 All right, so I think one of the really important pieces of helping somebody recover from substances is you have to do trauma work Because addiction is a trauma-based illness and you can have people go through all of the CBT and all of the classes All you want, but if you don't treat the underlying trauma for the reason that they're using They're not really going to recover and so trauma work is really essential and part of trauma work is teaching people Things that they can use to use for stress management So trauma is universal trauma happens to everybody, but not everybody develops post-traumatic stress disorder and you don't have to We do know that that's totally a bit avoidable Depending on how you handle things Substance abuse Most people that are in treatment have trauma issues and What you have to do is help people learn how to recover that where you're processing that and this is why you do the adverse childhood experience score and Everybody should be doing this. It's an items Questionnaire which really helps you understand what's going on with people from their childhood And they did this study at Kaiser Permanente just showing that the adverse childhood experience score affects your entire body So it affects all of your medical health, not just substance abuse or mental health When you have a traumatic experience it results in a memory and so these get implanted in your brain and PTSD is the consequence of failed memory integration So we have things happen to us all the time But you have to go through sleep at night and then you can just incorporate all this into your brain and then it doesn't cause post-traumatic stress disorder. So one of the best things you can do to avoid PTSD is to sleep after a trauma but most people end up not sleeping well after a trauma and They end up having the symptoms of post-traumatic stress disorder, which are basically you avoid Anything that might trigger you to think about that episode and people use drugs or alcohol to numb So they don't have to deal with it and sometimes people don't even have a conscious recall of the event that happened We have multiple memory systems. So we now have perceptual memory, which is all of our senses and Then we have episodic memory and semantic memory In order to have your episodic memory work You have to have an impact hippocampus because the hippocampus is where you put all your new memory and learning and then it gets Digested with all the other parts of your memory and then there are triggers that are put into your hippocampus So you can pull things out of your long-term storage We don't exactly know where your long-term memory is But the way I envision it is these file folders in your brain that you put all of your memories in and There's a trigger in your hippocampus so that you can pull them out of those file folders The episodic memory and the semantic memory are very different in what happens so my example is I may be saying things that you think are important and you're consciously putting those things in your hippocampus But there's all kinds of other things your brain is recording right now So your auditory cortex is recording my voice your visual cortex sees the slides your sensory cortex feels Temperature in the room. So all this is happening in your brain And then it will get digested and processed when you go to sleep at night And that's how you actually didn't remember it. This is why kids should never stay up all night studying For a test the next day you have to go to sleep at night to Incorporate everything you just put in your brain if you don't then you can't recall it and my example for this is Learning long division, you don't remember the exact day the classroom the teacher When you learn to do long division, you just know you learned it and If you don't use it ever again like you're always using a calculator, you think you've lost it However, when your calculator doesn't work, you can do long division because it's hard-wired in there And you just have to do a little work to pull it out and you remember how to do it Sleep is what you need to have memories Consolidated and digested so you have to go through the different stages of sleep and they all do different things And we have different EEG recordings of The different stages so you know what stage you're in So this is the normal sleep architecture. This is what people go through every night and you do this four or five times a night You go to one two three four rep One two is basically initiating sleep So that's falling asleep and there is different things on your EEG like in stage two You have sleep spindles Then three four is slow wake sleep and that's the most important sleep for your brain That's the sleep where you feel rested Then you have REM sleep, which is rapid eye movement. That's the most important sleep for your body And your body is not going to let you not have REM sleep because you have to have REM sleep to be able to function and So somebody who's been sleep deprived Like somebody who comes into substance abuse treatment They'll go into REM sleep very rapidly and this is why they have a lot of dreams Like a lot of using dreams and things like that and this is where your body to recover Because during REM sleep your body is basically paralyzed and your eyes are moving really fast because your brain is moving really fast so you can actually You go into your first REM like 90 to 100 minutes But if you can sleep deprived, you're going much faster than that And there's different chemicals happening in your brain at the different times of your brain So when you're awake you're walking and talking the communication is bi-directional So it's going from