ADDICTION AND ITS TREATMENT

ADDICTION AND ITS TREATMENT DR. CAMILLE WISSMANN PHARM. D. JUNE 14, 2014 2014 CPFI CONFERENCE, MYRTLE BEACH ADDICTION DEFINED ADDICTION IS A PRIMARY, CHRONIC DISEASE OF BRAIN REWARD, MOTIVATION, MEMORY, AND RELATED CIRUITRY DYSFUNCTION IN THESE CIRCUITS LEADS TO CHARACTERISTIC BIOLOGICAL, PSYCHOLOGICAL, SOCIAL AND SPIRITUAL MANIFESTATIONS REFLECTED IN A PERSON PATHOLOGICALLY PURSUING REWARD AND/OR RELIEF BY SUBSTANCE USE AND OTHER BEHAVIORS http:www.asam.org American Society of Addictive Medicine DISCLOSURE NO FINANCIAL INTERESTS IN ANY COMPANY, PRODUCT, OR SERVICE MENTIONED IN THIS PRESENTATION INCLUDING GRANTS, EMPLOYMENT, GIFTS, STOCK HOLDINGS, AND HONORABILIA Beginning addictive behavior Seeking pleasure or looking for a way to overcome pain The way seemed right at first not long before it becomes clear it is the wrong tract. OBJECTIVES 1. DEFINE ADDICTION 2. EXPLAIN DIFFERENT TYPES OF ADDICTION 3. DISCUSS VARIOUS ORGANIZATIONS THAT HELP WITH ADDICTION 4.DISCUSS A CHRISTIAN APPROACH OF HELPING WITH ADDICTION BY USING A GROUP CALLED CELEBRATE RECOVERY QUOTE WHEN OLD DRUGS BECOME ADDICTIVE, THEY ARE REPLACED WITH NEW NON- ADDICTIVE DRUGS. WHEN THE NEW DRUGS BECOME ADDICTIVE THEY ARE REPLACED BY NEW NON-ADDICTIVE DRUGS 2014 APHA Presentation on Addiction by Brian Fingerson BS, Pharm D, RPh FAPHA 1

DRUG ADDICTIONS TOBACCO ALCOHOL OPIATES CANNABIS (MARIHUANNA) SLEEPING MEDICATIONS BENZODIAZE- PINES AMPHETAMINES OTHER STIMULANTS- RITALIN TRAMADOL, LYRICA, PROVIGIL MEDICATION COGNITIVE THERAPY (CBT) MOTIVATIONAL ENHANCEMENT INTENSIVE OUTPATIENT PROGRAMS (IOP) TREATMENTS RESIDENTIAL TREATMENT 12-STEP RECOVERY PROGRAMS CELEBRATE RECOVERY OVERDOSE OVERDOSE ON DRUGS IS THE #1 CAUSE OF ACCIDENTIAL DEATH IN THE U.S. FEW PATIENTS RECEIVING DRUGS TO COMBAT ALCOHOLISM STUDY PUBLISHED MAY 14, 2014 IN JAMA LED BY DANIEL E. JONES MD MPH OUT OF UNIVERSITY OF NORTH CAROLINA, CHAPEL HILL ALCOHOL -3 RD LEADING LIFE-STYLE RELATED CAUSE OF DEATH-88,000/YR SHOWED EFFECTIVE DRUG TREATMENT IS NOT BEING USED NON-DRUG ADDICTIONS TREATMENTS-MEDICATION ASSISTED PORNOGRAPHY GAMBLING EATING (FOOD) SHOPPING CO-DEPENDANCY ANGER WORRY APPROVAL ACCEPTANCE SEXUAL ABUSE LOVE AND RELATIONSHIP (OFTEN WOMEN) DISULFIRAM (ANTABUSE) INTERFERS WITH ALCOHOL METABOLISM LEADING TO BUILDUP OF ACETALDEHYDE WHICH CAUSES VOMITING ETC. STUDY SHOWED NOT ADEQUATE TO PREVENT RETURN TO ALCOHOL. SOME STUDIES SHOW A CRAVING REDUCTION IN COCAINE ADDICTS NALTREXONE (REVIAL) NARCOTIC AGONIST THAT BLOCKS OPIATE EFFECTS AND HELPS PREVENT RELAPSE TO ALCOHOL ABUSE WORKS BY PREVENTING THE GOOD FEELINGS ASSOCIATED WITH DRINKING OR USING DRUGS. 2

