in their homes has been steadily increasing. To choose floor space over friends. To choose stuff over connection. The war on drugs we've been fighting for almost a century now has made everything worse. Instead of helping people heal and getting their life together, we have cast them out from society. We have made it harder for them to get jobs and become stable. We take benefits and support away from them if we catch them with drugs. We throw them in prison cells, which are literally cages. We put people who are not well in a situation that makes them feel worse and hate them for not recovering. For too long, we've talked only about individual recovery from addiction. But we need now to talk about social recovery because something has gone wrong with us as a group. We have to build a society that looks a lot more like Rat Park and a lot less like those isolated cages. We are going to have to change the unnatural way we live and rediscover each other. The opposite of addiction is not sobriety. The opposite of addiction is connection. So that was an actual experiment that was done. This is the actual Rat Park that they did and they did find that more drug use was observed in the rats when they were caged versus less when they were housed. So as we're trying to think about how we can apply the things that we're learning into the work that we're doing, I want you to kind of think about this. You're working with a client who's being treated for a substance use disorder and they have a family member that comes in with them sometimes and that family member just does not understand why they can't just stop using. Now with your new knowledge, a little bit of being a brain science expert, right, and the kind of understanding a little bit more about like different approaches that you can take, how can you help the family member better understand why it's so hard for their loved one to stop using the substance? So this is something to chew on if you all want to take some time and talk about this you can, but just start to really think about how you can take this and teach the client and teach their families like what's really going on in their brain and why it's so challenging or why they're displaying this behavior or that behavior. And that is what I have for you today. This is again just our survey slide that you can provide some feedback on today's presentation. Looks like we do have some time. Does anybody have any questions or comments today? Comments today? And if not, that's great. I have a loved one that's going through what we went through like why and that end of the slide the question that's what I was asking myself like why why are they using so much of it? And then after the end of the slide I it made me question more like how would you explain to somebody that because they're so hurt that they're using more but how would you explain that? To the how do you explain it to the the patient or your family member in this situation? I mean if you're asking okay let me make sure I understand your question. So you're wondering how to explain it to the person who is struggling with the addiction right now or a family member of that person? Probably like the person that is using it. So I think you know one piece of it is definitely helping them understand like what's going on in their brain and why it's so hard for them to actually stop using. And I think going back to that concept of like dopamine right it's we have the three things that we need to survive are food, water, and dopamine. And dopamine really is that that piece that provides the survival instinct in us. It's if we're hungry we're oh I'm getting a feedback here. If we're hungry we're going to do what we can to find food no matter what it takes. And essentially that's kind of the same concept of what's happening in our brain because once somebody starts using a substance that dopamine that is being created is no longer being created by our own brain because it's so used to being taken in by some other substance right. So that person they're literally kind of their brain is kind of hijacked I guess in a way by this idea to get this medication or the substance or whatever it is into their body. And so sometimes I think one of our next sessions is about medication for addiction treatment. So depending on what their substance use disorder is there's different medications that can actually help reduce that level of craving and help them kind of eliminate that piece to help that to I guess so that they don't their brain isn't hijacked continuously trying to figure out a way or how to get that dopamine. So for example if somebody has an opioid use disorder and they can't stop using opioids one option is to do medications for opioid use disorder treatment that might be using like ibuprofen or suboxone or something like that because what that does that medication helps to replace the dopamine it creates it helps to deal with the craving associated with that. So then their brains are not constantly on alert saying give me this give me this give me this their brain is then receiving the medication that it needs to allow them to get to this basic level of have this basic level of dopamine back into their brain so they can function and then they can work on the other behavioral and other pieces of their treatment that they need. So I'm probably going far down the rabbit hole right now but that's kind of how you know why it's so important to understand what's happening in the brain because we need to then understand how we can help them. And so even if it's just understanding how to explain to them that their brain you know is basically you know being taken over by this this dopamine this need to you know survive and what they need to survive in that current state according to their their dopamine and their brain is that substance. So it is really challenging and it's really and it's really hard and you know it's not easy especially in certain communities or rural communities or if there's not a lot of you know you know resources around or support but the brain science piece is a big part of understanding which leads to kind of maybe a little less shame embarrassment and all those other pieces that kind of can be stigmatizing. We can also put in the chat the actual link to some that YouTube video that I sent that you can re-watch that part again and maybe or show them or you know that whole video will be in another session going through a couple more pieces of that video but it's a it's got a lot of good information that you can look back on. There we go. It's not letting me, hey, post it. Technology apparently is not my friend right now. Okay, I think that should be the link in the chat for the video that we were watching earlier. But I know we're at time right now, but if you have other questions, then you can reach out to me or we can talk about it at our next session together. All right, thank you all. Thank you all so much. Thank you, Stephanie. I will have the recording for this session ready in about a week or so. So we will get that out to you as well. And then we will all, or we'll see you for our next session. I believe that will be later this week or next week. Let me see here. It looks like next week on Friday, the 20th. So we'll see you all then. Thank you.

brain science

addiction

opioid response

Native communities

SUD

dopamine

trauma-informed care

medication-assisted treatment

prevention