Heal Your Nervous System with These Neuroscience-Based Strategies

You. I'd like to welcome everybody to today's presentation of the Neurobiology of addiction. I should have said recovery. I'm your host, Dr. Donnelly Snipes. In this presentation, we're going to explore the interaction of addiction with other physical and mental disorders and really focus on the importance of physical health and HPA axis and autonomic nervous system regulation to support the body's ability to heal, to support neurogenesis and neurobiological recovery. There is a very strong correlation between trauma and addiction. You could actually argue that physically addiction is very traumatic to the body. And when we experience trauma, and we talked about this I think last week, stress can be physical stress, interpersonal stress, emotional, cognitive, environmental stress, it doesn't matter. Your body recognizes stress as stress. Your body recognizes trauma as stress. And when people have a lot of chronic stress, it starts to dysregulate their autonomic nervous system. It starts. Starts to strengthen the sympathetic nervous system, which is your fight flight response and weaken your relaxation response or your parasympathetic nervous system. There is a very strong correlation between trauma and addiction, even if we're not looking at the neuroscience, because a lot of people who develop addictions have had trauma or they had an addiction and they experienced trauma while in their addiction. Most people that I have worked with over a quarter century have experienced trauma while in their addiction, even if they didn't have it prior to. So we do need to recognize that a lot of people in early recovery are dealing with trauma, and as a result, in some way or another, they feel unsafe and disempowered. And one of the things that we need to do to help them feel safe and empowered and reduce their stress, well, to reduce their stress is to help them feel safe and safe and empowered. People with trauma or addiction show increased emotional dysregulation to general emotional stimuli, such, such as emotional faces. People who've experienced chronic stress through trauma or addiction tend to be hypersensitive, hyper vigilant, and when they react, they don't react a little bit. If they're going to react, it's a strong reaction. People with mood disorders or addictions are more likely to experience dysregulation of the HPA axis, which is the stress response. People who've had chemical addictions may develop compromised liver function, and this is especially true with people who use injectable drugs and people who use alcohol. But the liver is that organ, one of the organs that help filter out toxins. So whatever toxin you're putting in your body it's going through that liver, and it's likely causing a little bit of damage. The liver, interestingly enough, most people just think of it as a filter, but it actually plays a central role in amino acid metabolism. Why is that important? Because amino acids, those are. We break down our proteins into their component parts, the amino acids. Those amino acids are reused, repackaged, if you will, to build to. To make hormones and neurotransmitters and the things we need. So if the body cannot effectively break down the food you eat and convert it to usable parts in order to build the neurotransmitters, you're going to have a problem. The person is going to have difficulty feeling happy. The person's going to have difficulty developing making gaba, which is our natural relaxation chemical. So people need to recognize that in order to heal in, they need to provide their body the building blocks it needs in order to make everything that keeps your body factory going. Insufficient detoxification when the liver is injured can allow neurotoxins to enter the brain. And that's when we see that happening. You can imagine toxins entering the brain. What does that tell you? You're going to start having neuroinflammation. We know when we've got inflammation in the brain, we tend to have more anxiety, more depression, more reactivity. That, because that's a stressor. So it activates the stress response. We also often see as a result of changes in the gut microbiome, more gastrointestinal tract bleeding, malnutrition, and possibly concurrent renal failure when the liver backs up. When we're not getting those toxins out of the body, it causes chaos. Additionally, we often see people develop diabetes. We've talked a little bit about this last week in terms of inflammation, when, when people are using, they are flooding their body with way too much of a substance. Usually a toxin that's stressful, that activates the stress response. When we activate the stress response, your body dumps stress hormones as well as blood sugar to give you energy to fight or flee. And then when the person is sobering up, when the substance is leaving the body, that's also a stressor, because the brain's like, wait, I just got used to it and now I don't have it anymore. So then the person has another stress experience and another shot, if you will, of blood sugar. So they get blood sugar spikes going in and coming out, which is not helpful. The more often the receptors are bombarded with, with insulin. When we have blood sugar in our, in our body, Our liver sends out insulin or our pancreas, whatever. Our body sends out insulin to help the muscles absorb and use that blood sugar. But when those receptors are bombarded too often, they quit becoming receptive and people develop insulin resistance over time that can lead to diabetes. So we see a much, much higher rate of diabetes in people with addictions. And that is true for both chemical as well as behavioral addictions, like pornography