Entitled “Perinatal Pitocin as an early ADHD biomarker: neurodevelopmental risk?”, 172 children were examined comparing Attention deficit Hyperactivity symptoms and the use of  Pitocin and found a strong correlation unlikely to be coincidence: Of kids that had ADHD 67% of them had been exposed to Pitocin.

Pitocin is synthetic oxytocin.

Oxytocin is the neurohormone of trust.  The “cuddle” hormone, or “love hormone.”  It is what binds us together as human beings, intimately involved with how we feel when someone says, “You are amazing.”  It is what I believe is generated when you feel respected, as respect leads to value, value leads to trust, trust is about oxytocin, and trust leads to unleashing your unlimited human potential.

This makes the Pitocin connection a possible game-changer in the way we understand the impulsivity part of ADHD.  Wouldn’t it be interesting if ADHD was actually a function of being overly trusting, which in our world translates into a kid taking chances and doing things without thinking: being impulsive.  Part of the diagnostic criteria for ADHD includes these and other symptoms:

Impulsivity

1. Often blurts out answers before questions have been finished.
2. Often has trouble waiting one’s turn.
3. Often interrupts or intrudes on others (e.g., butts into conversations or games)

In many ways, Impulsivity can be understood as a lack of caution.  Caution, based on the survival fight-flight response, is a function of mistrust:  The environment is assessed for danger and a decision is made how to proceed.

How amazing it would be if perinatal exposure to pitocin, which is in effect oxytocin, created an overly

trusting child that expects the best outcome from the world, rather than not anticipating an outcome at all!  They do not utilize the fight-flight mechanism, and instead respond “impulsively” to the world because they “trust” the outcome will not endanger their chances for survival.

Using this lens blurting out answers would be because the child trusts that the rest of the world is interested in what they have to say, and that they are empathically connected to the speaker enough to anticipate the end of their sentence.

1. Often blurts out answers before questions have been finished.Being unable to wait one’s turn is a belief in altruism, with hypersensitive oxytocin receptors primed to respond to a world where goodness and giving exist beyond all.
2. Often has trouble waiting one’s turn.What seems to be interrupting is seen through a trust lens as a behavior in which one’s contributions are valued and encouraged, with no need to wait to be invited.  It is the epitome of the fourth branch and option we have evolved as human beings: friendship.
3. Often interrupts or intrudes on others (e.g., butts into conversations or games)A kid with ADHD is not inherently a bad or callous kid.  They may be an oblivious kid, but their impulsivity is not designed with the intention to hurt someone else.  They are not acting impulsively out of anger, but perhaps initially out of a remarkable trust in the world having positive, productive outcomes.  But all too often the world in which they are impulsive responds with the limbic system:  they are moving too fast and could therefore be a danger or a threat.  Our own mistrust activates, and then we may interpret their actions as being purposeful to undermine our rules and guidelines.  After all, we don’t cut in line!

Consistently these kids appear astonished that they have done anything wrong, but just as quick to understand how another person may have been unwittingly offended.  But despite the apology, they do it again.

What is also interesting is how we use dopamine secreting medication to address ADHD.  In essence, perhaps that amine portion sits in the receptor site of oxytocin, modulating its effects, and dampens impulsivity.  Are we slowing a kid down, or making them more cautious and less trusting?

The finding also bolsters an epigenetic consideration:  perhaps for this form of ADHD early exposure around the time of birth has an impact on the way future oxytocin receptors respond to the world around them.  Just as in the Imax Approach, the four domains interact even when the infant is still in the mother’s womb, the ultimate home environment.

I just hope I haven’t been too impulsive in writing this blog.

