Cfiorini Theoretical Handout 2s 111p

Theoretical Frameworks of
Addiction and TCM
By
Craig Fiorini
LAc
Leading Acupuncture CE Provider

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LEARN THE SCIENCE
SCIENCE. PRACTICE THE ART. HEAL
HEAL..
Theoretical Frameworks of
Addiction and TCM
Craig Fiorini
L.A.c, CACII
Lotus Institute Of Integrative Medicine

Tel: (626) 780-7182 Fax: (626) 363-9751
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Lotus Institute of Integrative Medicine, PO Box 92493, City of Industry, CA 91715

Shall not be copied, duplicated, or distributed in any format or be used for teaching without prior written consent from Lotus Institute of Integrative Medicine
Principles of Addiction

Tel: 626-780-7182 • Fax: 626-363-9751 • Website: www.eLotus.org • Email: info@eLotus.org
Shall not be copied, duplicated, or distributed in any format or be used for teaching without prior written consent from Lotus Institute of Integrative Medicine. 1
What is Addiction: Creating a Definition
• Chronic, recurring, • Perceived lack of
relapsing illness control
• Persists despite • Treatable brain
negative disease
consequences • Previously diagnosed
• Related behavior as abuse or
determined dependence
p
unacceptable by some • Currently diagnosed
predetermined on a continuum of
standard severity
Other Potential Characteristics of

Substance Use Disorder (SUD)
• Impulsive behavior • Limited coping skills
• Risk taking with need including social skills
for excitement which enable
• Small window of connection to
tolerance community
• Sense of hopelessness • Chronic high stress
regarding the • Historyy of trauma or
possibility of goal abuse
achievement • Co-occurring mental
health disorder

13 Principles of Addiction
Treatment
• No single treatment is appropriate for all individuals.
Matching treatment settings, interventions, and services to
eachh patient's
ti t' problems
bl and
d needs
d iis critical.
iti l
• Treatment needs to be readily available. Treatment
applicants can be lost if treatment is not immediately available
or readily accessible.
• Effective treatment attends to multiple needs of the
individual, not just his or her drug use. Treatment must address
the individual's drug use and associated medical,
psychological, social, vocational, and legal problems.
• Treatment needs to be flexible and to provide ongoing
assessments of patient needs, which may change during the
course of treatment.
13 Principles of Addiction Treatment

Continued
• Remaining in treatment for an adequate period of time is
critical for treatment effectiveness. The time depends on an
i di id l' needs.
individual's d For
F mostt patients,
ti t the
th threshold
th h ld off
significant improvement is reached at about 3 months in
treatment. Additional treatment can produce further progress.
Programs should include strategies to prevent patients from
leaving treatment prematurely.
• Individual and/or group counseling and other behavioral
therapies are critical components of effective treatment for
addiction. In therapy, patients address motivation, build skills
to resist drug use,
use replace drug using activities with
drug-using
constructive and rewarding nondrug-using activities, and
improve problem-solving abilities. Behavioral therapy also
facilitates interpersonal relationships

Continued
• Medications are an important element of treatment for
many patients, especially when combined with counseling and
other
th behavioral
b h i l th therapies.
i M
Methadone
th d andd llevo-alpha-
l h
acetylmethadol (LAAM) help persons addicted to opiates
stabilize their lives and reduce their drug use. Naltrexone is
effective for some opiate addicts and some patients with co-
occurring alcohol dependence. Nicotine patches or gum, or an
oral medication, such as bupropion, can help persons addicted
to nicotine.
• Addicted or drug-abusing individuals with coexisting
mental disorders should have both disorders treated in an
integrated way. Because these disorders often occur in the
same individual, patients presenting for one condition should
be assessed and treated for the other.

Continued
• Medical detoxification is only the first stage of addiction
treatment and by itself does little to change long-term drug
use. Medical
M di l d detoxification
t ifi ti manages the th acute
t physical
h i l
symptoms of withdrawal. For some individuals it is a precursor
to effective drug addiction treatment.
• Treatment does not need to be voluntary to be effective.
Sanctions or enticements in the family, employment setting, or
criminal justice system can significantly increase treatment
entry, retention, and success.
• Possible drug use during treatment must be monitored
ti
continuously.l Monitoring
M it i a patient's
ti t' drug
d andd alcohol
l h l use
during treatment, such as through urinalysis, can help the
patient withstand urges to use drugs. Such monitoring also can
provide early evidence of drug use so that treatment can be
adjusted.

Continued
• Treatment programs should provide assessment for
HIV/AIDS, hepatitis B and C, tuberculosis and other
i f ti
infectious di
diseases, and d counseling
li tto h
help
l patients
ti t modify
dif or
change behaviors that place them or others at risk of infection.
Counseling can help patients avoid high-risk behavior and help
people who are already infected manage their illness.
• Recovery from drug addiction can be a long-term process
and frequently requires multiple episodes of treatment. As with
other chronic illnesses, relapses to drug use can occur during
or after successful treatment episodes. Participation in self-help
support programs during and following treatment often helps
maintain abstinence.
American Society of addiction medicine (The ASAM

assessment)
• A set of criteria for providing

outcome-oriented and results-
b
based d care iin th
the ttreatment
t t off
addiction
• The most widely used and
comprehensive set of
guidelines for placement,
continued stay and
transfer/discharge of patients
with addiction and co-
occurring conditions.
conditions ASAM's
ASAM s
criteria are required in over 30
states

For treatment providers, the ASAM criteria provides a holistic
approach for determining individualized and outcome-driven
treatment plans for patients. Using the Criteria as a guide,
practitioners can:
1 2 3 4
Assist a patient from Work with the patient Help rank and rate all Determine intensity
assessment through to determine goals the patient’s risks, and frequency of
treatment using the Criteria’s service needed using
multidimensional the Criteria’s detailed
approach to determine guides to levels of
where to focus care
treatment and
services

5 Main Levels of Care
• Level 0.5: Early intervention services
• Level
L l II: O
Outpatient
t ti t services
i
• Level II: Intensive outpatient/Partial
hospitalization services (Level II is subdivided
into levels II.1 and II.5)
• Level III: Residential/Inpatient services (Level III
i subdivided
is bdi id d iinto
t llevels
l III
III.1,
1 III
III.3,
3 III.5,
III 5 and
d III.7)
III 7)
• Level IV: Medically managed intensive inpatient
services
Highest Level of Care: Detoxification

Non-medical (Social
Medical Detox Detoxification)j
• Severe
Severe, unstable withdrawal • Moderate withdrawal but
requiring 24hour nursing care requires 24 hour support to
and regular physician visits to complete detox and increase
modify detox regimen in order likelihood of continuing
to manage medical instability treatment
• Generally required for patients • Non-medical detox facilities are
detoxing off of staffed by clinicians trained to
Benzodiazepines or complete CIWA and COWS
Barbiturates assessments to determine
withdrawal severity.y Clinicians
Al ffor more medically
• Also di ll will administer withdrawal
compromised patients medication per facility protocol
suffering from other co- or physician instructions, but are
occurring biomedical unable to modify detox regimen
conditions beyond their scope of practice

Levels of Care
• Medically Managed vs Monitored Intensive Inpatient - 24

hour nursing care and daily physician care for severe
severe, unstable
problems. Counseling available to engage patient in treatment
vs. 24 hour nursing care with physician availability for
significant problems. Sixteen hour/day counselor ability
• Clinically Managed High, Medium, Low Intensity
Residential Treatment - 24 hour care with trained counselors
to stabilize multidimensional imminent danger and prepare for
outpatient treatment. Able to tolerate and use full active milieu
or therapeutic community with progressive decrease in
structure and hours of engagement with less intensity
Levels of Care
• Transitional Residential Treatment – Generally
intended for clients who are transitioning to
higher-intensity or lower-intensity levels of care
and/or are reintegrating with the community, and
whose history of chronic substance use
disorders, lack of functional and supportive living
situations,, possible
p unemployment,
p y , levels of
social or psychological dysfunction and lack of
housing necessitate low-intensity residential
treatment.

• Intensive Outpatient - 9 or more hours of
service/week (adults); 6 or more hours/week
(adolescents) to treat multidimensional instability
• Traditional Outpatient - Less than 9 hours of
service/week (adults); less than 6 hours/week
(adolescents) for recovery or motivational
enhancement therapies/
p strategies
g
• Early Intervention - Assessment and education for
at risk individuals who do not meet diagnostic
criteria for Substance-Related Disorder
Common Interventions in
Treatment Settings
Twelve Step Cognitive
Motivational
Facilitation Behavioral
Interviewing
Therapy Therapy
Relapse
Prevention Contingency
Matrix Model
Group Management
Counseling
Medication
Multisystem
Seeking Safety Assisted
Family Therapy
Treatment

Twelve Step Facilitation Therapy
• Designed for early recovery

• Abstinence based
• Brief, structured, manual-driven and implemented
over 12 to 15 sessions
• Based on principles of Alcoholics Anonymous
which includes aspect of spirituality as well as
behavioral and cognitive components
• Willpower alone is insufficient to maintain
abstinence
Twelve Step Facilitation Continued

• General focus – Acceptance of need for abstinence as
g
well as willingness to engage
g g in all aspects
p of 12 stepp
fellowship
• Clinician or counselor – Acts as a temporary sponsor
until such time as patient/client is able to attain their own.
Initial role is to explain 12 step methodology, actively
help to initiate client into 12 step community, and
introduce concepts p based on client pprogression
g through
g
step work.
• Often a client will begin working steps while in treatment
with the intent of working through the first 2 or 3 steps

Motivational Interviewing
• Counseling style – client centered

• Intended to help a client safely explore
ambivalence in order to elicit behavior
change
• Non-confrontational
• Encourages
E client
li t selflf efficacy
ffi
Cognitive Behavioral Therapy (CBT)

• Counseling style – Intended to help the patient/client
challenge belief systems and thinking patterns
• Basic philosophy is that changes in thoughts lead to
changes in feelings which then enable behavior
change
• Counselors will often seek to help client’s identify
thoughts
g and feelings
g before and after use or relapse
• Strong focus on skill training by practicing rational
thinking and problem solving and are to be practiced
by the client between sessions

Relapse Prevention Groups
• Focus on learning about and understanding
one’s
one s triggers or initiating factors that lead to use
• Explore positive and negative consequences of
use
• Self imposed structure to help monitor craving
and develop awareness of high risk
environments
i t
• Skill practice including CBT to help prepare for
difficult situations
Matrix Model
• Model of treatment initially intended for

stimulant
ti l t abusers,
b but
b t effective
ff ti forf allll addictions
ddi ti
• Mostly used in IOP (Intensive Outpatient)
settings
• Treatment consists of family support group,
relapse prevention, psycho-educational groups,
individual therapy and sobriety monitoring
• Generally about a 16 week program

Contingency Management
• Used in both mental health and addiction

treatment
• Based on behavior modification psychology
• Staff will reward or punish behavior
• Aspects of this style and theory are utilized
as partt off many programs suchh as drug
d
court reward and level system or simple
milieu management in inpatient programs
Multisystem Family Therapy
• Generally reserved for adolescents

• Intended
I t d d tto hhelp
l client’s
li t’ refine
fi underdeveloped
d d l d
skills such as decision making, problem solving,
communication, and appropriate expression of
feelings
• Encourages appropriate use of discipline and
i d d to rely
intended l more on a lleadership
d hi b basedd
parenting style as opposed to more punitive or
behavioral style

Seeking Safety
• Designed for co-occurring PTSD and substance use

• Manual based and able to be utilized in group as
well as in one on one counseling
• Can be used with men, women or both together in a
coed setting
• Designed to help people feel safe in the present
moment
• Content focus tends to be behavioral, cognitive,
interpersonal, with elements of case management
Medication Assisted Treatment

Examples
Antabuse – Alcohol Methadone – Opioid Buprenorphine –

Antagonist Receptor Agonist Partial Opioid Agonist
Suboxone – Partial
Opioid Agonist Naltrexone/Vivitrol – Acamprosate/Campral
bi d with
combined ith O i id A
Opioid t i t
Antagonist U l
– Unclear
Antagonist

Theoretical frameworks of addiction
Historical and modern

perspectives
ti
Ahead of His Time
• “In my judgment such of us as have never fallen victims

have been spared more from the absence of appetite than
from any mental or moral superiority"
• “I believe if we take habitual drunkards as a class, their
heads and their hearts will bear an advantageous
comparison with those of any other class.
• “The victims of it were to be pitied and compassionated,
just as are the heirs of consumption and other hereditary
diseases"
Abraham Lincoln

Theoretical Models of Addiction
• Basic tenets of belief regarding the origin or root of

addiction
• In many instances belief implies diagnosis
• Diagnosis therefore leads to ideas about appropriate
treatment
• Sets the agenda for inquiry or establishes initial
premises for argument
p g or conclusions
• Heavily influenced by social, economic, and political
views of the time in which the model is created
Moral Model
• Addiction is the result of choice
• The implications of this kind of choice includes
implications of willful disregard of social norms and
values
• Argument: People choose to drink/use. Drinking or
using leads to addiction. Addiction is therefore a choice.
If it is the case that people choose to drink/use then it is
possibleibl for
f them
th t abstain.
to b t i If they
th continue
ti t
to
drink/use they have chosen not to abstain. This failure
to abstain is therefore the result of a failure of character.

