The Brain Behind Addiction: Inside A Transformational Care Model-Where Hope Meets Science with Dr. Amber Deckard, Psy.D.

0:02 Welcome to the Let's Talk Brain Health podcast, a public health educational initiative of the virtual Brain Health Center. I'm your host, Doctor Crystal Color, and I'm so glad you're here. On this podcast, I sit down with incredible guests to explore all things brain health and Wellness. Together, we'll talk about how to care for your total brain health, mind, body, and spirit while sharing the latest brain Health Science practical tips and strategies you can use everyday. By prioritizing your brain health, you're taking an important step towards living a happier, healthier life. So let's dive in and welcome today's guest.

0:44 Today we're talking about addiction through a new lens, the brain First approach. My guest, Doctor Amber Deckard, leads Karen's Neuropsychological Services and its cutting edge Neurocognitive assessment program, bringing over a decade of hands on neuropsychology experience to the evaluation and treatment of cognitive, psychological and substance use disorders. the US Marine Corps veteran turned leader, Doctor Deckard combines military honed experience discipline with clinical insight to guide a multidisciplinary team focused on evidence based neurorestorative care. Her expertise includes the assessment of brain injuries, pharmacology, chronic pain, dementia, ADHD and Co occurring psychiatric conditions. Before joining Karen, Dr.

1:30 Deckard founded a concierge neuropsychology practice and served as director of Training and clinical supervisor across multiple memory and Wellness centers. She holds a Doctor of Clinical Psychology with a specialization in neuropsychology from Nova Southeastern University, where she now serves as an adjunct professor. Her leadership is rooted in clear communication, rigorous standards, and a belief that resilience and collaboration. Dr. Meaningful Recovery. Doctor Deckard, welcome to today's podcast. Is there anything else about your background that you'd like to share with our audience today? Thank you for having me. I would say maybe just to add what drew me to neuropsychology was the power of the connection between brain, behavior and emotional health. During my time working with patients who struggled with an array of concerns from trauma and addiction, I started seeing a pattern where people weren't failing treatment. Their brains needed healing first. When that clicked, everything changed for me. I'm so grateful you shared that because one of the things I think is so important on this podcast is it's not only our expertise that our guests bring, but it's the part that their brains in their hearts seem to bring them into the spaces in the communities that they serve.

2:53 So I'm grateful that you've shared that for us today, especially if we're going to drive into the topic of addiction as a brain based disorder. And I thought one of the best ways to really start this conversation is just to combat one of the most common myths surrounding this space that I hear people have always come to our virtual brain Health Center about as they're trying to better understand addiction very broadly of any type. It can be from dopamine addiction to substance use to why we're still relying on caffeine in the mornings. This whole idea that it's just a lack of willpower or people are lazy. What does the latest brain science actually tell us about addiction as a brain based disorder? Yes I agree.

3:38 So addiction is a brain based disorder and it's not a moral failing. Substances physically change the brain and whatever that substance is as you mentioned dopamine addiction or gambling and addiction to gaming, addiction to any type of substance from alcohol to fentanyl. It does physically change the brain, especially in the areas that are responsible for reward and motivation and memory and decision making and self-control. Think of those as the primary networks. The primary I call the CEO, right, the executor of the brain. Those substances change that that part of the brain.

4:20 And then to me it's really important to say how do we expect somebody to engage in life or remember something or engage meaningfully in treatment. So we expect them to attend groups or individual sessions and learn the information and encode it and consolidate it. And then how do we expect them to retain it and recall it and apply it if their brain is not functioning properly? So we know that the brain is changing. We know that there are significant impacts, but yet in many arenas, we continue to think that this is primarily a moral failing, that it's a choice, that it's lack of intelligence. And what we really want to change this to is this is about how the brain regulates impulse control, makes decisions and how it thinks.

5:15 So it is the primary organ to focus on is the brain. Treat it and then we can treat the substance use disorder, the mental health disorder and the whole person. It's a shift in a conversation for a lot of us to think about that, not just the person that may be coming in with the concern, but for those in their immediate support network. How do you think that conversation changes or shifts when families start to understand addiction through that ledge? Does that start to shift the change in the recovery journey for everyone involved? Yes, I think that the shift in the recovery journey is significant for the family system and the relationships.

