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12 Steps to Wholeness, Part 3

Ricardo Whyte


Ricardo Whyte

Instructor, Department of Psychiatry, School of Medicine, Loma Linda University



  • February 4, 2012
    2:30 PM
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are you named in God we just want to thank you for what you do and continue to commit yourself to do on our Lord we ask that you empower us with tools and an understanding that would allow us to help others who are struggling with addictions please help me to disappear and hear your voice and your linen we pray and things on everything is on you okay so so glad that you all came out in a move a little or else he doesn't fall asleep they blessed me with the most difficult time to speak to an audience that has been his audience after lunch on Sabbath afternoon our true moment of rest but I do want to talk to you about a very exciting topic it's called the neurobiology of joy so first off for my son and my name is apart away and I'm addiction psychiatrist psychiatrist specializing in addictions and I'm the medical director of the chemical dependency unit of Loma Linda University so I come from a landing in college for any fellow flames out there I trained that the University of Connecticut for my medical school training I had the blessing of going to Loma Linda University for my psychiatry training and then now UCLA for my addiction psychiatry Fellowship all right some for those of you who are you want to take notes for those of you who would like the PDF of my presentation just in case you just want to relax just e-mail me and I will e-mail you a PDF six as well S Doctor White Gmail .com so it's the why that makes the difference and why did you address and I'll e-mail your PDF timely fashion all right so as I was training to do is need to time myself where is the clock and is okay so as I was going through training as a psychiatrist one of the things I noticed was a number of our more prominent theories actually on influence my Greek mythology and that was a little concerning things so as exemplified by the eleventh is blacks are the Elektra complex of Jamaican are going to this point but nevertheless people would be coming in the end crisis and I would actually be treating them influence by theories were influenced by Greek myths that you would amend his amended something we accept is not true so I felt justified me insane okay what if I allowed my approach to patient care could be influenced by password and so it certainly a very interesting class and so I asked myself can we often hear people say there is no manual for living now if you get a device that is not complicated as simple as a stapler it comes with a manual so that the notion that we could be entrusted with this big world without being given a manual of how to navigate through it is a preposterous want and so I said okay they've gone more than a parts instructions for living where we keep on we put in the back of the book the middle of the book or we put it in the beginning and so I went to the beginning and as a result of that it has significantly impacted how I practice medicine and there's introduced that I want to share with you today the bottom line why were here is where trying to understand how a person goes from this let's presume that she is a productive member of society connected spiritually and then transitions to this okay that's what we're trying to understand today so we are going to approach understanding that by exploring God 's original design as I mentioned I was trained at the University of Connecticut and still one of the things we were taught right away was in order to understand the normal person one understand the norm so where to start understanding what was God 's original design then we of course again to discuss some of the neurobiological factors that underlay the addictions things like gambling sex and eating we're also going to discuss some treatment implications hang onto your hats is done of your bumpy ride okay occasionally occasionally we experience moments of sobriety moments of sobriety our world is designed such that those moments are fairly ran whining by moments of sobriety moments when we ask ourselves the meaningful questions of life what are those questions shoot them up one of those meaningful questions of life was is my purpose was another why am I here how did I get here but after grandma who do I belong to pull and I critical questions can you think of any others am I living my purpose how do I know that I'm living my purpose in moments of sobriety these are the powerful questions that we ask ourselves another truth when we survey our situations one of the things we notice very quickly is we have infinite is that controversial we have needs for health we have need for connectedness we have needs for finances and practical things we are desperately in need okay so this is the mindset of a sober person who picks up God 's word and the minute you open up God 's word and you go to that first verse it does something extremely important it says in the beginning God created the heavens and the year there is no book that makes powerful declaration notebook that makes the powerful declaration and it wastes no time in doing my job he understands exactly the mind of a sober person the important questions he would be asking that immediately jumps when not playing here thinking that God is saying you come to the right place in the beginning God created again we mentioned your knees and knees this is not God that assembles it creates you brought your names to a place creation is not wasting any time in letting you know this is your manual for living this is important book that's gathering dust on our bookshelves so the other thing I noticed was the process by which he creates now how does God create verse three says he's no steadfast so it is spoken and studied us what that means is that instead world humans