Moral Model Continued
• Moral model in the United States originates from a

belief in self determination and free will based in
Christian faith. Basic premise in this context presumes
the underlying argument that god imparted us with the
ability to choose right from wrong
• Choice is the basis for legal framework
• Treatment logic: If it is a moral failing then society and
social sanctions are the most appropriate form of
treatment
• Law enforcement are therefore the catalysts for change
Moral Model Continued I
• Continues to be the predominating belief

despite history and scientific evidence
• This model remains the personal view of
most Americans regardless of intellectual
acknowledgement of disease or other
models of addiction
• In fact their may be a neurological basis for
why the moral model remains preeminent

Temperance Model
• Originated as a response to alcohol consumption

• Basic
B i assumption ti iis th
thatt alcohol
l h l iis a d
dangerous d
drug
and that society must protect it’s people from the
dangers of alcohol
• Because it’s a dangerous drug, it must be impossible
for anyone to successfully drink in moderation
• This belief lead to the p prohibition movement and the
subsequent ratification of the 18th amendment making it
illegal to sell or consume alcohol except under certain
conditions
Moral vs. Temperance
• Subtle difference between the Moral and Temperance

model
• Moral model established the individual with agency and
power to choose whereas the Temperance model
indicated that the cause of the addiction was the drug
itself and not simply the character of the user that enabled
addiction
• One of the primary reasons for the development of the
temperance movement was violence against women and
the belief that in the absence of alcohol that married men
would be peaceful and faithful husbands

Spiritual Model
• Ultimately prohibition failed and was repealed with the
21st amendment
• Alcoholics Anonymous was founded in 1935
• AA as an organization espoused no particular cause of
addition, but endorsed a spiritual path to recovery
• Argument: Individuals are powerless to overcome
addiction. If one is powerless to overcome addiction then
individual efforts regardless of the method will ultimately
fail. If it is the case that one is powerless to overcome
addiction with individual effort then a power greater than
oneself must be employed in order to succeed.
Disease Model
• Declared a disease by the American Medical
Association in 1955
• Defined as: Progressive, irreversible and incapable
of being cured
• Though it may not be cured the progress may be
halted through abstinence
• Set the stage for inpatient treatment. Once a
patient is identified with a medically
p y recognized
g
diagnosis, treatment for addiction could be included
in a medical model and eventually linked with
insurance

Disease Model Continued
• The disease model shifts the cause of addiction
from the person to the disease
• Argument: Addiction is a disease. Cancer is also a
disease. One does not intend or act in such as way
as to cause cancer (except for smoking). If one
does not intend or initiate the cause of the disease
then one is not responsible for it’s symptom
presentation.
• At this
thi point
i t iin hi
history
t ttreatment
t t remains
i ffairly
il
confrontational, and the main method of treatment
remained 12 Step support groups. (a spiritual
solution to a bio-medical disease)
Psychological Model
• Identified addiction as a symptom/branch of a root problem
contained within the psyche, and that addiction is caused by a
pre-existing
i ti mentalt lhhealth
lth di
disorder
d or bby ttraumatic
ti experiences
i
• The basic belief was that a person was engaging in addictive
behavior to self medicate an underlying psychological condition
• Argument: Addiction is not a disease, but a set of behaviors
elicited by underlying psychological mechanisms. If one can
resolve the psychological root cause then addictive behaviors
will resolve on their own
• The origins
g of this theory
y reside in Freudian ppsychology,
y gy, but
some aspects of the theory more closely aligned with
behaviorism and concerned themselves more with habit
reinforcement and social learning/modeling

Psychological Model Continued
• This theory was more popular in the 1960s and was

in part a response to the question of how and why
women could become addicts
• There was a strongly held belief that women could
not become addicts instead believing that addictive
behavior was the result of “nervous breakdowns”
from histrionic women
• Betty Ford would help to change this perception.
(more on Betty Ford)
Sociocultural Model
• An adjunct model coinciding with other modern models
• The belief that society
y as a whole and that one’s subculture
and peer group had more influence over drinking/use patterns
than other relevant models of addiction
• Because there are more drugs available and greater access to
substances then there are higher rates of addiction
• If one’s environment includes more drinking/use behavior then
one is more likely to become addicted
• Argument: Drug use is heavily influenced by society and leads
addiction In order to reduce addiction one
to more cases of addiction.
must change societal attitudes.

Sociocultural Model
• Treatment prescription within this model relies on
legislation
g to manage
g availability
y with the hopes
p of
changing attitudes and enabled many of the laws that
still exist today
• Strategy for Sociocultural Intervention:
• Increase legal consequences by lowering BAL
standards for DUI, creating liability for businesses that
serve alcohol
• Reduce access banning smoking in certain public
places, making more restrictive liquor license laws
• Increase taxes: sin tax on alcohol and tobacco products
Biological Model
• Takes a reductionist view that all phenomena are best
understood at the lowest level of natural systems (e.g., cellular
or molecular)
l l )
• Early research into neurological causes of addiction
• Theories of genetic influence related to some subsets of people
studied who appeared to have unusual sensitivity to addictive
substances
• The concept of predisposition was developed indicating that
someone with certain genetic or biological markers could be
y to become addicted and is thus p
more likely predisposed
p to
addiction
• Much of this theory was influenced by the Cloninger study of
alcoholism in northern Europeans

Bio-psychosocial Model
• The biopsychosocial approach considers biological,
psychological, and social factors along with their
complex interactions in understanding health,
disease, and health care delivery.
• Biological, psychological, and social factors exist
along a continuum of natural systems
• Natural systems in this case include from the macro
to micro level in descending order:
• Biosphere, Society, Nation, Culture, Subculture,
Community, Family, Two Person, Person, Nervous
System, Organ System, Organ, Tissue, Cells,
Organelles, Molecules, Atoms, Subatomic Particles
Bio-psychosocial Model Continued

• Integrated consideration of psychological and social
pp
factors necessitates application of social sciences,, and
consideration of biological factors necessitates
application of relevant biological sciences.
• Both the biological and social sciences are therefore
not only important but imperative to medical practice.
• Psychological and social factors are highly valued in the
approach which requires the
biopsychosocial approach,
application of scientific method to biological,
psychological, and social phenomena as related to
human health

Bio-Psychosocial Model Continued I
• Application of the biopsychosocial approach in clinical practice
requires that one:
• Recognize that relationships are imperative to providing care
• Use self-awareness as a diagnostic and therapeutic tool (I
don’t think the medical community was aware of mindfulness
when this model was formulated)
• Gather the patient’s history within the context of life
circumstances
• Decide which aspects of biological, psychological, and social
influences are most important to understanding and promoting
the patient’s health
• Provide multidimensional treatment
Public Health
Model
• Focus is on the
overall health of a
community
• Theoretical basis for
managing addiction
stems from the
general public health
approach to it’s other
missions like
preventing the spread
of disease.

Public Health Model Continued
• Interventions may target any part of this

triangle and public health should improve
improve.
• With regard to addiction:
• Teaching relapse prevention to an individual
or group is an attempt to target the Host.
• Laws that target access like the sin tax
discussed earlier target the Agent
• Public health campaigns like “Just Say No,” or
commercials that reference “Your brain on
drugs” target the Environment.
Public Health Continued I

• Harm reduction - A type of public health strategy which is
more often employed as it relates to drugs and alcohol than
process addictions
ddi ti like
lik gambling.
bli
• Acknowledges that it is impossible to eliminate addiction in
society. The goal becomes reducing the harmful consequences
of addiction such as: overdose, the spread of HIV and Hepatitis
and DUI related death.
• Intervention: Needle exchange programs to slow the spread of
disease, overdose prevention training, ad campaigns to
encourage designated drivers
• Goals: Substitute high risk drug use with lower risk drug use.
Reduce morbidity and mortality of addicts and therefore the
public. Reduce crime associated with drug use.

Personality Model
• Addiction is essentially characteristics of personality.

• Origin of the term “Addictive Personality.” The belief
that a personality type exists that tends toward high
stress with an inability to manage stress along with a
host of other tendencies such as tendency to
manipulate or control while at the same time lacking
self esteem
• Treatment therefore requires changing the
fundamental nature of a person’s personality
Habit Model
• Denies the Premise- Argues that addiction

is a metaphor, and that the only reason to
make the distinction between habit and
addiction is to stigmatize

Opponent Process Model
• States that for every psychological event that occurs an
opposite
pp event will follow
• Example - Pleasure derived from drug use is naturally
followed by the opponent process of withdrawal.
• Related to the opponent process color theory.
• Other examples of opponent processes can be found in
the nervous system including taste, motor movement,
touch, vision, and hearing.
• Sound familiar? Any resemblance to Yin/Yang theory?
More to come on this theory when we discuss
motivation
Philosophy of Addiction
Free will, Morality, Motivation and

a littl i
little neuroscience

Basic Philosophical Concepts for
Review
• Premise - a proposition supporting or helping to support a
conclusion.
• Iff = If and only if
• A sentence is a priori true if and only if (iff) it can be known
independently of experience (contrast: a posteriori: can only be
known by experience).
• A sentence is necessarily true iff it couldn’t be false, i.e. it is
true in every possible world (contrast: contingent: false is some
possible worlds, true in others)
• An argument is valid iff the conclusion follows from the
premises
• An argument is sound iff it is valid and has true premises.
• Normative Statement – a statement expressing a value
judgment about whether a situation is desirable or undesirable.
Free Will vs Determinism

Incompatibilism
• Incompatibilism - is the belief that Free Will and

D t
Determinism
i i are llogically
i ll iincompatible
tibl
categories and therefore mutually exclusive.
• This could include believing that Determinism is
the reality, and therefore Free Will is an illusion
(known as Hard Determinism), or that Free Will
i ttrue, and
is d th
therefore
f D
Determinism
t i i iis nott (k
(known
as Libertarianism).
Incompatibility
• In order to demonstrate that free will is in fact
incompatible with determinism, we must assume
the truth of determinism, and argue for the absence
of free will.
• Conditional Proof: To prove the truth of a statement
if p, then q we assume p as a premise, and argue
from this premise, using only other true premises,
to q as our conclusion. If we can construct a valid
argument with p in addition to other true statements
as premises for q, it follows that the conditional
statement if p, then q must be true. Here p is the
truth of determinism, and q is the denial of free will.

Determinism (Hard)
• Determinism is the theory that everything in

th universe
the i iis governed
dbby llaws off nature
t
often referred to as causal laws.
• Determinism argues that we have no moral
choices and therefore no moral
responsibilities
• If action is governed by causal laws of
nature our actions are predetermined to
occur
Determinism Continued
• P1: If determinism is true, then every human action is

causally necessitated
• P2: If every action is causally necessitated, no one could
have acted otherwise
• P3: One only has free will if one could have acted otherwise
• P4: Determinism is true
• C: No one has free will
• Given that causes guarantee their effects and since
everything that happens is an effect manifested from a
cause, everything that happens must occur. Therefore
nothing is free.

No Choice Principle
• The no choice principle: If I have no choice about p, and no
choice about whether if p, then q, I have no choice about q.q
• We have no choice about events which occurred in the past.
• We have no choice about what follows from or the
consequences of the laws of nature
• Determinism: the laws of nature with the state of the universe at
a particular time determine the future.
• If these three ideas are true: The No Choice Principle, the
claims
l i th
thatt we h
have no choice
h i about
b t th
the occurrence off pastt
events, or laws of nature then, what the argument demonstrates
is that if determinism is true, we have no free will.
Libertarianism
• Libertarianism - the theory that we do have free wills.
• Libertarians argue
g that some,, not all of our actions are free.
• Libertarians provide two main arguments: – The argument
from deliberation and the argument from moral responsibility.
• Argument from deliberation - every human being is free to
make the choices that she/he does and that deliberations
leading to these choices follows.
• Moral Responsibility - Determinism conflicts with the thesis
that we have moral responsibilities.
• Moral responsibility implies that we have a choice between
good and evil actions.
• There can be no rational feelings of guilt if we were not
essentially free.