STUDY CONT. OFF LABEL USE TOPIRAMATE (TOPAMAX) ENHANCES GABA ACTIVITY AND ANTAGONIZES GLUTAMATE RECEPTORS THEREFORE DECREASES ABNORMAL ACTIVITY IN THE BRAIN- MAY HELP TO PREVENT RELAPSE TO ALCOHOL, OPIATE, AND COCAINE ADDICTION NALMEFENE AN OPIOD ANTAGONIST THOUGHT TO NEUTRALIZE OR COUNTERACT THE EFFECTS OF OPIATES- REDUCES CRAVINGS & THEREFORE PREVENTS RELAPSE IN ALC0HOL DEPENDENCY TREATMENT-OPIATE REPLACEMENT THERAPY METHADONE- (DOLOPHINE) A SYNTHETIC NARCOTIC THAT IS THOUGHT TO BLOCK THE HIGH THAT IS ASSOCIATED WITH OPIOD USE AND THEREFORE REDUCES THE CRAVINGS FOR OPIATES BUPRENORPHINE (SOBUTREX) WEAKENS THE EFFECTS OF OPIATES, LESS LIKELY TO CAUSE OVERDOSE, AND PRODUCES A LOWER LEVEL OF PHYSICAL DEPENDENCE THAN METHADONE CONCLUSIONS OF STUDY PATIENTS WITH AUD (ALCOHOL USE DISORDERS) SHOULD BE OFFERED OPTIONS MEDICATION, EVIDENCE-BASED BEHAVIORAL TREATMENTS AND SUPPORT GROUPS SUCH AS ALCOHOLICS ANONYMOUS TREATMENT PRINCIPLES ADDICTION IS COMPLEX HOWEVER TREATABLE AFFECTS BRAIN FUNCTION AND BEHAVIOR NO ONE TREATMENT IS APPROPIATE FOR EVERYONE NEEDS TO BE READILY AVAILABLE NEEDS TO ADDRESS MUTIPLE NEEDS OF PERSON- NOT JUST DRUG ABUSE OTHER MEDICATIONS RELATED TO GABA MECH. ACAMPROSATE (CAMPRAL) SIMILAR STRUCTURE TO GABA-THOUGHT TO WEAKEN ACUTE AND LONG-TERM WITHDRAWAL SYMPTOMS IN ALCOHOLICS MECHANISM MAY NORMALIZE NEUOTRANSMITTER ACTIVITY THAT HAS BECOME ACCUSTOMED TO THE PRESENCE OF ALCOHOL. BACLOFEN (LIORESAL) ACTS THROUGH GABA RECEPTORS TO INHIBIT THE RELEASE OF DOPAMINE AND THEREFORE REDUCES THE DESIRE FOR COCAINE INDIVIDUAL OR GROUP THERAPY COGNITIVE BEHAVIORAL THERAPY (CBT) SHORT TERM THERAPIST FOCUSES ON HELPING PATIENTS IDENTIFY THOUGHTS, FEELINGS, AND SITUATIONS THAT MAY LEAD TO DRUG USE, DEVELOP STRATEGIES TO AVOID HIGH-RISK SITUATIONS AND COPE MORE EFFECTIVELY WITH SUCH SITUATIONS 3

MOTIVATIONAL ENHANCEMENT THERAPY SEEKS TO CHANGE BEHAVIOR THROUGH STRATEGIES DESIGNED TO INCREASE A PATIENT S DESIRE TO ENGAGE IN TREATMENT AND STOP DRUG USE. JESUS IS THE CENTER OF RECOVERY IN THE BOOK OF CORINTHIANS THE BELIEVERS SHOW WHAT HAPPENS WHEN WE TAKE OUR EYES OFF JESUS PEOPLE AND RECOVERY TECHNIQUES ARE HIS TOOLS, NOT OURS. 12-STEP PROGRAM MANY PEOPLE HAVE BEEN HELPED BY THIS PROGRAM MOST COMMON GROUPS ARE ALCOHOLICS ANONYMOUS AND NAROCTIC ANONYMOUS ACKNOWLEDGE A HIGHER BEING AND THAT THEY ARE OUT OF CONTROL WITH THEIR ADDICTION. Our powerlessness and God s power I Corinthians 1:26-31 Paul points out that God s plan for recovery doesn t utilize our human wisdom, strength, or skill Until we can admit that we are powerless to change without God s help, we are doomed to cycles of painful failure. God s free gifts of forgiveness and the power to live a new life may appear foolish. However when we accept Christ as our Savior and we turn our will and our life over to him, we will discover genuine power and release from the bondage of our past CELEBRATE RECOVERY (CR) BIBLICAL AND BALANCED PROGRAM THAT CAN HELP ONE OVERCOME HURTS, HABITS AND HANG-UPS RICK WARREN DID AN INTENSE STUDY OF SCRIPTURE TO DISCOVER WHAT GOD HAD TO SAY ABOUT RECOVERY HE FOUND THE PRINCIPLES OF RECOVERY IN THE SERMON ON THE MOUNT BASED ON THE ACTUAL WORDS OF JESUS RATHER THAN PSYCHOLOGICAL THEORY - HOLY SPIRIT HAS USED THIS PROGRAM TO TRANSFORM LIVES. Finding God s Will 1 Corinthians 2:11-12 We can know God s mind and heart because he has placed his Holy Spirit within us to communicate these things to us. God s presence in us helps us know how to deal with our painful past as we make a accurate personal inventory. This leads to a healthy view of ourselves and the restoration of our broken life and relationships 4

