Sore knee - Grindavík · bittensaddiction.com How do we know ? You have complained about a sore...

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Sore knee ?


Presentation by Bitten Jonsson

Registered Nurse 1973 Further training medicine 1981

Treatment alcoholism 1985 Relapse/addiction training 1990- cont.

Terence Gorski, SECAD, Foodaddictiontreatment/training since 1993

Member of naatp since 1996 ADDIS cert. 1990

Nutrition and biochemistry 1999-cont. Member of FoodAddictionInstitute


How do we know ?

You have complained about a sore knee for several weeks and your colleagues begin to analyze the problem.

What do they say ?

Meniscus ?

Bursitis ?

Typical ACL( acute cruciate ligament ) injury?

Plain Inflammation ?

Tick bite


Guessing

”The lack of knowledge about how to

investigate people's relationship with an

psychoactive drug/process, means that they

often think they know, or just make a guess.

Börje Dahl CEO ADDIS Sweden

How do you treat ”guesswork”


Diagnostic evaluation tool

SUDDS-IV ® Substance Use Disorder Diagnostic Schedule Norman G. Hoffmann,

Ph. D and Patricia A. Harrison, Ph. D

www.evinceassessment.com

ADDIS® – Alcohol Drug Diagnostic Instrument

ADDIS-Adol – Alcohol Drog Diagnostic Instrument – Adolescents

www.addis.se

Based on DSM-IV/5 and ICD-10

http://www.evinceassessment.com

http://www.addis.se


SEPTEMBER 6, 2014

ADDIS SRE

(Sugar Research Edition) Screening, Assessment

Diagnostics


If it walks like a duck

and it quacks like a duck,

it’s probably a duck…


” New Kid In Town ”

Alcohol

Cocaine

Sugar

Nicotine

Cannabis

TCH etc

Natural? Heroin, opium


Sugar/flour a Psychactive Drug

It is the first drug an ”addictive prone”

brain encounters.

Lots of research during the years has

shown that it act as a pshycoactive drug

on the brains rewardsystem

Gold, Alena, Albertsson and many others


Addictive Foods?

”Some foods act as addictive substances on the brain,

a hard concept for experts in the nutrition/obesity field”

2007

Mark S. Gold & Kelly D. Brownell i boken

”Food and Addiction, a comprehensive handbook”

Oxford University Press 2012


ASAM has released a new definition of addiction 2011:

• Addiction is a primary, chronic disease of brain reward, motivation,

memory and related circuitry.

• Dysfunction in these circuits leads to characteristic biological,

psychological, social and spiritual manifestations.

• This is reflected in an individual pathologically pursuing reward

and/or relief by substance use and other behaviours.

• Addiction is characterised by inability to consistently abstain,

impairment in behavioural control, craving, diminished recognition

of significant problems with one’s behaviours and interpersonal

relationships, and a dysfunctional emotional response.

Like other chronic diseases, addiction often involves cycles of

relapse and remission. Without treatment or engagement in recovery

activities, addiction is progressive and can result in disability or

premature death.

ASAM new definition


Addiction

From the latin word Addicere

Means:

adjudge, sentence, doom

award, assign

be propitious

confiscate

enslave


Addiction Interaction Disorder

It is about the brain, not the drug…

ASAM 2011

Studies show that 17% at most, only

have one outlet and that 80% of

relapses are due to unknown outlets

AID


Multifaceted illness

One disease, many outlets ( AID )

Changing the outlet ( drug/process )

is as constructive

as changing cabin on the Titanic Börja Dahl, CEO ADDIS Sweden


Psychoactive Substances

Alcohol Cannabis Sedatives

Hallucinogen Amphetamine

Cocaine Opioid PCP

Inhalants Caffeine Nicotine

SUGAR/FLOUR


Process Addictions

Gambling Sex/Relationship

Working Internet Exercise Debting

Codependecy ?


Why is a diagnose important?

Unethical to treat a person without knowing what is to be treated.