animals so on and so forth and when they were eleven you wonder why they need to instead use the process and so it led me to one of my first theories what are the chances the process of his creating is the lesson plan and how we should assemble because we can create were not God so if you hear the intermingle the word create here assembled we can create I can bring anything out of scratch practically speaking about work with what God feeds so we can assemble what God is showing us process we can follow and how to create you say you're crazy Doctor Newman General Santos patients and Prolixin so he creates by his word and even then creating by his word God is teaching something we talked about earlier this morning God is so committed to his word it has created how is so common that it was more because creative power she is his word are you you are you your word honey I promise from the Ritchie on steel from my taxes I will be there at two thirty are you and your word God has set the example he's so committed to his work because creating what does God give us on day one and God said let there be light when you like us and there was like day one God gives us what is the lesson there what could possibly be the lesson there but what is life why don't we use God 's word to define life in Psalms one nineteen one oh five it reads thy word is a lamp unto my feet and shows me where to go and a light unto my path thy word is a lamp unto my feet and a light unto my side God is shining down on is the reality that we have to use this word is the first step in creating or assembling the first that the magnifying appointee dedicating an entire day just this issue like this is let there be light enough that likes to think about that is so critical that you begin to create illuminated by light God said that's enough for day one but remember to be one so what is my joy in God 's word is trivial when you recall when the Israelites are being rescued from the series of police they were the plague of what darkness was three days and it was described as a heavy thick darkness right until the verse reads and and and and and and and the kingdom of Egypt there was darkness but in the children of Israel there was like the government and again when they were trapped between the Red Sea and they see Pharaoh 's army coming role at the club it clap picks up goes over the children of Israel and this things and separates the the Egyptians from the children of Israel and what it's a bit it became darkness to the Egyptians but will the children of Israel God never leaves his children in this important darkness we chosen that in case he didn't beat you over the head with enough he pronounces it could keep renounces it good now I got a question for you what's the significance of the I hate sports analogies so you live in the winter and come right back please guys don't lose stones is a Michael Jordan the best basketball player in basketball says these shoes are good won't even do you play basketball so it's not like it when God says this is one creation principle number one beer word and create in the context of lines part of the problem with our world if you have too many people creating or assembling their lives in the context of darkness okay and ingest it you want to understand how terrorizing is to be in darkness think about where you sit right now philosophically believing that you are a child of the King a child of God special you a purpose believed in the context of life no wonder to step out of that light for a minute and tell yourself that we come from some primordial soup some radical primordial soup some Big Bang about life for many things see how terrifying it would be that we're just some random accident that does not have a defined and glorious purpose is like that he's given us a tremendous blessing that was day one all right the next issue is we talk about the creation of space recall the seventies that it separated the waters above from the waters below what that God is essentially done she had created this little area right here represents this blown up he created an atmosphere until you see the atmosphere has several layers okay he had created space what is this subtle lesson is teaching us there if you're going to create something you draw the is space for your creation single crime simple right we got that one nail down and so what you see in people who love planning people who are planning to have a child they wait for the child to arrive before the nursery rhyme because you didn't try that this would be the result that will be fairly frustrated what you see God doing is he plans to do this for his creation but a lot of the problems we have in our lives as we put the cart before the horse okay we commit ourselves to things before we had created big-budget the benefit into before we created the time that nothing is going to fit into an ergo the headaches that we experience you can make something create the space that is going to occupy what's also interesting is if you recall the atmosphere it has an ozone layer now what is the function of the ozone layer because the layer believe it or not shop certain things then keep certain things then and keeps other things out boundaries will leave that one alone space is driven to make something create space to accommodate it day three in a row when he doesn't be very vegetation all the things they're going to name fifteen God produces in day three there is not a life form on the planet there's nobody saying they are hungry he's emphasizing the point of free probation this will open the install provided can you imagine if we lived our lives this way can you imagine if we put that much focus determination and anticipating so what is creating what is this floor was given something for you gives us the sun and the moon was got essentially done he's given us the gift of time okay extremely sobering time as for example when I say it's two forty eight big mystery