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When an adolescent is developing a habit of drug using, he or she is positively encouraging the brain to continue learning these behaviors at the expense of other behaviors such as thinking about the future, planning and being patient. Heather Brenhouse and colleagues at McLean Hospital studied adolescent rats and found they formed pernicious addictions more resistant to treatment, have a tougher time quitting drugs, and be more susceptible to relapse once they have quit (Brenhouse, et al, 2008  Patoine, 2007). They propose this use-it or lose-it mechanism explains why human teenagers form a pattern of addiction that literally becomes embedded in the brain while healthy patterns are pushed aside. The use it or lose it paradigm of neuroplasticity is thus both remarkably adaptive and also dauntingly dangerous. This is what Ratey and other neuroscientists have emphasized about brain development, plasticity, and learning: the pathways we exercise are the pathways that, over time, push out the other, less utilized trails. This is could explain the mechanism why alcohol, and nicotine, are gateways to the use of other drugs of addiction for adolescents. (AMA, H30. 958).

The impact of adolescent drug abuse reverberates throughout our culture. However, the promise of plasticity holds opportunity, and should drive the design of a treatment approach. By capitalizing on the science of adolescence, troubled teens can phase out of this problem while gaining new insight to carry them through future challenges life may throw at them. Working with adolescents is a gift.  It is an honor and a privilege to work with these young people and their families, to be part of their path to overcome their challenges, to be privy to their lives at such a time of need, and to enjoy the pleasure of knowing that we are adding value to the world, one kid at a time.

References:

AMA Policies on Alcohol.
Retrieved from: http://www.amaassn.org/ama1/pub/upload/mm/388/alcoholism_treatable.pdf

Brenhouse HC, Sonntag KC, Andersen SL. J Neurosci. 2008  Transient D1 dopamine receptor expression on prefrontal cortex projection neurons: relationship to enhanced motivational salience of drug cues in adolescence. Mar 5; 28 (10):2375-82.

Gogtay.N, et al. (2004). Dynamic mapping of human cortical development during childhood through early adulthood. PNAS, 101, 21:8174-79.

Hardin, M., Ernst, M. (2009). Functional Brain Imaging of development-related risk and vulnerability for substance use in adolescents. Journal of Addiction Medicine, 3, 2: 47-54.

Jensen, F. (2009). Do you ever wonder why teens do what they do? Children’s Hospital Boston.
Retrieved from http://www.childrenshospital.org/patientsfamilies/Site1393/mainpageS1393P316sublevel357.html

Koob, A (2009) The Root of Thought: Unlocking Glia- the Brain Cell That Will Help Us Sharpen Our Wits, Heal Injury, and Treat Brain Disease.  FT Press 2009

National Institute on drug abuse (2009). Principles of Drug Addiction Treatment: A research based guide 2^nd edition.
Retrieved from: http://www.nida.nih.gov/podat/PODATIndex.html.
Patoine, B. (2007). Teen Brain’s Ability to Learn Can Have a Flip Side. Brain Work.

Retrieved from: http://www.dana.org/news/brainwork/detail.aspx?id=10108
Ratey, J., Hagerman, E. (2008). Spark: The Revolutionary New Science of Exercise and

 the Brain. New York: Little Brown and Co.
Society for Neuroscience. (2007). Brain Briefings; The adolescent brain. Retrieved from:
http://web.sfn.org/index.cfm?pagename=brainBriefings_Adolescent_brain#fullsiz

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Joseph Shrand, MD

However, this process of change leaves the adolescent brain particularly vulnerable to the toxic influence of drugs and alcohol.  Already in a major state of flux, the addition of drugs and alcohol that artificially induce dramatic and brutal changes in it’s neurochemistry, (especially the increase of dopamine, the molecule of pleasure that drugs and alcohol force out of the neurons),  places this brain at risk of life-long addictions.   This is partly due to the process of myelination that occurs in the adolescent brain as it forms.

But, at the same time that myelination is occurring, many of the neurons and networks themselves are being “pruned.” This pruning results in the elimination of redundant connections between brain cells, (one brain cell may have hundreds of connections to other brain cells), the reduction of brain cells themselves, and the organization of neural networks into more efficient processes. This process is believed by scientists to lead to more capable thinking and competent cognitive capacity (Gogtay, et al., 2004).