addiction, like gambling addiction. So we do need to be aware that that constant stress that the body is under and those frequent hits, if you will, releases of extreme levels of blood glucose can cause people to develop diabetes. People with diabetes may start experiencing fatigue and irritability, which can trigger relapse. We need to make sure in this early recovery period, well, always, but a lot of times we're only as clinicians, we're only involved during the early recovery period. We need to make sure people get tested for diabetes or at least screened for diabetes. If they exhibit fatigue and irritability, weight loss for some unknown reason, if they are drinking or peeing more than they usually do, if they get really tired after they eat, especially after they eat carbohydrates, we need to make sure that they get to the doctor quickly. I mean, it's not a medical emergency, but they need to get there and get this checked. Because uncontrolled diabetes will cause all kinds of physical complications, but it will also make them more irritable and more fatigued, which is a huge relapse trigger when people have uncontrolled diabetes. I know, brace yourself. It's a stressor which is going to increase inflammation in the body and it's going to prevent neurogenesis. It's going to prevent the nervous system from being able to use energy to heal itself because it's so worried about trying to suppress this inflammation right now. Low blood sugar activates the stress response. High blood sugar activates the stress response. Substance use and detox stress both wreak havoc with your blood sugar. We already covered that. Which further impairs the body's ability to heal itself. Hypocortisolism, now we're talking about cortisol are one of our main stress hormones. Hypocortisolism, which means you don't have enough that's actually working, is seen in stress related disorders such as chronic fatigue syndrome, burnout and ptsd, as well as in addiction. And usually it's functioning as a protective mechanism designed to conserve energy during threats that are beyond the organism's ability to cope and reduce excitotoxicity. When Cortisol is high, that means glutamate's high. When glutamate's high, that means you've got a lot of hot chemicals, if you will, in your brain and it becomes inhospitable for the neurons and we start seeing death in, in your, in your neurons. We call it excitotoxicity because the environment becomes toxic because of the excit, excitatory neurochemicals. Yes, we want some sometimes, but we don't want our brain constantly being bathed in stress hormones and neurotransmitters. Low cortisol has been found to relate to more severe hyper arousal symptoms and exaggerated stress response. In other classes we've talked about the Flat and the Furious. When the body stops responding effectively to cortisol, then the normal amount of cortisol that's sent out. When there's a stressor, the receptors just don't react. They're like whatever, don't have the energy to deal with it right now, never mind. So the person feels flat a lot of the time. But when there's a stressor that is sufficiently intense to cause the secretion of enough cortisol to actually activate those receptors, oh boy, oh boy. It's flat to furious, zero to 250. So we have this tsunami of stress hormones that are released, and they call it in the clinical literature, exaggerated glucocorticoid response. Because what we're seeing is what normally would be a small amount of cortisol being secreted. We have to, we're seeing three, four, five times that amount of cortisol being secreted, which is really overwhelming for the body. That amount of stress that's put on the body when that happens is exhausting. And it takes the person longer to downregulate. Just like if you spill a couple of drops of water on the floor, it'll evaporate in a couple of minutes. If you spill an entire gallon jug on the floor, it takes a whole lot longer to evaporate. It takes a whole lot longer to recover from what you did. A dysfunctional autonomic nervous system means that the stress response, the HPA axis, is often too strong and the relaxation response is often too weak. And the relaxation response we often loosely refer to as the vagus nerve. But there's a whole lot more involved in it. A dysfunctional hp, HPA axis activation or stress response will result in or be caused by hypocortisolism. When your cortisol is too low, obviously, or when the receptors are not receptive, it takes a lot More stress. It takes a lot more cortisol and glutamate to get things going, and that actually ends up causing imbalances in the stress response. There's an increased risk of PTSD development. People who have hypocortisolism tend to feel. Feel even more unsafe and disempowered when they experience a trauma, which makes sense when they are going through that stressful, traumatic experience. Their body has that exaggerated. I don't like that word, but it's. We'll use it for now that the body has an extra intense, quote, cortisol response. So they feel even more fearful than people who didn't have hypocortisolism. So it, to them, that experience is more overwhelming, more disempowering, which can lead to the development of ptsd. It can result in addiction relapse. A lot of times people want to numb. They. When they're flat, they want to feel something, so they may use. And when they're furious or frantic, they don't want to feel that out of control, so they use. We need to help them gain control of that autonomic nervous system of that stress response. People often develop mood disorders when they have addiction because all of the hormones end up getting out of whack. Their sleep gets out of whack. Their liver is not able to do what it needs to