5:55 We know that substance use impacts marital partner relationships, parent child relationships, sibling relationships, social relationships, workplace relationships. So allowing these individuals and more than just saying this is a shift in the understanding of it being a brain based disorder. But when we talk about treating a whole person, saying we're able to work with the family system, we're not just doing individual or group therapy, right? But focusing on the family system and their network of relationships allow them to also tell their side of the story and work through their experiences and bring them back together. But also understanding that how maybe they view their family member of maybe they stole from them, maybe they were extremely hurt, maybe there's generational trauma, whatever that is saying, how do we heal the family system and help them also understand that we want to treat the brain that this is not something that they are making a choice to purposefully hurt their family member. Even though in the moment it may seem like that, it may feel like it, it may look like it, but helping them all come to the realization that there is an underlying cause for this underlying source that needs to be addressed first. I think so much has changed in the field of neuroscience and neuropsychological assessment, especially now that we can see images of the brain.

7:18 And I know I can always speak from my personal experience of someone that has had family members with addiction. It's when I first saw brain imaging scans of what addiction can look like in the brain that I then began to better understand their behavior or a repeated behavior or why they may have had this cyclic behavior and was unable to get out of the loop. Because I finally then could understand what was better happening because I could see the imaging. I could see the areas of the brain that were impacted and was then better able to understand the behavior, at least for myself, and navigating that in my own journey, what I was learning and studying. Because now the pictures were worse, a lot more to, I think, link this behavior to the imaging and now this treatment plan that an individual was going to be going through.

8:09 And now you leave Karen's neurocognitive assessment program, which uses advanced tools like QEG and PET scan. So what kind of insights do these tools uncover that standard assessments often miss? That's a great question. That's a big part of this when we link the two together, the brain being the primary organ of focus. And then why do these cognitive assessments matter? And you spoke beautifully about what, when I first see the image and I'm like, oh, now this makes sense. I can link all of this together. One of the areas that I tend to focus on when I'm giving a talk or just generally speaking to patients is when you think about imagery. And many times you'll see a treatment centers or especially in the field of psychology or behavioral cell help, you'll see a tree use. And we understand the root system and the overall connections and the electrical systems in a tree. But the one of the images that I use as a part of this program is an upside down body in a tree.

9:08 And thinking of the broad canopy, the beautiful canopy as all of those things that we touched on, right? Family systems, relationships, mood, emotions, behaviors, all of the things that everybody overtly sees, right? And we attribute that to a moral failing. And then the trunk of the tree be more of that human physiological body and taking into account all of the things that impact the physiological symptom or the physiological system secondary to substance use, trauma, depression, anxiety, and then bringing it down to the base where this body's upside down is now the brain.

9:49 And I use that as the root system to really say when you think about a tree system, the canopy can be far spread and beautiful, but the root system is always significantly wider. The root system spans broader than the canopy for a tree. Understanding that the overall root system of addiction, of mental health, saying what came first, What do we focus on as a part of that? When we spoke a few moments ago about the reward system, right? Understanding that with substance use in the reward system, every day can feel flat or unpredictable. Feeling out of control that something is driving you, that you need something even when willpower wise you don't want this substance, but your brain is telling you that you need it or you have to have it to be able to function, to feel better, to feel less anxious, to feel maybe less flat. Understanding the frontal lobe, understanding executive functioning and how somebody plans and organizes and how they struggle to resist impulses.

10:55 Do you just give into your impulses or is your executive functioning piece of your brain functioning below expectation and therefore you really struggle to resist the impulses even though morally you don't want to? You don't want to engage in this behavior, but yet here we are time and time again. Emotional regulation, mood swings, irritability, anxiety and saying I don't want to be anxious, I don't want to feel this way, but yet I'm back in the same loop and I can't get out of my own way. It really allows us to understand the brain when we're using FDG, PET, QEG, neuropsychological assessment and a full history and physical. We understand the whole body, the whole person. The history and physical gives us that collateral piece to understand where some of these things stem from. We understand if the importance of let's say significant alcohol use and there's a thiamine deficiency, then the thiamine deficiency is going to impact both physical body and the brain.

