The Big Book s Been Right All Along Anatomy of the Disease

Transcription

1 The Big Book s Been Right All Along Anatomy of the Disease (This doctor s s opinion) Melissa Lee Warner MD Wm J Farley Williamsburg Place

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3 Prevalence 10-15% 15% General Population 1/3 with Genetic Connection

4 Predisposing Factors Genetics Intoxicant Use Stressors Primary Prevention Pediatric Illness

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6 % in each age group who develop firsttime cannabis use disorder 2. ADDICTION IS A DEVELOPMENTAL DISEASE 1.6% 1.4% 1.2% 1.0% 0.6% 0.8% 0.4% 0.2% starts in adolescence and childhood 0.0% Age Age at cannabis use disorder as per DSM IV NIAAA National Epidemiologic Survey on Alcohol and Related Conditions, 2003

7 Recent Studies Have Shown that Maturation of the Brain s Gray Matter Moves from Back to Front Brain areas where volumes are smaller in adolescents than young adults Source: Sowell, E.R. et al., Nature Neuroscience, 2(10), pp , 1999

8 Addiction Is Brain disease (NIH) Primary Characterized by dysregulation of specific neurochemical mechanisms in reward and stress circuits (Barthwell; FSAM 2006)

9 The doctor s s theory that we have an allergy to alcohol interests us. (AA; The Doctor s s Opinion) the action of alcohol on these chronic alcoholics is a manifestation of an allergy the phenomenon of craving is limited to this class and never occurs in the average temperate drinker (Doctor s s Opinion)

10 Allergy Abnormal Reaction Joe & Charlie of Mesolimbic System (Mid-brain) Normal Reaction to Intoxicants Abnormal Reaction

11 Limbic Brain where our instinctual drives and abilities to express emotion and pleasure reside. (Brick & Erickson 1998) Creation gave us instincts for a purpose harvest food construct shelter reproduce social instinct (Twelve Steps and Twelve Traditions; ; StepIV; p.42)

12 Addiction Is Brain disease (NIH) Characterized by dysregulation of specific neurochemical mechanisms in reward and stress circuits (Barthwell; FSAM, 2006)

13 Nuclei of the Mesolimbic System Ventral tegmental area drug drug-induced reward (high) Nucleus accumbens- James Brown nucleus (Sex/Drugs/Rock&Roll) Functions to alert and motivate when the opportunity presents itself to obtain something desirable (McCance-Katz) Orbitofrontal Cortex Controls impulses to seek gratification when they are out of line e with overall goals (McCance-Katz) Amygdala Establishing learned associations between motivationally relevant events and neutral stimuli that signal events (McCance-Katz) Locus Coeruleus Physical Dependence/ Withdrawal

14 Limbic Brain where our instinctual drives and abilities to express emotion and pleasure reside. (Brick & Erickson 1998) Instinctual Drives Maslow s s Hierarchy of Needs Paramount to Survival Pleasure/Emotion Intoxication Mammals get High

15 where our instinctual drives and abilities to express emotion and pleasure reside. (Brick & Erickson 1998) Addictive Diseases are Intoxicant Use Disorders Allergy Abnormal Reaction Limbic Brain Directs/ Over-rides rides the Thinking Brain Pathological usurpation (S. Hyman MD) in alcoholics the will is amazingly weakened when it comes to combating liquor, though it often remains strong in other respects. (AA; Bill s s Story, p.7)

16 Limbic Brain where our instinctual drives and abilities to express emotion and pleasure reside. (Brick & Erickson 1998) Creation gave us instincts for a purpose harvest food construct shelter reproduce social instinct (Twelve Steps and Twelve Traditions; Step IV; p.42)

17 Limbic (Reptile) Brain Feeding Fighting Fornicating Fear FOUR F sf HALT

18 FEAR Driven by a hundred forms of FEAR, self-delusion, self-seeking, seeking, and self- pity. (AA; p. 62) (fear) touches about every aspect of our lives. It was an evil and corroding thread; the fabric of our existence was shot through with it (AA; Step IV, p.67)

19 Instincts (Twelve Steps and Twelve Traditions; StepIV, pp.42-50) perfectly necessary and right, and surely God- given our great natural assets, the instincts, have turned into physical and mental liabilities instincts run wild in themselves is the underlying cause of their destructive drinking instincts gone astray,, have been the primary cause of his drinking

20 Instincts (Twelve Steps and Twelve Traditions; StepVIII,, p. 80) instincts in collision, which cause physical, mental, emotional, or spiritual damage.