your hippocampus to your semantic back and forth and there's a lot of chemicals flooding your brain So there is norepinephrine, there's serotonin, there's acetylcholine and This is when you're forming your episodic memories During non REM sleep Your thinking is logical But perceptive and you can actually dream during this stage and when you if you wake up And you're in a dream where you're just stuck and you're doing the same thing over and over and over again Normally that's the stage you're in and There's medium to low serotonin and norepinephrine and low acetylcholine And this is when things are starting to leave your hippocampus to get incorporated with the rest of your memories And then during REM sleep your thinking is illogical but progressive So that's when you have this really wild dreams where you know you're doing something probably never thought about doing but That is when your brain is being flooded by acetylcholine. So there's no norepinephrine It's like a brain flitches a flip, flips a switch and says okay Just acetylcholine Acetylcholine is the chemical in our brain that helps us focus concentrate learn and remember If you think about it If somebody has Alzheimer's like they're starting to get dementia They're given drugs called acetylcholine estrus inhibitors That means it inhibits the breakdown of acetylcholine so that we have more acetylcholine The problem with substances so people who have had trauma and they have PTSD Tend to start using substances addictive substances To help like this is why I'm totally against Medical marijuana for PTSD Every state has it as an indication and in Colorado It's like the number two indication for people using medical marijuana But there have been no studies supporting its years All of the studies have come out being very negative against it like it's not helpful In fact some of the studies show that it makes people worse But people are still using it and that's because all of the addictive drugs do work initially Like benzodiazepines alcohol because they know me so people that have post-traumatic stress disorder can use those substances and Temporarily feel better because they're known so they're not having the intrusive thoughts They're not having you know all the things that happen with PTSD But the studies are showing that that doesn't hold true over the long term and Actually people tend to then develop more tolerance to the drug They need to take higher doses and it's not really helping them over time and that's because these drugs Can really affect your sleep architecture the ones that are the absolute worst are alcohol and benzodiazepines They can totally knock out stage three four sleep Meaning you're not getting any restful sleep and then they can diminish REM sleep and so that makes the Processing difficult and so the other thing that happens when somebody's been traumatized is their adrenaline is really high and As in the previous slide I showed that during REM sleep, there's not supposed to be any adrenaline But if you've got a high amount of adrenaline then your REM sleep is not normal So we have this these two brain halves they look identical But they're not and I don't know if anybody's seen the Ted talk by Jill Balti Taylor To watch that. It's a really phenomenal head talk by a neuroanatomist who has her own stroke And so she's able to talk about the stroke looking from the inside out She starts the video we're talking about how she has a brother with schizophrenia And so she's done a lot of research on the brain and why you know People have different brains and then she talks about having a stroke and she had a very devastating stroke And I use this video to show my patience to show that the brain can Completely heal because here she's several years after the stroke Giving this lecture and she looks like totally together. So even though she had a really Damaging stroke. She didn't like fully recover and she talks about the two sides of the brain and how different they are and What we really want is people to have balanced brain using right left brain equally So the left brain is really where you do most of your thinking This is the I call it the L brain logical linear linguistic So this is the thinking brain and then the right brain is where you can do all of your visual spatial processing So you're paying more attention to people's body language their voice how they deliver things rather than what actually is being delivered and and so many people tend to be either right brain or left brain and when you're working with patients It's important to recognize whether they're right brain or left brain Because you're really going to respond to them differently people that are primary left brain Do a lot of defense mechanisms that are like intellectualization justification Rationalization, so they're thinking all the time and they have difficulty getting into their feelings Right brain people tend to be into their feelings very easily and have difficulty with thinking and and so they're more responding the way you present things and This is why when I talk to my patients about this I do this and say how does this come across? I mean that is a lot of people grow up like that having that kind of experience and they don't know how to respond because Message is different than you know how it's delivered So you also have your whole autobiography in your right brain. This is where your stress responses This is where your empathy responses And and they've actually done studies with yogis showing that people that meditate on the good of the world and try and eat Increased positive things in the world They can actually expand that part of the brain so it can get