Libertarianism Argument From
Deliberation
• I sometimes deliberate, with the view to making a decision; a
decision, namely, to do this thing or that.
• Whether or not I deliberate about what to do, it is sometimes up
to me what I do.
• I can deliberate only about my own behavior and never about
the behavior of another.
• I can deliberate only about future things, never about things
past or present.
• I can’t deliberate about what I’m going to do if I already know
what II’m
m going to do
do.
• I can’t deliberate about what to do, even though I may not know
what I’m going to do, unless I believe that it is up to me what
I’m going to do
Indeterminism
• Indeterminism – the idea that events are not caused
deterministically
• Peter van Inwagen’s Jane example
• We now imagine the current pulse traveling through Jane’s
brain.
• The pulse could go one of two ways. Which way it goes will
determine whether or not Jane speaks. In an indeterministic
world the pulse is therefore not influenced by the laws of nature
or the current state of Jane’s brain. If the pulse goes left or if
the pulse
p goes right
g g it ggoes outside of her control.
• If nothing determines whether someone chooses A or B, the
choice of A or B is random, and hence not a free choice

Compatibilism
• Compatibilism - is the belief that free will and
determinism are compatible
p ideas,, that one can hold
both ideas to be true without contradiction.
• The 2 main ideas of classic compatibilism.
• First: Requires redefining of the notion of freedom.
• Reimagining the notion of freedom: the concept of
freedom most closely related to moral inquiry is simply
one’s ability to do what one desires in the absence of
impediments
• Second: An attempt to explain how one could be free
to do otherwise even if one was pre-determined (or just
determined) to do what one ended up doing.
Compatibilism Continued
• For review: Consider the argument for determinism
listed below and imagine a potential challenge
• P1: If determinism is true, then every human action is
causally necessitated
• P2: If every action is causally necessitated, no one
could have acted otherwise
• P3: One only has free will if one could have acted
otherwise
• C: No one has free will

Compatibilism Continued
• Consider P3: One only has free will if one could have acted
otherwise
• One objection would be to deny P3 and claim that free actions
are the result of our desires and that we need not worry about
the possibility of doing otherwise. That an action is the result of
a desire is enough for this vision of free will and is thus
compatible with determinism. Again, free actions originate
from our desires and there is no need for it to be true that we
could have done otherwise
• If one attempts to maintain the idea from P3 that we could have
d
done otherwise
th i a standard
t d d compatibilist
tibili t objection
bj ti would ld b
be tto
make the claim: “I would have acted otherwise if I had desired
to do otherwise”
Compatibilism Continued I
• The revised argument should now read:
• P1: If determinism is true,
true then every human action
is causally necessitated
• P2: If every action is causally necessitated, no one
could have acted otherwise
• P3: One only has free will if one could have acted
otherwise i.e. if one would have acted otherwise or
if one had desired to act otherwise one would have
acted otherwise
• C: ?

Compatibilism Soft Determinism
• Soft determinism consists of two main claims:
• 1.
1 Determinism is true true. Every event
event, including
every human action, is causally determined. If you
selected vanilla rather than chocolate ice cream
last night, you could not have chosen otherwise
given your exact circumstances and condition.
• 2. We act freely when we are not constrained or
coerced. If my legs are tied, I am not free to run. If I
h d over my wallet
hand ll t to
t a robber
bb whoh iis pointing
i ti a
gun at my head, I am not acting freely. Another way
of putting this is to say that we act freely when we
act on our desires.
Compatibilism Soft Determinism

Objection
• The most common objection to soft determinism is that the
notion of freedom it holds onto falls short what most people
mean by free will.
• Imagine you are under hypnosis – While under hypnosis I plant
certain desires in your mind: e.g. a desire to get yourself a drink
when I ring a bell. I ring the bell and within seconds you get up
and pour yourself some water.
• Have you acted freely? If acting freely simply means doing what
you want, acting on your desires, then the answer is yes, you
acted freely. But most people would see your action as unfree
since, in effect, you are being controlled by someone else.

Moral Psychology
• Moral psychology is the study of moral identity

development or how people integrate moral ideals
development,
with the development of their own character.
• Moral psychology differs from moral philosophy in
that it studies how we make decisions, rather than
exploring what moral decisions we should make. It
encompasses the study of moral judgment, moral
reasoning, moral character, and many related
subjects at the intersection of philosophy and
psychology
Moral Psychology
• Egoism
• Intention
• Willpower

Egoism
• Egoism - the proposition that we always act from selfish
motives. It holds that all desires are egoistic desires, or else
derived egoistic desires.
desires
• Egoism elaborated: the proposition that one’s self is
(descriptive), or should be (normative), the motivation and the
goal of one’s own action.
• Variants: Descriptive and Normative
• Descriptive Variant - Egoism is a factual representation of the
human experience. People are motivated by their own
interests and desires alone. The normative variant proposes
th t people
that l should
h ld be
b so motivated,
ti t d regardless
dl off what
h t
presently motivates their behavior. Egoism should be
distinguished from egotism, which means a psychological
overvaluation of one’s own importance, or of one’s own
activities.
Normative Egoism/Rational
• Rational egoism claims that the promotion of one’s own interests is
always in accordance with reason.
• Ayn
A R Rand d - proponentt off rational
ti l egoism.
i R
Randd argues th
that:
t fifirst,
t
properly defined, selfishness rejects the sacrificial ethics of the West’s
Judaic-Christian heritage on the grounds that it is right for man to live
his own life and that selfishness is a proper virtue to pursue. She
rejects the “selfless selfishness” of irrationally acting individuals
declaring that “the actor must always be the beneficiary of his action
and that man must act for his own rational self-interest.” To be
ethically selfish thus entails a commitment to reason rather than to
emotionally driven whims and instincts.
I th
• In t
the strong i off rational
version ti l egoism
i d f d db
defended by R d nott only
Rand, l iis
it rational to pursue one’s own interests, it is irrational not to pursue
them. In a weaker version, one may note that while it is rational to
pursue one’s own interests, there may be occasions when not
pursuing them is not necessarily irrational.

Normative Egoism/Ethical
• Ethical egoism is the normative theory that the

promotion of one
one’ss own good is in accordance with
morality.
• Strong version - it is always moral to promote one’s
own good, and it is never moral not to promote it.
• Weak version - it is always moral to promote one’s
own good, it is not necessarily never moral to not.
That is, there may be conditions in which the
avoidance of personal interest may be a moral action.
Egoism Examined
• P: Everything I do is motivated by my desire to

do that thing
• C: Therefore everything I do has a selfish
motivation.
• Question: Don’t we often do things that we
don’t want to do, things we have to do or feel
we should do?
diff t way off saying
• A different i it:
it T
To b ti t d
be motivated
by one’s own desires is to be selfishly
motivated

Egoism Examined I
• Contrast: Being motivated by one’s own

desires vs
vs. Being motivated by a desire for
one’s own satisfaction
• The content of our desires: Actions like
revenge are typically not egoistic (though this
claim is debatable), it is unclear if one will be
motivated by all of their desires, and there is a
big difference between satisfying a desire, and
getting pleasure from the satiation of a desire.
Egoism Examined II
• Paradox of Hedonism/Pleasure Paradox – Pleasure seeking is
it’ss own impediment to pleasure.
it pleasure Constant pleasure-seeking
pleasure seeking
may not lead to the maximum pleasure as the need to
constantly pursue pleasure interferes with the ability to attain it.
• Some types of pleasure are directly connected to the activity
that one finds pleasurable: If one plays an instrument for
pleasure and at the same time having pleasurable experiences.
There is a subtle conflict between the two.
• Define Pleasure? If defined as the satiation of desires, then we
approach something like circular logic i.e. our only basic desire
is the satisfaction of our desires

Egoism Examined III
• Experiment: Convert Egoistic desire to I-desire
• First: Frame desires as propositions.
propositions e e.g.
g ‘II want
dessert’ becomes ‘I want that I have dessert’. The
thinking is that truly egoistic desires take this form (I
want that I…) These are then called I-desires a term
coined by Bernard Williams.
• Imagine a state of perceived altruism. One might claim
“I want to change lives for the better and heal the sick.”
What is the fundamental drive here? What is the
motivation? Is it the fundamental motivation “I want
that I change lives for the better and heal the sick?” or
“I hope that change and healing comes to the sick.”
Egoism Examined/Testing Altruism

• It can easily be suggested that seemingly altruistic
acts or thoughts are egoistic. From the above
example all one needs to do is apply an I-desire
reframe to evaluate motivation. If the desire is only
fulfilled by the I-desire it follows as egoistic.
• Whenever this seems to be the case it can be more
rigorously tested by imagining conditions in which
the I-desire could be achieved independently of the
altruistic desire
desire. If the agent in question is satisfied
by these conditions then one can be reasonably
certain that it is in fact not altruism but egoism
motivating the desire.

Humean Theory of Motivation
• Basic Tenet: All motivating reasons consist of a belief/desire
pair
• While necessary, beliefs are insufficient to move an agent.
One must also have corresponding desire.
• Desires are necessary to move an agent. For example:
Revealed Preference Theory: an agent’s preferences are
revealed by their actions.
• Revealed Preference Theory: A method of analyzing choices
made by individuals, mostly used for comparing the influence
of p
policies on consumer behavior. These models assume that
the preferences of consumers can be revealed by their
purchasing habits. Revealed preference theory was a means to
reconcile demand theory by defining utility functions by
observing behavior
The Problem of Intention

• Many different types of intention so the definition used must pertain to
the context in which it is used
• Philosophical
Phil hi l diffi
difficulty
lt related
l t d tto iintention
t ti originates
i i t withith th
three maini
considerations:
• Intention for the future action
• The intention with which someone acts (acting with continued
intention to act)
• Intentional action (I am doing something on purpose)
• Let’s Consider: Intention as Doing, Intention in Action, Intention as the
Good, Intention as Plans, Intention as Belief
I t ti as Doing
• Intention D i - Ab li f th
belief thatt actions
ti h
have some ffeature,
t (f t
(feature
F), along with the belief that the original action has that feature.
Action is intentional by virtue of its relation to a primary reason and
this reason gives the intention with which the action is done.

The Problem of Intention Continued
• Intention in Action - Doing P intentionally is doing it with
continued intention. Also,, doing g somethingg with the
intention of doing P.
• Intention as the Good – The first 2 aspects of intention
involve action as in some way related or connected to
intention. Intention as the Good is more concerned with
the thinking that intention must be connected to mental
state that contains within it some sort of evaluative
judgement. For example, does this state involve
d i ?S
desire? Some other
th b belief
li f about
b t what
h t one iis d
doing?
i ?
Shouldn’t I want to perform an action, know that I am
performing an action and hold in that state that it is
good?
The Problem of Intention Continued I

• Intentions as Plans – A particular kind of attitude with a
central role in pplanning g for the future. Intention involves
desire, but does not require commitment to action.
Intentions guide conduct in advance and need not be
completely re-established for every eventuality but must
be filled in in relation to future changes.
• Intentions as Belief – The thread that bind other
intention concepts. Intention in action contains the
belief that one is doing something. Intention in action
t i the
contains th belief
b li f that
th t one is
i doing
d i somethingthi ffor a
reason, and intention for the future contains the belief
about what and why someone will do something.

The Problem of Intention Continued II
• Velleman’s Theory: We all have a desire for self-knowledge
which is satisfied when it turns out that a belief which we
have about our current or future conduct is true. For
example, if I hold a belief that I will complete a certain action
and then I complete that action by the mere act of
completing the action I would have satisfied my desire for
self knowledge. In this case I turn belief into knowledge and
satiate a sort of primal or underlying need for self knowledge
in its most basic form
form. Beliefs now form the basis or reason
for action.
• Is this theory related to the upcoming topic on the theory of
constructed emotion?
The Problem of Willpower

• AINSLIE’S EIGHT MARKS OF THE WILL
• 1 A new force in addition to desires etc.
1. etc
• 2. Throws its strength on the weaker side.
• 3. Unites actions under a common rule.
• 4. Strengthened by repetition
• 5. Very vulnerable to non-repetition
• 6. Requires no diversion of attention
• 7 Doesn’t
7. Doesn t normally depend on each single choice
choice,
except where stakes are very high.
• 8. Tendency of failure in one sphere to spill into others
is variable.

Willpower and Hyperbolic Discounting
• The tendency for people to increasingly choose smaller-sooner
rewards over a larger/later reward as the delay occurs sooner rather
than later in time.
time When offered a larger reward in exchange for
waiting a set amount of time, people act less impulsively and choose
to wait as the rewards happen further in the future.
• People avoid waiting more as the wait nears the present time. The
classical view within economics (also called exponential discounting)
assumes that people discount a future reward by a fixed percentage
for each unit of time they must wait
• Evidence suggests that this is not entirely accurate and that people
choose by discounting future rewards at a greater rate when the delay
occurs sooner in i titime.
• The term “hyperbolic” is used because this concept can be
represented as an economic formula which is the generalized
function for a hyperbola
Hyperbolic Discounting Example
• Many people prefer $100 now to $110 in a day,

b t very few
but f people
l prefer
f $100 iin 30 ddays tto
$110 in 31 days.
• It appears people would rather wait 1 day for $10
if the wait happens a month from now.
• However, they prefer the opposite if they must
waitit right
i ht now. More
M ll the
generally, th rate
t att which
hi h
people discount future rewards declines as the
length of the delay increases

Willpower and Personal Rules
• Personal rules can sometimes lead an individual to
approximate an exponential discount curve for future events.
P
Personal l rules
l d do nott give
i one th the ability
bilit tto maximize
i i one’s
’
expected utility whenever making a choice. Personal rules to
not speak to the experience of spontaneous choice
making. Rule-governed choice has four properties that cause it
to fall short of these utilitarian ideals:
1. Categories of choice come to overshadow their individual
members.
2. Rules make lapses disproportionally damaging, and may
lead to symptom permanency.
permanency
3. Rules create a motive to distort the perception of reality.
4. Rules need not be in the person's longest range interest.

