SUD Knowledge and Brain Science
One physical sign a craving is starting.
Increased heart rate, tension, restlessness, stomach drop, fidgeting, etc.
One grounding skill you can use anywhere.
5-4-3-2-1, breathing exercises, naming surroundings, TIPP
Name one cognitive distortion.
All-or-nothing, catastrophizing, mind reading, emotional reasoning, fortune-telling, magnification and minimization, shoulds, labels, overgeneralizing, personalization...etc
One early warning sign of emotional or mental relapse.
Isolation, irritability, secrecy, skipping meetings, etc.
Repeat a positive affirmation out loud to yourself 10 times.
Difference between a trigger and an urge.
Trigger = cue, person, place, thing, sensation
Urge = craving that follows.
What is the STOP skill used for? And what does it stand for?
Pausing automatic reactions to choose effective action i.e. responding not reacting.
Stop, Take a breath, Observe, (nonjudgmentally if possible) and Proceed mindfully
label, magnification, overgeneralization, possible future telling, any others?
One boundary that protects your recovery.
Avoiding using friends, avoiding unsafe environments, no yelling during arguments, etc.
Each group member names one current fear out loud.
Did you do it?
One effect of chronic substance use on the prefrontal cortex.
Short Answer: Impaired decision-making, impulse control, judgment, or emotional regulation.
Long Answer: Prefrontal Cortex (PFC) governs behavior regulation, decision making, and impulse control. The dorsolateral prefrontal cortex (DLPFC) is crucial for working memory and cognitive flexibility, which are impaired in SUD. reduced DLPFC activity links to diminished self regulation, making cravings harder to resist or prioritize long term goals AEB decreased gray matter volume in the region.
VMPFC (ventromedial prefrontal cortex (VMPFC)-central to value based decision making and emotional regulation, integrating sensory and emotional input to guide behavior. substance use + VMPFC shows altered activity overvaluing drug related cues while diminishing sensitivity to natural rewards.
Explain urge surfing:
ANSWER: Notice the urge mindfully, accept non judgmentally → ride the wave → observe rise/fall →distract or delay if needed and allow it to pass.
Reframe: "I can't handle tough days without using"
I've handled hard days before, I have skills in my toolbox to help, and I can handle the uncomfortable feelings without using.
One green flag of recovery stability.
routine, sleep, coping skills, asking for help, emotional balance
Show one thing in your room that supports your recovery (people on phones can use what they have stored in their phone)
Hopefully you got points!
Define PAWS and give an example of what it could look like
Post-Acute Withdrawal Syndrome — mood swings, sleep problems, irritability, anxiety, low motivation.
This DBT strategy helps when someone feels overwhelmed by comparing the current moment to a time when things were harder — helping them see their progress. If you can give me the acronym it comes from, and list all the components of the acronym its an extra 200 points :)
Comparisons. ACCEPTS : Activities, Contributing, Comparisons, Emotions, Push Away, Thoughts, Sensations
Why distorted thoughts increase cravings?
They increase emotional intensity (i.e. I want to use vs. I need to use right now otherwise I won't survive this feeling) leading to increased urges to escape those emotions, leading to a spike in cravings.
What's one effective 'cope ahead' strategy for managing a trigger?
Role playing the situation, pre planning or writing a script, setting boundaries, scheduling support calls, leaving early, bringing grounding tools.
After listening to this prompt, use active listening to respond using a strategy from active listening. I'll determine if it qualifies
summarizing, reflecting, open ended questions, affirming, asking clarifying questions
This part of the brain is responsible for planning, decision-making, and impulse control. During addiction, it becomes less active, which can make it harder for people to “think through” consequences or stop urges even when they want to. Name this brain region. For an extra possible 100 points, name one specific sub-section of this brain structure. this is a hard one :)
prefrontal cortex: Often conceptualized as the “executive control center” of the brain, the PFC orchestrates a suite of higher-order cognitive functions indispensable for effective choice: rational thinking, planning, impulse control, working memory, attention allocation, and the ability to integrate diverse information to weigh consequences and formulate optimal decisions.
The Prefrontal Cortex: The Executive Decision-Maker
At the pinnacle of our capacity for complex, deliberate decision-making resides the prefrontal cortex (PFC), a highly evolved region of the frontal lobe. Often conceptualized as the “executive control center” of the brain, the PFC orchestrates a suite of higher-order cognitive functions indispensable for effective choice: rational thinking, planning, impulse control, working memory, attention allocation, and the ability to integrate diverse information to weigh consequences and formulate optimal decisions.
Specific sub-regions within the PFC play specialized roles. The dorsolateral prefrontal cortex (dlPFC) is crucial for working memory, strategic planning, and cognitive control, enabling us to hold and manipulate information actively during complex decisions. The ventromedial prefrontal cortex (vmPFC), on the other hand, is intimately involved in integrating emotion and value into decision-making, particularly concerning risk, reward, and social cognition. When faced with numerous or difficult decisions, both these regions, along with their extensive connections to other brain areas like the basal ganglia (for habit formation and action selection) and the limbic system (for emotional processing), exhibit heightened metabolic activity
Give an example of the following situation. Trigger → Thought → Skill → Outcome
Example of a challenged thought and outcome. (can be from your life)
(for example, situation---cognitive distortion--- reframing the thought----outcome in behavior)
after a panic attack ---- "I can't do this anymore, I can't feel like this" (emotional reasoning, future telling, catastrophizing)---
“This panic attack was really hard, but it will pass like it has before.”
“I don’t like feeling this way, but I’ve gotten through it before and I can again.”
“My body is reacting strongly right now, but it doesn’t mean I’m in danger.”
“This is temporary. I can take it one step at a time.”
“I’m stronger than this moment, even if it feels overwhelming.”----resistance to using
If you were hit with a sudden, intense craving right now, what are the first three things you would do?
Pause + breathe (STOP skill)
Move physically / leave the environment
Contact support or use grounding
(Any version of skill → change environment → seek support is correct.)
Demonstrate the Intense Physical Exercise part of TIPP for the group for 20 seconds based on your fitness level (pushups, wall sits, planks, jumping jacks, running in place, burpees, high knees, non-jumping jumping jacks) (if you're driving or can't do it you can ask another group member) For an extra 100 points do it for 45 seconds :)
good job :)