SELF PERCEPTION OFTEN TIMES WE WISH WE COULD BE SOMEONE ELSE, ONE REASON WE ACT OUT OUR ADDICTION IS THAT WE HATE OURSELVES. SELF-HATRED IS OFTEN ASSOCIATED WITH AN ADDICTIVE/COMPULSIE PERSONALITY. IT WE DON T LIKE WHO WE ARE AND FEEL HELPLESSS TO CHANGE WE CAN BE REASSURED IN KNOWING THAT GOD HAS THE POWER TO CHANGE US. SAFE PLACE PLACE TO SHARE DEEP DARK SECRETS AND DEEP HURTS GREAT FREEEDOM WHEN ONE TALKS ABOUT PROBLEMS IN A SAFE PLACE WHERE CONFIENDENTIALITY IS PROTECTED. FREEDOM LEADS TO PEACE, SERENITY, JOY AND MOST IMPORTANLY- STRONGER RELALTIONSHIPS WITH GOD AND OTHERS. ROMANS 12: 1-2..Let God transform you into a new person by changing the way you think. Then you will know what God wants you to do, and you will know how good and pleasing and perfect his will really is. TYPICAL AGENDA OPENING SONG TURN OUR ATTENTION TO OUR HIGHER POWER- JESUS CHRIST ANNOUNCEMENTS - UPCOMING EVENTS, OPPORTUNITIES TO SERVE WORSHIP TIME PRAISE AND WORSHIP SONGS TO TURN OUR MINDS FROM THE HASSLES OF LIFE TO THE HELP WE EACH NEED. THOSE WHO ATTEND CR MAY BE STRUGGLING WITH AN ADDICTION MAY BE DEALING WITH PAIN AND NEED TO OVERCOME HURTS, HABITS AND HANG- UPS GOD IS THE ULTIMATE HEALER. AND ONE EXPERIENCES THE FREEDOM THAT COMES FROM SURRENDERING ONESELF TO CHRIST AGENDA CONT. OFFERING- TO SUPPORT MINISTRY OPTIONAL LARGE GROUP- TEACHING FROM CELEBRATE RECOVERY BIBLICAL MATERIALS. OFFER A NEW WAY OF LIVING WITH SUGESTIONS FOR APPLYING THE PRINCIPLES TO REAL LIFE. FREEDOM FROM HURTS LIES IN THE SURRENDER OF OUR LIVES AND WILL TO THE CARE OF JESUS CHRIST- ALTERNATES EVERY OTHER WEEK WITH A TESTIMONIAL OF SOMEONE WHO IS LIVING OUT THE PRINCIPLES IN HIS LIFE SMALL GROUPS WHERE PEOPLE CAN FIND AND BUILD RELATIONSHIPS WITH PEOPLE ON A SIMILAR JOURNEY. 5