Risk for incorrect treatment in regards to abuse/harmful use and dependency/addiction.

Essential for an indiviual’s understanding of his/her condition, motivation and

formulation of realistic goals

Chosing adequate treatment programs and aftercare

Essential when doing research for treatment results – useless if one doesn’t know what condition has been treated!

Learn more: Avoid the perils of instrument abuse, Norman Hoffman pdf.


Assessment process:

1.Screening: questions, UNCOPE S

lab tests ; bloodsugar curve, weightcurve, fasting insulin, IGF, H

Clients story

2. Clincal evaluation and biochemical assessment within intergrated functional medicine and orthomolecular medicine

3. Diagnostic evaluation based on DSM-IV/5 or ICD-10

for ex: SUDDS-IV, ADDIS, SCID


ADDIS S RE assessment:

• a therapeutic interview

• objective – not dependent on who does the assessment

• provides quality insurance for both you and your client

• aids clients in gaining insight which in return affects

motivation

• provides information essential for precise treatment

planing for ex. current vs remission, early vs late stage etc.

• Takes away stigma, it,s a disease


ADDIS brakes thrue denial

Case study Female – 46 years old. Married, two children. Employed as a traveling saleswoman. Good economy. Very ambitious Always weightconscious – exercises daily. Current situation: During a recent business trip she did not show up at her client’s office and could not be reached. Returned to work that afternoon she was disheveled, stressed,

drained, agitated and very nervous. Chemical situation: Age 6, OE sugar/flour, lying about food, age 15 dieting Age 16: started smoking Age 18: started drinking Ages 18 - 22: dating, partying – living life Ages 22 and 26: Pregnacies (gained 60+ lbs. each

time – no alcohol or nicotine but resumed both after nursing. Can not loose weight, bingeing, vomiting


Case study

Age 29: Resumed alcohol and nicotine use. Started dieting, exercising daily - vigorously . Overeating, bingeing, vomtings. Problems within marriage –

work, weight gain, reduced exercise, avoidance of family. Age 33: Health problems: migrane-, body pain, – Tylenol - mood swings. Age 35: Sleeping problems, periods of depression. Bensodiazepines. Age 39: Continued health problems. Quit smoking, weight gain. Increased use

of alcohol and bensodiazepines. 41: Quit alcohol, bensoediazepines, smoking, cold turkey. Depression, anxiety 3

months. Foodbingeing totally out of control. 42: fibromyalgia , weightgain 46: Diabetes type II.


DSM-IV Diagnostic Criterier: Dependence

Tolerance Withdrawal Increased or longer periods of us Desire or unsuccessful efforts to cut down/control Time spent in obtaining, using or recovering Important activities – given up or reduced Continued used despite physical/psy. problems

A

Sugar/food

A

A

A

A

A

A

Sugar/food.: 23 symptoms in 7 criteria

DSM-IV Diagnostic Criterier: Dependence Tolerance

Withdrawal

Increased or longer periods of use Desire or unsuccessful efforts to cut down/control Time spent in obtaining, using or recovering Important activities – given up or reduced

Continued used despite physical/psy. problems

Alcohol: 8 symptoms in 7 criteria

Sedative/Tranq.: 10 symptoms in 7 criteria

NEXT: best tool ever ADD, Addiction Development Curve

Alcohol Sedative/Tranq.

A A

A A

A

A

A

A

A

A

A

A

A

ADDIS® Age 6 8 10 12 14 16 18 20 22 24 26 28 30 36 32 34 36 38 40 42 44 46 W

Sym

1

P1 P2 F D2 N 244

2 A

3 S

4 W 220

5 B

6

7

8

9 198

10

11

12 DA

13

14 176

15

16

17

18

19 154

20

21

22

23

24 132

Bing/Vom

Motivational therapeutic session from ADD

(Addiction development diagram)

Focus, helping clients see reality and at the same time educating and giving hope.

