From Research to Recovery: Linking Science and Treatment in Addiction Medicine

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From Research to Recovery Linking Science and
Treatment in Addiction Medicine

• Sean Koon, MD
• Chemical Dependency Recovery Program
• Kaiser Permanente, Fontana

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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

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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

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Neuroscience and the Commerce of Choice

• Homeostasis vs. Allostasis and compulsion in
  addiction
• Conflict between logical value and the urgency
  of immediate value

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Neuroscience and the Commerce of Choice
VS.
Maslows Hierarchy of Needs
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Millstones and the Angst of Addiction

• A painful discord between the patients core
  values and their behaviors, resulting from
  compulsion and poor trades
• Between these opposing millstones, integrity,
  self-esteem and hope suffer

INCOMPREHENSIBLE DEMORALIZATION
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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
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Incomprehensible Demoralization

• The addiction grows and demoralization continues
• Despair
• Concealment
• Isolation

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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

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Addiction and the Ripple Effect

• The enablers are caught between the millstones of
  their co-dependency needs vs. their personal
  suffering

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Addiction and the Ripple Effect

• The community is conflicted between
  marginalization of the addict vs. intervention

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Addiction and the Ripple Effect

• Even the government has its own millstones
  justice vs. mercy

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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

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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

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"Avoid old playgrounds and old playmates"
Stinkin' Thinkin'
"Hungry Angry Lonely Tired"
WHY
Slogans?
"One is too many and a thousand's not enough"
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Why Spirituality ?

• Spirituality at its 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

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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
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Treatment is Excessively Beneficial You get more
than you came for
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Foundations of Addiction Medicine Evidence and
Art CSAM 2004