here for eighteen minutes to help orient piñatas and then finally now in date five now we have sea creatures so he's beautifying his creation we have birds Ben and eighty six we have land creatures and then we get the creation of the man spreads I believe that was fine about it really believe that is coming directly from the hand of God Adam was a beautiful specimen put this here to remind me I want you also noticed a pattern of creation so God is building okay he's building the space to worship and have been so first to give the gift of life is that all will work to do now not a hold on that of course he gives us the gift of space I know no no no hold on this one second okay he gives us the vegetation is building okay I'm getting it now no don't look at these life forms that he gives us the line for and that of course he creates the man I know you like okay you've got to be done now you know I'm ready to worship and then he gives us the will and will just friends I think he was beautiful to governing direct command of God you have to invent something else and as soon as a man and the woman are created what does the purpose God gives them their purpose on minute taking three seconds just to say what was the purpose that God gave you can use any of the and God said let us make man in our image to our likeness and dominion that such a harsh word today we think domain but he was talking about Dominion would love okay to let them have dominion over the vision to see over the outlet air and over the title and over all the earth and over every creeping thing that creeps upon the earth this is yours to make better company so got in his own image in the image of God he had male and female created he them and God bless and God said to them be fruitful and multiply and replenish the earth and subdue it and make it better and have dominion over the fish of the sea over the foul air and over every living thing that movement on the earth somewhere I want to draw your attention to the first image okay so I said the purpose now we were made in his image what is the image of God who said consumers would like again is that love my good friend Frank said what is God 's image love now do we have some Scripture to back that up simply go to first John four eight it says he'd like that now no not God for God is the image of God 's love why is that so important because even I human and my mating partners when we reproduce this homework and reproduce a human okay what if I made in the image of love and my partner is made in the image of love when we reproduce guzzle more than a reproduce God was commanding us to make love but before we get all nebulous and lost we need some structure here and real quickly what is the definition of love that's confusing humanity nowadays what is the definition of love so let us go to first John chapter five verse three let's let God and his word to find the source is John fibers three good reason for this is the love of God that we keep his commandments and his commandments are not grievous all right so it's his commandments well that's interesting so if I go to Exodus probably commitments to our I have ten Commandments what was interesting is if I go over to the New Testament Matthew Mark and Luke squeeze those ten Commandments down how many commandments to remember those two commandments and okay the Commandments but then if I go to Romans Galatians and James they squeeze those two commandments down to one commandment and if there be any other commandment it is briefly comprehended in this thing namely thou shalt love thy neighbor as thyself God 's commandments is to love you we live under a cold man to make love to be loving as outlined by his work to get that that is our purpose and in the John's chapter three verse eleven degrees for this is the message that he heard from the beginning that we should love one another and verse twelve is not as Cain was hastily was thinking of the Genesis account we live we got this command from the beginning we have to live lives that are in money that we have to produce things that bear the image of God when we're doing that it's a natural high does that make sense right then on day seven this is why was talk among that whole building issue God is just created a world that he created the space of worship and on based seven he bills himself with that space of infinite space so in the creation of the Sabbath now a lot of times people struggle with pay how do you define that you know what exactly is the Sabbath and this is the best way I've found to describe it first and foremost I remember as a young person things they set it up as anonymous as they set there was nothing to do that now that I'm older now is the seventh negative elements to do him in I sometimes joke that Sunday like our real day of rest you know him but there's so much stuff to do you know where I started falling in love with the Sabbath and I'm still in love with the seventh I fell in love with the Sabbath in college I remember you would be so super busy you in order to get good grades we had pinholes this rule where you could only sit at the dinner table for thirty minutes okay you can only submit it and then you have to get up no matter what but come Friday afternoon from Friday afternoon things would slow down on the campus and now you can sit at that table and settle the world affairs no more worried about financial clear snow where my sands all you are focused on is this is a moment to kick back relax and have a moment with God in France for that matter so imagine for a moment is if you do it if you are burdened with the task of having a meeting place with people and that God wanted a holy place with his people right well think about the holy places on this planet right first of all they would be geographical limitations the getting to this holy place right and a lot of times with holy places that get nominated by someone powerful right and it is this place