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RichardbBrunner

~ creative arts therapist

RichardbBrunner

Tag Archives: Addiction

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

We walk together

02 Thursday Jun 2022

Posted by RichardB in creative arts therapy, Dance Movement Therapy

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Addiction, clients, meditation, movement therapy, Patients, Psychotherapy, recovery, rehab

In my work with clients/patients I sometimes use the written word to help process what they are feeling and what I am feeling about working with them.  I worked for years at a residential drug/alcohol rehab center and wrote a short poem about one experience.

1. We walk together
toe to heal
In the way we came here

Youngest to oldest – Male to female –
Opiate to alcohol – Forceps to stone

2. We all
Everyone of us
walk for a reason

3. Up the hill
breathlessly
we reach the top

4. around the pond and into the trees
A shelter – A holding
in the environment

5. Close your eyes
Notice your breath – As you inhale – as you exhale
Feel the wind – notice the smells – the scent of the earth

The sunlight and shadows sway back and forth to the rhythm of the branches moving in the wind

6. Don’t be afraid – shiver- cry out – weep – scream
We are all killers inside
We are all healers inside
Our blood runs through the veins of our ancestors
And is here to stay – an echo of times now gone

A dream of times yet to come

Interpretation

1. Today I took my clients outside to the park. We walked in a pecking order; the client with the most time were in front followed by the others in order of time, drug of choice, sex, finally by age. It was a metaphor for their life journey, of their choices and circumstances thrust on them from birth.

2. In the clients (and us all) our journey is a reflection of who and where we came from. Our personality and our history. Our wants and needs. Our understanding of these things. In this residential rehab clients have come because of an intersection of factors, both internal and external.

3. The walk with the clients took us up a sharp and steep hill, the last little leg of our walk before we reached the park and the pond. The walk of addiction is a mighty hard row to hoe in the discovery of the self

4. The clients were very happy to see the pond and dogs and people, and we headed for the trees to find some sanctuary. This little stand of trees I felt would be a good holding environment to do a movement meditation in a public space.

5. I led the group through a meditation in the environment, giving them a chance to be calm/passive and feel nature, with its enormous power. Like that higher power that 12 step teaches. Also nature has a rhythm that we, as earthlings cannot escape, it is deep inside us, with us since the womb.

6. In the mediation I encouraged the group to go to where it was safe and to go a little beyond safety, to a new place. Being different (clean/sober) in a setting (park) that is familiar is challenging. They will face that challenge when they leave the rehab. As addicts they must accept their dark side, and they must recognize their light side. This killer and healer is the story of being human, told by all cultures since we first lit a fire and huddled together. It is this story telling that teaches us to remember the mistakes so we know what to do if we make them and know how to avoid them.

catas

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.

Marijuana Addiction in the Age of Legal Weed

31 Thursday Dec 2020

Posted by RichardB in Addiction, Research, youtube

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Addiction, Marijuana, research

Generation X writer Neal Pollack thought he had it all: a good writing career, a strong marriage, even a lucrative 3-day run on “Jeopardy”! That brought him national attention. Like many in his generation, he also smoked a lot of marijuana. He had discovered that food, music and even his beloved yoga was much better when he smoked. In 2014, as several states in the country legalized pot, Pollack scored a writing gig for a marijuana site that provided free weed. He saw his drug use as harmless and joked about it often in his writing. But as more states, including California, began to legalize the drug, Pollack’s life began to fall apart, in part because of his drug use. Both of his parents died and he soon found himself spiraling out of control, sometimes in public. By 2018, Pollack admitted publicly he had a marijuana addiction and set about to conquer it, through honesty . . . and humor. Pollack’s new book, Pothead, is about coming to terms with his marijuana problems just as the country increased its recreational availability. The book is a cautionary and timely tale for those who think the drug isn’t dangerous and can’t cause serious addictive problems. Join us for a special evening program as Pollack discusses his story with Los Angeles novelist Bucky Sinister.

Addiction Hijacks the Brain

09 Wednesday Dec 2020

Posted by RichardB in Addiction

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Addiction

You’ve probably heard of the brain’s reward network. It’s activated by basic needs — including food, water and sex — and releases a surge of the feel-good neurotransmitter dopamine when those needs are met. But it can also be hijacked by drugs, which lead to a greater dopamine release than those basic needs. Brain-0020.jpg

But the reward network isn’t the only brain network altered by drug use. A new review concluded that drug addiction affects six main brain networks: the reward, habit, salience, executive, memory and self-directed networks.

