...is huge!

The beginning we all know, the kicker is at the end:

"How was it discovered that conditioning plays an important role in producing relapse?
In the 1950’s and 1960’s, convicted heroin addicts were often sent to a prison in Lexington,
KY, where the National Institute on Drug Abuse (NIDA) Addiction Research Center was then located.
NIDA researchers observed that addicted prisoners experienced gradual dissipation of their cravings
for heroin. For periods of years, while confined, these former addicts often experienced no heroin
craving at all. However, upon returning to their home communities, they would immediately
experience intense cravings for heroin, which almost inevitably led to impulsive heroin use and
relapse, often on the first day back. Relapse rates at that time were in the range of 90% or more.
How can this phenomenon be understood?
NIDA researchers demonstrated that Pavlovian conditioning was the primary factor causing
relapse. In his well known experiments on classical conditioning, Pavlov showed that dogs salivate
when a bell is rung, once the bell had been paired with the smell of meat. In addicted individuals,
there are many cues that become associated with heroin use, such as particular neighborhoods or
individuals and internal feelings, such as anger or sadness. Contact with these cues serve as “bells”
that trigger drug cravings. These cravings are accompanied by physiologic changes which mimic
opiate withdrawal, including dilated pupils, sweating, cramps, etc. Even after a period of prolonged
drug abstinence, these cues remain potent triggers that induce drug craving and abstinence
symptoms, which are identical to those that occur during narcotic withdrawal. This phenomenon has
been reproduced with human subjects in controlled laboratory settings.
The seemingly contradictory phenomenon of only 7% relapse rates for heroin-addicted soldiers
returning from Viet Nam, compared with over 90% relapse rates for detoxified addicts returning to the
communities where they had become addicted, may be understood by the phenomenon of
conditioning. The latter group returned to an environment that was filled with previously conditioned
cues, while those who became addicted in Viet Nam had no such cues when they returned home."

from : http://web.mac.com/reznick/iWeb/Site/buptreatment/documents/NALTREXONE_Handbook.pdf

Umm . . . This is precisely why we are admonished always to carry a dose of naltrexone with us. The triggers are lying in wait in the shrubs.

It's also the reason TSM is not suitable for an in-patient rehab setting; we need to be exposed to our triggers in order to extinguish them.


Interesting article.