It doesn’t take a lot of sense to stay sober….it just takes all you’ve got!

1. It doesn’t take a lot of sense to stay sober….it just takes all you’ve got! Dr John Mooney 1910 -1983

2. Thank You I would like to thank the staff of CAPTASA for allowing me the opportunity to present this information. I continue to believe that CAPTASA represents the finest gathering of committed addiction professional in existence today. ( Sandy P. – you know Burns can’t help it !!)

3. Avoiding GoofBall pitfalls in Sobriety Robert W. Mooney, MD

4. Thanks I would like to thank District 32 of the Florida AA community for the willingness to request information on a subject that will become more important as newcomers become old-timers, then become really old-timers.

5. Financial Disclosure I am employed at Vista Taos Renewal Center in Taos, New Mexico as Medical Director and Addiction Psychiatrist. They have supported my attendance at this presentation but have declined to present any information considered to be marketing materials. I will have contact information available for anyone having questions about information presented today.

6. Presentation Disclaimer The information presented is considered by Alcoholics Anonymous to be an outside issue. AA encourages cooperation with medical and psychiatric professionals when needed. However, the number of medications that have the potential to threaten recovery has increased dramatically over the past several decades. This presentation is meant to be informative only. Please see your personal physician about any questions which may be raised concerning your medical condition. Thank You

7. Bill’s Writing on Medications “Morphine, codeine, chloral hydrate, Luminal, Seconal, Nebutal, amytal, these and kindred drugs have killed many alcoholics. And I once nearly killed myself with chloral hydrate. Nor is my own observation and experience unique, for many an old-time AA can speak with force and fervor on the subject of “goof balls”. Language of the Heart 1945 Bill Wilson 1895 - 1971

8. Bill’s Writing on Medications “Some of us, perfectly sober for months or years, contract the habit of using sedatives to cure insomnia or slight nervous irritability. I have the impression that some of us get away with it, year after year, just as we did when we first began to drink alcohol. Yet experience shows, all too often, than even the “controlled” pill taker may get out of control. The same crazy rationalizations that once characterized his drinking begin to blight his existence. He thinks that if pills can cure insomnia so may they cure his worry.” Language of the Heart 1945

9. Bill’s Writing on Medications “Our friends the doctors are seldom directly to blame for the dire results we so often experience. It is much too easy for alcoholics to buy these dangerous drugs, and once possessed of them the drinker is often likely to use them without any judgment whatever.” Grapevine 1945

10. The Doctors Opinion “More often than not it is imperative that a man’s brain be cleared before he is approached, as he has then a better chance of understanding and accepting what we have to offer.” William Silkworth, MD Alcoholics Anonymous

11. Cooperation “…Try to remember that though God has wrought miracles among us, we should never belittle a good doctor or psychiatrist. Their services are often indispensable in treating a newcomer and in following his case afterward.” The Family Afterward Alcoholics Anonymous

12. What Do You Believe? Traditional Psychiatric Approach Excessive drinking is a deviant pattern of behavior which is secondary to an underlying emotional or mental disorder…..

13. What Do You Believe? Traditional Psychiatric Approach ……if the underlying emotional or mental disorder is properly diagnosed and treated, then the deviant behavior pattern of drinking will resolve and normal drinking behavior will ensue.

14. What Do You Believe? Traditional Psychiatric Approach Excessive drinking is a deviant pattern of behavior which is secondary to an underlying emotional or mental disorder….. ……if the underlying emotional or mental disorder is properly diagnosed and treated, then the deviant behavior pattern of drinking will resolve and normal drinking behavior will ensue.

15. “ The idea that somehow, someday he will control and enjoy his drinking is the great obsession of every abnormal drinker.” Alcoholics Anonymous Chap 3 Page 30

16. What Do You Believe? An almost allergic like response in roughly 1 out of 10 individuals to chemicals which change brain activity and reward systems. This response can be immediate, such as cravings. Or, it can be more gradual where thinking and perceptions become altered such that motivation for sobriety decreases and they return to previous patterns of behavior linked to drug of choice.

17. What Do You Believe? Because this type of response does not occur in the other 90 per cent of the population, they will not be at risk for addictive complications, they usually won’t take what they are given anyway! The previous 10 per cent is the focus of this presentation. What constitutes a hazardous substance for them?