In 2016, a total of 20.1 million people ages 12 and older in the U.S. had a substance-use disorder, according to the National Survey on Drug Use and Health, an annual survey on drug use. And drug addiction, regardless of the substance used, had surprisingly similar effects on the addicted brain, said the new review, published yesterday (June 6) in the journal Neuron.

The review looked at more than 100 studies and review papers on drug addiction, all of which studied a type of brain scan called functional magnetic resonance imaging (fMRI).

More than half of the studies out there look at the effects of drug use on the reward network, said Anna Zilverstand, lead author of the new review and an assistant professor of psychiatry at the Icahn School of Medicine at Mount Sinai in New York City. [7 Ways Alcohol Affects Your Health]

“Because we showed that the effects are very distributed across the six different networks … [we can conclude that] an approach that only looks at one of these networks isn’t really justified,” Zilverstand told Live Science. “This [finding] will hopefully lead other researchers to look beyond the reward network.”

For example, the memory network is pretty much ignored in research on substance-use disorders, Zilverstand said. This network allows humans to learn non-habit-based things, such as a new physics concept or a history lesson. Some research has suggested that in people with substance-use disorders, stress shifts the person’s learning and memory away from the memory network to the habit network, which drives automatic behavior, such as seeking and taking drugs.

Another less-studied network is the self-directed network, which is involved in self-awareness and self-reflection, the review said. In people with addictions, this network has been associated with increasing craving.

Two other networks are involved in substance-use disorders: The executive network is normally responsible for goal-maintaining and execution, but drugs can alter this network as well, reducing a person’s ability to inhibit their actions. The salience network picks up important cues in a person’s environment and redirects the individual’s attention to them. (In people with drug addiction, attention is redirected toward drugs, increasing craving and drug-seeking.)

Which comes first, the brain activity or the drug use?

“For me, the most surprising [finding] was how consistent the effects were across addictions,” Zilverstand said. What’s more, “the fact that the effects are quite independent of the specific drug use points to them being something general that might actually precede drug use rather than be a consequence of drug use.”

Zilverstand said she hopes that more studies will look at whether some people have abnormal brain activity in these six networks naturally and if that activity just gets exacerbated if they begin drug use. It’s important to know if some of these traits precede drug use; if that’s the case, it might be possible to identify people who are prone to addiction and intervene before an addiction begins, she said.

Some research has pointed toward this possibility already. For example, studies have shown that some people have “difficulties … inhibiting impulsiveness before drug use,” Zilverstand said. “Some of these impairments precede drug use, and they may become worse with more drug use, but they exist before the problem escalates.”

The good news, however, is that activity in four of these networks — executive, reward, memory and salience — moves back toward “normal” once drug use ends. “We know that four of the networks (partially — not fully) recover but not yet what happens to the other two networks,” Zilverstand said in an email.

Zilverstand added that she’s particularly excited about an ongoing study called the Adolescent Brain Cognitive Development (ABCD) Study, which is tracking 10,000 children across the U.S. from around ages 9 or 10 to age 20 (the children are now around 13). Some of these individuals will inevitably become addicted to drugs, most likely marijuana or alcohol, Zilverstand said.

“We’ll be able to see if the effects that we found [in the review] exist in youth who have not yet abused drugs,” she said, and she predicted that researchers will be able to find a lot of the effects identified in the review in the six brain networks.

The authors noted that because some regions of the brain are very small — for example, the amygdala, which is found toward the center of the brain — the studies can’t identify strong signals from those areas on brain scans. So, it’s possible that drugs affect additional networks in the brain that are hidden because of the limitations of our technologies, Zilverstand said.

“We don’t want to conclude that [those effects] don’t exist,” she said.

Drug addiction is complex

14 Wednesday Oct 2020

Posted by RichardB in Addiction, Research

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Addiction, research

We’re told studies have proven that drugs like heroin and cocaine instantly hook a user. But it isn’t that simple – little-known experiments over 30 years ago tell a very different tale.

Drugs are scary. The words “heroin” and “cocaine” make people flinch. It’s not just the associations with crime and harmful health effects, but also the notion that these substances can undermine the identities of those who take them. One try, we’re told, is enough to get us hooked. This, it would seem, is confirmed by animal experiments. 0312ILIN03-web.jpg

Many studies have shown rats and monkeys will neglect food and drink in favour of pressing levers to obtain morphine (the lab form of heroin). With the right experimental set up, some rats will self-administer drugs until they die. At first glance it looks like a simple case of the laboratory animals losing control of their actions to the drugs they need. It’s easy to see in this a frightening scientific fable about the power of these drugs to rob us of our free will.

