Brain Retraining in the Opioid Dependent Patient

Brain Retraining in the Opioid Dependent Patient


Brain healing is hard work because the patient does not always know that they have a cognitive problem. If the patient and their support team understands what the problem is and works towards healing, great strides can be made. This is about changing the actual structure of the brain pathways. 

Rebuilding Your Brain   

Addiction; A Disease of “Maladaptive Learning”.

>The Habit of drug use becomes embedded in the very fabric of your brain. (entrenchment)

>Becoming addicted is not all that different from learning how to ride a bike or mastering a good golf swing. Imagine trying to unlearn how to ride a bike or un-master a good golf swing. That’s how difficult it would be to “unlearn” an addiction. A learned addiction is like a network of deep “tracks”  imprinted throughout the brain:

First step; detoxification, the cleaning and covering up those tracks. 

Second step; digging new, alternative tracks that will compete and (hopefully) overwhelm the hidden tracks of “addiction”.

Physical activity and various sports can really help.

Studies suggest that physical activity strengthens self-efficacy by stimulating the damaged parts of the brain to restructure and heal.

Results from research show strong evidence that physical activity in various forms is able to serve as both a preventive and treatment that reduces relapse.

Personalization of the physical activity is important for compliance, particularly in the context of strengthening human connections and social support.

Via scientific research, direct observation and case studies we believe that mu receptors (craving) will resorb if they are not stimulated by opiates.

According to NIDA, Dr Volkow, Ruben Baler, PhD. and the TED talks by Johann Hari and Jacki Hillios, The main factors in patient recovery are; personalized care, a fulfilling job (purpose), healthy social relationships, and exercise.

According to Johann Hari addiction has less to do with chemical hooks and almost everything to do with a persons environment. People need a bond with something and people can be the best or the worst. Disconnection however is the major driver of addiction.

In one study, a rat in a bare cage was given 2 choices of water, one drugged and one not. The rat chose the drug water every time until OD. 

In the second scenario the rat was put into a rat park, i.e. other rats, good food, hiding places and things to do and almost no rats went for the drugged water. Why? Disconnection is the major driver of addiction. You need something to get out of bed for. Patients with OUD (opioid use disorder) may have burned a lot of bridges and alienated many healthy relationships, leaving themselves alone, feeling without purpose and vulnerable. In order to heal, we need to reconnect socially, find purpose and work to rebuild a normal life ASAP.

Every patient and their situation is unique and each patients treatment should be unique to them.

Only you can heal yourself. Medication will only help you to remain comfortable while you do the hard work of retraining and healing your brain. If you understand and agree with the treatment particulars and are a part of the design and implementation of your treatment, you will have a much greater chance of success.


There are 3 areas in the brain that need to be healed, those areas have to do with;

Dopamine regulation, pathway retrenching and prefrontal cortex stimulation.



Dopamine and its receptors are the part of the brain system that allows you to be happy and satisfied naturally. In the opioid damaged brain, this is disrupted (down regulated due to overstimulation). In order for you to feel normal, feel happiness and satisfaction in your day to day life and do it naturally, you need to up regulate the dopamine system in you brain.

Dopamine up regulation activities have to do with things that might stimulate dopamine production as well as help build new receptors by doing something that gives a natural happiness reward or satisfaction such as accomplishments, beauty, physical or mental stimulation. You can pick the things that you feel will enjoy most or come up with other activities that we have not thought of. 

Some examples are;

Exercise.   (Basic or endorphin producing). The more vigorous and regular the better. This can be used as a “cue” or sidetrack. If you normally would come home and play x-box and your first thought is that this would be better if i was high, instead of using, you can insert a different action to break the chain. That action could be anything pleasurable or endorphin producing such as exercise, cooking, fixing something ….anything different than the old ritual that brings satisfaction.

Good sex. Meaning longer, relaxing and with a good psychological connection.

Hobbies, identify things that are or could be enjoyable, specific to you. 

Try to identify a potential benefit target or an outcome that gives satisfaction.

Adrenergic activities i.e. extreme sports, scary movies, rollercoasters, anything that is thrilling.

Mindfulness training i.e. yoga, meditation, long walks, sauna/steam, massage etc

Pathway retrenching, has to do with activities that can take the place of old negative habits, activities and cues. (consistency is key here) and this is hard.

The old entrenched pathway might be…..  you come home from work or whatever, grab a bite to eat and play x-box. Your first impulse might be that this would be better if i was high. Instead of using, you insert a different action to break the chain and head down a different path, thus starting a new better habit. The “cue to use” is probably all the way back to getting off work or getting home. The “cue” actually is what starts the dopamine release “reward” so that you will continue down the old pathway. The point at which to break the habit is at the step just prior to the cue or trigger. Thats why we need to find the cues and there are many.

Once you have developed a new pathway or habit, the old bad one will start to heal but one slip up and the old habit or pathway gets revitalized.


Remember from the past lessons, that the reward is no longer the actual use, the actual reward has now become the anticipation of the reward! 

