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RichardbBrunner

Category Archives: Addiction

Why We Get Addicted

01 Wednesday Mar 2023

Posted by RichardB in Addiction, brain

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addicted, biopsychosocial

Think about an experience that makes you feel good. It could be successfully completing a project at work, eating a warm chocolate chip cookie or taking a swig of whiskey. It could be a puff of a cigarette or a shopping trip. A dose of Vicodin or a hit of heroin.

Those experiences don’t automatically lead to addiction. So, what makes a particular habit or substance an addiction? What propels some people to seek out these experiences, even if they are costly or detrimental to their health and relationships?

“Addiction is a biopsychosocial disorder. It’s a combination of your genetics, your neurobiology and how that interacts with psychological and social factors,” said Maureen Boyle, a public health advisor and director of the science policy branch at the National Institute on Drug Abuse. That means it’s a lot like any other chronic disorder, such as type 2 diabetes, cancer and heart disease. And just like other chronic diseases, addiction is both preventable and treatable, Boyle said, but added that if left untreated, it can last a lifetime.

Though everyone’s path to addiction is different — whether he or she tries a drug or a behavior because it’s what that person’s parents or peer do, or just out of curiosity — what’s common across all substance and behavioral addictions is their stunning ability to increase levels of an important chemical in the brain called dopamine,Dopamine is a molecule that ferries messages across the brain’s reward center. It’s what gives people the feeling of pleasure and reinforces behaviors critical for survival, such as eating food and having sex.

When someone uses a drug or engages in a pleasurable experience, the same natural reward circuitry is activated. “The problem with drugs is that they do the job better than natural rewards,” said Dr. Hitoshi Morikawa, an associate professor of neuroscience at the University of Texas at Austin.

Different drugs tap into the dopamine reward system in different ways. Marijuana and heroin have a chemical structure similar to another neurotransmitter and can trick some brain cells into activating neurons that use dopamine. Cocaine and amphetamines, on the other hand, prolong the effect of dopamine on its target neurons, disrupting normal communication in the brain.

How quickly each drug can get into the brain, and how powerfully it activates neural circuits, determines how addictive it will be, Morikawa told Live Science. Some modes of use, like injecting or snorting a drug, make the drug’s effects almost immediate. “That’s why heroin, for example, is the last drug you want to take,” he said. “It’s very addictive.”

As individuals continue with addictive habits or substances, the brain adapts. It tries to reestablish a balance between the dopamine surges and normal levels of the substance in the brain, Morikawa said. To do this, neurons begin to produce less dopamine or simply reduce the number of dopamine receptors. The result is that the individual needs to continue to use drugs, or practice a particular behavior, to bring dopamine levels back to “normal.” Individuals may also need to take greater amounts of drugs to achieve a high; this is called tolerance.

Without dopamine creating feelings of pleasure in the brain, individuals also become more sensitive to negative emotions such as stress, anxiety or depression, Morikawa said. Sometimes, people with addiction may even feel physically ill, which often compels them to use drugs again to relieve these symptoms of withdrawal.

Eventually, the desire for the drug becomes more important than the actual pleasure it provides. And because dopamine plays a key role in learning and memory, it hardwires the need for the addictive substance or experience into the brain, along with any environmental cues associated with it — people, places, things and situations associated with past use. These memories become so entwined that even walking into a bar years later, or talking to the same friends an individual had previously binged with, may then trigger an alcoholic’s cravings, Morikawa said.

Brain-imaging studies of people with addiction reveal other striking changes as well. For example, people with alcohol-, cocaine- or opioid-use disorders show a loss in neurons and impaired activity in their prefrontal cortex, according to a 2011 review of studies published in the journal Nature Reviews Neuroscience. This erodes their ability to make sound decisions and regulate their impulses.

Some people are more susceptible to these extreme neurobiological changes than others, and therefore more susceptible to addiction. Not everyone who tries a cigarette or gets morphine after a surgery becomes addicted to drugs. Similarly, not everyone who gambles becomes addicted to gambling. Many factors influence the development of addictions, Boyle said, from genetics, to poor social support networks, to the experience of trauma or other co-occurring mental illnesses.