But there is more to the real scientific story, even if it isn’t widely talked about. The results of a set of little-known experiments carried out more than 30 years ago paint a very different picture, and illustrate how easy it is for neuroscience to be twisted to pander to popular anxieties. The vital missing evidence is a series of studies carried out in the late 1970s in what has become known as “Rat Park”. Canadian psychologist Bruce Alexander, at the Simon Fraser University in British Columbia, Canada, suspected that the preference of rats to morphine over water in previous experiments might be affected by their housing conditions.

To test his hypothesis he built an enclosure measuring 95 square feet (8.8 square metres) for a colony of rats of both sexes. Not only was this around 200 times the area of standard rodent cages, but Rat Park had decorated walls, running wheels and nesting areas. Inhabitants had access to a plentiful supply of food, perhaps most importantly the rats lived in it together.

Rats are smart, social creatures. Living in a small cage on their own is a form of sensory deprivation. Rat Park was what neuroscientists would call an enriched environment, or – if you prefer to look at it this way – a non-deprived one. In Alexander’s tests, rats reared in cages drank as much as 20 times more morphine than those brought up in Rat Park. 

Inhabitants of Rat Park could be induced to drink more of the morphine if it was mixed with sugar, but a control experiment suggested that this was because they liked the sugar, rather than because the sugar allowed them to ignore the bitter taste of the morphine long enough to get addicted. When naloxone, which blocks the effects of morphine, was added to the morphine-sugar mix, the rats’ consumption didn’t drop. In fact, their consumption increased, suggesting they were actively trying to avoid the effects of morphine, but would put up with it in order to get sugar.

‘Woefully incomplete’

The results are catastrophic for the simplistic idea that one use of a drug inevitably hooks the user by rewiring their brain. When Alexander’s rats were given something better to do than sit in a bare cage they turned their noses up at morphine because they preferred playing with their friends and exploring their surroundings to getting high.

Further support for his emphasis on living conditions came from another set of tests his team carried out in which rats brought up in ordinary cages were forced to consume morphine for 57 days in a row. If anything should create the conditions for chemical rewiring of their brains, this should be it. But once these rats were moved to Rat Park they chose water over morphine when given the choice, although they did exhibit some minor withdrawal symptoms.

You can read more about Rat Park in the original scientific report. A good summary is in this comic by Stuart McMillen. The results aren’t widely cited in the scientific literature, and the studies were discontinued after a few years because they couldn’t attract funding. There have been criticisms of the study’s design and the few attempts that have been made to replicate the results have been mixed.

Nonetheless the research does demonstrate that the standard “exposure model” of addiction is woefully incomplete. It takes far more than the simple experience of a drug – even drugs as powerful as cocaine and heroin – to make you an addict. The alternatives you have to drug use, which will be influenced by your social and physical environment, play important roles as well as the brute pleasure delivered via the chemical assault on your reward circuits

It suggests that even addictions can be thought of using the same theories we use to think about other choices, there isn’t a special exception for drug-related choices. Rat Park also suggests that when stories about the effects of drugs on the brain are promoted to the neglect of the discussion of the personal and social contexts of addiction, science is servicing our collective anxieties rather than informing us

Addiction: Is Love All You Need?

06 Thursday Aug 2020

Posted by RichardB in Addiction

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Addiction

If anything deserves to be called “the establishment view,” it is what Johann Hari — in his new book on addiction and the war on drugs, Chasing the Scream: The First and Last Days of the War on Drugs — calls the pharmaceutical model of addiction.

The pharmaceutical model says that addiction is about chemicals. Addiction is a chronic incurable disease of the brain. The brain’s pleasure centers are hijacked.

The pharmaceutical model may be the conventional wisdom, but it is certainly not without controversy. Researchers such as Gene Heyman and Bruce K. Alexander have long questioned whether the data support this picture.

As Hari reminds us, heroin use was rampant among U.S. soldiers stationed in Vietnam during that conflict. According to one study he cites, 20 percent of these American servicemen were heroin users. Over 85 percent of these users gave up heroin when they got home, the book says; they simply stopped taking the drug.

How do we reconcile this fact with the idea that the drug hijacks the brain and takes over? If that’s true, you wouldn’t expect a change of scenery (coming home from Vietnam) all by itself to break the neuro-chemical stranglehold. Alternatively, you might speculate that perhaps these heroin users were not really addicted. That the fact that they stopped proves this. But then we face a new problem: If the addiction is a chemical effect of the drug, then why weren’t they addicted?