do. They're not a. Their liver is not able to process the amino acids. Th. Those are all stressful. And that can lead to anxiety, depression, irritability. We see abnormal immune system activation. Well, if the liver is not clearing what it needs to, if the person is under chronic stress, then we do start to see increased systemic inflammation, increased autoimmune diseases. We see increased allergic reactions, increased irritable bowel syndrome, symptoms such as constipation and diarrhea. Reduced tolerance to physical and mental stresses, including pain, believe it or not, which seems kind of counterintuitive, but whatever. When people are under chronic stress, many times their pain threshold literally drops. It's not just all in their head. They actually are more sensitive. Their, their receptors are more sensitive to what's going on. They're more hyper vigilant about what's going on. People who are in early recovery and if, if you've been there, you know what it's like. If you've ever tried to detox off of something, you know, the body registers that as a stressor, you start getting cranky. Think of even if you've tried to quit something like caffeine, which pales in comparison to benzos or something harder. But even if you tried to quit caffeine, there's that period where you start getting irritable and you start getting a headache and, you know, you start feeling stressed, and then something happens. And it's much harder to deal with life on life's terms when, when you are already stressed to begin with. When you're already stressed to the max, you don't have any. Any more room to tolerate anything that's going on, which is a relapse trigger. Again, we need to help people downregulate so they can get into their wise mind and better manage these triggers. And finally, we also see altered levels of sex hormones, and that isn't just to say that their libidos changed. Estrogen is neuroprotective. If we don't have enough estrogen in our system and in our brain, those neurotoxic chemicals, those stress chemicals, are more able to actually cause neuronal death. They're actually able to cause more brain shrinkage. So we don't want that. We don't want people to have too high or too low levels of any of their hormones or neurotransmitters. In terms of addiction. When we're using it triggers the stress response or the HPA axis and alters our neurotransmitters. Dopamine is our neurotransmitter that's involved in arousal, perseverance, motivation, attention, and when it's too low, depression, and sometimes when it's too high, anxiety. We need to recognize that the levels of dopamine are really important. We also need to recognize that it's not necessarily about having too much of a neurochemical. It could be that the receptors just aren't receptive, they're not doing their job. You can have plenty of dopamine and, and it's just not getting through, or you can have plenty of dopamine, but it's getting reabsorbed too quickly, broken down and reabsorbed too quickly. So there are a lot of different ways we can have imbalances in our neurotransmitters. We do know that people with addiction have been really hammering their dopaminergic system for a long time, which means those receptors and that entire system is completely miscalibrated. So they are going to have difficulty with arousal, with persevering in the face of resistance, with motivation, with attention, and they're going to experience mood issues. We need to help people develop tools to manage that so they don't feel Feel completely flat, completely overwhelmed, completely, just blah all the time. And we can do that to a certain extent by helping them engage in better health behaviors to heal their body and engaging in behavioral activation, doing a little thing, setting small goals, having small successes, and making sure that they're not setting goals that are too overwhelming. Every time you have a small success, the body goes, okay, I can do that. I feel empowered, I feel safe. Let's do that again. Or I can do a little bit more. And that's great. But we don't want people to take on too much at one time, get overwhelmed, because that's a stressor and it's going to set them backwards. Norepinephrine is involved in energy, attention, motivation, and mood. When people's stress response is too strong, they have been secreting a lot of cortisol, a lot of glutamate, a lot of norepinephrine, and a lot of dopamine in, in many cases. And so all of those systems are out of whack. Again, what do we do? Well, the way our body works, unfortunately, we just can't, like, manually reset it. The way our body works is we need to reduce the stress so those receptors aren't constantly bombarded. Once the body realizes, okay, I'm not going to be flooded, then it will start producing new neurons and the body will heal. But we need to reduce the stress. Glutamate is our main energy neurochemical, if you will, and it's actually broken down to make gaba, which is kind of interesting. You take the main energy neurochemical to make the main relaxation neurochemical. Who knew? Interesting parallel, but I digress. We need glutamate for energy, but too much gluten, glutamate really contributes to that neurotoxicity. And so we don't want sustained periods or regular repeated periods of extreme stress. Thyroid hormones get out of whack. Interestingly, in your autonomic nervous system and in your body, you have the HPA axis, which is the hypothalamic pituitary go hypothalamic pituitary adrenal axis. Then you have the hpg, which is the hypothalamic pituitary gonadal, and the hpt, which is the hypothalamic pituitary thyroid axis. All of these work in concert when there is a stressor. Your cortisol, your glutamate, your thyroid hormones, your