Addiction and Recovery Update 2020: The Latest Clinical Takeaways from Neuroscience Research – Kevin McCauley

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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.

1. Appraise the latest neuroscientific explanations of substance use disorder pathophysiology and interpret Substance Use Disorder symptomology in light of this research.
2. Investigate and analyze the arguments for and against the conceptualization of addiction as a brain disease.
3. Analyze elements and evaluate examples of Recovery Management, post-treatment support/aftercare, and Recovery-Oriented Systems of Care.
4. 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)
  • Recovery Residences
  • 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
  • “Hedonic Rehabilitation”

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