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Integrating: 12-Step Spirituality, 21 st Century Psychopharmacology, Addiction Psychiatry, and Dual Diagnosis Concepts

Integrating: 12-Step Spirituality, 21 st Century Psychopharmacology, Addiction Psychiatry, and Dual Diagnosis Concepts In Addiction Treatment Settings By GARRETT O’CONNOR, M.D . The Radisson-Miyako Hotel San Francisco October 8-11, 2003. ADDICTION MEDICINE: STATE OF THE ART 2003.

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Integrating: 12-Step Spirituality, 21 st Century Psychopharmacology, Addiction Psychiatry, and Dual Diagnosis Concepts

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  1. Integrating: 12-Step Spirituality, 21st Century Psychopharmacology, Addiction Psychiatry, and Dual Diagnosis Concepts In Addiction Treatment Settings By GARRETT O’CONNOR, M.D. The Radisson-Miyako Hotel San Francisco October 8-11, 2003 ADDICTION MEDICINE: STATE OF THE ART 2003

  2. ADDICTION IS A BRAIN DISEASE

  3. THE RE-ENTRY OF PSYCHIATRY INTO THE ADDICTION TREATMENT FIELD

  4. ADDICTION IS A CUNNING POWERFUL BAFFLING DANGEROUS DEVIOUS UGLY & HIDDEN DISEASE

  5. BUT MORE THAN A DISEASE, ADDICTION IS A WAY OF LIFE

  6. RECOVERY IS ALSO A WAY OF LIFE

  7. ADDICTIONISTHE GREAT IMITATOROFALL DISEASES(Especially Psychiatric Ones)

  8. INTOXICATION CAN MIMIC OR OBSCURE: Panic Disorder Anxiety Disorder Major Depression Psychotic Disorder Bipolar Disorder Drug-Induced Organic State Obsessive Compulsive Disorder Chronic Alcohol/Drug Use Attention Deficit Disorder

  9. The Co-occurrence of a Substance Use Disorder and a Psychiatric Disorder (Major Mental Illness Or Severe Personality Disorder In the same Person) DUAL DIAGNOSIS

  10. Is Important Because of: Its Arguably High Prevalence, (b) Its Prognostic Significance (c) The Important Rx. Implications of Making a Correct Diagnosis DUAL DIAGNOSIS

  11. THE DIFFERENTIAL DIAGNOSIS BETWEEN CO-OCCURRING PSYCHIATRIC DISORDERS AND ADDICTIVE DISEASE IS A VITAL CLINICAL DETERMINATION!

  12. DANGER! Prescribing Psychotropic Medications for the Wrong Diagnosis Failure to Prescribe PsychotropicMedications for the Right Diagnosis

  13. A MISTAKE EITHER WAY CAN LEAD TO EVENTUAL RELAPSE AND EVEN DEATH!

  14. INTEGRATING TWO POTENTIALLY ANTI-THETICAL MODELS “12-STEP” (BPSS) ABSTINENCE, SPIRITUALITY SERVICE, HIGHER POWER, BIG BOOK AUTHORITY, GROUP CONSCIENCE. “PSYCHIATRIC” DUAL DIAGNOSIS, MEDICAL AUTHORITY, PRESCRIPTION AUTHORITY, PSYCHOTHERAPY, PSYCHIATRY AS HIGHER POWER.

  15. I2-STEP ORIENTED TREATMENT PROGRAMS MUST NOT ALLOW BIOLOGICAL PSYCHIATRY, SCIENCE, AND PSYCHOTROPIC MEDICATIONS TO BECOME THEIR HIGHER POWER

  16. A BALANCED APPROACH IS ESSENTIAL

  17. IT’S REALLY AN ORGANIZATIONAL CULTURE PROBLEM!

  18. Shared beliefs and values of a group: The beliefs, customs, practices, and social behavior of a particular nation, class or group of people. CULTURE:

  19. INTEGRATINGFIVE CULTURESACTIVE ADDICTIONABSTINENCE-BASEDTREATMENTAND12-STEP SPIRITUALRECOVERYCOGNITIVE-BEHAVIORALTREATMENTDYNAMIC PSYCHIATRY BRAIN RESEARCH &BIOLOGICAL PSYCHIATRY

  20. EACH ONE OF THESE FIVE CULTURES HOLDS DIFFERENT, AND OFTEN CONFLICTING, BELIEFS ABOUT THE NATURE OF ADDICTION, AND HOW IT SHOULD BE TREATED

  21. THEREFORE, THE NATURE, TASK, ROLE, BOUNDARIES, AND AUTHORITY OF EACH CULTURE MUST BE DEFINED, UNDERSTOOD, AND ACCEPTED

  22. FOR EXAMPLE, DIFFERENTIATE TREATMENT FROM RECOVERY!

  23. DIFFERENTIATE ABSTINENCE FROM HARM REDUCTION FROM CONTROLLED DRINKING

  24. SOME “DIFFICULT” ELEMENTS OF 12-STEP SPIRITUALITY

  25. THE SPIRITUAL CONCEPT OF A HIGHER POWER

  26. ACCEPTANCE AND SURRENDER

  27. THE INFLATED ALCOHOLIC EGO MUST BE DEFLATED AT DEPTH (Bill W.)

  28. SELECT AND SUBMIT TO A SPONSOR

  29. SERVICE IN AA COMMITMENTS 12-STEP WORK WORK WITH NEWCOMERS H & I G.S. REPRESENTATIVE SPONSORSHIP CENTRAL OFFICE

  30. SOBRIETY IS AN UNNATURAL STATE FOR ADDICTS

  31. SOBRIETY IS THE #1 CAUSE OF RELAPSE

  32. GIFTS FOR RECOVERING ALCOHOLICS • (Opportunities for Spiritual Growth) • Suffering! • Humiliation! • Disappointment! • Disillusionment! • Betrayal! • Loss! • Extreme Guilt & Shame! • Abandonment! • Failure! • Success!

  33. THE SPIRITUAL VALUE OF SUFFERING

  34. THE RE-ENTRY OF PSYCHIATRY INTO THE ADDICTION TREATMENT FIELD

  35. ABOUT 50% OF ALCOHOLIC/ADDICTS ADMITTED TO THE BETTY FORD CENTER ARE ALREADY ON PSYCHOTROPIC MEDICATIONS PRESCRIBED BY PCP’S OR PSYCHIATRISTS, OFTEN WITHIN 3-6 MONTHS PRIOR TO ADMISSION

  36. SCIENTIFIC EVIDENCE FOR ADDICTION AS A BRAIN DISEASE • NEW EMPHASIS ON THE • DUAL DIAGNOSIS CONCEPT • AGGRESSIVE TV AND OTHER MASS MARKETING OF SSRI AND OTHER PSYCHOTROPIC DRUGS; BENZO’S ETC. • AWARENESS OF POPULATIONS NEEDING TREATMENT. E.G., LICENSED PROFESSIONALS, • URBAN HOMELESS ETC.

  37. PSYCHIATRY AND PHARMACEUTICAL COMPANIES BELIEVED THEY COULD ENHANCE THE EFFECTIVENESS OF 12-STEP TREATMENT & RECOVERY FROM LATE 80’S, MAJOR ADDICTION MEDICINE SOCIETIES (AAPA; ASAM; CSAM; Etc.) ACCEPTED “EDUCATIONAL” MONIES FROM DRUG COMPANIES

  38. DRAMATIC BREAKTHROUGHS! NEW FRONTIERS! REVOLUTIONARY ADVANCES! EVIDENCE-BASED TREATMENT APPROACHES

  39. Disulfiram Naltrexone LAAM Acamprosate Methadone Buprenorphine Mood Regulators Anti-depressants Sedative-hypnotics (Rarely, if ever) Anti-psychotics (When indicated) DRUGS USED AFTER DETOXIFICATION INTREATMENT OF ADDICTION