gonadal hormones, all are called into service, if you will, in order to help you survive the stressor. So if your cortisol receptors, if your dopamine receptors are getting out of, out of balance, if they're becoming resistant, you can almost bet that your thyroid hormones and your gonadal hormones are probably also experiencing changes and some level of resistance. As we reduce the insults to those neurotransmitters to those neurons, the body will start rebuilding itself. But in early recovery, some people may benefit. Some people may need to be on thyroid medication. Some people choose to take a short course of antidepressants to help balance that. There's a lot of debate about whether antidepressants are a good intervention or a bad intervention. That's something you need to talk with your, talk over with your doctor. Thyroid hormones are a lot easier to take. And then if your body starts adjusting, then you don't need to take them anymore, especially after you get through that recovery period. Serotonin is another neurochemical and increases in 5ht2 increase glutamate, anxiety, and hypertension. There are more than 17 different types of serotonin receptors, and 5ht2 is only one type. But as when 5ht2 receptors are hyperactivated, then we start seeing a lot of stress and a lot of anxiety. Decreases in 5 HT1 increase depression, anxiety, and pain. A lot of your antidepressants actually target 5ht1, but we need to recognize that we can. By calming the nervous system, we can help reduce the activation of the 5ht2 receptor. And by doing other things that support our body's functioning, we can see increases in 5ht1 GABA, our main relaxation chemical. It's a great thing. You don't want too much of it. You know, everything. Is that Goldilocks principle. Not too much, not too little, just right. Decreased peripheral benzodiazepine binding sites may inhibit the regulation of norepinephrine circuits. So what we see is if the body's not using these gabasytes, if the body's not using this relaxation neuro receptor, then they start going away. It's like, oh, I don't need those anymore. Likewise, if the person is abusing something like alcohol or benzos that activate the GABA receptors, then they are bombarding them and we're going to see the neuro neurons start to become resistant. When that happens, the person has difficulty regulating norepinephrine circuits. Remember, norepinephrine is one of those stress, stress neurochemicals that gives us energy and motivation and can contribute to anxiety and agitation and restlessness. And as I Mentioned earlier. Gonadal hormones are impacted by stress. And anytime you mess with any one of these, you increase or decrease dopamine, norepinephrine, glutamate, serotonin, gaba, thyroid, gonadal hormones, and even cortisol. You are going to alter every single other one of them. They don't operate in isolation. It's. It's a family. They bring along their buddies. Endogenous opioids act upon the same nervous system, Receptors that are active, activated by exogenous opioids such as morphine or heroin, and exert inhibitory influences on the HPA axis, which means our internal opioids that our body makes act upon the same receptors that opioids that we take by, by mouth or by injection work on, and they inhibit the stress response. When people take opioids, it basically helps calm them down. For some people that I've worked with that have been addicted to opioids, they felt a relief. They felt like their uber selves because they didn't have that anxiety that was just oppressive on them anymore. So they actually felt like they had more energy. Whereas other people, when they take opioids, it puts them straight out to sleep. Understanding what's going on kind of under the hood is really important. Understanding that when we help somebody relax, they may have a paradoxy. Whereas other people, when they take opioids, it puts them straight out to sleep. Understanding what's going on kind of under the hood is really important. Understanding that when we help somebody relax, they may have a paradoxical response because we're addressing the imbalance in their neurotransmitters and in their nervous system. Naltrexone appears to be effective in treating symptoms of dissociation and flashbacks in traumatized persons. And naltrexone has also been explored for the use in helping people that are undergoing opioid benzo and alcohol withdrawal. So what's the point? Why have we gone through all this? Addiction, trauma and mood disorders all alter the body's stress response. The altered stress response leads to alterations in all major neurochemicals, gonadal and thyroid hormones. Imbalances in these symptoms lead to continued mood symptoms, hyper or hyporeactivity, distress and cravings, and an increased relapse potential. Recovery help has got to be holistic. It's got to be multifaceted. We need to make sure that the body is getting the building blocks necessary to make those hormones to rebuild those neurons. We need to assess and address imbalances in go gonadal and thyroid Hormones. Now, not everybody wants to go on hormone replacement therapy. I get it. However, we need to help the person figure out what's going to be the best solution to help them balance everything that's going on in their body. We need to help them re regulate their circadian rhythms. Stress causes our circadian rhythms to get out of whack. Stress causes high cortisol. High cortisol prevents the release of melatonin. When melatonin is not released, we don't get good sleep. We also have to recognize that our circadian rhythms control pretty much every other system in the body, including our hormone cycles, our hunger and our satiation hormones, our go nadal hormone cycles. All of