would be extremely voice of God would want access to it as quickly as possible one thing God is not us solving this problem its God so we can put this meeting place and high and now it is believed this to everyone you can get to it at the speed of thought along the path to force you into the space got chosen it's right here some as union that makes sense it's the Cathedral in time it's also like a hot date so often some people like remember the Sabbath you know but you can see I was getting ready for a hot date I want to get all the distractions out of the way I will watch the Super Bowl is my is my significant other is coming you know make sure the place is clean compile what I will with it this is one entertaining it's a hot and unruly distractions I just want to be with that person all right let's summarize what we've covered so far we mentioned that they were creation principles Genesis account right we talked about space three provisions the creation of life we talk about man being given up purpose of blueprints men given a weekly holiday but that in Genesis chapter three it actually is going to explain why the challenges are right okay so some point I want to emphasize I want you to notice how God ordained for us to be connected connected to one another alright connected to him he explains our police in nature and our job was to protect nature make it more beautiful he connects us to a purpose and he connects us to him God 's creation stood to be one connected and that's very significant it's as if we follow God 's plan we were given the factory system producing low rate family producing love every person just producing products of love and the result would've been a world that reflects the image of God love can you imagine what that world will look okay and so now we have to discuss the neurobiology of addiction neurobiology of addiction but given atop another twenty minutes and you guys are going to break okay so it's not a twenty minute break all right so before a gentleman by the name of Phineas Gage it was fairly difficult for scientists to appreciate the fact that a physical part of the brain could actually explain behavior morals etc. so along came in nineteen seventy eight Doctor Paul Rocha was a famous French neurologist and he identified parts of the brain that he clustered into what was called what he called the limbic mode so he is famous for coining the term limit but when he was coming up it was invoked to talk about loans so he said limbic mode then along came Phineas Gage and for those of us in neuroscience is a very famous case the confusing for me to understand the functions of the human brain I would have to go through IRB and this is what the application with some insane well guys what I want to do is question Susan I am what I do is I want to understand how Susan 's brain works so well into the minute damage a portion of it and under the sea black changes take place and what functions disappear we just think you think that counsel would would would would you prove that you are from him I think together related him I have to like how I learn the methods that we might not be so proven it okay so that alone can even use gauge something is gated the timing is this twenty five -year-old railroad worker it is said by most accounts that he was a fairly responsible person the mere fact visa form in twenty five attest to how dependable he was well that instrument that he is holding is what's called an iron camping rock and he was working with that rod and dynamic that combination so the blast goals off and that Ron goes through his okay and the reason why we're talking about is because believe it or not he lives to the blues consciousness is what the Robert Langone through the okay that's what this was so whatever the case that the reason this was such a dramatic case was because of the transition the change that the police and his personality so what we observed with one minute he's super responsible when the accident he became somewhat more irresponsible actually said that he he was on display at the Barnum Barnum and Bailey Circus by the Barnum Museum became a featured but it highlighted part of the function of the part of his brain which is called orbitofrontal cortex are right it speculated that he may well been part of the brain that was that was injured in this accident the other contributors to understanding some of the functions of the brain are this is the gentleman by the name of Henry malaise recolonization and when the shaman was wrong about nine or ten no accounts very is riding his bicycle he falls off his bike and ends up with this gash in his head by the time he's sixteen years old he's starting to have seizures so he goes to the dashing neurosurgeon of the day this is over in my home in the woods over and now goes to Hartford Hospital this guy was the head of the neurosurgery department Doctor Scoville at Hartford Hospital and the good doctor what he does is he recommends conservative treatment he says you know what what we try and find seizure medications so he tries them and of course it doesn't work doesn't stop the seizures and Doctor Scoville 's day was a procedure that was famously being used on acutely psychotic psychiatric patients okay yeah that was frontal lobe lobotomy 's economic and describe what how that was done and I don't have a picture of that doesn't happen him I will still little like you all was horrified by this procedure because in addition to know knocking out on the frontal lobe of the brain it would actually rob them of their personality it was effective in calming them down but they would lose their personality he was horrified by the deep hostility and hate it we would focus and understand exactly the areas that were involved in only maybe take on those areas to be the person would receive would Bruce Reed trained more of their function and so that's what he proposed to a child when the medications that work well believe