12:01 And how do we treat that? If there's imbalance cortisol levels, how does that impact the brain? And how do we go about understanding the impacts to the patient and their anxiety and their regulation? It also tells us, as far as the FGG PET goes, it tells us blood flow and it while FGG PET primarily looks at glucose uptake as a part of that. When you're looking at the imaging, usually we can see where the uptake is flowing in the brain. If there's a reduction in that area, it also aligns with reduced blood flow. We want to understand if the brain is not getting healthy oxygenated blood flow to certain areas with the QEG, we want to understand electrical activity, is it fast wave activity, is a slow wave activity. So basically is your brain processing information, the connections, are they too slow?

12:51 Is it too fast? And then switching that into how do we tie that all together functionally? So if we see let's say in the temporal lobe on a FDG PET scan, we can see those reduced blood flow. And on the QE e.g, we can see some of that cortical involvement that may be impacting a language area on the temporal lobe in a memory area. And then on functional testing, we see that their auditory and visual memory is below expectation and they struggle to produce some words. We are able to tie all of that together and show there's multiple pieces of the brain impacted by their substance use.

13:31 And then the next step is how do we target our treatment to help them heal the part of their brain that is impacting their functioning the most, so they can engage meaningfully in treatment and therefore with the goal of sustained recovery in the long term? Wow. I think if we didn't know how interconnected the mind and the body were for a level of detail, when you can go into one place that will really take the time to look at that and to put the pieces of the puzzle together through tests and then figure it out. Would you mind telling us more that about how once you have those results and that personalized data, because this is unique to every individual, as we always say, like one brain is so unique to its patterns.

14:18 And that of course would also change over time as well. And when you start to see those, how do you see that in outcomes once you start to take your more personalized Taylor approach for someone? Can you walk us through that? Sure. But once individuals have gone through, and I like that you said that an individualized assessment process, once they go through the assessment piece and we have all of the objective data, we sit down together and we review next steps and recommendations and that looks different for every individual. If I can just use an example, if we have an individual who has a history of substance use, but they also have a significant history of borderline personality disorder, for example, and that shows up on their objective testing that their trajectory forward or their recommendations would include some of those same things. Some individual therapy, group therapy, family therapy, support groups, but they also include specialized treatment. So we may recommend them specifically for dialectic behavioral therapy or DBT, right, to say we want to focus on something that may serve as a barrier to your treatment, which is the borderline personality symptoms and characteristics. We may also have individuals whose primary symptom presentation is severe cognitive impairment. If that is the individualized case, then what we're going to do is focus on neuro restorative care that would still engage in individual sessions and group sessions, but we may focus more so on helping restore their

15:49 brain with brain training. I'm sure you've heard of it. The brainhq.com is an excellent resource for brain rehabilitation. We may recommend hyperbaric oxygen therapy, which kind of ties when you think about the FGG PET. So we're saying we're seeing areas of the brain that are under perfused or hypo perfused. So we may recommend hyperbaric oxygen therapy to help reperfuse the brain. A good way to think of that is for your listeners, especially if we told everybody while they're listening for the remainder of the podcast to sit on their hand and continue sitting on it until the end, it's going to go down. And if we told them to sit on it for probably another couple weeks or so, it might fall off.

16:30 We need healthy oxygenated blood flow to tissue in order for it to regenerate. Overall goal is knowing that neuroplasticity in the brain or the ability for the brain to create, work around networks and heal itself and neurogenesis, the creation of new neurons in the brain that the goal is to help understand that is happening naturally. So the natural recovery, the cone of spontaneous recovery is going to occur, but how can we help maybe speed up that timeline so that they can engage more meaningfully in the therapeutic process? And in doing so, it would be hyperbaric oxygen therapy, but also have options for spiritual fitness, nutritional counseling, physical fitness, the overall things that we know when we treat the whole person and the whole body. The goal is every single piece of that where we can see that there is a deficit.

17:24 We want to help them get to a better level of functioning both cognitively, mentally, neurologically and physically to help improve their chances of recovery through increased neurogenesis. So it's a true interdisciplinary holistic approach to self-care that's very individualized to where they are. And it seems you give them recommendations as well as they have a role in the process as well as to where their goals are and where they're aiming to go to as well as where they're prioritizing. It seems like at this moment in time, what may be important for where they're striving to be? Because you've leaned into the whole point. As neuroscience shows, this brain has this incredible capacity and ability to heal, and we can do it through multiple modalities.