One of the biggest risk factors is age. “The younger someone is, the more vulnerable they are to addiction,” Boyle said. In fact, a federal study from 2014 found that the majority (74 percent) of 18- to 30-year-olds admitted to treatment programs had started using drugs at age 17 or younger.

Additionally, like most behavioral and mental health disorders, there are many genes that add to a person’s level of risk or provide some protection against addiction, Boyle said. But unlike the way in which doctors can predict a person’s risk of breast cancer by looking for mutations in a certain gene, nobody knows enough to be able to single out any gene or predict the likelihood of inheriting traits that could lead to addiction, she said.

Secondhand Marijuana Smoke and Drug Tests

04 Wednesday Jan 2023

Posted by RichardB in Addiction, Drug Tests, Handout, Marijuana

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secondhand smoke

People who are exposed to secondhand marijuana smoke may feel a bit of the “high” that comes with using the drug, a study finds. They may also feel unable to think clearly, and they may even have detectable levels of the drug in their urine or blood. But all of this happens only if they are exposed to marijuana smoke under severely unventilated conditions, the study found.

“If you’re going to breathe in enough passive cannabis smoke to feel high and potentially be slightly impaired, you could fail a drug test,” said Evan S. Herrmann, the study’s lead author and postdoctoral fellow in psychiatry and behavioral sciences at Johns Hopkins School of Medicine. “But this only happens under a very extreme situation.”

Cannabis is the world’s most commonly used illicit drug. It is often smoked in small, enclosed spaces with poor ventilation, according to the study.

Studies in the 1980s showed that such “social exposure” to pot smoke could trigger positive drug tests for cannabis’ main psychoactive ingredient, tetrahydrocannabinol (THC). But such studies had several limitations. They used marijuana that had much lower potency than that available today and they failed to account for normal levels of ventilation in rooms. They also did not examine how people may feel or behave after such exposures.

“This study probes a question people have been wondering forever,” said Ziva Cooper, an assistant professor of clinical neurobiology at Columbia University, who was not involved in this research. “Do people actually get high from these ‘hot box’ effects? And if so, does it change your capabilities or cause you to fail a drug test?”

In the first study of its kind, Herrmann’s team recruited about 20 healthy people between the ages of 18 and 45, including some who smoked marijuana and some who didn’t use the drug. The researchers tested the participants’ blood, saliva, urine and hair samples for cannabis biomarkers, and then asked six smokers and six nonsmokers to relax in a Plexiglas and aluminum smoke chamber about the size of a dorm room. Participants underwent two separate sessions, each an hour long.

The researchers gave each of the six smokers 10 marijuana cigarettes, each containing 1 gram of high-potency weed, and instructed them to smoke at their leisure for the hour while the six non-smokers sat by their side in the chamber.

During one test session, the room’s ventilation system was switched on, allowing air to flow in and out at a standard office-building rate. In the other session, the researchers restricted the airflow in the chamber. After the 60 minutes, each participant completed a series of biological, cognitive and subjective surveys and tasks at regular intervals for up to 34 hours after exposure.

“Our results are pretty consistent with what we expected,” Herrmann said. The new findings confirm “it’s really hard to get a positive [drug test result] from passive smoke unless you’re in an extreme scenario,” he said.

Under the unventilated, “hot box” condition, the nonsmokers showed slight impairments on cognitive tests, reported feeling high, and had detectable levels of THC in their blood and urine for up to 22 hours post-exposure. Those in the ventilated condition had much lower levels of THC in their blood, did not feel impaired or high, and did not test positive for THC in their urine.

But the unventilated room is not representative of most real-life situations, the researchers said. “We modeled the worst-case scenario,” Herrmann said. “You are in an enclosed room for an hour with 15 grams of cannabis being smoked.”

Ideally, the study would have had a placebo group, in which nonsmokers were exposed to smoke without THC. This would have helped the researchers determine whether the feeling of being high was due to the marijuana or simply a placebo effect, from being exposed to smoke.

Still, “this study is really important because it adds to our limited knowledge of the direct effects of cannabis smoking and the potential dangers of second-hand smoke,” Cooper said.