18. Hazardous Drugs Hazardous Drugs are those substances which in our experience have contributed to relapse. Our 50 years of experience have shown this to include most if not all CNS active substances.

19. Sources • Recreational/Street Drugs • Prescription/Pharmaceutical Drugs • Over The Counter/Dietary Supplements

20. Hazardous Medical Procedures • Dental Procedures:Nitrous Oxide, local anesthetic with epinephrine, Rx • Diagnostic Procedures: Versed, propofol, Fentanyl • Surgery: Adverse brain effects last for about 3 months following general anesthesia. • Pregnancy:OB’s like their patients calm.

21. “In addicts, doses of drugs that are too low to produce any conscious recognition that they received drugs are still capable of inducing changes in the brain and influencing behavior…” Mark S. Gold, MD Dept of Psychiatry University of Florida

27. Willingway Tranquilizer Rule There are two types of tranquilizers: habit-forming and non habit-forming. The habit-forming ones are the old ones and the non habit-forming ones are the new ones. When the new ones become old, they become habit-forming and are replaced by new non habit-forming ones.

28. Approved Medications • Antabuse • Methadone • Buprenorphine (Suboxone/Subutex) • Naltrexone (Revia/Vivitrol) • Acamprasate (Campral)

29. Medications Used in Addiction Medicine • Prozac • Effexor • Paxil • Cymbalta • Zoloft • Trazodone • Depakote • Neurontin • Klonopin • Xanax • Ultram • Soma • Adderal • Concerta • Lithium • Seroquel • Abilify • Geodon • Zofran • Topamax • Baclofen • Ambien • Lunesta • Wellbutrin • Lamictal • Provigil • Marijuana

30. Psychiatric Training • Increase Meds • Change Meds • Add Meds

31. Once you have committed to a chemical solution, it is almost impossible to revert to a spiritual solution.

32. Problem Child of History Alcoholics and more recently drug addicts have been resistant to “cures” since earliest recordings of history. The Bible records cases of alcoholism but no “cure”. Early medical attempts included: Typhoid treatment, VD cures, ice baths, insane asylums, lobotomy and electro-convulsive therapy. Then something occurred in 1941 which has changed everything……

33. Prior to 1941 alcoholism relied primarily on psychiatrists and mental institutions for treatment which was mostly ineffective.

34. Where Are We Heading? There is rush to develop strategies and pharmaceutical agents to treat alcohol/drug addiction at the expense of 12 step programs. The expectation of changes in delivery of healthcare will increase the pressure from pharmaceutical and insurance companies as a result of the billions of dollars which are at stake. The belief that 12 Step recovery is ineffective will push healthcare providers to encourage alternative approaches, which may in fact increase risks of failure in continued sobriety.

35. Research Intent “ADial is developing compounds that affect the reward center of the brain, thereby decreasing the craving for alcohol and reducing alcohol consumption. Our medications appear to be effective based on a combination of an ability to leverage propriety targeted genetic efforts with synergistic treatment mechanisms –targeting multiple neurological pathways in the brain, thereby enhancing efficacy while reducing side effects. In addition, our compounds can be given to patients currently drinking, no abstinence prior to treatment required. This significant improvement not only increases access to treatment; it increases the likelihood of success, which can now be measured as a reduction in alcohol consumption and control over one’s drinking. Adial Pharmaceuticals Bankole Johnson, MD

38. Stuart Gitlow, MD “There are risks in leading the patient to believe that a pill or injection can save them from an illness where that patient mistakenly has believed that problems can be cured by taking something.”

39. “It doesn”t take a lot of sense to stay sober – It just takes all you’ve got !!! Dr. John Mooney Founder – Willingway Hospital

41. I would like to thank my parents, Dot and Dr. John Mooney who believed in what they saw and gave me an opportunity to be part of an amazing experience that one day may no longer exist. I hope we never forget.

42. Resources • Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America by Robert Whitaker • Mad in America by Robert Whitaker • A Voice from the Wilderness by Andrew D. Bennett (Article in March/April issue of Addiction Professional)

43. “You can read, study and learn everything about alcoholism but if you can’t laugh…you’re screwed!”

45. Vista Taos Renewal Center