This series of processes occurring in the development of the teenage brain also can create unique challenges for the “recovering” adolescent. Clinicians who work with adolescents recognize these needs: simply being an adolescent may interfere with their interests in sobriety and their attention to the clinical work needed for achieving sustainable recovery. According to the National Institute on Drug Abuse (NIDA), adolescent drug abusers have distinctive needs stemming from their immature neurocognitive and psychosocial stage of development.  In other words, some kids may not have the reflective ability to even consider that they have a problem.  And if this is not addressed, it can continue into adulthood.  Any of you readers know someone who has no idea that they have a drug or alcohol problem?  This may not just be denial, but a true inability to make the cognitive connections needed for insight!  (Fear not.  In a later blog I will address some ways to help shift a person from this pre-contemplative, pre-motivational stage to at least acknowledging there may be a challenge.)

A series of separate reports at the Society for Neuroscience conference adds new support to the idea that the dramatic remodeling of the brain during adolescence holds opportunities for development and learning but also appears to enhance a teen’s vulnerability to the long-term effects of environmental influences such as stress and drug experimentation (SFN, 2007).The development of our mental facilities in adolescence is not produced solely by the addition of new synapses (a synapse is the small gap between neurons.  Chemicals either float or are actively transported across this synaptic cleft, inducing a change in the “down-stream” neuron), or connections between neurons. Development is also facilitated by the elimination of neural networks that are weak and underused. The brain is a “use it or lose it” kind of organ (Ratey, & Hagerman, 2008).

This is why adolescent addiction is so dangerous: it occurs during pruning.  The formations of pathways most frequently used are less likely to be discarded.  Thus the neural connections most often being used, such as the teen getting and finding the ways and means to deliver more drugs to the system will be solidly reinforced. In addition, the dopamine reinforcing pleasure response of the brain using drugs results in the teen unconsciously attributing greater importance to those immediately gratifying actions at the expense of rewarding activities with longer term returns such as school and family responsibilities.

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Joseph Shrand, MD

The Oxford English dictionary defines plasticity as the ability to be easily molded or to undergo a permanent change in shape.  The biological definition describes plasticity as the adaptability of an organism to changes in its environment; specifically the ability to alter the neural connections of the brain as a result of experience, in the process of learning. Neuroplasticity thus holds promise for many people who previously existed in a rigid world without options. Victims of traumatic brain injury, and people who suffer from mental illnesses including anxiety, depression, and addictions, now have the hope that treatments and therapies can change their brain. However, the promise intrinsic in neuro-plasticity also creates the perils our young people incur when they decide to abuse substances. The actions we take can and do influence and create sustainable change in our neural nets, and the changes we create are not always positive.

The adolescent human brain is at a pinnacle of plasticity, creating downright danger even in the promise of possibility. According to Dr. Frances Jensen, senior assistant in Neurology at Children’s Hospital Boston and professor at Harvard Medical School, the teenage brain had been thought to be just a young adult brain.  New research has shown that is an enormous misrepresentation. The adolescent brain is not like the adult brain at all.  In fact, because of the rapid changes and re-organization of neural pathways, according to Dr. Jensen (2009) “teen brains can get addicted faster and stronger than adult brains and teenagers can have a lifelong problem with trying to shed an addiction that has been acquired as a teenager.”

To understand this process, one has to first understand how the brain “matures.” Neurons, or brain cells, are basically electrical wires that transmit signals from one cell to another.  Like any wire, having a sheath around the wire enhances its ability to conduct that signal.  The sheath around a neuron is actually composed of specialized glial cells (oligodendrocytes.  I love that word!) that create a fatty coating called myelin.  Maturation is measured, in part, by the amount of myelin around the neuron.

For example, you may have seen a baby wiggling around.  As it grows the baby begins to crawl, to pull itself up, to walk with a wobble, then walk with more balance, and eventually be able to run a sprint.  This development is due to the progressive myelination of that part of the brain, the motor neurons, that controls the muscles of the legs.  Myelination is the general process of development and maturation of the brain.  (Multiple Sclerosis, a devastating disease that slowly results in people losing the ability to walk or talk or see, is a progressive de-myelination of motor neurons due to the death of those oligodendrocyetes.  Myelin is really important.)