Continued
• Categories of choice overshadow it’s members - Perception of choices as
precedents often makes a choice much more important for its expected effect
on future choices than for the rewards that liter-ally
liter ally depend upon itit. If this is
the case, choice becomes detached from the properties of its objects.
• Rules Magnify Lapses - When a person violates a personal rule, the result is
a decrease in one’s chance of attaining the rule’s intended reward. This
chance to attain the reward is what is used motivate against the oppositional
impulses. A lapse then implies that one is weak willed, a conclusion that may
actually serve to weaken one’s will. In order to protect one’s self-concept of
having willpower, one will be strongly motivated to connect the lapse to some
special condition that existed at the time of the lapse thereby leading one to
further lapses in willpower whenever those conditions exist. This may lead to
a series of exceptions to the rule that are self protective ensuring one
one’s s
concept of willpower remains unthreatened. Example, “I only overeat on
special occasions. “ Or, “I only drink after I attain a significant goal. ”
Instances of these impulses will appear to cause the behaviors automatically,
without the possibility of choice.

Continued I
• Rules motivate misperception - Personal rules rely on
perception. One must constantly remember one’s choices and
relevant circumstances/rationale for creation. Personal rules
govern many aspects of one’s motivation leading to the
inclination to subvert perception for gain and protection. During
and after lapse, it is in one’s long and short term interests not to
recognize the lapse. One’s short term interest is to keep the
lapse from being detected in order to protect the behavior and
allow it to continue. One’s long g term interest is also to p
protect
the lapse from being consciously acknowledged, because
acknowledging the lapse would decrease one’s self concept of
self-control desperately needed to manage impending
challenges to one’s will.

Continued II
• Personal rules need not serve the persons
long term interest – The most concrete
example is of compulsion. Compulsions
engender a sense similar to addiction but
tend to be highly systematic, enduring and
seemingly
g y rational.

Dissociation
• Dissociation avoids intrusive thoughts

• Dissociation protects personal rules in the
person’s long term interest
• Dissociation may serve to help avoid rules
closely aligned with compulsions
The Theory of Constructed Emotion
Lisa Feldman Barrett

The brain as described by Barrett
• What is a brain?
• A brain is a network of billions of communicating
neurons, bathed in chemicals called neurotransmitters,
which permit neurons to pass information to one
another. The firing of a single neuron or groups of
neurons represents the presence or absence of some
feature at a moment in time. However, a given neuron
or neuron group represents different features from
moment to moment because many neurons synapse
onto
t one(many-to-one
( t connectivity),
ti it ) and
d a neuron’s
’
receptive field depends on the information it receives.
What is a Brain?
• One neuron may also synapse on many other

neurons as in
i one tto many connectivity
ti it
• Neuron are multi-purpose
• Brain is viewed as a massive network, rather than
a single organ or a collection of mental
components. The brain and its massive
ll ti off neurons can create
collection t an unfathomable
f th bl
number of spatiotemporal patterns

Degeneracy
• Degeneracy - the capacity for dissimilar representations (e.g.
different sets of neurons) to give rise to instances of the same
category
t (e.g.
( anger)) iin the
th same context
t t
• A common concept within biology, Barrett applies it to
neurology in order to help explain theory of constructed
emotion
• With regard to emotion, degeneracy means that instances of
an emotion (e.g. fear) are created by multiple spatiotemporal
patterns in varying populations of neurons. Therefore, it is
unlikely that all instances of an emotion category share a set of
core features
f t
• A core aspect of her hypothesis is that emotions are somewhat
like arbitrary categories with highly variable instances
What is the Purpose of a Brain?

• Nope! You’re wrong! It is not for rationality, the pursuit of
happiness, freedom, purpose or perception
• All brains
b i accomplish li h th
the same core ttask k which
hi h iis tto efficiently
ffi i tl
manage resources for physiological systems within the body.
Barrett calls this the internal milieu. Efficient resource
management allows the body to survive and reproduce.
That’s it.
• Allostasis - the process by which a state of internal,
physiological equilibrium is maintained by an organism in
response to actual or perceived environmental and
psychological stressors
• Allostasis is not a set condition, but a process for how the
brain regulates the body according to costs and benefits. In
order for the body to operate efficiently it requires the ability to
anticipate the body’s needs and satisfy them before they arise

Allostatic Balance
• An animal thrives when it has sufficient resources to
respond to the world in which it resides
• The brain helps to consolidate experience for later use
with respect to future energy expenditure.
• Too much of a resource (obesity) or not enough
(Fatigue) is suboptimal. The longer imbalances are
allowed to persist the more likely they can lead to
illness and potentially change the way the brain
responds leading to behavior change.
• Any of this sounding familiar? Is there a sense of
excess and deficiency to allostatic balance? Could it be
that there is a treatment in the world that help to create
this balance?
Allostatic Balance Continued

• Your brain does a lot, but regardless of what higher level
function it is doing weather it’s thinking or feeling it’s always
working
ki tto create t andd maintain
i t i bbalance
l b
between
t th
the various
i
aspects of your nervous system, respiratory system,
cardiovascular system etc.
• Brain regions responsible for allostasis - amygdala, ventral
striatum, insula, orbitofrontal cortex, anterior cingulate cortex,
medial prefrontal cortex (mPFC), collectively called
visceromotor regions. These are the brain regions most
commonly linked with emotional expression and memory.
Th
• These i
regions h
exchange iinformation
f ti with
ith midbrain,
idb i b i t
brainstem,
and spinal cord nuclei that coordinate autonomic, immune, and
endocrine systems.

Allostatic Performance
• Effective regulation requires that the brain utilize an internal
model of the body in the world also called embodied simulation.
• This internal model is not simply a symbolic representation, but
a metabolic investment, implemented by allostatic effort that, in
humans, occupies 20% of our total energy consumed
• Embodied simulation models the world based on the body’s
biological needs. What follows is that the brain’s internal model
includes both pertinent statistical information from the outside
world and statistical information from the allostatic effort to
regulate the internal milieu. Collectively, the representation and
utilization
tili ti off th
these iinternal
t l sensations
ti is
i called
ll d ‘i‘interoception.’
t ti ’
Interoception
• Interoceptive sensations are the experience of affect
• What exactly y is affect? We all have a sense of what it means
and use it in conversation, but what is it really?
• Affect is not an emotion, but a general sense of feeling with two
component parts: Valence and Arousal
• Valence – How pleasant or unpleasant one feels
• Arousal – How calm or agitated one feels
• Affect is brought about by interoception and by allostatic effort.
The implication of this is that one is always experiencing affect
regardless of if one is asleep or awake
awake. It is a fundamental
component of consciousness
• Interoception does not create affect though affect depends on
interoception. The emergence of affect is apparently still
somewhat of a mystery to science

More on Affect
When the body is out of balance one
experiences affect without conscious
information related to the cause of
one’s affect. That experience prompts
one’s brain to search for an
explanation for affect
The brain uses past experience to
predict which events will impact
allostatic balance, which changes
one’s affect leading to what’s known
at the affective niche,
Affective niche - Everything that has
any impact on your body at the
present moment
Implications of Affect
• Affect leads us to draw conclusions about the world
• Affective Realism - the tendency of your feelings to influence your
conscious
i reality
lit iincluding
l di what
h t you thi
think,
k ffeel,l and
d actually
t ll see.
• Leads us to believe that objects or events/circumstances have an
inherent quality of positive or negative
• Barret gives examples: “The phrase “an unpleasant image” is really
shorthand for “an image that impacts my body budget, producing
sensations that I experience as unpleasant.” and “I feel bad, therefore
you must have done something bad. You are a bad person.”
• Affective realism is an example of naïve realism or the belief that
one’s
one s senses provide an accurate representation of the world
• More on Affect when we look at acupuncture and specifically nutrition,
supplements, and herbal treatment

Predictive Not Reactive
• Neurons are constantly activated and do not wait for
stimulation.
• Our internal model is predictive not reactive – one theory is that
our brain predicts in much the same way as a Bayesian Filter
continuously predicting or anticipating events in the
environment
• Bayesian Filter - A technique for identifying incoming e-mail
spam. Unlike filtering techniques that look for spam-identifying
words in subject lines and headers, a Bayesian filter uses the
entire context of an e-mail when it looks for words or character
strings
ti that
th t will
ill id
identify
tif th
the e-mailil as spam. B
Bayesian
i filt
filters
learn to identify new spam the more it analyzes incoming e-
mails.
Predictive Not Reactive Continued

• Based on past experience, the brain creates
multiple competing simulations to find the
simulation that best matches past experience with
current situation
• Simulation is a partially completed pattern that
helps organize sensory information for the purpose
initiating action related to efficient allostatic actions
• Pattern completion helps to decide among
i l ti
simulations andd lleads
d tto iimplementation
l t ti off a
completed pattern. Primary to pattern
implementation is that it maintains physiological
efficiency.

Predictive Not Reactive Continued I
• In predictive coding sensory predictions arise from motor
predictions and simulations arise from visceromotor
predictions.
di ti Th
These predictions
di ti are th
there tto prepare ffor
immediate action.
• A commonly held view in neuroscience and psychology is the
stimulus/response model of mind. This predictive model
challenges these assertions. For example it is highly unlikely
that anyone could ever hit a fastball if the brain did not
formulate several simulated instances in advance and then
predict in advance which on would occur. If I waited until I
consciously recognized the experience of the ball leaving the
pitchers hand I would never stand a chance.
• Perception is dependent on action, not the other way around.
The Brain is a Conceptual System

• The content of the simulations within the internal model
concepts which give meaning to sensation further
organized
i d iinto
t categories.
t i
• Predictions are concepts
• Concept - the population of representations that
correspond to events or a group of distributed patterns
of activity across some population of neurons.
Concepts can be perceptual or goal driven as in to go
out and have fun with friends, complete a task (grocery
h )
shop)
• Category - a population of events or objects that are
treated as similar because they all serve a particular
goal in some context

Constructing Emotion
• “The brain uses emotion concepts to categorize sensations to
construct an instance of emotion”
• “The
“Th b brain
i constructs
t t meaning i b by correctly
tl anticipating
ti i ti (predicting
( di ti
and adjusting to) incoming sensations. Sensations are categorized
so that they are (i) actionable in a situated way and therefore (ii)
meaningful, based on past experience. When past experiences of
emotion (e.g. happiness) are used to categorize the predicted
sensory array and guide action, then one experiences or perceives
that emotion (happiness)”
• “An instance of emotion is constructed the same way that all other
perceptions are constructed, using the same well-validated
neuroanatomical
t i l principles
i i l ffor iinformation
f ti flflow within
ithi th
the b
brain.”
i ”
• “Predictions literally change the firing of primary sensory and motor
neurons, even though the incoming sensory input has not yet
arrived”
Constructing Emotion Continued
• All action and perception are created with concepts. All

concepts contribute to allostasis and represent changes in
affect.
• Consider the wide variability to emotion. How many different
kings of happiness and sadness concepts do you have?
• Happiness concept examples: completing a task,
succeeding in school, first kiss, vacation, surfing, holding
hands, favorite food etc.
• The list can go on an on, but we must hold concepts for
each of these experiences and yet categorize them as
happiness

Constructing Emotion Continued II
• An additional hypothesis related to opposition to classic theory
of emotion: information from the amygdala to the cortex is not
necessarily
il emotional
ti l but
b t iimplies
li uncertainty
t i t with
ith regard
d tto
predicted sensory input and helps to adjust allostasis as a
result. Arousal signals associated with increases in amygdala
activity can be considered a learning signal
• As information flows from sensory regions to limbic and other
regions in frontal cortex, it is compressed and reduced in
dimensionality.
• Dimension reduction allows the brain to represent information
with
ith a smaller
ll population
l ti off neurons, reducing
d i redundancy
d d and
d
increasing efficiency. Additional efficiency is achieved because
conceptually similar representations reuse neural populations
during simulation
Traditional Chinese Medicine

and Addiction
Examining Addiction From

Yi /Y
Yin/Yang, Fi
Five El t M
Element, idi
Meridian,
Zang Fu Perspective

First a Word on the Root of Addiction
• It is a commonly held belief that addiction is the result of self
medication, that one uses substances to mask, manage, or otherwise
numb painful emotions and intrusive thoughts.
thoughts In theory that is
essentially correct although the contributing factors and trajectory into
addiction can variable.
• The problem is that is only the beginning of the story and the rest of
the story is rarely discussed and poorly understood leading to an
over-reliance on self-medication theory to inform treatment
• For the vast majority of addicted patients treating the initiating factor
alone will be insufficient to treat addiction
• The p process that lead to addiction is jjust that, the p
process that lead to
the condition. Once addiction forms it establishes itself as its own
independent condition. The process that lead to it’s formation will
inform treatment but will not be useful as the primary guide to
treatment.
Root of Addiction
• Many people struggle letting go of their preconceived notions of
addiction and for good reason. It makes sense. Our
preconceived
i d notion
ti with
ith regardd tto addiction
ddi ti are often
ft accurate
t
but incomplete.
• If someone uses substances to mange depression or anxiety
for example it makes sense that if one resolves depression and
anxiety that the addiction will therefore also naturally resolve.
• What we find is that this is not the case for people with true
addiction
• A true addict will use when depressed,
p , happy,
ppy, stressed,,
relaxed, in mourning or celebrating
• This is an observation of behavior not a judgement.

