Post on 20-Jan-2016
From Research to Recovery: Linking Science and Treatment in Addiction Medicine
Sean Koon, MD
Chemical Dependency Recovery Program
Kaiser Permanente, Fontana
The Dichotomy of our Science and Practice At conferences such as
this, we often delve deeply into cell biology and neuroscience to understand this disease process
Yet, many of us will return a world of group therapy, recovery slogans, surrender, denial, relapse, 12-steps, and even issues of spirituality
Neuroscience and the Commerce of Choice Motivational neural circuits – reward
us for life sustaining behaviors Drugs of abuse have a substantial
effect on brain pathways of motivation and learning
Neuroscience and the Commerce of Choice
Homeostasis vs. Allostasis and compulsion in addiction
Conflict between logical value and the urgency of immediate value
Neuroscience and the Commerce of Choice
VS.
Maslow’s Hierarchy of Needs
“Millstones” and the Angst of Addiction
A painful discord between the patient’s core values and their behaviors, resulting from compulsion and “poor trades”
Between these opposing “millstones”, integrity, self-esteem and hope suffer:
INCOMPREHENSIBLE DEMORALIZATION
“Millstones” and the Angst of Addiction How do you relieve this friction?
– DENIAL
– CODEPENDENCY (get by with a little help from your friends)
– MORE USE
If personal loss “outpaces” the effectiveness of these three, then “rock bottom” is felt
If these three are effective, rock bottom is not felt until greater loss occurs
“Rock Bottom”
“Sick and tired of being sick and tired”
Incomprehensible Demoralization
The addiction grows and demoralization continues– Despair
– Concealment
– Isolation
Addiction and the Ripple Effect
In the brain, compulsion begins to win over good judgment in the commerce of choice
The addict suffers between these “millstones” of values and compulsions
Addiction and the Ripple Effect
The enablers are caught between the millstones of their co-dependency needs vs. their personal suffering
Addiction and the Ripple Effect
The community is conflicted between marginalization of the addict vs. intervention
Addiction and the Ripple Effect
Even the government has its own millstones: justice vs. mercy
Addiction and the Ripple Effect With roots in biology, it becomes a disorder
with moral, social, family, spiritual, mental health, legal, and medical elements
Ironically, each of the above disciplines also contributes to the solution
Why Treatment? Medical: Addresses medical consequences and educates the
patient Mental Health: Treats organic or substance induced mood
disorders Family: Engages and treats the family system. Treats
codepency. Occupational: helps employers assess and deal with workers
with addiction Legal: Cooperates with the legal system and provides an
effective alternative to incarceration in non-violent offenders Spiritual: addresses spirituality, shame, and demoralization Social: deals with isolation and engages the patient into
recovery community. Encourages resocialization
WHY
12 Step Program Slogans Research Correlates
“Old Playmates and Old Playgrounds”
Conditioned place preference, associative learning
“H.A.L.T.”
“Gratitude is an attitude”
Negative affective states increase propensity to relapse
“One drink is too many and a thousand is not enough”
Priming effect
“Stinking thinking” Cognitive distortions increase probability of relapse. CBT
“Get out of the drivers seat” Impaired decision making in addiction
“A drug is a drug is a drug” Cross addiction
“Easy does it”
“One day at a time”
Stress as a precipitant to relapse
Why Spirituality ? Spirituality at it’s core implies connection
within (integrity of value and action) as well as a connection without (community and “higher power”).
Addiction is a disease of disconnection, it causes a rift within the addict, as well as a rift between the addict and everything else
How it works: The Cast of Recovery
Unmanageability Honesty, openness, willingness allows the
faulty inclinations to be exposed Community:
– Accepts– Forms around– Aligns and redirects the impaired choices– Continues to Support
Surrender, sponsorship, group therapy, “one alcoholic helping another”
Treatment is Excessively Beneficial: You get more than you came for…
Foundations of Addiction Medicine
“Evidence and Art”
CSAM
2004