Narcan Kits

06 Tuesday Dec 2022

Posted by RichardB in Addiction, Opioids, Substance use

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addicted, life, relapse

From SLATE: Narcan kits, the drug that every parent of a teen needs in their house now. https://slate.com/human-interest/2022/12/narcan-kits-free-parent-instructions-overdose.html

Treating Heroin and Opioid Use Disorder

Positive Traits Handout

23 Wednesday Nov 2022

Posted by RichardB in Addiction, Creative Therapy Tools, groups, Handout, positive

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handout, positive traits, Self Esteem

This handout is a quick way to start the conversation in groups. I have folks circle the 10 traits that they (think/feel) have. Than I ask them to put them in a numbered order (1 to 10), best to worst. One day someone suggested that they had way more negative traits so…. I started asking folks (after they shared the positive traits) to write their negative traits on the back and share.

Most of the people that I worked with for the last 10 years were men between 20 and 35. Most had started using intoxicants as teens with cannabis and moved onto oxie and later stronger opioids and/or fentanyl. Most had felony possession charges and/or were on probation.

I kept a lose record of what people chose as their top 3 positive traits: 1. Hardworking, 2. Reliable, 3. Strong. One last thing, I usually asked folks at the end of group would their loved ones and/or family (however they chose to define that) agree with their list of positive traits. Most said (hell) no.

Opioid Addiction – Brain Functions

19 Wednesday Oct 2022

Posted by RichardB in Addiction, brain

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Addiction, brain, opioid

Substance addiction is a perplexing phenomenon for those who fortunately do not suffer from it. Although it is incredible to believe that people would willfully engage in behaviors that create problems with their lives on so many levels, substance addiction is a reality for millions of people. According to data published by NIDA (National Institutes of Drug Abuse) nearly 20 million Americans have undergone opioid de-addiction therapy in 2010. What makes some people so susceptible to substance abuse while others are able to protect themselves? A study of brain images of heroin addicts, conducted by Gold, Liu and colleagues, shows significant differences in brain activity even in resting state, without heroin use. Functional MRI (fMRI) images from opioid addicted patients were compared with similar images from health people.

Resting state fMRI images of men undergoing opioid substitution therapy showed that areas of the brain engaged in reward perception, motivation, memory and self-control show significantly different activity than comparable regions in healthy individuals. Areas like the orbitofrontal cortex, cingulate gyrus and hippocampus show consistently different resting state activities in heroin-dependent and healthy subjects. The prefrontal cortex of dependent patients was less active than that of healthy patients in the resting state, during de-addiction therapy. However, this area which controls motivation as well as degree of inhibition, was observed to be highly active during periods of opioid use. Other areas of the brain like the hippocampus which regulates memory, also showed activity patterns that were different from those in healthy subjects, in the resting state in addicted individuals. These images shed light on the mechanism of addiction in people and the areas of the brain that are engaged, perhaps constitutively, in sustaining addiction.

Given that study participants were enrolled from de-addiction clinics, episodes of heroin abuse had already taken place in their life. It is unclear whether the same areas of the brain would show similar activity in naive individuals. If this possibility is validated by comparative studies, these fMRI imaging techniques may have tremendous diagnostic potential in identifying people who are at high risk for addiction. One drawback of this investigation is that only male patients were included in this study. Therefore, we do not know whether there are gender-based differences in the resting state brain activity of female opioid addicts.

The study does throw up interesting possibilities. It is possible to enroll naive subjects, possibly teenagers or pre-teens, and obtain baseline brain images before these people have tried out any addictive substance like tobacco, heroin or alcohol. Follow-up studies with the same people can indicate whether experience of addictive substances can change the baseline pattern of activity. This kind of long-term and long-range study may help to identify brain markers for specific addiction disorders. The study also indicates why counseling fails to have an impact on some patients. It is likely that profound changes in resting state brain activity resulting from addiction may override the effects of received and processed advice.