Stage of
Change
Stage of Change or
Transtheoretical Model
• Stage of Change/Transtheoretical Model - an integrative, biopsychosocial
model to understand the process of intentional behavior change. TTM
attempts to integrate key ideas from other theories into a comprehensive
theory of change that can be applied to a variety of behaviors, populations,
and settings.
• Evidence suggests that people move through a series of stages when
modifying behavior. While the time a person can stay in each stage is
variable, the process that leads one to the next stage appears constant.
• Correct application of change principles work best at each stage to reduce
resistance, facilitate progress, and prevent relapse. A few of the guiding
principles include mindful attention to decisional balance, self-efficacy, and
processes of change.
• Only a very small percentage of people are poised to take action with regard
to change at any particular time. Overly action-oriented treatment can be
counterproductive in early stages. This is where the acupuncturist or
counselor must truly remove personal (even well intentioned) motives and
meet the patient where they are in the change process.

Stages of Change
• Precontemplation (Not Ready) - People in the
Precontemplation
p stage
g have no intention to take action
in the near future (or about 6 months give or take).
Multiple unsuccessful attempts at change can lead to a
lack of self-efficacy about the ability to change.
• Contemplation (Getting Ready) - Contemplation is the
stage in which people intend to change in the next six
months. The natural state of ambivalence that prevails
from the decisional balance can lead to one remaining
i thi
in this stage
t ffor a significant
i ifi t period
i d off ti
time lleading
di one
to languish from months to years while seeking to
overcome ambivalence.
Stages of Change Continued
• Action – Some specific intervention has been

employed for change.
change Typically for it to be
considered action it needs to be a set of
sustained actions geared toward change.
• Maintenance - People have utilized specific
interventions in their lifestyles and are working
to prevent relapse, but do not require
increasing levels of intervention to sustain
recovery.
• Relapse – Return to use

Decisional Balance
• A decisional-balance is a pro/con inquiry performed
consciously or unconsciously by anyone considering change.
I treatment
In t t t settings
tti it iis often
ft used d as an exercise
i iin
elaborated form to review and organize feelings about potential
change.
• Provides an opportunity to examine both the negative and
positive aspects of a behavior, acknowledge ambivalence, and
allow clients to feel understood rather than judged
• A common process would be to start by exploring the benefits
of a given change then to contrast with the negative
consequences off change.
h S
Soon to
t follow
f ll would
ld b
be an
exploration of negative consequences of no change as well as
the benefits of no change. Essentially pros of status quo vs
change then cons of status quo vs change
Self Efficacy
• Beliefs about one’s capabilities to produce levels of
performance that exercise influence over circumstances that
impact one
one’ss life
life.
• Self-efficacy beliefs determine how people think and feel and
serves to motivate behavior.
• High self-efficacy – Belief in capabilities approach difficult tasks
and see them as challenges to be mastered rather than as
threats to be avoided. Tends to be psychologically protective
leading one to conclude failures are the result of poor effort,
circumstance or lack of information rather than a judgement on
one’s
one s own ability
• Low self-efficacy – Doubt one’s capabilities and avoid difficult
tasks which can be psychologically threatening. Tendency to
dwell on their personal deficiencies, see only impediment and
strive only for goals in which they are already likely to succeed.

Phase of Recovery
• Early Abstinence – day 1 to 3 months

• Early Recovery – 3 months to 1 year
• Active Recovery and Maintenance – 1to 5
years
• Advanced Recovery – 5 years or more
Yin/Yang and Opponent

Process Theory
• Drug addiction is the result of linking the drug
induced experience of pleasure and the
emotional/physical symptoms associated with
withdrawal. Initial stage drug use induces, high
levels of pleasure and low levels of withdrawal. As
tolerance develops pleasure decreases leading to
increase in withdrawal and continued use despite
decreased pleasure.
• Our focus here is on opposition,
opposition not necessarily the
nature of yin and yang as cool nutritive qualities of
yin vs. the hot moving nature of yang. We simply
need to notice that the rules apply here too.

Yin/Yang Continued
• Opposition – Nothing can be more opposite than
the experience
p of being
g high
g vs being g in withdrawal
• Interdependence – Regardless of severity use
leads to withdrawal and withdrawal depends on
use. Use leads to a high but the absence of use
leads to a negative pre-use state
• Mutual Consuming – There is a dynamic balance
formed between yang of use and yin of abstinence
(yin/yang correspondence isnisn’tt important) When
pleasure is high withdrawal is low or absent
• Intertransformation – Use leads to withdrawal. The
discomfort of withdrawal leads to use
Zang Fu
• Zang Fu pathology/diagnosis and addiction are intimately
connected. Careful attention to all aspects of Zang Fu will
yield a better understanding of addiction as well as better
treatment protocols.
• Yin/Yang theory, along with Zang Fu and aspects of Five
Element theory make up the core of my vision for
understanding addiction from a Chinese medical
perspective.
• Zang Fu organs and organ systems relate to addiction in 2
primary ways. The first is their respective emotional
characteristics. The second relates to their role in creation
and maintenance of the qi mechanism

Zang Fu and Emotions
• Liver – Anger
• Heart – Joy
• Spleen – Pensiveness - suggestive of sad
thoughtfulness
• Lung – Worry (also taught as grief)
• Kidney - Fear
Zang Fu and the Yin/Yang of

Emotions/Normative Opposites
• If Yin/Yang theory is true then all things contain their
opposite
• What are appropriate opposites for Zang Fu organ
emotions? Consider your first impression might look
something like this…
• Liver: Anger vs. Forgiveness and Compassion
• Heart: Joy vs. Depression and Sadness
• Spleen: Pensiveness vs. thoughtless pleasure
• Lung: Worry (Grief) vs. contentment and (delight,
gladness, happiness) respectively

Zang Fu of Emotion/Logical Opposites
• Liver – Anger vs. Absence of Anger

• Heart – Joy vs. Absence of Joy
• Spleen – Pensiveness - suggestive of sad
thoughtfulness vs. Absence of Pensiveness
• Lung – Worry (also taught as grief) vs.
Ab
Absence off W
Worry
• Kidney – Fear vs. Absence of Fear
Zang Fu and Qi Mechanism

• Heart – Govern blood and blood vessels, transformation of food qi
and circulation, manifests in the complexion, houses the mind
• Liver
Li – Stores
St blood,
bl d regulates
l t qii flflow anatomically
t i ll andd emotionally,
ti ll
controls sinews, aids digestion, oh yeah and has the ability to help
plan one’s life
• Lungs – Govern Qi and respiration, controls diffusing and descending
of qi and fluid, controls channels and blood vessels, regulate water
passages, control the skin
• Spleen – Transformation and transportation, controls the ascending of
qi, controls blood
• Kidney – Store essence and produce marrow, control the reception of
qi, house the will (zhi)
• Pericardium – Also houses the mind, relates to depression, anxiety,
insomnia and agitation
• Gallbladder – controls the capacity to make decisions

Drugs of Abuse and Implication for
Zang Fu
• All drugs of abuse when used for abuse lead to a clouding of
the sensorium and should be implied when considering specific
d
drugs and d th
their
i effects
ff t on Zang
Z Fu
F
• Alcohol - Damages the SP/ST. Alcohol is considered hot and
damp and thus leads to damp heat. Alcohol also erodes the
lining of the stomach and esophagus leading to ST Yin Xu.
Alcohol effects the liver leading to LV Qi stagnation and LV Qi
stagnation with heat or LV yang rising.
• Stimulants – Effect HT/PC due to increased HT rate and
intense dopamine release. The Effect the SP due to tendency
t
towardd prolonged
l d perseveration
ti and d paranoia.
i M May effect
ff t
lungs depending on rout of administration.
• Sedatives – In general lead to dampness and stagnation
• Marijuana – Goes to the SP/ST and damages the lungs
The Five Elements Represented by

Movement Correspondence
• Fire – upward movement as in fire flaming
upward
• Earth – empty state, stable or neutral
• Metal – contraction or inward directionality
• Water – downward movement
• Wood – expansive and outward

Five Element with Stage of Change
• Fire – upward movement as in fire flaming

upward d ((relapse)
l )
• Earth – empty state, stable or neutral (pre-
contemplation)
• Metal – contraction or inward directionality
(contemplation)
• Water – downward movement (Action)
• Wood – expansive and outward (Sustained
change or maintenance)
Consider the Controlling Cycle a Five

Element Explanation of Ambivalence
• Fire controls Metal – upward movement(relapse)
overcontrols contraction (contemplation)
• It is very difficult to be introspective in the midst of a
relapse
• Metal controls Wood – contraction (excessive
contemplation) overcontrols expansion (sustained
change)
• The ambivalent deliberations of the contemplation
stage overcontrol or lead to self doubt in a person
attempting to maintain change

Consider the Controlling Cycle
Continued
• Wood controls Earth – Expansion (sustained change)
overcontrols the neutral state of precontemplation
• Sustaining change requires continued movement and mindful
recognition of the addiction state which is completely opposed
to the stable unmoving and unaware state of precontemplation
• Earth controls Water – Neutral and Stable (precontemplation)
overcontrols the beginning stage of Water’s downward
movement (action)
• The hallmark state of denial within precontemplation negates
g
action. In a denial state action is not even on the agenda.
• Water controls Fire – Downward movement (action) controls
upward fire (relapse)
• It is more difficult to forget progress when you’re in motion
Root Branch/Yin Yang Reversal Theory

• My proposition for beginning to form an understanding
of addiction from a TCM perspective
p p
• Based on observations from each stage of change and
each phase of recovery
• Intended to create the correct initial framework in order
to guide diagnosis and treatment. Other practitioners
may discover patterns which predominate over those
which I reference but with the proper initial framework it
is more likely
y one will accurately
y identify
y the proper
p p
pattern and treatment
• Considers the notion that both root and branch, cause
and symptoms are behavior states as well as
perceivable somatic body phenomena

Root Branch Models in Addiction
• Initiating Root/Branch (IRB)– Underlying imbalance or
constitutional deficiency and it’s related TCM consequences
leading to inaccurate overcorrection with false
f qi
• Addiction Root/Branch (ARB) – Maintenance of false qi
overcorrection leading to failure to move or engender qi.
• Reversal Pattern: (RRB) - Failure to move and engender
leading to constitutional deficiency and tendency to
stagnation
• IRB and ARB are the major Root/Branch patterns from
which all other patterns are derived
• Withdrawal pattern will be discussed later as an intermittent
stage of ARB
Finding the Pattern

• Proper addiction specific pattern identification must be
informed by accurate assessment of stage of change and
phase
h iin recovery
• Pattern diagnosis remains essentially the same but by adding
these 2 considerations to the 10 questions one can drill down
the correct pattern
• Based on stage of change and recovery phase one can
determine which of the 2 major root branch theories applies
• Once the proper general root branch has been identified then
pattern
p identification can resume as usual while beingg informed
by common patterns seen in addiction as well as by
referencing stage of change and recovery phase

Determining Phase of Recovery
• This is essentially as easy as determining how long someone
has been sober or abstinent
abstinent. Based on period of abstinence
one can locate phase of recovery, though one must carefully
assess and be informed by stage of change in order to
accurately determine phase of recovery.
• Phase of recovery is important to recognize because each
phase has certain characteristics which depending on stage of
change or other co-occurring factors can help, harm or
otherwise
th i influence
i fl the
th likelihood
lik lih d off sustained
t i d sobriety.
bi t
• It is the job of all treatment providers to be aware of the general
pitfalls of each phase, but also the patient’s particular
vulnerabilities

Continued
• Early abstinence is a delicate time when one is especially vulnerable to
relapse. It can also be a profoundly rewarding experience as addicts
commonly experience what is considered the “pink pink cloud
cloud” effect of clarity and
joy from newly found sobriety. The contrast from the typical depressed,
anxious, and scared feelings one has during and toward the end of use to
feeling relatively normal or near relative homeostasis is a high in and of itself
and resembles something close to deficient heat.
• Pink Cloud can last beyond early abstinence into early recovery and can be a
tremendously beneficial motivating force to help maintain sobriety. However,
this phase inevitably fades away as one adjusts emotionally to a more
balanced nervous system and slightly more organized and regular qi flow.
• That being said it is crucial that a patient in Pink Cloud be encouraged, but
also properly prepared for the inevitable drop they are going to experience
experience.
This transition is one of the most common times for relapse. It is at this point
that life can feel dull and boring and the anhedonia one feels can become
unbearable.

Continued I
• Early recovery is about surpassing milestones. Just like the transition from early
abstinence into early recovery involved “pink cloud” awareness and strategy, so will
earlyy recoveryy require
q awareness and strategygy
• Early recovery is a time for skill building and habit forming in order to set the stage for
lifelong recovery. While this is true one must consider the landscape of affect, post
acute withdrawal, diminished self-efficacy and potential trauma a person is dealing with
while slowly building skills for sobriety.
• It will be important that the clinician have completed a thorough use history to give
additional context to the current attempt at sobriety. Most likely this is not the first time
your patient has tried to remain sober. They may have had long periods of sobriety
and have a relapse history with identified patterns of success and failure.
• Certain relapse signs emerge at different periods of sobriety and many occur at specific
intervals of time. For instance many people will have a time period they struggle to
surpass. Some people can’t stay sober a month, while other always relapse at 3 or 6
or 9 months. Those individuals will be fearful of those milestones and will have
underlying worry, anxiety and shame related to their inability to maintain sobriety after
some much hard work to get that far.