A staged, intense and dramatic crisis with strong feelings which is exactly what is needed for most clients

to accept help

A strong foundation for treatmentplanning


16/17 – increased use / increased amount

22 – high consumption

30 – using more then planned

31 – longer period of use then intended

34 – increased toleramce

36 – obsessing about using

41 – less money for daily living

35a – decreased awareness

45 - using./recuperaing large part of day

38 – loss of control

36a – protecting supply

42 – neglect of planned activities

33 – binging/periods of loss of control

47 – memory/concentration problems

48 - emotional problems

39 – can not stop using

41 – Econominal problems

40 – Stops leisure activitys/change of friends

67 – Using despite pshycological/physiological worsening

43 – ”sickleave” from school/work

44 – Neglect of work/school

68 – spending less time with family/ close friends

69 - withdrawal

46 – drug centered lifestyle

37 – total loss of control at all times

70 – severe withdrawal

71 – using to stop withdrawal

72 – Confusion/ blackouts

73- Collapse physical and pshycological

Symptomcurve Addis

34 20

16/17

41

36a

32

33

31

39

38

35a

36

43

47

45

66

48

67

30 22

37

72

46

71

44

42

68

40

69

70

Early stage, phase I

Medium stage , phase II

Late stage , phase III

34 goes with

20

A A1 L

73

Frequent use

Related healthproblems

How information received in ADDIS is processed

DSM-IV checklist ICD-10 checklist assessment/diagnose Presentation checklist educational & motivational Addiction development diagram insight, understanding acceptance of problem



ADDIS S RE ADDIS Sugar Research Edition

ADDIS S RE is a process where we now are validating

the instrument in the same way alcohol , pills and drugs

are validated. And mesuring it,s reliability

”Reliability is the degree to which an assessment tool produces stable and consistent

results. Validity refers to how well a test measures what it is purported to measure”

Establish contact with patient/client

Screening instrument: CAGE, AUDIT, UNCOPE

Negative

”DRUG”: indentification, diagnose, evaluation, treatment planning, treatment and evaluation

Short motivational counseling (FRAMES and/or MI)

Diagnostic assessment of problem and severity (DSM-IV or ICD-10)

a positive answer

2+ positive answers

Rescreen periodically using questions and/or lab tests for ex. GT and CDT

No problem, intervention is unnecessary

Evaluation within intergrated functional medicine

Motivational therapy , detox, biochemical repair , structured professional treatment program with 12 step integrated. Aftercare

Contious Evaluation , lifelong follow up.

Cost-effective in regards to time and education of practitioner

Greater cost with regard to time and education of practitioner

Lynn Wickström and Bitten Jonsson

Original diagram with AUDIT screening instrument: Claudia Fahlke, Ulf Berggren & Jan Balldin (Göteborg Alcohol Research Project)

OBS! • Different types of screening tests can be used • Clinical evaluation can consist of different types of tests • GT and CDT can be supported by for.ex. ASAT och ALAT

Screening result

Treatment plan from ADDIS

1. Chemical history, acute stabilization

2. Medical detox, brain repair

3. Primary treatment , holistic approach and relapse prevention program

4. Aftercare, holistic treatment, self help programs, brain by pass and nutrition teaching and training

5. Extended after care for clients with PAA

6. Life long maintenance with regular workshops and checkups



Diabetes < 60%

Hypertension < 40%

Asthma < 40%

Behavioral changes less…..

Diet, even less….

At least 7-10 yrs to change lifestyle

Compliance

COMPLIANCE

Since the beginning of 2000, when starting to

use this concept we see

a much higher compliance and a much greater interest from the client in his/her own well

being, health issues and brain/body repair and also a greater awareness of life on Earth.



ADDICTION ”Empty brain”

Sore knee - Grindavík · bittensaddiction.com How do we know ? You have complained about a sore...

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Transcript of Sore knee - Grindavík · bittensaddiction.com How do we know ? You have complained about a sore...