Reference

Zhang Y, Tian J, Yuan K, Liu P, Zhuo L, Qin W, Zhao L, Liu J, von Deneen KM, Klahr NJ, Gold MS, & Liu Y (2011). Distinct resting-state brain activities in heroin-dependent individuals. Brain research, 1402, 46-53 PMID: 21669407

Research Identifies How Stress Triggers Relapse

05 Wednesday Oct 2022

Posted by RichardB in Addiction, brain, Stress

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research, wellness

Recent research from Brown University could pave the way for new methods of treatment for those recovering from addiction. Researchers identified an exact brain region in rats where the neural steps leading to drug relapse take place, allowing them to block a crucial step in the process that leads to stress-induced relapse.

Prior research has established that acute stress can lead to drug abuse in vulnerable individuals and increase the risk of relapse in recovering addicts. But the exact way that stress triggers the neural processes leading to relapse is still not clearly understood. The Brown study provides new insights on how stress triggers drug abuse and could lead to more effective treatments for addiction.

According to the study, stress has significant effects on plasticity of the synapses on dopamine neurons in the ventral tegmental area (VTA), the brain region where the neural activities leading to a stress-induced drug relapse take place.

Stress activates kappa opioid receptors (KORs) in the VTA, and the researchers found that by blocking the KORs, they could prevent the rats from relapsing to cocaine use while under stress.

Published in the journal Neuron, the study shows blocking these receptors may be a critical step in preventing stress-related drug relapses in humans, as well. The chemical used to block the receptor, “nor-BMI,” may eventually be tested on humans, according to the study’s authors.

“If we understand how kappa opioid receptor antagonists are interfering with the reinstatement of drug seeking, we can target that process,” senior study author Julie Kauer said in a statement. “We’re at the point of coming to understand the processes and possible therapeutic targets. Remarkably, this has worked.”

Kauer noted that the study builds upon over a decade of research on how changes in brain synapses relate to behaviors like addiction. The advance is significant and could accelerate progress towards a medication for those struggling to recover from addiction.

“If we can figure out how not only stress, but the whole system works, then we’ll potentially have a way to tune it down in a person who needs that,” Kauer said.

Addiction: One Perspective

31 Wednesday Aug 2022

Posted by RichardB in Addiction, Coping Skills

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perspective

Whether consciously acknowledged or not, we live in an almost constant state of anxiety. We are concerned with what we may lose, or what we may not gain. We also live in grief and regret over what we have left behind or at least feel we may have indeed lost. We thus attach ourselves to the very things that we cannot, ultimately, control, the past and the future. In truth, there is only today, this moment, and this breath with which we are, and can be, connected. The past is gone, and the future has not yet happened. We are here, now.

From a Buddhist perspective, addiction might be considered the archetype of attachment. Addiction is, in fact, a collection of attachments. It is attachment to fear, attachment to loss, and attachment to longing, emptiness, and a lack of a sense of purpose. Whether we choose alcohol, drugs, sex, food, pornography, exercise or even shopping, we are simply employing the means serving the compulsion to fill a space and dampen our pain. The means does not matter; that is simply a gesture. The compulsion is the crux of it, and that compulsion is not so much to drink, or do drugs, or to spend; that compulsion, ultimately, is to fill that space.

And just what is that space? We might look upon it as the “God-shaped hole.” The wisdom teachings suggest that in identifying with a self, a “me”, we divorce ourselves from the true nature of our existence. From a psychological perspective, this division presents itself as inauthenticity, and the internal conflict that condition engenders promotes internal strife. In our attempt to reconcile this sense of inauthenticity, we cling even more desperately to establishing a sense of “me-ness” and can, in some cases, become morbidly self-destructive in our attempts to soothe the pain of failure in that reconciliation.

Addiction generally begins as an interest. As soon as we express an interest in something, we are expressing a preference. In expressing a preference, we are dividing our attention and creating an attachment to something in the world around us. As that interest turns into a fascination, our attachment deepens. Our attention becomes more and more exclusive, and we become increasingly imbalanced; emotionally, intellectually, and spiritually.

Fascination may then flower into obsession, and we become a slave to our attachment. We are no longer ourselves, and rather than ‘losing our mind’, which would be the skillful means by which to escape our attachment, we are trapped inside the mind.

