4/13/ Actions to Overcome Addiction. John Fitzgerald, PhD, LPC, CAS. relationships

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1 5 Actions to Overcome Addiction John Fitzgerald, PhD, LPC, CAS relationships 1

2 What is addiction? 2

3 Socially-constructed 3

4 Risk Factors 80% 15 years-old Addiction Protective Factors Risk Factors Domain Protective Factors Early Aggressive Behavior Lack of Parental Supervision Individual Family Impulse Control Parental Monitoring Substance Abuse Peer Academic Competence Drug Availability School Antidrug Use Policies Poverty Community Strong Neighborhood Attachment 4

5 Abuse Psychological (by parents) Physical (by parents) Sexual (anyone) Emotional neglect Physical neglect Household Substance Abuse Mental Illness Parental Separation/Divorce Mother Treated Violently Imprisoned Household Member 5

6 Strong, graded relation to ACEs Smoking COPD Heart Disease Diabetes Obesity Hepatitis Alcoholism Other Substance Abuse Depression Attempted Suicide Revictimization Teen Pregnancy Fractures Promiscuity STDs Poor Job Performance Poor Self-Rated Health Violent Relationships 6

7 Addiction is not a brain disease, nor is it caused by chemical imbalances or genetics. Addiction is best viewed as an understandable, unconscious, compulsive use of psychoactive materials in response to abnormal prior life experiences, most of which are concealed by shame, secrecy, and social taboo. Vincent J. Felitti, MD Principle Investigator, Kaiser Permanente 7

8 Drug addiction is a brain disease. Nora Volkow, MD Director, National Institute on Drug Abuse relationships alcohol gambling drugs sex food internet 8

9 9

10 smoker alcoholic obese cocaine non-smoker normal normal normal 10

11 Cocaine Abuse and Brain Glucose Metabolism Normal subject Cocaine abuser 10 days post Cocaine abuser 100 days post Percentage Who Relapse Type I Diabetes 30 to 50% Drug Addiction 40 to 60% Hypertension 50 to 70% Asthma 50 to 70% 11

12 More than 75% of U.S. healthcare spending is on people with chronic conditions. Addiction Diabetes Asthma Chronic Pain US Lung Disease Mental Illness Heart Disease Hypertension 12

13 What do we do? Addiction Treatment System Hospitals Outpatient Clinics Residential Facilities Prison System Private Practitioners Therapeutic Communities Mental Health Clinics Primary Care Community Health 13

14 < 10 % get help ~ 60 % drop out > 60 % relapse 1 Motivate 5 Create 5 Actions 2 Evaluate 4 Resolve 3 Manage 14

15 15

16 How to Help? CRAFT! CRAFT Intervention Al-Anon 64% 30% 10% Mental Health Sexual trauma Depression ADD Anxiety Addiction Alcohol Pot Food Work Physical Health Obesity High blood pressure Sleep Apnea apnea Environmental Few supportive friends Poor financial resources Poor housing situation 16

17 Addiction & chronic issues Manage ACEs & acute issues Resolve Good life & purpose Create Manage Resolve Create Sleep apnea Food / Obesity Poor housing situation Poor financial resources Nurturing Relationships Meaningful Work High blood pressure Sexual trauma Art ADD Pot Spiritual Connection Alcohol Few supportive friends Anxiety Depression 17

18 Chronic Condition Addiction Hypertension Heart Disease Diabetes Conditionspecific Interventions Opioid- Blocker, Methadone Diuretics, Beta-blockers ACE Inhibitors, ARBs Insulin, Diabetes Pills Stress Management Friendship Networks Motivational Interviewing Shared Interventions Diet Sleep Goal Setting Spirituality Brief Interventions Collaborative Team Exercise Program Community Supports Helping Relationships Evidence-based vs. Common practice Treatment Modality Rank Order Evidence Score Brief interventions Motivational Enhancement GABA agonist (Campral ) CRA Self-change manual Opiate antagonist (Revia ) Twelve-step facilitation AA Residential treatment Psychotherapy General alcoholism counseling Education (tapes, lectures, films) Source: What works? A summary of alcohol treatment research in R.K. Hester & W.R. Miller (Eds.), Handbook of alcoholism treatment approaches: Effective alternatives (3 rd ed.), 2003, Allyn & Bacon. 18

19 addiction & other chronic conditions unmet basic needs unresolved ACEs developmental deficits/constrictions acute psychiatric lifestyle choices community risk factors 19

20 Developmental Skills Self-regulate Engage in relationships Two-way communicate Solve problems Create ideas Bridge between ideas 20

21 All children are artists. The problem is how to remain an artist once he grows up. Picasso 21

22 1 Motivate action for change 2 Evaluate system of issues and ID leverage 3 Manage chronic life issues 4 Resolve acute life problems 5 Create meaning and purpose 22

23 23

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