SMALL GROUPS A LEADER FACILITATES THE GROUPS DISCUSSION AS WE FOCUS ON A PARTICULAR PRINCIPLE EACH WEEK. CAN FOCUS ON A QUESTION FROM THAT PRESENTED IN THE LARGE GROUP OR TESTIMONY OR CAN FOCUS ON YOUR OWN HURT, HABITS, HAND-UPS AND HOPES YOU ARE STRUGGLING WITH THAT WEEK. 12 STEPS/8 RECOVERY PRINCIPLES BY APPLYING THE BIBLICAL PRINCIPLES OF CONVICTION, CONVERSION, SURRENDER, CONFESSION, RESTITUTION, PRAYER, QUIET TIME, WITNESSING AND HELPING ONE ANOTHER, WHICH ARE FOUND WITHIN THE 8 PRINCIPLES & CHRIST-CENTERED 12 STEPS, YOU WILL RESTORE AND DEVELOP STRONGER RELATIONSHIPS WITH OTHERS AND WITH GOD. (PASTOR JOHN BAKER, FOUNDER) CURRICULUM LIFE RECOVERY BIBLE FOOTNOTES REFER TO YOUR EMOTIONS AND HOW THE PASSAGES CAN APPLY TO YOUR RECOVERY, HAS DEVOTIONS ON THE 12 STEPS, EIGHT RECOVERY PRINCIPLES, AND SERENDITY PRAYER DEEPER STUDY USING 4 PARTICIPANT GUIDES 4 PARTICIPANT GUIDES 1. STEPPING OUT OF DENIAL INTO GOD S GRACE 2.TAKING AN HONEST AND SPIRITUAL INVENTORY 3. GETTING RIGHT WITH GOD, YOURSELF, AND OTHERS 4.GROWING IN CHRIST WHILE HELPING OTHERS 8 RECOVERY PRINCIPLES BY WORKING THROUGH THE 8 PRINCIPLES FOUND IN THE BEATITUDES ONE BEGINS TO EXPEREINCE THE TRUE PEACE AND SERENITY ONE SEEKS. YOU WILL NO LONGER RELY ON DYSFUNCTIONAL, COMPULSIVE, AND ADDICTIVE BEHAVIOURS AS A TEMPORARAY FIX FOR YOUR PAIN. - FIND HEALING FOR THE DEEPEST HURTS. SPONSOR/ACCOUNTABILIT Y PARTNER SAFE PERSON WHO WALKS WITH YOU DOWN THE PATH OF RECOVERY BE THERE TO DISCUSS ISSUES TOO PESONAL DURING THE GROUP OR MAY TAKE TOO LONG AVAILABLE DURING TIMES OF CRISIS OR RELAPSE ENCOURAGE YOU- DON T WORK STEPS FOR YOU 6

SPONSOR/ACCOUNTABILIT Y PARTNER TRIES TO MODEL THE LIFESTYLE RESULTING FROM WORKING PRINCIPLES AND STEP.S EVERYONE NEEDS SPONSOR/ACCOUNTABILITY PARTNER CAN BE THE SAME PERSON OR SEPARATAE PEOPLE. SPONSOR MUST BE SOMEONE WHO HAS GONE THROUGH THE PROGRAM AT LEAST ONCE. SELF-ASSESSMENT QUESTION CELEBRATE RECOVERY IS A RECOVRY PROGRAM THAT INCORPORATES: 1. 12 STEPS 2. BEATITUDES 3. SERENITY PRAYER 4. ALL OF THE ABOVE THINGS CELEBRATE RECOVERY IS A SAFE PLACE TO SHARE A REFUGE PLACE OF BELONGING PLACE TO CARE FOR OTHERS AND BE CARED FOR RESPECT IS GIVEN TO EACH MEMBER CONFIDENTIALITY IS HIGHLY REGARDED PLACE TO LEARN PLACE TO GROW AND BECOME STRONG AGAIN WHERE YOU CAN TAKE OFF YOUR MASK PLACE FOR HEALTHY CHALLENGES AND HEALTHY RISKS POSSIBLE TURNING POINT IN YOUR LIFE SELF-ASSESSMENT QUESTION WHAT IS THE #1 CAUSE OF ACCIDENTAL DEATH IN THE U.S. 1. FALLS 2. CAR ACCIDENTS 3. GUN SHOT WOUNDS 4. DRUG OVERDOSE THINGS CELEBRATE RECOVERY IS NOT PLACE FOR SELFISH CONTROL THERAPY PLACE FOR SECRETS PLACE TO LOOK FOR DATING RELATIONSHIPS PLACE TO RESCUE OR BE RESCUED BY OTHERS PLACE FOR PERFECTION A LONG-TERM COMMITMENT PLACE TO JUDGE OTHERS A QUICK FIX SELF-ASSESSMENT QUESTIONS TRUE OR FALSE ONLY ALCOHOL AND NARCOTIC ADDICTIONS ARE CONSIDERED HARMFUL. 7

QUESTIONS? DR. CAMILLE WISSMANN PHARM. D. MEDOWL CONSULTING CELL PHONE 920-268-7251 E-MAIL CAMWISSMANN@GMAIL.COM 8