Indeed, as Heyman claims in his book, there is good evidence that most addicts in the general population, as a matter of fact, eventually stop using drugs. They stop because they get to a point where they want or need or find that they are able to stop. They decide to stop. Now, this doesn’t fit very well with the conventional wisdom. You can’t simply decide to give up other diseases like diabetes or heart disease!

Or consider the fact that, as Hari explains, actual chemical dependence seems to be only a small part of drug addiction. If addiction were just about chemicals, then you would expect that the availability of nicotine patches — which can deliver smokers every bit of the nicotine they would get from a cigarette — would, in one fell swoop, eliminate the feeling that one needs to smoke. But not so. Only 17.7 percent of smokers using nicotine patches, according to Hari, break their addiction to smoking.

Hari also describes a fascinating reverse case. At some point in the 70s, heroin interdiction in Vancouver was so effective that there was virtually no heroin on the streets. This didn’t stop dealers from selling white powder and calling it heroin, and it didn’t stop addicts from hustling to get their hands on this powder so that they could shoot up. If it is the chemical itself that drives addiction and controls the addict, then you would have expected that Vancouver’s junkies, deprived of real heroin, would have been weened of their dependence.

That this didn’t happen is striking evidence — assuming the anecdote, originally reported by Alexander, is true — that not only is the chemical itself not sufficient to explain addiction, it isn’t even necessary.

Data like these suggest that addictions, although they no doubt interact with neural chemistry, can’t adequately be understood alone in neuro-chemical terms. And this is because it is people, not brains, that get hooked. To understand the actions of addicts, you need to look at their lives as a whole. When doctors claim, as they do, that addiction is a disease of the brain, they are saying something that is either trivially true (that the brain plays a role in addiction) or something entirely false (that the brain is the whole story).

It is true, as the old commercial made vivid, that a rat in a cage will forego water to self-administer morphine every time — and will continue to do so until it is dead. But, maybe, it’s not the morphine that best explains this but, rather, the fact that the sorry rat is locked up exposed, in complete isolation from its fellows, in an otherwise empty cage.

This observation led Alexander to wonder: Would a rat in a richer environment — one including not only water and morphine, but also other rats and good food and interesting landscapes — take the same self-destructive course of action? Or, rather, would this other rat find itself so totally dominated by the rewards that the drug alone provides? To investigate this, Alexander designed “rat parks” that were much larger, interesting and hospitable environments in which communities of rats were placed. He found that happy rats in happy rat parks behaved more like casual human drinkers than liked crazed addicts, in that they limited themselves to small amounts of morphine.

This result is striking — and it certainly corresponds to my own personal experience of addiction. I have known addicts, but I have known many more drug users who were not addicted.

Now, Hari is convinced that Alexander has unlocked the true essence of addiction. Addiction is caused by isolation. And the cure for addiction, it follows, is love. We need to give the addict back his or her feeling of connection to others.

This is a beautiful idea — and I like beautiful ideas. I also think that it gets something right. Addicts are disconnected and isolated. But we need to be careful in drawing a too-speedy conclusion. The fact that being isolated is a cause of addiction doesn’t yet clarify how sociality, love, friendship, isolation, etc., function in the lives of addicts. In particular, it doesn’t mean that you can fix addiction with love.

One reason love might not be all you need is that it could be that the wounds that lead us to turn to drugs, to really give ourselves over to drugs, might have their roots in our early lives. It’s hard to simply “get over” early childhood trauma. (Hari also celebrates the work of Mate Gabor, a clinician who argues, in ways that some thinkers worry might be a bit reductive, that the sources of addiction lie in trauma.)

But there is a deeper reason to worry that love couldn’t suffice. Whatever its causes, addiction would seem to be — something like this is Heyman’s view — a disorder of one’s ability to connect to others and value the things that human beings tend usually to value (such as food, exercise, sex, family, work). The remarkable and striking thing about many addicts is that they opt for self-medication over encounter — they turn inward and shut out the world.

It might be right, as Hari claims, that we would fix addiction if we could restore in the addict a sense of connection with the world around him or her, and with other people. But that’s not a prescription as much as it is a statement of the problem. Addicts are shut off.heartbot.jpg

TED/ED: Opioid addiction

15 Wednesday Jul 2020

Posted by RichardB in Addiction, Uncategorized, youtube

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Addiction, opioid, youtube

Addiction and trust:

25 Friday Oct 2019

Posted by RichardB in addicted, recovery, trust, Wellness, YouTube

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Addiction

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