18:12 And you feel eloquently highlighted all these different areas where we can have supports really through a biopsychosocial approach. It can be biology, it can be through spirituality, it can be through our social supports and our networks. And yet when we seem to tap into all those multiple dimensions of our Wellness and well-being, we really can better support ourselves as well as the mental health that we are striving to support. And you really encapsulated all that well. And your response. How do you best understand that for people with their outcomes and their support and recovery? Do you find one modality works really well because you seem to have this multi faceted approach and do you seem that's the best approach from what you seem to run at your center?

19:00 Is this holistic approaching care? Yes, we know that certain things work better going back to we know that CBT works better for borderline personality disorder than let's say CBT. However, what we've really realized is that this comprehensive approach and having it all in one space really running into when we hear patients feedback about I've been doing this for years, I've been in and out of treatment for years or I've been seeing a therapist for years or I have this doctor over here. But I was recommended to go see XY and Z specialist and I can't get into them for six months or nine months. Or I had an appointment but it was cancelled and now it's six months later. We noticed that when it's all in one place and it's accessible to the patients to engage in simultaneously, we're not reinventing the wheel.

19:49 We know that nutritional counseling in of itself is important. We know that spiritual Wellness is important. And we know that individuals that have this faith base have a stronger chance of recovery. And we know that the physical piece and getting the body back in shape is important. And when you're not engaging in physical fitness, there's a higher risk for calling the decline. What we're simply doing is taking all of these pieces that have been. Researched and are backed scientifically and in neuroscience and saying let's put them all in one place. One model of care and at the basis of this model of care is instead of being subjective, someone come in and say I feel anxious or I feel down or I'm having trouble thinking.

20:39 The basis of this model is objective assessment, numbers based, scientifically based findings, and then making an individualized treatment plan that encapsulates the entire body and everything that we already know that works per person. So I can't say that there's one thing that I know works better than the other, but when I know that all of these things have been proven to work in history and we put them all into one place simultaneously to give the most comprehensive care package, that's where we're seeing the significant impact to individuals, both mental health side and also substance use disorder treatment side.

21:19 I'm so glad you shared that because it trends with everything we see in brain health. It's multimodal lifestyle interventions. That's where the science goes. And it's very hard to disentangle once we say we've given you nutritional education and physical exercise at these intervals. And of course, they include the brain training with Brain HQ as well. And those interventions as well as it's very hard to break them apart and say it's been 1 leading factor and everything seems to come, come back to this multimodal intervention and support. And I look back to even when I did my doctoral training on integrated care is it matters in one location. And we know these referral drop off rates, I believe at that time to behavioral health providers was well over 70 or 80% is the amount of people who will not follow up.

22:05 And then by the time they make the appointment at the higher percentage after that, that they even show up to the first appointment is abysmal. So it's like the idea that we do need these integrated care centers where these multidisciplinary providers are all in one spot is the best chance of success and likelihood for people to get a comprehensive integrated care approach. So I'm so grateful you took the time to walk us through all the modalities of your program and what it is you are doing. I want to ask for you to highlight one more aspect for us because I do think it's unique in the aspect of what you are doing there because it is becoming a bit more mainstream, especially under this brain health arm and with the work you're doing there is, if you wouldn't, telling us a bit more about neurofeedback and those types of similar therapies I think are becoming more common or it's one that people are actively seeking out as I think some of it depends on maybe the diagnosis someone may have and if it's billable and reimbursable through insurance. But this seems to also be one that people are more akin to paying possibly out of pocket as well as we're seeing more science behind this space.

23:16 So how does it help the brain rebuild or rewire itself? Or what would you like people to know about it success that you're seeing in your programming as well in terms of using neurofeedback? Neurofeedback. Is best described as real time EEG training so real time brain training, electrical brain training used to optimize and kind of rewire brain waves or brain wave patterns. We've seen it enhance attention, mood regulation, executive functioning. It's also had some impacts on sleep and overall improved sense of energy, less fatigue feeling.

