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bittensaddiction.com
Presentation by Bitten Jonsson
Registered Nurse 1973 Further training medicine 1981
Treatment alcoholism 1985 Relapse/addiction training 1990- cont.
Terence Gorski, SECAD, Foodaddictiontreatment/training since 1993
Member of naatp since 1996 ADDIS cert. 1990
Nutrition and biochemistry 1999-cont. Member of FoodAddictionInstitute
bittensaddiction.com
How do we know ?
You have complained about a sore knee for several weeks and your colleagues begin to analyze the problem.
What do they say ?
Meniscus ?
Bursitis ?
Typical ACL( acute cruciate ligament ) injury?
Plain Inflammation ?
Tick bite
bittensaddiction.com
Guessing
”The lack of knowledge about how to
investigate people's relationship with an
psychoactive drug/process, means that they
often think they know, or just make a guess.
Börje Dahl CEO ADDIS Sweden
How do you treat ”guesswork”
bittensaddiction.com
Diagnostic evaluation tool
SUDDS-IV ® Substance Use Disorder Diagnostic Schedule Norman G. Hoffmann,
Ph. D and Patricia A. Harrison, Ph. D
www.evinceassessment.com
ADDIS® – Alcohol Drug Diagnostic Instrument
ADDIS-Adol – Alcohol Drog Diagnostic Instrument – Adolescents
www.addis.se
Based on DSM-IV/5 and ICD-10
bittensaddiction.com
SEPTEMBER 6, 2014
ADDIS SRE
(Sugar Research Edition) Screening, Assessment
Diagnostics
bittensaddiction.com
Sugar/flour a Psychactive Drug
It is the first drug an ”addictive prone”
brain encounters.
Lots of research during the years has
shown that it act as a pshycoactive drug
on the brains rewardsystem
Gold, Alena, Albertsson and many others
bittensaddiction.com
Addictive Foods?
”Some foods act as addictive substances on the brain,
a hard concept for experts in the nutrition/obesity field”
2007
Mark S. Gold & Kelly D. Brownell i boken
”Food and Addiction, a comprehensive handbook”
Oxford University Press 2012
bittensaddiction.com
ASAM has released a new definition of addiction 2011:
• Addiction is a primary, chronic disease of brain reward, motivation,
memory and related circuitry.
• Dysfunction in these circuits leads to characteristic biological,
psychological, social and spiritual manifestations.
• This is reflected in an individual pathologically pursuing reward
and/or relief by substance use and other behaviours.
• Addiction is characterised by inability to consistently abstain,
impairment in behavioural control, craving, diminished recognition
of significant problems with one’s behaviours and interpersonal
relationships, and a dysfunctional emotional response.
Like other chronic diseases, addiction often involves cycles of
relapse and remission. Without treatment or engagement in recovery
activities, addiction is progressive and can result in disability or
premature death.
ASAM new definition
bittensaddiction.com
Addiction
From the latin word Addicere
Means:
adjudge, sentence, doom
award, assign
be propitious
confiscate
enslave
bittensaddiction.com
Addiction Interaction Disorder
It is about the brain, not the drug…
ASAM 2011
Studies show that 17% at most, only
have one outlet and that 80% of
relapses are due to unknown outlets
AID
bittensaddiction.com
Multifaceted illness
One disease, many outlets ( AID )
Changing the outlet ( drug/process )
is as constructive
as changing cabin on the Titanic Börja Dahl, CEO ADDIS Sweden
bittensaddiction.com
Psychoactive Substances
Alcohol Cannabis Sedatives
Hallucinogen Amphetamine
Cocaine Opioid PCP
Inhalants Caffeine Nicotine
SUGAR/FLOUR
bittensaddiction.com
Process Addictions
Gambling Sex/Relationship
Working Internet Exercise Debting
Codependecy ?
bittensaddiction.com
Why is a diagnose important?
Unethical to treat a person without knowing what is to be treated.
Risk for incorrect treatment in regards to abuse/harmful use and dependency/addiction.
Essential for an indiviual’s understanding of his/her condition, motivation and
formulation of realistic goals
Chosing adequate treatment programs and aftercare
Essential when doing research for treatment results – useless if one doesn’t know what condition has been treated!
Learn more: Avoid the perils of instrument abuse, Norman Hoffman pdf.
bittensaddiction.com
Assessment process:
1.Screening: questions, UNCOPE S
lab tests ; bloodsugar curve, weightcurve, fasting insulin, IGF, H
Clients story
2. Clincal evaluation and biochemical assessment within intergrated functional medicine and orthomolecular medicine
3. Diagnostic evaluation based on DSM-IV/5 or ICD-10
for ex: SUDDS-IV, ADDIS, SCID
bittensaddiction.com
ADDIS S RE assessment:
• a therapeutic interview
• objective – not dependent on who does the assessment
• provides quality insurance for both you and your client
• aids clients in gaining insight which in return affects
motivation
• provides information essential for precise treatment
planing for ex. current vs remission, early vs late stage etc.