21 Craving An intense and prolonged, desire, yearning or appetite Webster s s New World Dictionary Craving is a major component of Addiction.a major contributor to relapse (Eliot L Gardner PhD, NIDA)

22 Craving the phenomenon of craving is limited to this class and never occurs in the average temperate drinker (Doctor s s Opinion) they were drinking to overcome a craving beyond their mental control (Doctor s s Opinion) Limbic vs. Cerebral Pathological usurpation

23 Nuclei of the Mesolimbic System Ventral tegmental area drug drug-induced reward (high) Nucleus accumbens- James Brown nucleus (Sex/Drugs/Rock&Roll) Functions to alert and motivate when the opportunity presents itself to obtain something desirable (McCance-Katz) Orbitofrontal Cortex Controls impulses to seek gratification when they are out of line e with overall goals (McCance-Katz) Amygdala Establishing learned associations between motivationally relevant events and neutral stimuli that signal events (McCance-Katz) Locus Coeruleus Physical Dependence/ Withdrawal

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25 The Memory of Drugs Front of Brain Amygdala not lit up Amygdala activated Back of Brain Nature Video Cocaine Video

26 Relapse Triggers Intoxicant Use Cueing (People, Places & Things) Stressors Mild stressors are extremely effective

27 Craving incubates with the passage of time It is easy to let up on the spiritual program of action and rest on our laurels. We are headed for trouble if we do, for alcohol is a subtle foe. We are not cured of alcoholism. What we really have is a daily reprieve contingent on the maintenance of our spiritual condition. (AA; p.85)

28 .a seemingly hopeless state of mind and body (AA; Forward to First Ed.) Addictive Illness documented throughout history Palliative treatments only, no remission 1935 the spiritual answer and program of action (AA; p.42) Rarely have we seen a person fail who has thoroughly followed our path. (AA; p.58)

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30 Sobriety Essentials the spiritual answer and program of action (AA; p.42) Abstinence Spiritual Experience Addict w/ Addict

31 Abstinence The only relief we have to suggest is entire abstinence (AA; The Doctors Opinion) Cross- Addiction

32 Nester

33 Spiritual Remedy (AA; AA; p. 39) To be doomed to an alcoholic death or live on a spiritual basis are not always easy alternatives to face. (AA; We Agnostics) But after a while we have to face the fact that we must find a spiritual basis of life- or else. (AA; We Agnostics) For most cases, there is virtually no other solution (AA; AA; p.43) unless this person can experience an entire psychic change there is little hope of his recovery.(aa; The Doctors Opinion)

34 Spiritual Experience relieved of his drink obsession by a sudden spiritual experience (AA; Forward to Second Edition) vital spiritual experiences.in the nature of huge emotional displacements and rearrangements (Carl Jung)(AA; p. 27) he has undergone a profound alteration in his reaction to life tapped an unsuspected inner resource awareness of a power greater than ourselves is the essence of the spiritual experience (AA;; Appendix II)

35 Spiritual Experience (con t) we have had deep and effective spiritual experiences which have revolutionized our whole attitude toward life, toward our fellows and towards God s s universe (AA; p. 25, There is a Solution) but now we begin to have a spiritual experience.we feel we are on the Broad Highway, walking hand in hand with the Spirit of the Universe. (AA; p. 75) Step V promises

36 Addict w/ Addict the theory that only an alcoholic could help an alcoholic this seemed to prove that one alcoholic could effect another as no non-alcoholic could. strenuous work, one alcoholic with another was vital to permanent recovery the conviction grew that AA s s had to hang together or die separately recovery begins when one alcoholic talks with another alcoholic, sharing experience, strength and hope. (AA; Forward to Second Edition)

37 Addict w/ Addict (con t) Practical experience shows that nothing will so much insure immunity from drinking as intense work with other alcoholics. It works when other activities fail (AA; p.89) Though they knew they must help other alcoholics if they would remain sober, that motive became secondary. It was transcended by the happiness they found in giving themselves to others. (AA; p.159)

38 Life will take on new meaning. To watch people recover, to see them help others, to watch loneliness vanish, to see a fellowship grow up about you, to have a host of friends- this is an experience you must not miss.. Frequent contact with newcomers and with each other is the bright spot of our lives. (AA; p 89)

39 Your job now is to be of maximum helpfulness to others.(aa; others p.102)

40 The Circle and the Triangle The Circle stands for the whole world of AA, and the Triangle stands for AA s s Three Legacies of Recovery, Unity, and Service (AA comes of Age, p. 139)

41 To receive a copy of this lecture visit: Click: Resources Click: Doc Lectures