Research has demonstrated that the brain undergoes a prolonged process of development and refinement. Myelination occurs from birth to early adulthood. However, during the teenage years a developmental shift occurs. Adolescent behavior transforms from more impulsive to more reasoned and reflective. In fact, the brain areas most closely associated with aspects of responsible behaviors such as decision making, judgment, planning, and self-control undergoes a period of rapid development during adolescence.

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It never made sense what my teachers in medical school were telling me back in the late 1980′s about the brain: that brain cells did not replicate and once dead were therefore not replaced.  Practically all other parts of the body have some way of reproducing.  From our skin to our blood, cells replicate.  Our gut cells die and are replaced by new ones.  You have all had the experience of a sun burn, having the old skin peel off only to be replaced by new skin.  Imagine if this didn’t happen!  The liver, the kidneys, our bones, all of us are in some ways brand new every few months.

There is a huge evolutionary premium to be able to replicate our cells.  It is the way to ensure longer term survival: organisms that had a way to repair themselves survived longer than organisms that did not.  To think that our brains, arguably the most important organ in our body, would be precluded from this ability just seemed silly.

But new research has shown that our intuitive belief that the brain had to have some mechanism to reproduce and adapt does indeed happen.  Important families of brain cells called glial cells actually have the ability to replicate, and some stem-cell glial cells can be prompted to mature into neurons.

(SIDE BAR:  Remember that phrase we only use ten percent of our brain?  Nonsense!  This belief is a response to a misunderstanding of the function of glial cells.  The brain is composed basically of two types of cells.  Neurons, the name of which precedes suffix words like neuroscience and neurology, comprise ten percent of our brain, the ten percent we thought we used.  Neurons were believed to be the cells that took information from the outside world, translated it, and then transmuted it into a thought, feeling, and action. For a hundred years, neurons, the ten percent of the brain, have been seen as royalty and leaders.  And just like royalty, they needed the support of serfs, a complex network of servants responsible for feeding them, nurturing them, protecting them, and getting rid of their garbage.  The other 90 percent of the brain were seen as no more than chaff: the lowly glial cells.)

Glial cells are now coming into their own (Koob, 2009)  Responsible for much more than being a garbage scow, they are actually a family of cells with grand names like astrocytes because of their star like shape, or oligodendrocytes that coat the neuron with the fatty sheath of myelin which we talk about in more depth later in the blog.  It is the glial cells that appear to be receiving the information transmitted from the neurons, and then telling the neurons what to do.  And it is the glial cell that is replicating, dying, being replaced, and in some cases transforming into neurons.

This has enormous implications for the brain.  With each moment our brains are receiving information, processing and interpreting that information, and then responding in action to that information.  These responses actually change, at a microcellular (really, really small) level the intricate interconnections of our brain. The brain is not static but constantly evolving, adapting, and changing.

Called   Neuroplasticity, this concept has replaced the old ideology that the brain is the brain is the brain, never changing, immutable. It just makes so much more sense than the idea I was taught, that the brain does not re-generate. This new understanding has enormous implications, none more so than for the brain of the adolescent.

For now, however, we will focus on neurons and their role in “neuroplasticity.”  (At some point I am sure scientists will change the phrase to “glialplasticity,” but not today!)

Koob, A (2009) The Root of Thought: Unlocking Glia- the Brain Cell That Will Help Us Sharpen Our Wits, Heal Injury, and Treat Brain Disease. FT Press 2009

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Over the last few weeks I have introduced you to my concept of the Imax Approach, which I have been working on and refining since 1982.  This week I hope to present one of the remarkable components of this very simple yet profound concept.  I am asking each of us to see the other at an Imax, a profund position of respect.  And because each of us have an Imax, and each of the domains so intimately connected, small changes can have big effects.

This is a very important aspect of the Imax.  Because these domains are so intimately and fluidly interconnected, a small change in any one domain can have an amplified and ripple effect throughout the whole system.  This is very important, especially in recovery, as it implies that we do not have to make these huge changes in our lives.  Small changes can have a big effect.  Going to a meeting, not taking that first drink, saying thank you or holding open the door for the person behind you, in these small samples of respect we can have a huge impact on each other’s brain.  When is the last time you got angry at someone treating you with respect?  You don’t.  If anger is truly an emotion designed to change the behavior of someone else. Why would you want to change feeling respected?

