Transcript From Research to Recovery: Linking Science and Treatment

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
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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
12 Step Program Slogans
“Old Playmates and Old
Playgrounds”
Research Correlates
Conditioned place preference,
associative learning
“H.A.L.T.”
Negative affective states
increase propensity to relapse
“Gratitude is an attitude”
“One drink is too many and a Priming effect
thousand is not enough”
WHY “Stinking thinking”
“Get out of the drivers seat”
Cognitive distortions increase
probability of relapse. CBT
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