Transcript Back to Basics & Into Action Renewal, Rebuilding, and

Back to Basics & Into Action
Renewal, Rebuilding, and
Reinventing
A Lifestyle of Recovery:
Rebound, Relapse and
Recovery
► Kevin
Scheel
Director of Educational Services
Distance Learning Center for Addiction Studies
[email protected]
Alcohol and Drugs in America
► Beverage
alcohol played an important role in the
history of the United States.
► The Mayflower landed at Plymouth Rock because,
as it says in the shop's log, "We could not now
take time for further search or consideration, our
victuals having been much spent, especially our
beer."
► Alcoholic
beverages were an important source of
fluid and nutrition for early American settlers.
► Spanish
missionaries brought grapevines to
the New World, and before the United
States was a nation, Spaniards were making
wine in California.
► The Dutch opened the first distillery on
Staten Island in 1640.
► Whiskey was produced during and after the
Revolutionary War as a backwoods
substitute for rum
► Whiskey
became a key trade commodity
during the Revolutionary War. After the war,
it was a major form of barter here in the
United States.
► Fire gutted a warehouse at a church
sponsored distillery, burning oak barrels
(Elijah Craig) creating . . .
► Cocaine
► "Pemberton's
French wine coca"
► 1886 - 'Coca-Cola: the temperance drink'
► Opium,
morphine and codeine
 Opium dens
 Civil War
 Tuberculosis
► 1898
– “Cure for Narcotic Addiction”
► Snake Oils and Elixirs
 Dilaudid
► Moving
forward – prescription medications
 Amphetamine – 1927
 Synthetic Narcotics
 Tranquilizers (Miltown 1954)
► 1960’s
and beyond – Drug Revolution
History of Treatment
Benjamin Rush – Jefferson Era
► Rush believed that the alcoholic loses
control over himself and identified the
properties of alcohol, rather than the
alcoholic's choice, as the causal agent.
► Dr.
► In
1791 the government placed first tax on
liquor, sparking the Whiskey Rebellion of
1794
► The Jefferson era was known for rampant
problems associated with alcohol.
► The Temperance Movement was founded in
this era with the goal of "moderation" in the
consumption of beverage alcohol.
►A
variety of groups, including the
Independent Order of Good Templars of
1850, grew and expanded across the United
States.
► By 1869 the movement became known as
the National Prohibition Party, advocating
the complete suppression of liquor by law.
► 1906
– Pure Food and Drug Act
 Lydia Pinkham’s Vegetable Extract
 Mother Winslow’s Soothing Syrup
► 1914
– Harrison Narcotic Act
► 1917 the 18th Amendment to the Constitution was
passed by Congress.
 The law went into effect on January 16, 1920.
 Repealed by 21st Amendment in 1933, which was
introduced into Congress by Franklin D. Roosevelt.
In 1935 a business man by the name of Bill
Wilson was traveling in Akron, Ohio after a
one year bout with sobriety
► In 1939 the book "Alcoholics Anonymous"
(The Big Book) was first published.

 the program began to grow rapidly after the
publication of the AA story in the Saturday
Evening Post in 1940.
► Late
1940’s – Minnesota Model
 1948 – Pioneer House
 1949 – Hazelden
 1950 – Wilmar State Hospital
► 1950’s
– E.M. Jellinek and the AMA
 Disease Model
► Alcoholism
is an illness characterized by
preoccupation with alcohol; by loss of
control over its consumption, such as to
usually lead to intoxication or drinking done
by chronicity; by progression and by
tendency to relapse. It is typically
associated with physical disability and
impaired emotion, occupational and/or
social adjustments as a direct consequence
of persistent and effective use.
► 1960’s
Vernon Johnson – “I’ll Quit
Tomorrow”
► 1970’s
– Harold Hughes and the Nixon
Adminstration
 NIDA
 NIAAA
 NIMH
► Growth
of the Treatment Industry
► 1972
– National Association of Alcohol and
Drug Abuse Counselors
 http://naadac.org/
► 1981
– International Certification and
Reciprocity Consortium
 http://www.icrcaoda.org/
Treatment Works
► 1980’s
– Industry Boom
► 1990’s – Industry Bust
 Profits over Performance
 Resistance to Managed Care
► Treatment
Days declined from an average of
29.5 days to 9.2
 This despite innovative approaches to care
What is Addiction?
► Definitions
of Addiction on the Web:
 Psychological and bodily dependence on a
substance or practice which is beyond voluntary
control
 An illness in which a person seeks and
consumes a substance, such as alcohol, tobacco
or a drug, despite the fact that it causes harm.
 A primary, chronic, neurobiologic disease, with
genetic, psychosocial, and environmental factors
influencing its development and manifestations.
 Uncontrollable craving, seeking, and use of a
substance such as a drug or alcohol.
 Psychological and/or physiological reliance on a
substance, typically characterized by cravings and
compulsive use, neurochemical changes in the
brain, and possibly withdrawal symptoms when the
substance is stopped.
 Is characterized by the repeated use of a
substance or behavior despite clear evidence of
negative consequences resulting from the use
of the substance or behavior. Addiction usually
has two components – physical addiction and
psychological addiction.
 A maladaptive pattern of substance use, leading
to clinically significant impairment or distress, as
manifested by three (or more) of the following,
occurring at any time in the same 12-month
period:
►7
items for consideration
Alcoholism
► New
AMA definition, as published in The Journal of
the American Medical Association, August 26,
1992:
 Alcoholism is a primary, chronic disease with genetic,
psychosocial, and environmental factors influencing its
development and manifestations. The disease is often
progressive and fatal. It is characterized by impaired
control over drinking, preoccupation with the drug
alcohol, use of alcohol despite adverse consequences,
and distortions in thinking, most notably denial. Each of
these symptoms may be continuous or periodic.
What is Recovery?
► Definitions
of Recovery on the Web:
 The act or process of regaining or repossession
of something lost
 A return to normal health
 Refers to end of a particular illness. In the case
of meth addiction, recovery begins when the
addict makes the decision to abstain not only
from the use of the drug, but to change the
drug lifestyle.
►Addiction
 9-12 years average onset
►Recovery
 9-14 days of treatment on average
►Major
Disconnect!
► Homeostasis
 The ability of a system or living organism to
adjust its internal environment to maintain a
stable of equilibrium
 BODY NORMAL
 Hypothalamus
► Regulation
by neurotransmitters
 Acetylcholine - voluntary movement of the
skeletal muscles (via the sympathetic pathways)
and movement of the viscera (via the
parasympathetic pathways)
 Norepinephrine - wakefulness or arousal - via
the sympathetic pathways
 Epinephrine - similar to nor-epinephrine. Large
amounts of it are produced and are released by
the adrenal glands. Also called adrenaline.
 Dopamine - voluntary movement and
motivation, "wanting", pleasure, associated with
addiction and love
 Serotonin - memory, emotion, wakefulness,
sleep and temperature regulation
 GABA - inhibition of motor neurons
 Glycine - spinal reflexes and motor behaviour
 Neuromodulators - sensory transmission,
especially pain
► Homeostasis
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►A
and Rebound
Use
Misuse
Abuse
Dependence
Lifestyle of Addiction
► Homeostasis
and Recovery
► A Lifestyle of Recovery
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Bio
Psycho
Social
People, Places, Things
► Continuum
of Recovery