I mean this was a Hackel so we actually takes in through this radical surgical procedure and effectively resuscitate button when HM awakens from this surgery no matter how many times you introduce yourself a job it's like your meeting him for the first time as far as he's concerned totally eradicate his memory formation okay so unlike with his gauge when it was only one physician kind of tracking some of these developments with HM Doctor Scoville enlists the assistance of Doctor Brenda Milner class neurosciences coming from I believe McKillop in Canada so she immediately enrolls HM into a study that studies him for the rest of his life forgot finally died in two thousand eight recently but that was not enough for the research community what they did was actually harvested his brain and they are in the process of generating ultrahigh resolution images of his brain just to increase our understanding of how the brain works so major contributor to our understanding of the brain and so now we went from Paul broke was talking about Olympic globe to change the this will nineteen thirties he actually identified a few more brain structures and now called the limbic system to let me show you then of course the definition of the limbic system is it integrates emotional learning executive function and memory all right let's get a picture of the limbic system so what I want to notice as we have a covering brain we call that a cerebrum but we have a undermine based on cortical brain that we call our limbic system this is what's called the man this is what we call our test hippocampus and this was the structure than two thirds of it was removed with our patient HM but this is the structure obviously is very critical in memory formation so again you have a covering brain but then you have a subcortical brain all right and you want to know that when we are functioning optimally there is top down control okay there's top-down control so it's not the under system that is driving my behavior it is my covering brain meaning man with nothing to grasp but when I left just start yelling but not without started yelling with it because my covering brings know that when the appropriateness of a good thing to do let's just listen but after that procure one word about what that guy is saying but let me act like actually care this is the covering Brian you know that is functioning the problem becomes when the brain is functioning okay so the whole reason why we're talking my the limbic system in the first place is because I want to talk about your pleasure center okay the pleasure center that's really what we want to get you today so what pleasures center basically business started right here so we have the ventral segment and what is that narrow transmitter that plays an important role in addiction and I know was that it don't mean different over here on the dopamine plays a very important role in addiction and I hear sertraline to the money on sertraline Zocor sertraline does play a role but the reason I brought up dopamine is because in the ventral tegmental area there is a high large amount of concentration of neurons that use that neurotransmitter dopamine while this area will project to the nucleus a comments all right and the nucleus of comments please is very very important role in addictions in fact substances that are addicted that are addictive will have a tendency of increasing dopamine at the level of the nucleus of a comments okay so you want to be aware of that the amygdala is also part of the limbic system and the way the amygdala works is it tends to assign significance commemorates okay it will tend to assign significance amounts I looked outside I see wavy grass and immediately my fight or flight system is activated because I remember the last time I saw a lady dressed in this nation and so I know not to go into analysis mode I know to be knowing exactly where the exits are in marketing who is the slowest person in the event the only prison I need to be right okay so that's with the amygdala does but I talked about the nucleus accumbens and so what I want to do now is help you understand what happens with addictions addictions on a whole use illustration of cocaine and/or methamphetamines but facilitate this is a cry for methamphetamines it's going to spike the level of dopamine and their nucleus company try spike in the unfortunate part is it plummets fairly quickly let's estimate this like fifteen minutes before talking about cocaine I so it plummets this part is and that will actually sit lower than where the person started okay so the person now is feeling pretty side and down but not only are they silent down there also recalling how did they develop just a second ago okay and so that drives them to try it again this time of course it doesn't go quite as high still very high and then again it sits below baseline and so that keeps driving you to keep trying right now contrast that with what I call lights natural enhancers you know that you know there are natural behaviors that we do that we get a dopamine hit from what are some of those behaviors exercise anything else about the program and now get the snare so there's the exercise there's sexism and that will spike dopamine but for the time it doesn't associate with high pictures of more like this but notice how longer how much longer the dopamine will stay of with those kinds of natural enhancers now what is this redline all about the significance of the red line is this is how the dopamine level increases when you have drives of abuse on board noticed you can experience the same amount of pleasure from these natural enhancers when drugs on board and you see the okay suggest something for you to be aware of one introduce you to the orbital frontal cortex when we first meet are worthless when you stay with us my thought is that right and so what is the function of the orbitofrontal cortex are right it helps to control impulse to write