that is controlled, at least in part, by the circadian rhythms we need to help people re regulate. Which means circadian rhythms are set by light, by temperature and by routine. People who are in recovery need to have some sort of routine. It doesn't need to be down to the minute, but some sort of routine where they're getting up about the same time and they're going to bed about the same time, ideally eating about the same time each day. If they can do that, that is huge. That is absolutely huge. And one of the things that I used to harp on in when I was working in residential was I wanted the residents to be up about the same time to eat their meals in the cafeteria instead of skipping them and to try to stay awake throughout the day. But if they needed to sleep, because sometimes they did, you know, they'd been awake on a binge for, you know, three, five, seven days prior to detox. So they're still catching up on some sleep. I get that the body's still struggling. I get that their naps were limited to less than 45 minutes. So they didn't get into that deep sleep and they didn't screw up their circadian rhythms. It, you know, they'd been awake on a binge for, you know, three, five, seven days. A lot of people found that just by starting to have that semblance of routine and structure helped their body start to balance. Their sleep started to improve. They started to feel a little less irritable. We want to help the person develop skills and tools to tolerate and mitigate stress, to prevent over activation of the stress response and reduce excitotoxicity in the brain. The brain has already been exposed to too much of the stress hormones and we need to give it a break. You know, if you get a burn on your arm, it doesn't feel very good when you're taking a shower and hot water hits that, you know you don't want to do that because those nerve endings are already hypersensitive. So think of it that way. We want to help people reduce as much stress as they can, which is easier said than done in early recovery. Don't get me wrong. But the more they can reduce their stress or the less time they spend stressed out, the better chance their body is going to have to be able to start healing. And that's one of the reasons that I harp on developing downregulation skills. Whether that's square breathing or you breathe in for four, hold for four, exhale for four, hold for four, and repeat. You blow bubbles. It can be with bubble gum or bubble stuff. I don't care. You sing loudly. Whatever it is that makes you slow your breathing is going to trigger that relaxation response. It's going to trigger that response. There are devices for vagus nerve stimulation that have been used in clinical trials in people who are in addiction recovery. And it's been found to help them trigger that relaxation response when they start feeling cravings, when they start feeling irritable even prior to having cravings, it can help trigger that vagus nerve and reduce the stress response. Every time we turn that stress response down, we're giving the brain a break. It's like a cool breeze when you're laying out on the, on the, on the beach and you're just like sweating your, your ever loving butt off and a cool breeze comes by and you're like, oh, finally a little bit of relief. And we want to actively increase the natural release of gaba, dopamine and serotonin. GABA is relaxation. Relaxation depends on the person. They can meditate, they can stretch, they can walk in nature, they can listen to music. Whatever it is that helps them feel saf and relaxed. For a lot of people, they may not know what that feels like. Sometimes I substitute the word content instead of relaxed. But safe is definitely important because if they don't feel safe, they're going to be tense, they're going to be stressed. Helping them feel safe and content or safe and relaxed. Dopamine is there. I want to do that again. Chemical. What is it that they can do that? They're like, hey, that was, that was pretty enjoyable. I want to do that again. Drugs. We can see why somebody, they have a pleasurable reaction to it, their brain says, let's do that again. We don't want to do that again. So what can they do in recovery that is pleasurable enough that Their brain says, I liked that. Whether it's, you know, rock climbing and I mean in a rock climbing gym, I don't mean like going out there and trying to, to climb on actual rocks, but playing games with people, you know, whether it's card games or Scrabble or whatever it is that they enjoy doing and they finish it and they're like, you know, that wasn't too bad. I wouldn't mind doing that again. Hey, if we can get to it, I wouldn't mind doing that again. I'm thrilled. Especially in those first six to 12 months of recovery. I'm not expecting a wow out of much of anything. But if I can get somebody to say, that wasn't so bad, I wouldn't mind it. I'm thrilled. I'm just over the moon. And serotonin, we typically talk about it as our antidepressant neurochemical, but it does so much more than that. Anything you do that is good for your body is going to help improve your serotonin levels. But it is important to laugh and laugh. Laughter helps release GABA and dopamine. Remember, you increase one, you're going to increase the rest of them, they just, they work together, they go in a group. So if you increase serotonin, you are going to increase GABA and dopamine. If you increase dopamine, serotonin is probably going to go along. GABA may depends on what you're doing, whether it's enjoyable and exciting or enjoyable and contenting. But I digress. Serotonin, we want to focus on things that the person enjoys. I tell people, find something every day that makes you laugh. And I work really hard