With obsession, our attachment becomes even more intensified, and our exclusion even more narrow. As we become slaves to our attachment, our mind, and our behavior, we lose the ability to exercise free will and, in that light, move from obsession to compulsion; from place of being driven, to a place of need.

At this point we fail the First Noble Truth; our attachment has become so involved that we have invited suffering. We are no longer willful, but, rather, subject to and at the sufferance of the will of our attachments. When we find ourselves in a place that we cannot live without exercising this attachment, whatever it may be, we have fallen into a state of addiction.

Within the context of addiction, people often feel that they do not have a choice. Nothing could be further from the truth. We always have a choice. When confronting someone who themselves is confronting an addiction, saying to them, “Stopping your behavior is your choice.” is, however, often met with profound resistance for their failure to see that choice.

The key to getting a grasp on this is recognizing that choice is a constant state; it is not a single moment in time. If the choice not to be addicted were a single choice point, then all we would ultimately do is move our attachment from something socially defined as negative (say, drinking or being promiscuous) to something that is socially defined as positive (not drinking or being chaste). In fact, we would become addicted, or at the very least attached, to not being addicted.

Buddha spoke of the Middle Way. Within the context of choice that suggests that if we are present in the moment, our choices are constant. We do not, then, go right or left, say yes or no, think good or bad, or see black or white; rather, we are aware that both opportunities are presenting themselves, we recognize this and acknowledge it, then choose neither.

When we lose the Middle Way and fall off our balancing point, we create our pain. We create our sense of emptiness, and our anxiety around loss. We deceive ourselves into believing that we are less than whom and what we are by virtue of attaching ourselves to things, objects, situations, emotions, and anxieties that take us away from ourselves. This is the engine of addiction.

Coming back to the present moment brings us back to our constancy of choice. We find ourselves in the Middle Way, on the balancing point and we are able to see both choices. Seeing both sides in balance and in perspective then gives us the opportunity to exercise compassion. Most importantly, it gives us the opportunity to exercise compassion toward ourselves. We are able to see the left and the right, and we are also able to see the left in the right and the right in the left.

Our frustration with the world and sense of victimhood thus becomes transformed into the recognition that we must set an intention in our lives. Our depression finds an antidote for itself in the gratitude that we can express simply for being alive. We begin to see outside ourselves with a clear vision and recognize that the things outside ourselves are, in fact, quite outside ourselves. In letting go of our attachments we also let go of the things that influence us and draw us into a state of mind where we feel less than we are, where we feel that something is missing, where we need to fill the space, or dampen the pain, or simply make it go away.

Coming back to the breath as a marker for the present moment and exercising the constancy of choice in that moment and every moment also gives us an opportunity to break free of the bonds of this supreme state of attachment and begin to climb out of the pit of suffering into which we have gotten ourselves.

The New Face of Heroin

09 Thursday Jun 2022

Posted by RichardB in Addiction, Heroin, Wellness

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drugs, vermont

The explosion of drugs like OxyContin has given way to a heroin epidemic ravaging the least likely corners of America – like bucolic Vermont, which has just woken up to a full-blown crisis.
Read more: http://www.rollingstone.com/culture/news/the-new-face-of-heroin-20140403

vth

FRONTLINE – Chasing Heroin

22 Friday Apr 2022

Posted by RichardB in Addiction, Heroin

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Addiction

Why Do We Get Addicted

08 Friday Jan 2021

Posted by RichardB in Addiction

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Addiction

Think about an experience that makes you feel good. It could be successfully completing a project at work, eating a warm chocolate chip cookie or taking a swig of whiskey. It could be a puff of a cigarette or a shopping trip. A dose of Vicodin or a hit of heroin.

Those experiences don’t automatically lead to addiction. So what makes a particular habit or substance an addiction? What propels some people to seek out these experiences, even if they are costly or detrimental to their health and relationships? Brain-0010.jpg

“Addiction is a biopsychosocial disorder. It’s a combination of your genetics, your neurobiology and how that interacts with psychological and social factors,” said Maureen Boyle, a public health advisor and director of the science policy branch at the National Institute on Drug Abuse. That means it’s a lot like any other chronic disorder, such as type 2 diabetes, cancer and heart disease. And just like other chronic diseases, addiction is both preventable and treatable, Boyle said, but added that if left untreated, it can last a lifetime. [Do Smokers’ Lungs Heal After They Quit?]