23:58 It is popular. It's one of the neurotherapies that we use and I would say in the civilian world, it's one of the more affordable neurotherapy. So you're correct. It's going to be leaned on a bit heavier maybe than transcranial magnetic stimulation or more than hyperbaric oxygen therapy. And it's well known. A colleague of mine here at Karen, I'll use his terminology. He likes to say that neurofeedback is physical therapy for the brain. Basically, if you broke your knee and then in recovery you were told, OK, we're going to assign you 12 weeks of physical therapy. You wouldn't think twice about going to your physical therapy appointment and being put through maybe some rigorous training that maybe is a little bit uncomfortable at times, but it pushes you to improve your functioning so that you can ambulate independently and return to your baseline.

24:52 Neurotherapy or neurofeedback is no different. It is training the brain. I would say maybe the difference is it's not uncomfortable, it's not painful, but basically it's focusing on the brain and the central nervous system to help manifest change in the neural activity as the goal to stimulate you with the feedback to return you back to an improved level of functioning and get you closer to your baseline. And that's that takes us back that baseline matters. So that's why the brain mapping or the QEG and the FTG pad and the neuro psych testing are important so that we understand the baseline, so that we have an objective data-driven comparison for pre and post.

25:37 So after neurofeedback we can test again and say yes, we achieved this level of improvement, not just subjectively, I guess I feel better, but we can actually see domains of the brain showing standard deviations of improvement. And thinking about some of those improvements, and I know this may be a broad question to ask, are there any early signs that the brain is beginning to heal even before maybe some of the behavior catches up that people may want to make note of? Objectively, I couldn't say anything regarding earlier signs simply because of when we're testing and retesting and there's a pretty big stand in between that. But subjectively, as far as our patients have reported, they have reported an array of things, again, individualized. We recently had a veteran that reported before we could see it objectively on paper that reported feeling more energized, feeling more positive, reported reduced depression, the symptoms, reduced anxiety, increased ability to focus and concentrate.

26:48 We weren't able to see that objectively until about the month and a half the two-month mark out on objective data. But those reports came in, I want to say about two weeks after engaging in hyperbaric and also with neurofeedback. I appreciate you sharing that. I think this is always the one that's the balance. Because even with health tech data coming online and so many of us having these wearables or we're tracking things that still some of the times you wake up and you're like your sleep's telling you we're slept great that night and you're thinking I do not because I know how I have felt. And so it's this balance of the data we're using and we want good data that's indicating this. But also having this balance of real world use and then having it in the clinical setting.

27:38 But still being able to say if these things are working for us still subjectively and it's good, that's still enough motivation to keep going on the right path. And it's finding that balance. And I think we've had authors write how many books about this around behavior change, and it's just enough to help us know when we're trying on this path of I think lifestyles changes. They always joke, it's not going to be the one salad that's going to overhaul your healthy diet. But where is enough of these intervals that just let us know we're on the insights for these right path? Because this holistic brain healthy lifestyle that ideally is a lot of what your whole program is looking at is it takes a long time for these change, but where we can acknowledge these small things along the way is always helpful for us. And it seems like we have covered a lot of ground in a short amount of time.

28:28 So I want to make sure as we're winding down that we have covered the topic that we have set out today. Is there anything that we may have missed that might have been a misconception or something you want to set straight around the conversation about brain health and recovery that you think the science should be emphasized in today's conversation? I think maybe 2 points that only based on some of the questions that we get with this model, we recognize that there are multiple mechanisms and pieces to this model and we don't have the answer yet to say, OK, but what is the most significant mechanism of change? That's because we are in the field of treating patients. We are not solely researchers.

29:16 In the near future, yes, our goal is to move into a research study separate from what we're doing as far as treating patients. That would also have a control groups that we could maybe begin to understand and maybe answer that question. Between all of these mechanisms, what is the greatest mechanism of change? We're not there yet, but I think there's a powerful case to at least acknowledge where we have done some separately. We've seen significant improvement with neurofeedback alone. We've also seen a significant improvement with hyperbaric oxygen therapy alone. There's a brief case study, if you don't mind me just mentioning that of a 21 year old with traumatic brain injury and overdose secondary to fentanyl. That individual had severe cognitive impairment, severe the daily dysfunction, the ability of fine motor skills, reading level was below 4th grade, the ability to ambulate. We had urinary incontinence, fecal incontinence, so very severe presentation.