with, with my husband because it's hard for him to laugh. I don't know why, but when he starts laughing, the dog like comes over and starts licking him because he's like, mom, you broke dad. What's wrong with him? But laughing, even giggling like I just did there, that causes the release of serotonin and a good old belly laugh. Oh my gosh, that is so good for helping to balance those neurotransmitters, activate the relaxation response, the parasympathetic nervous system, and reduce inflammat in terms of protein and nutrition. Now, a lot of people who have been addicted, and this can be chemical addictions or even behavioral addictions, their gut microbiome, it's a mess because stress alters the gut microbiome. It doesn't matter what the stress is. It's going to alter your gut microbes, which is where all your food is broken down and you're one of the places the vagus nerve gets signals about whether you're relaxed and in a good place or stressed. Which is another reason why we start to see GI bleeding and stuff. If there's a stressful situation going on inside your body, it's going to alter the gut microbiome. And some people, they, they develop ulcers. We always say ulcers are the result of stress. Well, how does that happen? Part of it is as people get stressed, their microbiome changes and the ph of their microbiome changes, and in not a good way. We need to make sure that if a person's eating a healthy diet and they don't seem to be benefiting from it, we need to encourage them to talk to their doctor, but also to focus on eating a diet that is rich in antioxidants. So colorful foods and pre and probiotics. Probiotics are like your, your fermented foods, your yogurts and your, your kefirs, your kombucha. And prebiotics are your fibers. Those fibers, those prebiotics are found in fruits and vegetables. So if you're eating a colorful diet, you're probably getting a fair amount of prebiotics in your diet already. So that's good. Eating a diet that's colorful, that is lowish in highly processed foods, so lowish in simple sugars, low ish in white flour. All of those are very helpful at reducing stress on the body, reducing blood sugar spikes, and helping create an environment that will allow the nervous system to heal. Thyroid hormones, dopamine and norepinephrine are derived from the. The amino acid tyrosine. Now, remember I said if the liver can't break down the proteins that it's given into the amino acids, it's not going to do a whole lot of good. They're not going to be able to be used. So the liver needs to be functioning, the gut microbiome needs to be functioning. Serotonin and melatonin are made from tryptophan. Glutamate and GABA are made from glutamine. And gonadal hormones are made from cholesterol. So tyrosine, tryptophan and glutamine, these are all amino acids that are found in most complete proteins. And for those who are vegan or vegetarian, chia seeds is another place that you can find complete proteins that have all your essential amino acids. And cholesterol. Yeah, fat cholesterol. It's important. We do need it to function now, we don't need huge amounts of it, but people that try to cut all cholesterol out of their, but out of their diet are actually working against themselves. Carbohydrates, these are your, your sugars and your fibers provide energy and increase serotonin and dopamine. One of the reasons that people gravitate towards high fat, high carbohydrate foods when they're feeling depressed or when they're feeling upset is because it increases the level of serotonin and dopamine. It increases those feel good chemicals and fats. Fats provide long sustained energy. Sugar is for that. Sprint fats are for the marathon. Fats provide energy, increase serotonin and dopamine and and are necessary for fat soluble vitamin utilization. I don't know, I think it's about half, maybe a little less than half of your vitamins are fat soluble. That means they, you need to have fat for your body to actually be able to effectively, effectively use them. Water supports chemical reactions in the body, improves cognitive performance and energy because it flushes out those toxins and removes toxins from the body, which contribute to fog and inflammation. When you have inflammation, you're not going to have recovery, you're not going to have neurogenesis. So we need to remove the toxins from the body, remove the stress from the body as much as possible to reduce inflammation and give the body a chance to rebuild. You are not going to rebuild your city in the middle of a hurricane, which is kind of like what you're trying to do. If you're maintaining high stress levels and everything while you're in, in recovery and trying to heal your body's, you're not able to do it efficiently and effectively. Vitamins and minerals found in food equivalent ratios are essential. What do I mean by that? Some vitamins, when you take them, actually inhibit the absorption of other vitamins and some vitamins, when you take them, actually increase the absorption of other vitamins. They found that the ratio of vitamins in natural foods is the most bioavailable that it can be the ratio of the vitamins as we take them in multivitamins and pills, it ain't optimized. So you may actually not be getting enough or be getting too much of one or another thing. Vitamins and minerals are kind of like the spark plugs in the chemical reaction that helps build the neurotransmitters and hormones in your body. They are needed for converting your macronutrients, your proteins, carbohydrates and fats to Hormones and neurochemicals. If you don't have vitamins, you're going to be out of luck. Now this helps you see, the creation of melatonin starts with tryptophan. And you need iron, magnesium, calcium, B6 