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

From Research to Recovery: Linking Science and Treatment in Addiction Medicine. Sean Koon, MD Chemical Dependency Recovery Program Kaiser Permanente, Fontana. At conferences such as this, we often delve deeply into cell biology and neuroscience to understand this disease process.

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

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  1. From Research to Recovery: Linking Science and Treatment in Addiction Medicine Sean Koon, MD Chemical Dependency Recovery Program Kaiser Permanente, Fontana

  2. 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 The Dichotomy of our Science and Practice

  3. 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

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

  5. Neuroscience and the Commerce of Choice VS. Maslow’s Hierarchy of Needs

  6. “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

  7. “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”

  8. Incomprehensible Demoralization • The addiction grows and demoralization continues • Despair • Concealment • Isolation

  9. 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

  10. Addiction and the Ripple Effect • The enablers are caught between the millstones of their co-dependency needs vs. their personal suffering

  11. Addiction and the Ripple Effect • The community is conflicted between marginalization of the addict vs. intervention

  12. Addiction and the Ripple Effect • Even the government has its own millstones: justice vs. mercy

  13. 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

  14. 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 Treatment?

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

  16. 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

  17. 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”

  18. Treatment is Excessively Beneficial: You get more than you came for…

  19. Foundations of Addiction Medicine “Evidence and Art” CSAM 2004

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