The Imax Approach breaks down the chaos of life into four manageable bits, encouraging you to look at the interactions between them, and helping you identify what you need to change in any one domain, that will have a ripple effect throughout the other domains.  It is a road map to your success, and to your next Imax.

Returning to the question of the disease model of addiction, the Imax now asks what is disease at all?  If we are all doing the best we can, perhaps the real question is how can we develop each other’s current maximum potential rather than viewing it through a lens inherent with disrespect.  If we feel disrespected through the Ic domain we will want to change someone else’s behavior, potentially leading to aggression, or simply shutting down our connectedness.  Perhaps the love one feels in meetings, which one reader commented on in a response to the first of this series of blogs on the concept of addiction as a disease, perhaps this love is indeed seeing each of us at an Imax: we don’t have to like the behaviors of addiction, nor condone them.  We will hold each other responsible and accountable.  But given the influence of the four domains, our home environment, social environment, the Ic and our biology, this is the best we can do at this precise moment in time, but it changes from second to second.  Just as I have changed writing this blog, and perhaps you have changed by reading it.

It is an Imax thing.

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Your biology: brain and body

Biology and genetics are reflected in this fourth Domain.  Here belongs the process of development, what genes are turned on or off at this moment in time, what neural pathways are in process of myelination or plasticity, have the bones stopped growing, are coronary arteries developing plaque, are you digesting a meal, etc.  It also recognizes that one’s daily state of health and nutrition can impact all of the other Domains. If one has a cold, has cancer, or is on heroin, the truly inner world of genetics and biology then impacts choices one makes in the outer world. It is in this Domain one explores the influence of inherited traits, of the use of medication, and the physiological responses of the internal to the external environments.

But the body is going to do what the body is going to do, depending on the influences of the other domains.  A brain cell does not have a choice if exposed to heroin or alcohol or any substance. It is not able to say, “Hey, I’m not going to let this get me high.”  But it will do that if it has built up tolerance, also an Imax of a cell after exposure to the drug. A heart cell does not wake up one day and say, “Hey, today I’m only going to beat half as much,” but it may if other factors are influencing it in its external and internal environments. And each of these potentials, all of these potentials, just as in quantum physics, all of these current maximum potentials is an Imax.

The external Domains of home and your social environment, and the internal Domains of how you see yourself, how you see others and how others see you,  and your biology, brain and body, result in a fluid interaction and continuity that seamlessly blends nature and nurture.  As a result of the fluid interaction between the Domains, a small change in one can have an amplified effect in the others. The result is the Imax: your current maximum potential.

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Last week we explored the first two domains, the home and social environments that influence the Imax.  These two domains are external, and represent the attachments we have in our lives.  But those attachments influence the next two domains, the internal domains of the Ic (to be explained below), and the biological domain of our brain and body.  Continuing my introduction of the Imax Approach, this week I will explore with you the next domain,  the Ic.

The Ic Domain: How I see myself, how I see others, and how I think other people see me

Both the Home and Social Environments are external domains: the domains of attachments. It is these two domains that influence the first internal domain called the Ic. The Ic domain is how you see yourself and how you think others see you.  This Domain is your current individual concept, your psychology, character, and personality. Our self-image is very much influenced by how we think other people see us.  The home and social Domains reflect external Domains outside ourselves.  This third Domain is an internal Domain about our ability to appreciate what someone else is thinking and feeling, (empathy) and perhaps more importantly, what are they thinking or feeling about us!

The Ic domain is where the power of respect has its entry point.  As we perceive how others view us, it influences our own self-concept.  How I see the world now is critical to how I interact with the world.  And how I think the world sees me, is equally influential.  In this third Domain live our thoughts and feelings.  Perhaps more than any other Domain, this one helps define who you are and why you do what you do.

Embedded in the third Domain is the human tendency to wonder what other people think or feel about me.  This is not the same thing as empathy, our ability to infer what someone else is thinking or feeling.  This is a distinct experience in that individuals are particularly interested in how they are perceived.  We wonder and worry about it a lot. For example, if you go to a job interview you don’t go in your pajamas!  You want to be seen a certain way and influence that perception by how you dress.