30:17 We understood when we speak about it being individualized, we understood that person could not go through an in depth assessment. That person could not go into individual therapy or group therapy. At this point we had to work on Neuro Restorative care 1st. So that individual received 20 sessions of hyperbaric oxygen therapy at 1.5 atmospheric pressures and then we did a post test before moving into the next steps in decision making for where they would go and what that would look like for their care. And that individual showed on an FDG PET scan. So again located that reduced perfusion in the brain. They were -4 and -5 standard deviations below where they should be for their age.

31:03 Severe hypoperfusion. Once we repeated the FTG PET scan after 20 sessions of hyperbaric, their brain was there's only one area that was broadly normal, but the rest of their brain was reperfused and normal. Meaning we're getting healthy oxygenated blood, increasing the chance of neurogenesis, improving functioning. That individual after was able to engage in the testing, was able to engage in a therapy setting and following our last follow up with that individual was still substance free and was holding a part time job. Yes, our goal is to understand all the mechanisms separately, but right now what we do know is working or is the comprehensive multimodal approach.

31:49 And I would say is the last take away is mental health, substance use, Co occurring disorders that the brain is at the center of everything, your mood, your decisions, your relationships, your motivation. In short, our goal is to have mainstream media and insurance networks understand that brain health is treating the brain is healthcare, it is a healthcare model, and that brain health is mental health and that it should be treated no differently than a physical injury to a part of the body or cancer. It should be treated as a healthcare modality. I think anyone tuning in understands why you're here today as an expert on our podcast diving more into this topic with us.

32:43 This is my favorite time of the podcast where I get to pick your brilliant brain for some actionable takeaways for us. I'm going to ask a bit of a personal question though. As an expert in behavioral health and psychological care, what is your one non negotiable for your personal brain care? Part of brain care maybe turns a bit existential and I am a water baby. For me my non negotiable is time in nature especially open water shark swimming I. Say that's a new one for us on the podcast.

33:23 I love open water shark swimming. There is something about being in that environment that is so much greater than you, that is unpredictable, that allows me to feel gratitude and grounding at the same time. I get that it can be scary for a lot of people. And even in those moments of being able to recognize an ability to control the fear and appreciate your surroundings in the midst of that, I think it ties together all of the emotions and the cognitive demands to be able to control your heart rate and your breathing in those moments and just experience a sense of gratitude.

34:05 You explained that so lovely, so thank you so much for sharing the way you take care of your brilliant Brandy. How can our listeners learn more about you and follow your work? If the listeners want to find out more about the neurocognitive assessment program, but a bit more about the work we're doing here or some of my backgrounds, they can go on our website, karen.org. And we are primarily the NAP program or neurocognitive assistant program is located in Florida. So if they look at what the Florida offerings are, they'll be able to find my background there along with details for the program and they can also reach out. My contact information is on the website if they have follow up questions.

34:48 And thank you for making yourself available to our listeners for questions, for follow up, and for those listening who may be in recovery or supporting someone through it, what message of hope would you want them to take away from today's conversation? The strongest message of hope is that the brain can heal with the right support, just like any other organ, and that your loved one and their struggles can make AU turn to be patient with them. To understand that this is not a conscious choice that they are making and that there is help there for them to heal their brain and get them to a place of sustained recovery and to get them back to a point of functioning where they can be that loved one.

35:41 They could be the father, sister, brother, mother that you either imagined they could be or that they once were. That sentiment is worth repeating. The brain can heal. Viewing addiction through a neurobiological lens opens new possibilities for recovery, compassion, and lifelong brain health. Doctor Amber Deckard, thank you so much for letting me pick your brilliant brain on the Let's Talk Brain Health Podcast. Thank you for investing your time and energy into your personal brain care by listening to today's episode of the Let's Talk Brain Health Podcast. I hope our conversation gave you fresh insights, a bit of infiration, or practical steps that you can take on your own personal brain care journey.

36:28 If you enjoyed today's conversation, I'd like to ask you to please share this episode with someone who could benefit from it or consider leaving us a review. If you have questions or a topic in brain health you'd like me to explore, please e-mail me anytime at podcast at virtualbrainhealthcenter.com. I'd love to hear from you. We have so many more exciting topics ahead, and I can't wait to continue this lifelong journey of better brain health together with you and our growing virtual community. Until next time, remember to give your brain the care it deserves and make your brain health a priority.