Here are some of my personal examples;

Thanksgiving dinner, i love to plan it out and cook it but I don’t usually enjoy eating the dinner.

Movies, i love the anticipation in the beginning of the movie but the end is usually blah for me.

Gardening, i love the planning and visualization of how it will grow but when its done i need to rearrange and do more.

Sex, the anticipation, chase and planning is sometimes better than the act.

Xmas, planning and memories of past times is better than the actual receiving of presents.

Sports, doing well is a rush so it makes me want to work out harder so that i can win again.

Art, I love starting a painting or sculpture but struggle to finish.


The change that is needed is at whatever action precedes the point at which the first thought of use appears. So if it happens when you pull into the drive, then, back into the drive or park on the street and go in the back door etc….anything to change it up and break the normal chain of events. You may need to move the “change in direction” point further into the future, such as not driving right home after work, but going shopping or exercising before coming home. 

Change your patterns! This creates new habit pathways in your brain that will eventually become your new normal.


Another big one is people places and things. If you have friends who “use” get rid of them and their phone #s from your phone and block them from even calling because they are triggers and can only hurt you. 

The same thing goes for places you live (move) or used to go to that could trigger you (find a different bar) and things (x-box)  eeek get a different game or stop it for a long while.


Your Brain Workout

Write down as many cues as you can think of.

Write down all the daily habits that lead into the cues.

One by one find a way to substitute something to do in place of the “cue” or prior to the “cue” so that every time that “cue” comes up you have a default, an automatic thing, that you do instead. Something positive or productive if possible. This should be done also in relation to the habits and ways that lead to the cues i.e. remember that the reward is no longer the drug but is actually the action that gives the anticipation of the use of the drug. Thus the anticipation of the reward becomes the actual reward.


Prefrontal cortex stimulation activities are those that can help you to develop consequential thinking.

In other words you are testing yourself and then training your brain to think many moves ahead to determine the relative importance and priority of a decision (rather than emotional or impulsive decision making). When you get good at this, it will help you move forward by smoothing out your life by having less negative consequences.

OUD (Opiate use disorder) can result in damage to the frontal cortical regions in the brain which effects consequential thinking and executive decision making. To put it simply, it becomes difficult for you to think ahead as far as you should and your decisions may be based more on emotion than on importance of outcome. 

These exercises are designed to retrain your brain to think ahead and in a way that is more directed toward the proper outcome and priority. As you make better decisions your life will become simpler and more fulfilling making it easier to stay in recovery. Here are just a few suggestions but you may know better ones.

Plan a meal, shop, cook, review.

Plan several meals at a time, what are all the things you might need for several meals including how you might recycle some leftovers into the next meal. Then go get all the stuff at once. Review! Did you have everything you need or did you forget some things? What went wrong? Write it down.

Plan a weeks worth of meals. Same as above just more complicated.

The plan should include writing down all the things that you will need, going to get them and then seeing if you had thought it through properly.

Some people eat very simply, i.e. pizza or take out. Remember that you are trying to heal and improve your situation so what you eat matters. This may take a lot of time and effort that you are not used to having to spend but we are trying to heal your brain by exercising it.

Chess n checkers

Higher level eastern strategy games.

Gardening and the planning involved!!  If you have a yard or spot to garden in. This serves 3 functions, brain training through planning, dopamine up regulation via satisfaction and exercise, health and financial benefits of home grown foods. Kids love it too!

Work on the house or apartment, fix stuff, gain satisfaction while changing your pattern and improving your surroundings.

Think of someone in your predicament, what would you tell them to do?


Mindfulness training exercises,  Pre Frontal Cortex, decision making skills, forward thinking and assignment of importance due to priority and possible outcomes (salience) instead of what you would like to do (impulsive). Delayed gratification is good!

FUN MATTERS! Because it motivates and produces dopamine.


You are not your disease!

Have hope for the future and make plans for it and move towards it!  Progress feels good!

This is an area that is really hard to do because you don’t know what you don’t know and the more you know the more you realize how much you don’t know!!??

So you need to have a bit of faith. You can see that this is true when you look at your past paths, patterns and decisions and see that there have probably been quite a few times that a better decision could have been made.

You will be retraining your brain to think ahead (consequential thinking) and to train it to make  good executive decisions, (assignment of relative value).


Journaling  (quickly)

This is an exercise to help you to see if and to what extent you are able to think ahead (consequential thinking) and how well you can make executive decisions, (assignment of relative value).


Scribble down a daily plan of what should happen each day in detail…what could go wrong….what will be easy….what is in your control and what is not and why?

At the end of the day, scribble down how it went? why? What could have been done differently?


Next do 2 days at a time but reflect daily. Then 3,4,5,6,7 at a time then try it for a month in overview, not in minute detail, just the important stuff. 

Then review that time period to see what went right and what went wrong and scribble it down.


Other than time wasting work, what does this feel like? 

What are the consequential highlights?


By thinking about your future and the possible events and consequences, you are training your brain to do it not only more but better. It is important to be brutally honest about whether good decisions were made or if a consequence was even thought of.