and folic acid to convert tryptophan to 5 HTP. And then you need vitamin C, B6, zinc and magnesium to convert 5 HTP to serotonin. If you don't have enough serotonin, you're going to experience gut and heart problems, sleep problems, fibromyalgia, inflammation and other pain conditions, and cravings for carbohydrates, alcohol and certain drugs. Okay, none of that is something that we want in early recovery. Which tells, takes us to the place where I'm saying it's important to make sure that our patients are aware of the importance of a good diet. And ideally if they need to consult with a dietitian or a nutritionist, if they don't know a lot about nutrition, it's really helpful. Trauma, anxiety and depression are all highly correlated with sleep disturbances and circadian rhythm disruption. Addiction, because of what we do in our addiction, is often highly correlated with circadian rhythm disruptions and sleep disturbances. So in early recovery, 99 times out of 100 or more people have disrupted circadian rhythms and poor sleep, poor sleep. Well, circadian rhythm disruption impairs sleep quality. Poor sleep impairs your ability to manage intrusive and negative thoughts, your ability to think clearly, your emotional regulation, lack of quality sleep. So poor sleep triggers the stress response and puts you in fight or flight, which disengages the prefrontal cortex, which is where we do our thinking and reasoning. So you're using emotion based functioning, which is sort of the pathway to relapse. Sleep deprivation causes the stress response, worsening of autoimmune diseases, worsening of pain, reduced stress, stress tolerance, adenosine buildup in the brain and adenosine buildup is the chemical. Adenosine is the chemical that's produced when we think, when we go through the day, as adenosine builds up, we develop what the scientists call sleep pressure. And when we go to sleep and we get into that deep sleep phase, got to get into deep sleep. The adenosine is cleared out and, and it makes room for, you know, attracting, if you will, the adenosine. The next time, think of, think of it kind of like the, the receptors, kind of like a vacuum cleaner. And it can suck up adenosine all day long, but then its bag is full and we got to empty the bag before we can think clearly again in terms of sleep hygiene, Encourage patients to stick to a schedule. Create a sleep routine doing the same two or three things that they do every night. Eat dinner, take a shower, read a book. Great. Awesome. Eliminate blue light from their devices two hours before bed and that also means dimming the lights as much as possible and switching to kind of a a yellow light. If you can reduce things that wake you up like light, noise, allergies, animals, something that's going to wake you up in the middle of the night and disrupt that deep sleep. Engage in relaxation activities before bed. Consider exploring guided imagery or progressive muscular relaxation. Anything you can do to help trigger that relaxation response. To trigger that parasympathetic nervous system will help you trigger the release of gaba, which is your calming neurotransmitter, and help you get better sleep. Cool down. Most people sleep best between the temperatures of 62 and 72. That doesn't mean you can't take a warm shower before bed, but you need to be able to cool off right after that shower. Pay attention to your sleep ergonomics. If you're not comfortable, you ain't gonna sleep well. And try to reduce caffeine six hours before bed and nicotine two hours before bed. And have a blood alcohol level of 0.0 at bedtime and some of you are going well, if I'm in recovery, I'm not drinking, right? Not necessarily. If you're in recovery from gambling addiction, you may still drink alcohol. That is a personal choice. Is it recommended? Probably not, but blood alcohol at blood alcohol in your blood system bloodstream. Wow. When you are trying to go to sleep is going to have problematic effects on your sleep quality. It may help you get to sleep faster, but the quality of your sleep is going to be much, much worse. Get a Physical Addiction and mood disorders are stressors on the body and can lead to or worsen stress related illnesses which lead to continued activation of the HPA axis. Stress related illnesses include cardiovascular issues, especially hypertension, blood sugar issues, insulin resistance, diabetes, prediabetes, back and neck pain just from tension can keep you up at night, can cause you a lot of pain and consternation. Migraines and headaches will get worse when people are under stress. And remember that recovery from addiction is a stressor. You know eventually you're going to feel a lot better, but it's a stressor. Just like recovery from open heart surgery, it's a stressor on your body to start healing everything and putting it all back together. But once it's put all back together. It's grand. It's wonderful. Stress related illnesses also include polycystic ovarian syndrome, low testosterone, many cancers, and hypothyroid or low thyroid. Some of these, many of these there are treatments for, there are interventions for. And if you heal or manage effectively manage the stress related illness, guess what? It reduces that extra stress on the body and allows it to try to start healing itself. Evaluate physical, emotional, cognitive, environmental and interpersonal causes of stress. We want to prevent as many as possible physical sources of stress. We are undergoing an incredible heat wave and up here in my office, it, the AC just doesn't keep up. It is hot as blazes in here right now and so is that stressful? Is that making me a little cranky? Yeah, quite honestly it is. As soon as I'm finished doing this, I'm