bigger I've actually done MRI that data on Therapy showing that therapy can change the structure So we have a lot of neuroplasticity What we want to do in therapy is integrate the right in the left brain so that they're balanced and they talk to each other and This is difficult when you've got adolescents using substances because that makes it even more difficult for this to happen And these drugs can do a lot of problematic stuff You know, somebody's not integrated when you ask the question like have you ever been? Abused as a child do they think that I'm here as a child and the message comes back the answer you by going yes No, you know, I really can't remember my childhood Because what's happening here is that's a question that's coming to your left hippocampus So then that's Asking for an affidavit answer So you have to go to the other side of your brain and say we ever abused his children And then it can't come back because they're not talking to each other And so this is what therapy is about is trying to integrate the right and left brain. So they're talking to each other and This allows you to start putting feelings into words And one of the things that can be really helpful with this is learning mindful meditation And that's something we did earlier today with the family groups that we're in And then telling your story This is why I think AA is so helpful because what are you doing AA or any of the sole partners? You tell your story over and over and over again and that actually Facilitates the integration of the right and left brain. This is another technique other than mindful meditation that helps people kind of learn how to calm down and controller autonomic nervous system because that is Kind of the goal when you're working with people is to teach them skills where they can calm down and Learn how to cope So what that talks about is? Your heart and your brain communicate constantly and this actually came out of Heart transplant research where they were taking hearts out of dogs and putting them out of the dogs and When they do that they only sew up the vessels because that's really all you can find you can't find the nerves and so this heart When they shock it to start it working again because the heart has its own brain And it starts pumping the blood that found that then there's no longer a communication between the heart and the brain and That actually why they think people with heart transplants don't live that long because they can't Calm the system down because it's the biggest nerve that comes from the brain into the chest that actually calms the heart down from the brain But in this research they found that they're actually more nerves going to the brain from the heart than there are from the brain to the heart And so it's really the heart for the sending messages to the brain in Terms of warning the warning system and so you want to have the system because it's called the checker system It's supposed to warn you about stuff But some people their system is overactive, and it's mostly people that have trauma And so you want to teach people how to be able to say I really I'm glad you're here because you helped me But when it's overactive what happens is like somebody who has Been in an explosion and they have big trauma with that When they hear a slamming door and they're right back where they were that that's an overactive system So you want to teach people how to do that? I wanted to explain why EMDR is really helpful. They made an EMDR therapist EMDR to me is kind of the gold standard to work with somebody with trauma It's high movement desensitization reprocessing. So it's when somebody follows your finger with your eyes Or you can do your sound so it's alternating stimuli across the corpus callosum and What they have found is that when you change your focus Across the corpus callosum like you're looking over here looking over here or you hear in here or there's physical Sensations on either side of the body you actually get an acetylcholine surge because that is your Chemical saying pay attention pay attention pay attention And that's actually what happens in the startle reflex. So the startle reflex actually can be helpful Except it's not because what happens is yes, you get this acetylcholine surge But then the norm the adrenaline comes up and then you're very anxious and you feel like after one way or five or something And so this is the only thing that is similar to REM so REM sleep is flooding the brain with acetylcholine and then this bilateral stimulation actually then floods the brain with acetylcholine and so that's the idea of why it might help digest memories Because PTSD is consequence of failed memory digestion integration And so if you can do this while somebody's awake and you can actually do this treatment Then it can actually cause the memories to Kind of not having the affect waiting anymore or if they don't bother So this is from Bessel-Bauber-Polk who's considered one of the premier Trauma therapists. These are his four steps to helping people with trauma, but the one I think is important is the first one It is starting with self-regulation. So people teaching people Self-regulation how to calm down and relax and So to me this is like the first effective tool and so we earlier had an acupuncturist here who is getting people this Protocol so this is a standardized protocol of five points in the ear and It was originally developed to help with substance abuse, but we found that it helps with all kinds of things and It was used a lot during 9-11 To help people recover from trauma there And this is where we found out that even though this is not a standalone treatment for