  40. DUAL DIAGNOSIS • PSYCHOTROPIC • MEDICATIONS • IN RECOVERY • BOO-HOO FOR 12-STEP! • (NO “SCIENTIFIC” EVIDENCE!)

  41. ON THE CONTRARY, RECENT RESULTS FROM PROJECT MATCH SUGGEST THAT AA MAY BE THE MOST EFFECTIVE APPROACH FOR LONG-TERM ABSTINENCE AND SOBRIETY

  42. POTENTIALLY USEFUL & VALID NEW TECHNOLOGIES MAY BE EXPERIENCED BY STAFF AS THREATS TO THE 12-STEP CULTURE

  43. AFTER DETOXIFICATION, PSYCHOTROPIC MEDICATIONS SHOULD BE PRESCRIBED FOR ALCOHOLICS AND OTHER ADDICTS IN RECOVERY ONLY WHEN THE DIAGNOSIS OF DUAL DISORDER HAS BEEN CONFIRMED

  44. INSENSITIVE DANGEROUS (ANTI-AA) ARROGANT DRUG-ORIENTED IGNORANT ABOUT ADDICTION ABUSIVE NON-SPIRITUAL MINIMIZE IMPACT OF ALCOHOL MONEY-GRUBBING COMPETITIVE CONTEMPTUOUS THREATENING NEGATIVE ATTITUDES IN AAABOUT PSYCHIATRISTS/PSYCHOTHERAPY

  45. SUBSTITUTE DEPENDENCY AA IS “ADJUNCTIVE” A FOLK MOVEMENT RELIGIOUS BIBLE THUMPING A CULT FOSTERS DEPENDENCY IN MEMBERS NO FOLLOW-UP NO CONTROLLED RESEARCH EFFICACY NOT PROVED DISORGANIZED HOSTILE TO PSYCHIATRY LACKSACCOUNTABILITY UNCOOPERATIVE COMPETITIVE NON-INTELLECTUAL FREE NEGATIVE ATTITUDES OF PSYCHIATRY TOWARDS AA

  46. GRATITUDE (38% OF AA MEMBERS SAY THEY WERE REFERRED TO THE PROGRAM BY PSYCHIATRISTS OR OTHER THERAPISTS) MANY AA MEMBERS EXPRESS GRATITUDE TO PSYCHIATRISTS FOR SUPPORT AND FOR PRESCRIPTIONS OF ANTI-DEPRESSANTS OR SSRI’S WHICH THEY SAY “GOT THEM THROUGH”,“TOOK THE EDGE OFF”, OR “MADE IT POSSIBLE FOR THEM TO STAY SOBER”. POSITIVE ATTITUDES IN AAABOUT PSYCHIATRISTS, PSYCHOTHERAPYAND COUNSELORS

  47. SUPPORTIVE LIFE-SAVING INDISPENSABLE DIVINELY INSPIRED COOPERATIVE COMPLEMENTARY REVOLUTIONARY ADMIRATION GRATITUDE POSITIVE ATTITUDES IN PSYCHIATRY ABOUT AA

  48. NEGATIVE 12-STEP ATTITUDES TOWARD MEDICATIONS A Crutch Easier Softer Way Impede Spiritual Recovery Foster Dependency Substitute for Higher Power Violate AA Traditions Bad Example for Newcomers Ill-Trained Physicians Stupid Physicians Criminal Conduct by Docs

  49. UNDERSTANDING RECOVERY • AND ADDICTION (M.BEAN) • THE NATURE OF ADDICTION • THE THINKING DISORDER • (“STINKIN THINKIN”) • THE MECHANICS & DYNAMICS • OF RECOVERY • THE ALCOHOLIC IDENTITY • THE RECOVERING IDENTITY • THE ROLE OF SPIRITUALITY IN RECOVERY • AA IS NOT “AN ADJUNCT” TO • PSYCHOTHERAPY

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