You also probably won’t reveal secrets that may jeopardize you getting the job.  This third Domain is the Domain of Secrets.  A secret is not a secret because of what you have done.  A secret is a secret because we worry, “How will someone else view me if they know my secret?”   We are very interested in what someone else is thinking or feeling about us.

This is the Domain of self-esteem, self-doubt, self-loathing, and self-importance.  In a later chapter I will argue that this interest in what other people are thinking and feeling about us is the core of human interaction, at the root of the stigma of mental illness.  Adopting the Imax approach can have a profound influence on how we see people in general, unleashing the power of respect.

I show two cartoons to help illustrate the power of the Imax.

In this cartoon a little boy is playing baseball with his dad.  He can’t hit it, throw it, catch it. He’s terrible.  But his dad says to him “You were amazing out there!” and the little boy walks away smiling.  Through the eyes of his father he sees himself as valuable.

Let me draw your attention to the two squirrels.  The one squirrel does not believe in an Imax.  “That kid needs a lot of work” implying “what’s wrong with him?  He should be doing better.”  But the other squirrel does believe in an Imax.  “I remember when you couldn’t climb a tree.”  The squirrel is commenting that at that moment n time, at that Imax, the best you could do was not be able to climb a tree.  But now you can.  You’re Imax has changed.  Both as valid, both as valuable, both deserving of equal respect.  How we see ourselves is highly influenced by how we think other people see us. This is the power if the Ic domain.  We are interested in what other people think or feel about us.  But there is a dark side.  And here it is.

Charlie Brown.  Your prototypical depressed kid.  Why is he depressed?  In this cartoon, what does he say:  “Believe in me.  Believe in me.  Believe in me.  I just can’t get people to believe in me.”  This is why Charlie Brown is depressed.  Through the eyes of others he sees himself as a loser.

Human beings are interested in what other people think or feel.  And if it is always malevolent, a very dark and dangerous things happens: we shut down our interest in what other people think or feel about us.  Why would we want to know?

But the real danger is this:  when we shut down an interested in what other people think and feel about us we shut down an interest in what they are thinking and feeling: we shut down empathy.  We stop caring about other people.  Unlike the Rose is Rose cartoon which is a world of vibrancy and color, of nuance and connectedness, the Charlie Brown world is black and white.   There is no nuance when we shut down empathy.  Things are good or bad, and nothing in between.  But even this is an Imax.

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The Four Domains

Your home environment

I don’t think anyone will argue with me that one of the first main influences on who we are today is our Home Environment: the family we grew up in.  It is just common sense that the influences of this primary and critical environment have had an impact on shaping and molding who we are today.

This Domain emphasizes the importance of our family. The vast majority of human beings want to be attached to other individuals. The qualities of these attachments are profoundly influenced by our early experiences with our family.  (In the next chapter I will explore attachment further as a fundamental component of human interaction).  The home environment represents the experiences, values, and potential devaluation that we grow up with through interaction with parents, siblings and relatives.  It is given a place of honor and respect as the first Domain. From these nascent experiences stem many of our responses to all the other Domains: the social environment, our self-conceptualization, and the inherited genetic components that may be influential in our individual development.

Your social environment

I have kids. My kids are growing up in their home environment. But the family that my wife and I have created is a product of my own home environment and that of Carol’s. Those different experiences have influenced our choices in the next Domain, the social environment.

This Domain builds on the first, extending attachments into the world outside the family circle. In the Social Domain we consider school, work, friends, social pressures, religious choices to marry, to divorce. In this Domain may lay the influence to build a career, to play sports, to do drugs.  It is a critical component of the social networks we build in childhood, adolescence, and adulthood, often profoundly impacted by experience in the home environment. It is an extension of Attachment outside of the family. Choices made in the social environment are influenced by experiences in the home Domain, and vice-versa. For example, a conflict at home may lead a child to seek friends who also have conflicts with their parents, creating a social support network. Alternately, a home in which education is encouraged and supported can have an influence on how the child does in school, and their relationships with peers and teachers.