probably going to go downstairs with where it's a whole lot cooler and mitigate that. I am going to prevent unnecessary stress. So physically we want to attend to anything that's going to cause us pain. Sleep disruption, poor nutrition, dehydration. Emotionally, we want to address our distressful feelings. You don't want anxiety and anger and depression to go away forever and never come back. We have them for a reason, but we don't want to steep ourselves in them when we feel anxious. Okay, that's our body saying, hey, there might be a threat. Better get off your duff and see if there is one. It's not your body saying, hey, let's feel anxious for a while and really just perseverate on this. That's not what we're supposed to do. Anger is the same way depression tells us we lost something that was important to us or, or that we've been angry or anxious for way too long and we're just plum out of gas. Depression says, hey, I need a minute, I need a minute again. You don't want to pack your bags and hang out there for weeks on end. But understanding that your feelings are your body's way of communicating with you is really important. Preventing unnecessary emotional distress. Don't watch oh gosh, Old Yeller. Don't watch that movie if for some reason you don't have to. I can't think of any reason you'd have to watch something that makes you sad or makes you angry. Don't watch the news. Stay off of Twitter. Oh my gosh, please. Any of those things that are likely to trigger your stress response is probably not healthy and probably not helpful right now. Cognitively write things down. Don't expect your brain to work overdrive to remember things, write things down and try not to get cognitively overloaded where you're just like your head spinning with all this stuff you've just taken in and environmental stresses. This is noise, temperature, light, smells, any of those things, and safety. If you want to put safety down here, you want to feel safe and nurtured in your environment, not overwhelmed and bombarded by all of these things. We want to mitigate unavoidable stressors using mindfulness. If people are mindful, they're more likely to pick up on hey, I've got a stressor coming up or Hey, I noticed that I'm starting to get anxious, what can I do to address it? If you're not mindful, then you probably don't notice until you're all the way out into a full on stress response. Develop distress tolerance skills. Whatever it is that you need to do, whether it's grounding, noticing five things you see, four things you hear, three things you smell, two things you feel, you can just notice what it feels like to be sitting in the chair that you're sitting in. There are a ton of different grounding skills that you can use to get focused on the present moment, which will help you down regulate that stress response. Developing distress tolerant thoughts is also helpful. Instead of telling yourself I can't deal with this, rephrasing that and saying this really sucks right now and this too shall pass, it's a little bit different. I'm saying I can deal with this. I don't want to, but I'll get through it. It's not going to completely consume me. Developing psychological flexibility, that ability to live in the and and recognize what's important in your rich and meaningful life. And addressing cognitive distortions. I typically encourage people to address cognitive distortions with the mnemonic fe fit cat facts in this context at this time. That works for most of your distortions. Emotional reasoning. Well, if you're looking at the facts, then you're going to be able to address emotional reasoning personalization. It's all my fault. Well, what are the facts in this context at this time? Jumping to conclusions. This must be going on. Well, what are the facts in this context at this time? See, it works. It really works. But in order to think about the facts in this context at this time, you've got to get out of fight or flight and into your wise mind, which means you have to be able to down regulate a bit what works for you to downregulate, actively increase the natural release of gaba, dopamine and serotonin with sunlight, vitamin D, really important, but sunlight as well. Light exercise, gentle walking, dancing in your house, playing with your dog, massage and relaxation. Emotionally, whatever makes you happy, curious, or enthusiastic. Do at least one thing every day. Cognitively turning your attention for 20 minutes a day. I'm not saying all day long, just 20 minutes. Turn your attention to the things that you're grateful for, the successes you've had or, and. Or the things that went well that day. Environmentally, add pleasant smells, sights, and sounds to your environment so you feel nurtured. It's a place you want to be and interpersonally connect with positive people. And even if it's online, you know, finding a safe place that you can connect with positive people and is really important because it helps release oxytocin, which is a huge modulator of our stress response. Believe it or not, recovery from addiction and mental health issues Requires attention to the whole person in the environment. For brain chemicals and hormones to rebalance, the body needs the building blocks. So you need good nutrition and the body, the body has to have the ability to actually use the food you eat. You need water, and you need protection from repeated stress activation due to pain, sleep disturbances, hormone imbalances, illness, stressful thoughts, or environmental triggers. So there's a lot we need to do. But by reducing stress and reducing inflammation, we can help people create an environment that their body can restore itself to health, if you will, during the addiction recovery process.