Treatment Ladder
Sleep and Recovery
Brain Basics
Alarm System
Recovery Rewires the Brain
100

True or False: Everyone must complete every level of the treatment ladder in exactly the same order.


What is false?

100

This stage is the transition between being awake and being asleep.


What is N1/light sleep?

100

In our hand model, this part—the fingers—represents planning, judgment, decision-making, and impulse control.

What is the prefrontal cortex?

100

In our hand model, the thumb represented this brain structure—the brain's alarm system.


What is the amygdala?

100

True or False: Once substance use has changed the brain, the brain cannot change again.


What is false?

200

This level of care focuses primarily on safely managing withdrawal and medical stabilization.


What is detox?

200

This stage is especially important for physical restoration, tissue repair, immune functioning, and restoring energy.


What is N3/deep sleep?

200

What is the responsibility of the reptile brain?

What is basic functioning such as eating, sleeping, breathing, etc.

200

Anger, arguing, or aggression are examples of this survival response.


What is fight?

200

•relationships.

True of false, With repeated use, ordinary rewards may feel less motivating while drug-related cues become more powerful.

What is true?

300

This level provides 24-hour structure and support after detox for people who need continued treatment.


What is residential treatment?

300

This stage is associated with dreaming and plays an important role in memory, learning, and emotional processing.


What is REM sleep?

300

In our hand-brain model, this area represented emotion, reward, motivation, memory, and learning.

What is the palm/middle brain?

300

Leaving, avoiding, or escaping are examples of this survival response.


What is flight?

300

People, places, smells, music, money, routes, emotions, and routines can all become these, causing the brain to associate them with substance use.


What are cues/triggers?

400

Put these in order from more intensive to less intensive: Aftercare, Residential, detox, IOP, PHP.


What is Detox, Residential → PHP → IOP → Aftercare?

400

This substance may make someone fall asleep faster but can fragment sleep later in the night and interfere with REM.


What is alcohol?

400

Name two of the four neurotransmitters we discussed.

What are GABA (brake), glutamate (gas), serotonin and dopamine.

400

Shutting down, isolating, or feeling stuck are examples of this survival response.


What is freeze?

400

This term means the brain can change in response to experience and repeated behavior.


What is neuroplasticity?

500

Name three activities referred to as aftercare.

Attending a meeting, getting a sponsor, therapy, psychiatry, faith based activities, others may apply.

500

These substances commonly interfere with sleep while being used and may be followed by a crash/excessive sleep followed by disrupted sleepwhen use stops.

What are Methamphetamine and cocaine?

500

Name three factors we discussed that can affect how quickly or completely someone's brain recovers from substance use.

What are substance used, duration/intensity, age of first use, genetics, overall health, sleep, nutrition, smoking, stress, co-occurring conditions, or social support? Any 3.

500

Constantly trying to keep others happy or please them to reduce conflict or feel safe is this fourth survival response.


What is fawn?

500

What are three reasons given in class to continue treatment beyond detox?

Being removed from your drug of choice, opportunity to learn and apply coping skills, opportunity to build a sober community, engaging in therapy, to create new neuropathways, others may apply.


Daily Double: 

Name FIVE behaviors discussed this week that can improve sleep quality.Keeping a consistent bedtime and wake time

  • Developing a regular bedtime routine
  • Getting daytime exercise/physical activity
  • Getting natural light during the day
  • Limiting daytime naps, especially long or late naps
  • Avoiding caffeine late in the day
  • Avoiding nicotine close to bedtime
  • Avoiding alcohol and other substances as a sleep aid
  • Limiting screens/phones/TV before bed
  • Keeping the bedroom cool, dark, and quiet
  • Using the bed primarily for sleep rather than hanging out in bed all day
  • Practicing relaxation skills such as breathing or progressive muscle relaxation
  • Having a wind-down period before bedtime
  • Avoiding heavy meals immediately before bed
  • Addressing stress, anxiety, and racing thoughts rather than using substances to shut them down
  • Giving the brain and body time to readjust during recovery