it helps us understand what are the social and cultural mores are right to appreciate the consequences of one's actions can you see why we start thinking hey there may be a biological basis or infections because when were thinking about next and the comical were preaching to them hey man you may not go to heaven and they appreciate the consequences will be no so the other issue is we talk about inculcation of social and cultural mores and so you want to so how exactly does this look well it's Thanksgiving and you know you got all seated around the table and everyone knows that Sue is onto her third spouse but my noses but everyone knows not to say anything okay cause your orbital frontal cortex dysfunction nonparental on the other hand is a loosening of him I and so he likes so is the worldwide all right lower for nuclear weapons and losing love my favorite part of the brain the pre- frontal cortex and to perform the function we call an executive function what exactly the executive functioning well I have a list of things to do but some are more important than others so that this part of the brain associated sequence things okay critical part of the brain helps us to adapt to change for those of us who work with addicts and treatment is a comical when we had any sort of change in their schedule all how breaks loose I think the changes in fashion now and last but not least there's delayed gratification delayed gratification so this is the part of the brain that helps us with delayed gratification so if you guys read the book why zebras don't get ulcers by Stephen Sapolsky he talks about this experiment where you have a researcher sitting at a table with a toddler and the top on the table there's a marshmallow in the researcher says the unpopular you can eat the marshmallow but if you wait till I come back then I'll give you two marshmallows now when you got them to be the one bird in the hand verses to overhead what with the study has essentially done was it was able to separate those group of toddlers into those that would eat one versus those that would wait for two and then these diligent researchers actually follow those toddlers twenty years forward and what they notice with the group that were able to wait for to is that the more much more self assertive they were much more successful what was the quality that they had just identified they had the ability to delay ratification they could delay gratification this is not part of the brain that helps us delay gratification okay critical part of our brain all right and so Dr. Scholl's talk about experiment where you teach a monkey or an animal task when the bell rings they perform the task and they get that treats where in this scheme the link they first experienced dopamine was that when the bell rings when the bell rings okay so even when the bell rings in anticipation of the reward they get a little jolt of the now how does that show function what does it do for them is that your four hi five and comes along with the dopamine rush but thanks okay that's when things in the wind as he focuses you and motivates you to overcome obstacles to attain the rewards okay so that's why men watched as a messenger that will keep it on the download is online now shame and hello our secrets like I was shy but is Doctor Phillips over at UCI Carolina what he did was he actually injected dopamine into the reward system of animals and noticed that now they would start drug seeking behavior support what is drug seeking behavior for around one press and in the drug gets dispatched an cylinder given dopamine then they start bar pressing what this highlights is just the role of dopamine in stimulating drug seeking behavior all right and in this life what it highlights is just that it's one thing for you to know that if you bar press you're going to get the drive right it's a whole other poor it cannot be certain you to get the reward when you bar press right so when you introduce probability into the equation and so what are some examples of that so gambling for example sometimes you win sometimes you don't win you win the rush is even more powerful is like that would address to because sometimes you know the connection to be there other times you do not okay now I realize there may be some folks who are in recovery and audience and there may be the possibility that I may trigger you in this message and so I then have to be respond will show what you do with that trigger in the event that you are triggered I hired you not to focus on the positive aspect of the trainer in the twelfth and so we talk about his player forward single pass the pleasurable feeling and go to the negative consequences that's what you want to focus on Iraq so I suggest just emphasizing uncertainty plus anticipation leads to a powerful reward the other issue is Doctor Mohler and Doctor P Ossa when they injected glucocorticoids into the reward system now based on drug seeking behavior what are the implications of the glucocorticoids are a stressful and what the highlighting of the fact that when you are stressed it can cause drug seeking behavior and this is part of the rationale why when you are in rehab for the purpose of rehab is to provide a structured environment but also a protective environment to minimize your exposure to stress okay because stress can be a trigger all right and so now we come to addictions so being showed you my word is not three nineteen that is and what you guys can do is there those of you who need that shakeout in a wing of love that also want to take him five or seven minutes but then there those of you who may have some questions surrounding the time for a question on one of his news media was reduced by hunting rumors including anything out someone you would like to learn more about the NAV from please visit www. and help someone .com wireless and more online was www. audio versions on board


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