Continued II
• Active Recovery and Maintenance – These are your patients
who have 1-5 ,or 5 or more years in recovery. These clients
are becoming
b i more and d more stable
t bl andd while
hil th
they may
continue to identify as addicts are beginning to form identities
that include much more than their recovery plan. Though they
are generally more stable they are not immune to addictive
thinking, cognitive distortions, and relapse.
• The signs of relapse may be less obvious with this phase, but
they remain the same. The reason they will be less obvious is
due to the amount of trust their community has in them and the
amount of confidence they now have in themselves
themselves. This
makes it much easier for the addict and their treatment
providers to overlook common signs of impending relapse.

Common Signs of Relapse/Addictive
Behavior
• No longer engaging in support network or change in engagement –
No longer attending 12 step group or leaving early, or not
participating in step work,
work firing a sponsor
sponsor, failure to attend counseling
• Non-disclosure of feelings - Doubting ability to stay sober but not
telling anyone. Being afraid but acting tough, avoiding talking about
problems or recovery
• Overconfident - Deciding I can be abstinent without recovery
program.
• Life Balance - Work too much or too little. Getting too much exercise
or very little.
• Substitution – Overdoing or including anything at the expense of
recovery
• Isolating – Physically or emotionally
• Unrealistic expectations of self or others – Includes unrealistic goals
or plan
Common Signs of Relapse/Addictive

Behavior
• Excessive rumination about the past – tendency to
glorify using
• Blaming others and failing to take responsibility
• Living with or engaging with drug using community
Allowing commonly abused substances to be
prescribed
• Not enough or excessive sleep
• Resentments
• Any form of regular dishonesty
• Allowing or languishing the experience of craving

Identifying Stage of Change
• Stage identification will be informed by Phase of recovery

just as phase of recovery will be informed by stage of
change
• Change process is fluid and though generally all process
occur in order it is common for there to be a regression in
stage of change. Some regressions are more likely to occur
in certain Phases of recovery, but they can happen at any
point and they
p y can exist independent
p of abstinence. For
instance, someone with long term sobriety can experience
self-doubt and regress to contemplation or even pre-
contemplation (usually headed for relapse)
Identifying Stage of Change Continued

• Listen for or attempt to elicit change talk in order to help identify stage
of change
• 6 Kinds
Ki d off Ch Change TTalk
lk – Desire,
D i Abilit
Ability, R
Reasons, NNeed,d
Commitment, Taking Steps
• Desire – “I want to…I would like to…I wish…” Any statement and
indicates a desire for change
• Ability – “I could…I can…I might be able to…” A statement related to
self efficacy
• Reasons – “I need to because…I would feel better if…” Arguments for
change
• Need – “II have to…I
to I ought to
to…II should
should…” Statements indicating
feeling compelled to change
• Commitment – “I promise…I will…I intend…” Statements which
indicate a greater potential for change
• Taking Steps – Reports of action interventions

Developing Your Pattern
• Consider the use history you gathered and ask some general
questions: How long has my patient been using? What have
th been
they b using?
i ?H How d do th
they use ((method
th d suchh as IV
IV,
smoking, snorting)? Under what circumstances (risky behavior,
with friends, isolating, in response to emotional distress, for
celebration, only at parties etc.) Has the use remained static or
has it increased in amount or frequency and if so over what
period of time? Are there any obvious use related
consequences physically, emotionally, behaviorally,
relationship related?
• History in Recovery: Recent periods of sobriety
sobriety, length of
periods of sobriety, relapse patterns, history in treatment
including number of treatment and kind of treatment (inpatient,
outpatient, peer support groups etc.)
Developing Your Pattern/Examining

Progression/IRB to ARB
• Is your patient in early stages of use and beginning to develop an addiction or
is there now a separate addiction condition apart from the origins of use?
• Example of progressions:
• IRB to ARB: Many people drink heavily in college and gradually taper off as
they enter adulthood. Some people continue to drink as they did in college or
the way they drink adapts to circumstances but persists. Your patient drank in
college as much or slightly more than his peer group. After college he would
hit the bars with friends and drink as much or more than his peer group. As
his peer group began going to bars less his drinking became more relegated
to over drinking at other social gatherings and dinner with his partner.
Regardless of circumstance your patient would drink to achieve a certain
level of intoxication to feel satisfied and could not be satisfied by 1 to 3 drinks
episode
per episode.
• In this case the precipitating factor for beginning to use (to fit in, have fun,
make friends, other social convention) no longer apply and use continues
because a new root has formed.

IRB to ARB Pattern Recognition
• The Kidney: Most, if not all IRB to ARB transitions initiate in the
Kidney with the logical consequences that follow. Typically one
would ld might
i ht di
diagnose organ system
t d
deficiency
fi i (SP Qi Xu,
X LV
Yin Xu, HT Yin Xu), and the tendency will be to overlook the
Kidney because patients in the initiating phase of addiction
tend to be younger. There are certainly cases where the onset
of addiction happens later in life and a link to the Kidney will be
more obvious. Though Kidney patterns tend to play a role in
initiation they are also present at later stages of addiction
• Most common IRB patterns:
• KD X Xu lleading
di tto S
Sp Qi X
Xu, LV Yi
Yin X
Xu, HT Qi and d Yi
Yin X
Xu, KD
Heart not Communicating
IRB. Why Treat the Kidney?

• Ask yourself: What are you doing when you nourish the KD in
order to help it nourish other organs? What are you doing
when
h you nourish i h KD and
d other
th organ systemst ttogether?
th ?
• Context of addiction – In the context of addiction, you are
nourishing the Kidney to provide balance. You are balancing
Qi by regulating affect. Regulating affect allows your patient
space to adjust their window of tolerance and to use skills to
maintain sobriety.
• Support change don’t provide it: You are regulating affect in
order give your patient support while they experience the
di f t off depression,
discomfort d i i t agitation,
anxiety, it ti d other
and th diffi lt
difficult
emotions. The difficult emotions are essentially brought on by
Sp Qi Xu, LV Yin Xu, HT/PC Qi and Yin Xu etc., but the main
focus of your treatment in this case is to provide support, not
an immediate solution to deficiency.

Stage of Change and Stage of
Recovery in Context of IRB
• This takes time - Constitutional KD deficiency can be treated over
time, but as we all know it really does take time and may persist and
cause problems throughout lifelife. KD nourishment and tonification at
this stage serves to help your patient buy time to learn to manage
tendencies toward organ system deficiency and stagnation. It is ok to
address other organ systems, but it should be done with the intent of
providing gentle support.
• Keep your concepts present - It is always important to have these
concepts in the back of your mind when providing treatment. It will
inform your pattern identification and appropriate treatment
• IRB Masking and Managing - In the case of someone who is truly in
IRB th
they are using
i tto mask kd
deficiency
fi i and
d manage emotional
ti l
discomfort. This pattern implies though that they are not yet addicted
and in fact may have what we call a mild use disorder. Confirm your
diagnosis by evaluation of stage of change and phase of recovery
Stage of change and stage of recovery

in context of IRB
• History, change talk - How long have they been using?
Is this new behavior or has it been g going
g on for a few
years? Have they tried to stop before? Have they have
ever considered stopping? Are you hearing change
talk? If not should you be?
• Preventing misdiagnosis – In the initiating phase you
are likely to encounter individuals in pre-contemplation
or contemplation stage of change. You may find
someone experimenting with brief periods of sobriety
t ti th
testing i will
their ill and
d examining
i i lif ith t substances
life without b t
• Get them involved – Educate them on why you are
nourishing the Kidney mainly and not focusing on the
obvious other patterns like HT Qi Xu etc.

Progression/Direct ARB
• Direct to ARB – Sometimes progression from IRB to ARB is so short
and the transition to ARB so fast that the initiating factor becomes
immediately irrelevant
• Early onset addiction: This pattern will be seen in early alcoholism.
Often it takes years to develop true alcoholism or true addiction, but
sometimes a person is so well suited neurologically to alcohol or
other drugs that the original reason for use hardly matters.
• Many addicts report of their first intoxicating event or events as a
period of discovery which concludes that alcohol/drug is the missing
piece in their lives and that this discovery appears to fix everything.
These patients are often identified early due to severe consequences
• May or may not have physiological dependence to identify this
pattern. If untreated this patient will begin developing dependence
over time.

Progression/Standard ARB
• Standard ARB - Maintenance of false qi overcorrection leading
to failure to move or engender qi.
• My belief is that when in a state of dynamic balance or dynamic
homeostasis qi flows where it is needed. Excess is diverted to
deficiency until deficiency becomes excess and so on…
• In addiction natural homeostatic balance becomes confounded
by artificial qi movement. False qi overcorrection leads to a
breakdown of the Qi mechanism. Why move qi when it is
constantly being moved by drugs or alcohol? Why nourish
when the body is unable to feel depleted?
• The consequence of this is a decreased ability for self
regulation and a dependence on artificial qi to move and
nourish. In addition this process leads to a decreased ability to
recognize qi flow or nourishment when produced naturally

Progression Continued I/Standard ARB
• Qi flow will now be hindered due to overcorrection of false qi.
Patients will find it very difficult to move qi on there own and will
continue
ti to
t look
l k ffor ways tto move and d nourish.
i h ThThe primary
i
diagnostic mechanisms in this case are stagnation and the
perception of stagnation during times of deficiency and the
erroneous unconscious desire to move qi in the absence of
nourishment
• The 12 Step word calls this the Phenomenon of Craving. They
call it a phenomenon because it is a complex system of
experiences which includes but is not limited to: internal
feelings of emptiness
emptiness, hunger
hunger, fatigue
fatigue, anxiety
anxiety, depression
depression, and
intrusive or compulsive/repetitive thoughts
• The Chinese Medicine world I believe would call this Qi
Stagnation or Qi Stagnation with Heat

Progression Continued II/Standard ARB
• Switching Focus: Treating the Kidney alone will do little in the short term to
change the experience of someone who’s Qi mechanism is failing and is
experiencing debilitating craving
craving.
• Primary treatment: Move Qi. The practitioner will seek to move Qi not only
where they identify stagnation based on zang fu/meridian diagnosis, but will
also move qi in zang or meridians identified as potentially related to the effect
of their drug of choice. You will also seek to move qi related to their stage of
change
• What do I mean? I mean that the patient is always right. If you diagnose LV
Qi stagnation, but all they talk about is fear or reluctance you will recognize
contemplation and treat metal. You will also treat the Kidney.
• If you diagnose LV Qi stagnation but in addition to being easily angered they
also talk about how they used to stay up all night dancing with endless
energy you should consider moving HT Qi.
• Your job in the short term is to manage craving for the patient to the best of
your ability. You will likely want to sedate the nervous system with NADA and
help them relax, but until they are able to move qi on their own it is your job to
do it for them.

Progression Continued III/Standard ARB
• What’s your stage of change? – Standard ARB will likely be in
Contemplation or Action stage of change if they are in your
office. Even if they are in relapse, if they are in your office that
communicates a desire for change. Still, it is important to listen
for change talk to monitor hints of a potential relapse or for
signs of strength to encourage.
• What phase of recovery? Is this their first time getting sober
and experiencing craving? Have they been here many times
b f
before andd never made
d it pastt a month?th? D
Do th
they hhave a llong
history of sobriety? Are they newly sober and experiencing
Pink Cloud? How long before Pink Cloud goes away and
craving returns?
Withdrawal
• Withdrawal – This is addiction increasing in

severity to the point of severe physical
dependence. The experience of craving in
and of itself an indication of dependence, but
a withdrawal state is much more severe, takes
longer to develop and has potentially life
threatening side effects.
• Withdrawal - is the group of symptoms that
occur upon the abrupt discontinuation or
decrease in intake of medications or
recreational drugs.

Withdrawal Continued
• Withdrawal symptoms vary based on the kind of drug, the
amount and rout of use,
use length of time in addiction,
addiction titration
method, and constitution
• Many withdrawal syndromes exhibit characteristic signs and
symptoms. Individuals will experience these symptoms in
varying degrees. Some will experience all typical symptoms,
some only a few. Many will be much worse while others
minimal.
• Based in Yin/Yang it is my belief that careful observation of an
individuals withdrawal tendencies will provide clues as to why
the patient used their drug of choice and what reward they
most craved.
Withdrawal from a Chinese Medical

Perspective
• Withdrawal Yin/Yang Basics – In a very general sense, Alcohol,
Benzodiazepines, Opioids all sedate the central nervous system. They all do
it in slightly different ways but essentially they are sedating
sedating. Cocaine and
Amphetamines are stimulants and they over stimulate the nervous system.
When the drug is abruptly removed the body quickly seeks a return to
neurological homeostasis leading to characteristic withdrawal syndromes.
• Sedation is Yin and Stimulation is Yang
• A person experiencing withdrawal from sedating drugs is experiencing ARB
and Yin Xu Heat simultaneously with Yang exuberance and wind
• A person experiencing withdrawal from stimulants is experiencing ARB and
Yang Xu with Yin excess
• Withdrawal is a fascinating g phenomenon, but not an ideal time for extensive
full body acupuncture. Withdrawal from alcohol, benzodiazepines or
barbiturates can lead to serious medical consequences and should be
referred to a doctor or Withdrawal Management (detox) location.