post-traumatic stress disorder it can be a standalone treatment to prevent post-traumatic stress disorder because what it's very helpful with is helping people sleep and And so It's something where you you get the needles and you sit quietly for 30 to 45 minutes and I've used it in my program since 2000 we would offer it five days a week and the patients loved it and it's a really way to Help people calm down so they can learn to cope It's it's I find it very difficult to teach people especially with mental illness Mindful meditation But I find it much easier to treat to teach them a partner But then I find that if you put needles in people's ears, they sit still and you can teach them anything And so this is why I really like this protocol because it helps people Learn that they can actually sit still be mindful be aware of what's going on without being agitated and having to move around and And it's it's useful because it's non-verbal. It can be used in any setting It's cheap. It has minimal side effects and you can take it with you I mean people do it out in the woods And it's a very very effective treatment You don't have to talk to me and this is just a study showing that acupuncture actually It's the only study I found Where something can increase stage three four sleep. I Don't know of any medication we have that actually does that and This is just showing the full body acupuncture does that I'm hoping that somebody will do a study on this fear acupuncture to see if it does it too But that's So this is not a standalone treatment for PTSD We have many evidence-based treatments for post-traumatic stress disorder And I really do think that EMDR is really the old standard mainly because It's not verbal. I mean most of it is non-verbal So you don't have to retraumatize the person so they don't have to be talking about their their trauma over and over again It does require a master's level or higher to be trained in EMDR And that's mainly because it can cause what are called ab reactions so it can make person worse and the therapist has to be Well trained enough to know how to recognize an ab reaction and how to help somebody come with it And so there is an EMDR trainer in Colorado Springs who came up with this other kind of training That where he can train anybody And it's called brain synchronization therapy You can't really Google it because there's nothing out there about it But it uses the same stuff that EMDR does Although it's slower softer gentler and even though EMDR is very rapid In BST, we just do like one movement and then see what comes up And so I actually do train people to do this and we can train anybody It's the same philosophy of the as EMDR and so both of them do this kind of thing where When you're going to work with somebody you get a timeline and you put down all of the times from zero to now That they've had bad experiences that they're still bothering them You don't work on anything that they've already resolved But you have triangles and then there's big triangles of how much it bothers them and little triangles And then you pick one of them to start working on to do And then you ask them for a PAST And this really starts the integration of the right and left brain Because you say, okay so we're going to work on this incident So say this person was sexually abused ultimate number of times But they pick one incident that they really remember because then they're all going to rejoin together And so you ask, well do you have a picture of that in your mind? So they have to describe a picture of the incident And then you ask, how does that make you feel? So the picture is right occipital cortex How it makes you feel is right amygdala Where do you feel that most in your body? Because we hold emotional memories in our body That's right insula And then the question is, when you look at all that What's the negative thought you have about yourself? And that's left hippocampus So just doing that starts this process of integration And then we're going to do bilateral movements to help people kind of digest that But we have to use skills to make sure they don't get a ground on the surges So a big part of this training is focusing on how to help people manage the autonomic nervous system And this is a system that has been called autonomic because it works automatically If you don't do anything it works automatically But what we now know is you can control it completely You can learn how to control your autonomic nervous system And so we teach techniques And so we teach these techniques which are Most of them are meridian based therapies One is just teaching people how to breathe And then we do this thing called tapas And then tapping And then this cardiac coherence heart path So we teach these techniques And then we basically then determine We want to keep people in their window of tolerance So if you look at that picture How much does it bother you on a scale of zero to ten? Ten is you're going to run out of here because you can't stand it from zero It doesn't affect you at all And then you want to find out how high do we have to be to access it And how high can you tolerate it? And most people have a window of tolerance of like three to seven And you want to maintain it in there all the time And so that's why we use these skills So once they get outside their window You bring them back down before you continue to do any bilateral And it's a long process But what happens is people just start Things come up, things change Things move in their body They have different thoughts about it The picture changes And you don't really have to do any talking And that's what's really amazing about it Okay, that's all I have