The mutual mechanism

Though everyone’s path to addiction is different — whether he or she tries a drug or a behavior because it’s what that person’s parents or peer do, or just out of curiosity — what’s common across all substance and behavioral addictions is their stunning ability to increase levels of an important chemical in the brain called dopamine, Boyle told Live Science.

Dopamine is a molecule that ferries messages across the brain’s reward center. It’s what gives people the feeling of pleasure and reinforces behaviors critical for survival, such as eating food and having sex.

When someone uses a drug or engages in a pleasurable experience, the same natural reward circuitry is activated. “The problem with drugs is that they do the job better than natural rewards,” said Dr. Hitoshi Morikawa, an associate professor of neuroscience at the University of Texas at Austin.

Different drugs tap into the dopamine reward system in different ways. Marijuana and heroin have a chemical structure similar to another neurotransmitter and can trick some brain cells into activating neurons that use dopamine. Cocaine and amphetamines, on the other hand, prolong the effect of dopamine on its target neurons, disrupting normal communication in the brain.

How quickly each drug can get into the brain, and how powerfully it activates neural circuits, determines how addictive it will be, Morikawa told Live Science. Some modes of use, like injecting or snorting a drug, make the drug’s effects almost immediate. “That’s why heroin, for example, is the last drug you want to take,” he said. “It’s very addictive.”

From experimenting to getting hooked

As individuals continue with addictive habits or substances, the brain adapts. It tries to reestablish a balance between the dopamine surges and normal levels of the substance in the brain, Morikawa said. To do this, neurons begin to produce less dopamine or simply reduce the number of dopamine receptors. The result is that the individual needs to continue to use drugs, or practice a particular behavior, to bring dopamine levels back to “normal.” Individuals may also need to take greater amounts of drugs to achieve a high; this is called tolerance.

Without dopamine creating feelings of pleasure in the brain, individuals also become more sensitive to negative emotions such as stress, anxiety or depression, Morikawa said. Sometimes, people with addiction may even feel physically ill, which often compels them to use drugs again to relieve these symptoms of withdrawal. [Booze Snooze: Why Does Alcohol Make You Sleepy, Then Alert?]

Eventually, the desire for the drug becomes more important than the actual pleasure it provides. And because dopamine plays a key role in learning and memory, it hardwires the need for the addictive substance or experience into the brain, along with any environmental cues associated with it — people, places, things and situations associated with past use. These memories become so entwined that even walking into a bar years later, or talking to the same friends an individual had previously binged with, may then trigger an alcoholic’s cravings, Morikawa said.

Brain-imaging studies of people with addiction reveal other striking changes as well. For example, people with alcohol-, cocaine- or opioid-use disorders show a loss in neurons and impaired activity in their prefrontal cortex, according to a 2011 review of studies published in the journal Nature Reviews Neuroscience. This erodes their ability to make sound decisions and regulate their impulses.

Risk factors

Some people are more susceptible to these extreme neurobiological changes than others, and therefore more susceptible to addiction. Not everyone who tries a cigarette or gets morphine after a surgery becomes addicted to drugs. Similarly, not everyone who gambles becomes addicted to gambling. Many factors influence the development of addictions, Boyle said, from genetics, to poor social support networks, to the experience of trauma or other co-occurring mental illnesses.

One of the biggest risk factors is age. “The younger someone is, the more vulnerable they are to addiction,” Boyle said. In fact, a federal study from 2014 found that the majority (74 percent) of 18- to 30-year-olds admitted to treatment programs had started using drugs at age 17 or younger.

Additionally, like most behavioral and mental health disorders, there are many genes that add to a person’s level of risk or provide some protection against addiction, Boyle said. But unlike the way in which doctors can predict a person’s risk of breast cancer by looking for mutations in a certain gene, nobody knows enough to be able to single out any gene or predict the likelihood of inheriting traits that could lead to addiction, she said.

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