Developing Your Pattern/RRB
• Reversal Pattern: (RRB) - Failure to move and engender
leading to constitutional deficiency and tendency to stagnation
• Implicit in this pattern is that this is long term addiction.
• The progression went from IRB to ARB and remained constant
for a significant period of time. The damage of chronic drug
and alcohol abuse leads to its opposite.
• In the beginning a strong individual having fun, experimenting,
risk taking, pleasure seeking, pain avoiding begins transitioning
to a slowly degrading, weak, labile constitution. Even if
addiction was rarely y fun as is the case for most,, the initial stage
g
involves engagement in avoidance and engagement and
resistance to depression and sadness. The reversal pattern
involves resignation.
Developing Your Pattern

Continued/RRB
• ARB remains and a new pattern of underlying deficiency
emerges.
g
• In IRB a constitutional KD deficiency lead to various zang fu
deficiencies which lead to overcorrection with false qi.
• ARB entails failure to engender or move as the result of chronic
overcorrection
• The condition of chronic inability to engender or move due to
chronic overcorrection with false qi slowly damages tissues and
organs and organ systems leading to deficiency by direct
damage to organs. In addition one aspect of chronic drug
abuse is the change in epigenetic expression of genes which
Chinese medically involves damage to the Kidney.

Developing your Pattern Continued
I/RRB
• Treatment Protocol – Treat everything.
• At this point you have initial underlying KD Xu, various zang fu
d fi i
deficiency andd stagnations,
t ti ffailure
il tto engender
d or move
independently, and anatomical damage that may be effecting gene
expression in the way that constitutional KD deficiency would.
• However, the timing and focus of your treatment will change
depending on stage of change and phase of recovery. Change talk
and history are imperative to note at this stage.
• During times of stability one will treat the Kidney root mainly while still
addressing the tendency to inability to move. When your patient is
cravingg or g
goingg through
g ap particularly y difficult time, moving
gqqi will be
your priority. In this case you are not only moving qi to buy time and
manage craving to prevent relapse, but you are buying time to
prevent relapse in order to allow the body to heal from systemic
damage.
Meridian Related Implications

• Consider the topography of the meridian. Meth-amphetamine
in particular will show signs of disease or imbalance on the
meridian.
idi
• Patients suffering from opioid addiction tend to suffer from
opioid induced hyperalgesia, or hypersensitivity. Some areas
may be more sensitive than others and often it is generalized
skin sensitivity. In these circumstances think economy of
needles. Use source/luo, 4 needle technique without
stimulation, or light superficial style needling.
• Alcoholics will often suffer neuropathy and in addition to zang
f related
fu l t d treatment
t t t and
d nutritional
t iti l guidance
id ill b
it will be iimportant
t t
to address the channels on which the neuropathy resides

Thoughts on Treatment Style
• Point selection is always important as is needle technique, but in the
case of addiction treatment the perfect point prescription is secondary
to the correct diagnosis
diagnosis. The correct diagnosis will lead you to your
point prescription that will be best for your patient as you meet their
current needs.
• For example: 4 needle technique is great, but if one or more of the
points in that prescription seem inappropriate due to sensitivity or
infection one must be flexible to amend the treatment accordingly.
Overreliance on point prescription systems will hinder patient
progress. However, point prescription and herbs must be informed by
addiction specific concepts
• Be careful with needle technique
technique. Even if your client is able to
tolerate strong qi sensation the release of endorphins from vigorous
stimulation can be triggering for patients in early or long term
recovery. Overly activating or sedating patients in recovery can be
problematic. Focus on moving or sedating with point selection not
technique.
Nutrition, Chinese Herbs,

Supplementation and More
Strategies for Early and Sustained

Recovery

Early Recovery
Early Recovery Nutrition Basics

• Addictive behavior doesn’t necessarily stop with
abstinence from one’s drug g of choice. Addicts will still
consciously or unconsciously seek neurological reward.
• Self care is almost unheard of when in active addiction
and lifestyle choices of addicts often leave them
malnourished.
• Some addicts will find ways to meet caloric needs, but it
is rare that an addict is eating in such a ways as to
meet recommended levels of p protein,, fiber,, and
micronutrients etc.
• Frequently addiction diets are full of processed foods
with high levels of sugar and carbohydrates.

Malnutrition
• Alcohol generally makes up more than 50 percent of the
calories ingested by alcoholics. Alcohol also depletes the
b d ’ stores
body’s t off vitamins
it i B B, A and
dCC.
• Many opiate-addicted patients have constipation during
addiction and then diarrhea during detox.
• Opioid use, acute and chronic, is also associated with weight
gain, glycemic dysregulation, and dental pathology. The
literature supporting the connection between opiate use and
development of preference for sweet tastes is developing and
striking that the medical community would recognize and study
such h a phenomenon
h
• Cocaine, Meth amphetamine and stimulant prescription
medication all work to decrease the appetite.
• Every newly recovering addict struggles with craving to

use alcohol and drugs
drugs. Research has show that a diet
with the right types of high protein and high
carbohydrate-rich foods can make a big difference.
• Food affects mood. Along with amino acids, deficiency
of nutrients like folic acid and the other B-complex
vitamins also have a serious and negative impact.
S
Sugar andd caffeine
ff i can contribute
t ib t tto mood
d swings,
i so
intake of both should reduced during the early stages of
recover.

• Alcohol and drug use prevents the body from
properly processing two important amino acidsacids,
tyrosine and tryptophan. They are responsible for
the production of norepinephrine, dopamine,
serotonin. These compounds are
neurotransmitters that are essential for emotional
stability, mental clarity, and a general state of
well- being. Decreased levels of these
neurotransmitters negatively affect mood and
behavior.
• Decreased control over food intake resembles

neurological patterns similar to those found in
drug addiction, where loss of control over
behavior leads to compulsive drug use.
• Recent studies have demonstrated direct
leptin effects on dopamine neuron function
and behavior. This provides a new mechanism
by which peripheral hormones influence
behavior and contributes to a more
comprehensive model of neural control over
food intake.

Amino Acid Precursor Loading
• This strategy consists of administering protein

supplements (tyrosine
(tyrosine, taurine
taurine, phenylalanine
phenylalanine, glutamate
glutamate,
and tryptophan) to addicts in an effort to increase the
brain’s production of its neurochemicals to restore
homeostasis.
• Though this technique has not yet been validated by
rigorous research, many treatment programs report good
patient compliance and positive outcomes when amino
acid precursor loading is added to the treatment process
for cocaine, amphetamine, alcohol, and opioid
dependence.

Continued
• Tyrosine is a precursor to the neurotransmitters
norepinephrine
p p and dopamine--chemical
p messengers
g
that promote mental acuity and alertness. It is one a
nonessential amino acid found in protein-rich foods
such as meat, poultry, seafood and tofu.
• Tryptophan is integral to the production of serotonin,
which has a calming effect and is important for proper
sleep. It is found in foods such as bananas, milk and
sunflower seeds, as well as turkey meat
• These conversions require vitamin B6 and vitamin C. A
few studies suggest potential antidepressant effects of
L-phenylalanine and L-tyrosine.

Continued I
• Administration of L-tryptophan, a precursor
for serotonin, is seen to double the
production of serotonin in the brain. It is
significantly more effective than a placebo
in the treatment of mild and moderate
depression.
p This conversion requires
q
vitamin C. 5-hydroxytryptophan (5-HTP),
also a precursor for serotonin.
Recovery Diet
• Reduce sugar - Start by staying away from foods and drinks
that are highly concentrated with sugar like soda, energy drinks
anddddesserts.
t E Eventually
t ll working
ki ttoward d anything
thi withith added
dd d
sugar such as foods with hidden sugar (anything with added
sugar counts) will help stabilize blood sugar levels, which will
help with mood swings, anxiety and depression.
• Reduce refined carbohydrates - Choose whole grains and limit
white potato or potato products.
• Increase protein - Amino acids in proteins are the building
blocks for neurotransmitters, which as we have seen are often
d fi i t or outt off b
deficient l
balance as th lt off addiction.
the result ddi ti
• Increase fiber - Fiber from pre-biotics in fruits and vegetables
help heal the gastrointestinal system

Recovery Diet Continued
• Increase healthy fats - Good fats help the body absorb

fat soluble vitamins
fat-soluble vitamins. Choose olive oil
oil, flaxseed oil and
omega-3s (found in fatty fish, nuts and flax seeds).
• Decrease processed foods - Liver repair is critical in
early sobriety, says Henninger, so stay away from
processed foods with artificial ingredients.
• Decrease caffeine - Caffeine can exacerbate insomnia
and anxiety, which are especially prevalent in early
sobriety.
Chinese Herbal Formulas for

Consideration in Early Recovery
• With respect to damage done during drug
and alcohol abuse there are a few common
formulas for effective treatment of the
related consequences of use.
• ST Yin Xu
• Counterflow Qi
• HT fire with dream disturbed sleep

Stomach Yin Xu and Counterflow
• Alcohol damages the lining of the esophagus and the stomach.
Persistent alcohol abuse will weaken the esophageal sphincter
l di tto frequent
leading f t acid
id reflux.
fl Spleen
S l qii xu with
ith and
d without
ith t
damp will also be present and will require attention, but may be
secondary to ST yin xu depending on severity.
• Yi Wei Tang – Sha Shen, Mai Men Dong, Sheng Di Huang, Yu
Zhu, (Bing Tang)
• Mai Men Dong Tang – Mai Men Dong (clears xu heat from ST
and directs downward), Ren Shen, Geng Mi, Da Zao, Gan Cao,
Ban Xia
• Xuan Fu Dai Zhe Tang – Xuan Fu Hua, Dai Zhe Shi, Ban Xia,
(Sheng Jiang), Ren Shen, Zhi Gan Cao, Da Zao
Heart Fire with Dream Disturbed Sleep

• Insomnia with generalized irritability and dream disturbed sleep
are very common in early recovery. The first few weeks of post
acute
t withdrawal
ithd l and
d even months th after
ft completing
l ti detox
d t can
be incredibly difficult for patients. Sleep during this time can in
and of itself promote a stress response as the patient is well
aware that the night ahead will be rough.
• Most patients will experience vivid using dreams where they
imagine using and experience the guild, shame, and an acute
sense of fear while in the dream. They awake often unsure if
they have in fact relapsed.
I addition
• In dditi patients
ti t willill experience
i th ki
other d off di
kinds t bi
disturbing
dreams and will aggressively toss and turn, sweat, and panic.

Heart Fire with Dream Disturbed Sleep
Continued
• Implied in the Root/Branch addiction pattern diagnosis
and treatment is the idea that substance use is a way of
artificially moving qi. Over time this artificial movement
creates a situation where the qi mechanism suffers. But
as long as one continues to use the state of the qi
mechanism is unknown.
• Shortly after detox qi acutely stagnates. Abstinence
initially creates a confluence of stagnation leading
dampness into phlegm and qi into heat setting the stage
for phlegm fire to assault the Heart.
Heart Fire With Dream Disturbed Sleep

Continued I
• Wen Dan Tang – Zhu Ru, Zhi Shi, Ban Xia,
Chen Pi, Fu Ling, Gan Cao, (Sheng Jiang)
• Zhi Zi Dou Chi Tang – Zhi Zi, Dan Dou Chi
• Dou Chi San – Sheng Di Huang, Mu Tang,
Dan Zhu Ye, Gan Cao

Affective Based Treatment For
Sustained Recovery
Circumplex Model of Affect
• Treatment based on the Circumplex Model of Affect

• The
Th circumplex
i l model
d l off affect
ff t proposes that
th t allll affective
ff ti
states arise from cognitive interpretations of core neural
sensations and are the product of two independent
neurophysiological systems
• When questioned in studies people rarely describe feeling
a specific emotion without also claiming to feel other
similar emotions
• Affective experiences can be viewed on a continuum of
highly interrelated and often ambiguous states.

Valence and Arousal
• A quick reminder: all affective states arise from

t
two independent
i d d t neurophysiological
h i l i l systems.
t
Every affective experience is the consequence of
a linear combination of these two independent
systems, which is then interpreted as
representing a particular emotion
• Valence – How pleasant or unpleasant one feels
• Arousal – How calm or agitated one feels
Valence and Arousal Continued

• Joy, for example, is conceptualized by circumplex theorists as
a neurophysiological state typically involving the combination of
positive valence and heightened arousal in the CNS. The
subjective experience of joy arises out of cognitive
interpretations of these patterns of physiological activity.
• As emotions are experienced in the brain, cognitive
interpretations are employed to identify the neurophysiological
changes in the valence and arousal systems and conceptually
i th
organize h i l i l changes
these physiological h iinto
t memories
i off prior
i
experiences, behavioral responses, and semantic/interoceptive
knowledge.