However, the Home Domain is not an immunization against the vagaries of the social domain. I gave a talk recently to parents who are part of an important group called Learn To Cope. These parents have older children who have become addicted to prescription drugs like Oxycontin and Percocet. In my talk I mentioned the group we have at CASTLE, Family Table. Many parents became angry with me, stating that they had meals at home with their kids, but their kids wound up doing drugs anyway. I felt their powerlessness, but also their anger at me. In that moment in time, they thought I was holding them responsible for their kids’ addiction, and suggesting that if they had only had more family time their kids would not have turned to drugs.

This could not have been further from the truth of what I was talking about.  But these parents were angry: they wanted me to change my behavior.  What I was trying to tell them about kids, was what I have spoken about before in these blogs:  Adolescents like to feel pleasure, take risks, and be social. In that context the Social Domain can become powerful, overriding the Home Domain. In fact, as you begin to study the Imax Approach you will find that there is some developmental weighting to the Domains.  In early childhood the Home Domain takes precedence. The family can be a satisfying nucleus for the infant and young child. But as the child grows older, and begins to explore the world outside, the social domain begins to have more influence.

For the children of the Learn To Cope parents, the social domain, which includes not just other peers, but the availability of diverted prescription medicines, influenced their kids, exposing them to these powerful opiates.  But once exposed to the drug, the brain is going to do what the brain is going to do, at its Imax.

Check back Friday for the last two domains

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I believe people are always doing the best they can at any moment in time.  I call this your Imax, your current maximum potential.  I propose that no one chooses to do worse than their Imax.  You are always doing the best you can.  This does not mean that your current Imax is the best you will ever do, but that no one chooses to do worse than their Imax.

I think this is worth repeating:  The Imax construct is not saying that who you are, what you are doing, thinking, feeling, at this moment is the best you will ever do.  It simply says that at every moment in time people are doing the best they can do at that moment.

Your Imax changes from second to second, yet remains an Imax.

The Imax approach to people ultimately results in unleashing the power of respect.  Of all the human desires, I think that feeling respected is one of the most fundamental.  People want to feel respected by others, and actually get very angry if they are not.   But when is the last time you got angry at someone treating you with respect?  You don’t.  The brain is not designed to activate the primal limbic response of anger when it truly believes it is being respected.  Why should it?  Anger is an emotion designed to change the behavior of someone else.  That is why we get angry.  We feel threatened, dismissed, invalid which provokes a desire to change the other person so they will go away or change their behavior towards us.  In extreme cases this anger turns to its enactment, or aggression.

But why would we want to change the behavior of someone who makes us feel good?  Feeling respected is feeling valued by another person.  This is what humans want: to be valued by another human being.  So respect is a key component to this sense of value.  In fact, respect leads to value, value leads to trust, and trust leads to unleashing our unlimited potential.

I believe that the brain not activating anger when it feels respected has the same reliability as gravity:  apples do not fall up and the brain does not acti

vate anger when it perceives it is being respected.  This is the core component of the Imax approach, which ultimately approaches people from a position of respect.

And even though modern physics is beginning to consider gravity as a by-product of quantum physics, the Imax Approach remains consistent as it suggests that any choice you could make at any moment in time is possible, but the one you make is the most realistic possible choice at that moment given the influence of the four domains:  the domains that are in a dynamic equilibrium with your Imax.

THE FOUR DOMAINS

This particular blog built upon questioning the disease model of addiction, and wonders if disease exists at all given the lens of the Imax Approach.  But what goes into an Imax?  What are the influences on who we are right at this moment in time?

The Imax is always changing influenced by four  Domains.

• Your home environment,
• Your social environment,
• How you see yourself , how you see others, and how you think others see you
• Your biology, your brain and body.

These four Domains interact together so that a small change in one Domain can have an amplified and ripple effect in the others.  Each time there is a change in any Domain there is a change in your Imax.   And as your Imax changes it influences the choices you make in the Domains.

Next week I will explore these in more detail.  I appreciate your comments and thoughts.

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