Valence and Arousal Continued II
• The prefrontal cortex, within the context of the

circumplex model integrates
integrates, organizes
organizes, and
structures the primitive sensations of pleasure and
arousal with knowledge present stimuli within life
contexts with past experience and likely future
outcomes.
• Cognitive functions of the prefrontal cortex support
the creation and conscious recognition of specific
emotions by associating and integrating core
neurophysiological sensations with specific internal
and external cues

Affective Treatment Principle
• Affective Treatment– Treatment which intentionally
incorporates any modality likely to effect affect over time.
• The purpose of categorizing and defining this as a method of
treatment is to create a paradigm shift in the philosophy of long
term care for any patient suffering from addiction, depression,
or anxiety. Those 3 conditions do not form overnight and they
will not radically change in 3 months of treatment. However,
they can and do change with consistent care and attention.
• Basic Concept: Subtle alterations or shifts in affective
experience can change one’s Affective Niche. The Affective
Ni h is
Niche i the
th lens
l with
ith which
hi h one iinterprets
t t th
the world.
ld CCareful
f l
affective treatment can shift affect and make one more resilient
to biological and psychological experiences that shift affect.
Nutrition, Supplementation and

Chinese Herbal Considerations
Treatments, strategies and

t ffor affective
concepts ff ti ttreatment
t t

Ideas for Sustained Recovery
• Continue with Recovery Diet and Amino

Acid Precursor Loading
• Regulate Circadian Rhythm: Light Therapy
and Time Restricted Eating
• Chinese Medical Affective Root Formula
with appropriate Root/Branch pattern
Circadian Rhythm
• The human brain has a master circadian rhythm center

called the suprachiasmatic nucleus (SCN)
(SCN). Our SCN is the
master regulator of our sleep and wake cycles and is set by
exposure to bright light.
• We have evolved to wake with the sun and sleep when it is
dark. Morning light initiates the Circadian Rhythm. Many
addicts suffer from insomnia due to circadian dysregulation.
In the p
past they
y mayy have self medicated to fall asleep.
p
When this is no longer an option regular sleep is incredibly
important. What is more important is that sleep not be a
struggle. Failure to sleep is an easy relapse justification.

Circadian Rhythm/Light Therapy
• The most successful method of regulating circadian rhythm
seems to be exposure to bright light first thing in the morning.
Thi can be
This b achieved
hi db
by going
i outt iin th
the sunlight,
li ht or b
by sitting
itti
in front of a bright light intended to treat seasonal affective
disorder.
• Recommended exposure is 10,000 lux for between ½ and 2
hours. It is important to note that the intensity is a function of
how far your eyes are from the light.
• I recommend a “wake up” alarm. Wake up alarm’s will slowly
fill the room with light about a half hour before your wake up
ti
time. I also
l recommend d picking
i ki a setting
tti and d sticking
ti ki tto itit. It’
It’s
great to get extra sleep, but if you struggle with addiction or
insomnia routine is your friend. Following wake up ½ hour of
bright light therapy.
Yin and Yang of Leptin and Ghrelin
• Two opposing forces Leptin and Ghrelin. One satiates

hunger Leptin (Yin) and the other facilitates the hunger
hunger,
response, Ghrelin (Yang)
• The dynamic balance between the two is just as important
in early recovery as it is in sustained recovery/remission.
• Hunger is a need. Hunger is a desire. Hunger is Craving.
• Most of us associate hunger with food, but an addict may
associate the subtle or even obvious signs of hunger with
substance use leading to intense craving and risk of
relapse.

Ghrelin
• Ghrelin - a peptide hormone produced in the
gastrointestinal tract which functions as a
neuropeptide in the central nervous system.
Ghrelin regulates appetite and energy usage. It acts
on hypothalamic brain cells to increase hunger, and
gastric acid secretion
• Ghrelin also plays an important role in regulating
reward perception in dopamine neurons that link the
ventral tegmental area to the nucleus accumbens
Leptin
• Leptin is a polypeptide hormone secreted mainly
by adipose tissue
tissue. It acts on the central nervous
system by inhibiting food intake and increasing
energy expenditure, with an important role in
controlling body weight
• Leptin plasma concentrations are elevated during
chronic alcohol consumptionp and normalize
during withdrawal and abstinence. Leptin
regulates the HPA-axis and inhibits the cortisol-
mediated stress response.

Circadian Rhythm and Meal Timing
• The suprachiasmatic nucleus also interacts with peripheral
oscillators which are located in many organs such as adrenals,
li
liver, pancreas, stomach,
t h esophagus.
h
• The peripheral oscillators function as circadian clocks for those
organs and help regulate many processes including the
hormone secretion and cell repair. Communication between
the peripheral oscillators and the SCN link our search for food
and our consumption and digestion processes with daylight
(when we are awake), and metabolic repair processes (when
we are asleep when it is dark).
• Circadian
Ci di rhythm h th iis primarily
i il ddriven
i b
by exposure tto b
bright
i ht lilight,
ht
but it is strongly influenced by meal timing. Linking eating
behavior with light and dark is beneficial to one’s circadian
rhythm as well as being metabolically beneficial. Consider
meal timing a strategy for sleep optimization.
Time Restricted Eating

• It’s what, but when you eat – Most people are more insulin
sensitive in the morning than at night. We therefore are better
able
bl to
t utilize
tili sugars coming i ffrom carbohydrate
b h d t iin th the morning
i
and as the day progresses. Similar levels of carbohydrate
intake will lead to higher blood sugar in the evening.
• Preliminary studies show that mice on time restricted programs
had improved biomarkers for cardiovascular health, decreased
fat mass, decreased inflammation, and improved glucose
tolerance and insulin sensitivity
• The first thing ingested in the morning starts one’s metabolic
l k Even
clock. E thi as simple
something i l as coffee
ff willill start
t t th
the
metabolic circadian rhythm.
• Regulating the Circadian Rhythm with metabolic structure as
well a light therapy will lead to dramatically improved sleep

Time Restricted Eating
• Suggested Time Window - 10-12 on, 12-14 off eating pattern
which promotes a healthy circadian rhythm and allows for daily
metabolic
t b li restt and
d repair.
i E Essentially
ti ll thi
this means th
thatt one
would eat within a 10-12 hour window each day, generally
starting between 8-10am and ending between 6-8pm
• Initially hunger and food craving is high, but balances out after
a few weeks. This is not recommended for those in early
recovery, but will help provide additional stability to those
looking for long term recovery. Patients in early recovery
should be encouraged to simply have their meals at the same
time and avoid excessive snacking.
snacking
• Subtle improvement in bio-markers indicate the potential for
Affect change. Predictable meal schedule will help the patient
link hunger with healthy regular meals and avoid the
association of hunger craving with addiction craving.
Chinese Medical Affective Treatment

• Chinese Medical Affective Treatment – is designed to make subtle changes over time
based on the patients general affect. The Affective Treatment model is designed for
l
long tterm ttreatment.
t t All h
herbal
b l choices
h i mustt th
therefore
f b
be safely
f l administered
d i i t d over an
extended period of time. If you are unsure of how long someone can take an herb or
formula make a different choice.
• Because Affective Herbal Treatment is a long term strategy it can and should be
secondary to addiction specific treatment or other more acute identified patterns
• As we see from the Circumplex model of Affective experience people find comfort in a
variety of states related to pleasure and arousal. Whenever possible Affective
treatment should be tailored to the patients affective presentation.
• Somatic Experiencing – Affective treatment will also include herbs to specifically target
areas or systems within the body that are consciously identified by your patient.
Treatment of the Chinese Medical pattern addresses a large aspect of the somatic
experience already. As your patient grows in awareness through somatic exercises,
mindfulness practice and increased emotional granularity the rage of options for
Affective treatment based on somatic experience will also grow.

Chinese Medical Affective
Treatment Continued
• High Activation/Low Valence – This patient feels anxiety when stimulated and
may experience the world with a general sense of fear or apprehension.
Affective treatment should focus on sympathetic sedation generally
generally.
Sedation should be periodically and intentionally stopped for the purpose of
focusing on resilience to activation.
• High Activation/High Valence – This patient feels depressed and anxious in
the absence of stimulation and will look for ways to maintain activation in
order to maintain high valence. Affective treatment should focus on Qi
movement and heart/pericardium nourishment generally. Qi movement
should be periodically and intentionally stopped for the purpose of developing
resilience to low activation.
• Low Activation/Low Valence – This patient feels depressed in the absence of
stimulation Affective treatment should focus on Qi movement and
stimulation.
nourishment.
• Low Activation/High Valence – This patient feels anxious in the presence of
too much stimulation. Affective treatment should focus on sedation.
Examples of Chinese Medical Affective

Treatment/General
• Yue Ju Wan – Used in the treatment of mild Qi stagnation of various
systems.
• Cang
C Zh
Zhu (d
(damp),) Ch
Chuan Xi
Xiong (Bl
(Blood),
d) Xi
Xiang F
Fu (Qi)
(Qi), Zhi Zi (H
(Heat),
t)
Shen Qu (Food)
• Note: Zhi Zi has a sedative effect and may increase drug-induced
sleep time when used concurrently with sedatives such as
antihistamines, narcotic analgesics, barbiturates, benzodiazepines
and others. Basically don’t give this if you are worried that your
patient will relapse. Otherwise it’s safe to prescribe.
• Give the lowest therapeutic dose QD or BID alone or incorporated
with other relevant formulas
• Imagine the effect on Affect if the body is running just slightly more
efficiently over a longer period of time. Imagine how you might feel if
you had an additional hour of sleep every day this year. How might
that subtle improvement impact your Affect?

• Pai Qi Yin (Discharge Gas Formula) –
Chen Pi, Xiang Fu, Wu Yao, Mu Xiang, Zhi
Ke

Treatment/Focused
• There are many ways to treat specific Affect presentations. I
am providing examples to illustrate the principle. My hope is
th t after
that ft taking
t ki thi
this course you will
ill llook
k att h
herbs
b ffrom ththe
perspective of shifting Affect and use what makes sense for
your patient at the time. Use my suggestions if you wish, but
do not be constrained by them.
• High Activation/Low Valence – Tian Ma Gou Teng Yin – Tian
Ma, Gou Teng, Shi Jue Ming, Zhi Zi, Huang Qin, Yi Mu Cao,
Chuan Niu Xi, Du Zhong, Sang Ji Sheng, Ye Jiao Teng, Fu
Shen
Hi h Activation/High
• High A ti ti /Hi h V l
Valence G L
– Gua Xi B
Lou Xie Baii Ji
Jiu T
Tang
(minus the wine) – Gua Lou, Xie Bai plus
• Tian Wang Bu Xin Dan – Sheng Di, Ren Shen, Tian Men Dong,
Mai Men Dong, Xuan Shen, Dan Shen, Fu Ling, Yuan Zhi,
Dang Gui, Wu Wei Zi, Bai Zi Ren, Suan Zao Ren Jie Geng

Treatment/Focused Continued
• Low Activation/Low Valence – Bu Zhong Yi
Qi Tang plus Yue Ju wan – Huang Qi, Ren
Shen, Bai Zhu, Zhi Gan Cao, Dang Gui,
Chen Pi, Sheng Ma, Chai Hu
• Low Activation/High Valence – Tian Ma
Gou Teng Yin (could be appropriate) or
Suan Zao Ren Tang – Suan Zao Ren, Fu
Ling, Zhi Mu, Chuan Xiong, Gan Cao
Modulation of Drug Effects and Anti-Priming
• A fairly recent development is the use of medications that

can modulate or blunt the pleasure
pleasure-reinforcing
reinforcing effects of
addictive drugs. Research demonstrates that risk of
relapse is great when a recovering addict is primed or
uses an addictive substance.
• Sub-reinforcing doses of abused substances or drugs that
block this priming action can decrease relapse. This anti-
priming strategy is behind the development of low-dose
nicotine delivery systems, such as the nicotine patch,
gum, spray, and inhaler, to treat nicotine addiction.

Modulation of Drug Effects and Anti-Priming
• Two classes of drugs under study for their ability to blunt the
reinforcing effects of abused drugs are the calcium and sodium
i channel
ion h l bl
blockers.
k
• Calcium channel-blocking medications prevent calcium ions
from entering brain cells. This then blocks the release of
dopamine and prevents the reinforcing effects of cocaine,
opioids, and alcohol from occurring. Nimodipine, amlodipine,
nifedipine, and isradipine are all calcium channel blockers
being developed to treat addiction to cocaine, opioids, and
alcohol
• Sodium
S di ion
i channel
h l bl
blockers
k iinclude
l d such
h medications
di ti as
riluzole, phenytoin, and lamotrigine, which interfere with neuron
transmission by blocking the cells’ uptake of sodium,
enhancing the effects of GABA. Increased GABA activity
results in muting cocaine’s reinforcing effects.
• Craig Fiorini
• craigmfiorini@gmail.com
• Whole Body Health Center
• 303-232-2600

• To read articles by today’s speaker, watch
online videos, or to see his/her complete
seminar/webinar schedule for this year,
please visit www.elotus.org
• More information on the classic single herbs mentioned

in this seminar/webinar can be found in the Chinese
Medical Herbology and Pharmacology
• More information on the classic formulas can be found

in the Chinese Herbal Formulas and Applications
• Collection formulas can be found in the Lotus Clinical

Manual of Oriental Medicine
• All the above texts are available through www.elotus.org

• Herbs mentioned in this seminar/webinar,
are available through our sponsor
Evergreen Herbs & Medical Supplies.
Please contact them for a catalog and
pricing information.
This webinar is sponsored by:
Evergreen Herbs & Medical Supplies

Toll-free Tel: 866-473-3697
Website: www.evherbs.com
Email: sales@evherbs.com

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and Tina Chen, siblings and coauthors of the Chinese Medical
Herbology and Pharmacology, and the Chinese Herbal Formulas
and Applications books.
Evergreen is a family business that is run by professionals like you
who care about Chinese medicine. And as a family business, we
have the well-being and satisfaction of our customers at the top
of our list. We care about the quality of our herbs, because we
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