• Takes away stigma, it,s a disease
Case study Female – 46 years old. Married, two children. Employed as a traveling saleswoman. Good economy. Very ambitious Always weightconscious – exercises daily. Current situation: During a recent business trip she did not show up at her client’s office and could not be reached. Returned to work that afternoon she was disheveled, stressed,
drained, agitated and very nervous. Chemical situation: Age 6, OE sugar/flour, lying about food, age 15 dieting Age 16: started smoking Age 18: started drinking Ages 18 - 22: dating, partying – living life Ages 22 and 26: Pregnacies (gained 60+ lbs. each
time – no alcohol or nicotine but resumed both after nursing. Can not loose weight, bingeing, vomiting
bittensaddiction.com
Case study
Age 29: Resumed alcohol and nicotine use. Started dieting, exercising daily - vigorously . Overeating, bingeing, vomtings. Problems within marriage –
work, weight gain, reduced exercise, avoidance of family. Age 33: Health problems: migrane-, body pain, – Tylenol - mood swings. Age 35: Sleeping problems, periods of depression. Bensodiazepines. Age 39: Continued health problems. Quit smoking, weight gain. Increased use
of alcohol and bensodiazepines. 41: Quit alcohol, bensoediazepines, smoking, cold turkey. Depression, anxiety 3
months. Foodbingeing totally out of control. 42: fibromyalgia , weightgain 46: Diabetes type II.
bittensaddiction.com
DSM-IV Diagnostic Criterier: Dependence
Tolerance Withdrawal Increased or longer periods of us Desire or unsuccessful efforts to cut down/control Time spent in obtaining, using or recovering Important activities – given up or reduced Continued used despite physical/psy. problems
A
Sugar/food
A
A
A
A
A
A
Sugar/food.: 23 symptoms in 7 criteria
DSM-IV Diagnostic Criterier: Dependence Tolerance
Withdrawal
Increased or longer periods of use Desire or unsuccessful efforts to cut down/control Time spent in obtaining, using or recovering Important activities – given up or reduced
Continued used despite physical/psy. problems
Alcohol: 8 symptoms in 7 criteria
Sedative/Tranq.: 10 symptoms in 7 criteria
NEXT: best tool ever ADD, Addiction Development Curve
Alcohol Sedative/Tranq.
A A
A A
A
A
A
A
A
A
A
A
A
ADDIS® Age 6 8 10 12 14 16 18 20 22 24 26 28 30 36 32 34 36 38 40 42 44 46 W
Sym
1
P1 P2 F D2 N 244
2 A
3 S
4 W 220
5 B
6
7
8
9 198
10
11
12 DA
13
14 176
15
16
17
18
19 154
20
21
22
23
24 132
Bing/Vom
Motivational therapeutic session from ADD
(Addiction development diagram)
Focus, helping clients see reality and at the same time educating and giving hope.
A staged, intense and dramatic crisis with strong feelings which is exactly what is needed for most clients
to accept help
A strong foundation for treatmentplanning
bittensaddiction.com
16/17 – increased use / increased amount
22 – high consumption
30 – using more then planned
31 – longer period of use then intended
34 – increased toleramce
36 – obsessing about using
41 – less money for daily living
35a – decreased awareness
45 - using./recuperaing large part of day
38 – loss of control
36a – protecting supply
42 – neglect of planned activities
33 – binging/periods of loss of control
47 – memory/concentration problems
48 - emotional problems
39 – can not stop using
41 – Econominal problems
40 – Stops leisure activitys/change of friends
67 – Using despite pshycological/physiological worsening
43 – ”sickleave” from school/work
44 – Neglect of work/school
68 – spending less time with family/ close friends
69 - withdrawal
46 – drug centered lifestyle
37 – total loss of control at all times
70 – severe withdrawal
71 – using to stop withdrawal
72 – Confusion/ blackouts
73- Collapse physical and pshycological
Symptomcurve Addis
34 20
16/17
41
36a
32
33
31
39
38
35a
36
43
47
45
66
48
67
30 22
37
72
46
71
44
42
68
40
69
70
Early stage, phase I
Medium stage , phase II
Late stage , phase III
34 goes with
20
A A1 L
73
Frequent use
Related healthproblems
How information received in ADDIS is processed
DSM-IV checklist ICD-10 checklist assessment/diagnose Presentation checklist educational & motivational Addiction development diagram insight, understanding acceptance of problem
bittensaddiction.com
bittensaddiction.com
ADDIS S RE ADDIS Sugar Research Edition
ADDIS S RE is a process where we now are validating
the instrument in the same way alcohol , pills and drugs
are validated. And mesuring it,s reliability
”Reliability is the degree to which an assessment tool produces stable and consistent
results. Validity refers to how well a test measures what it is purported to measure”
Establish contact with patient/client
Screening instrument: CAGE, AUDIT, UNCOPE
Negative
”DRUG”: indentification, diagnose, evaluation, treatment planning, treatment and evaluation
Short motivational counseling (FRAMES and/or MI)
Diagnostic assessment of problem and severity (DSM-IV or ICD-10)
a positive answer
2+ positive answers
Rescreen periodically using questions and/or lab tests for ex. GT and CDT
No problem, intervention is unnecessary
Evaluation within intergrated functional medicine
Motivational therapy , detox, biochemical repair , structured professional treatment program with 12 step integrated. Aftercare
Contious Evaluation , lifelong follow up.
Cost-effective in regards to time and education of practitioner
Greater cost with regard to time and education of practitioner
Lynn Wickström and Bitten Jonsson
Original diagram with AUDIT screening instrument: Claudia Fahlke, Ulf Berggren & Jan Balldin (Göteborg Alcohol Research Project)
OBS! • Different types of screening tests can be used • Clinical evaluation can consist of different types of tests • GT and CDT can be supported by for.ex. ASAT och ALAT
Screening result
Treatment plan from ADDIS
1. Chemical history, acute stabilization
2. Medical detox, brain repair
3. Primary treatment , holistic approach and relapse prevention program
4. Aftercare, holistic treatment, self help programs, brain by pass and nutrition teaching and training
5. Extended after care for clients with PAA
6. Life long maintenance with regular workshops and checkups
bittensaddiction.com
bittensaddiction.com
Diabetes < 60%
Hypertension < 40%
Asthma < 40%
Behavioral changes less…..
Diet, even less….
At least 7-10 yrs to change lifestyle
Compliance
COMPLIANCE
Since the beginning of 2000, when starting to
use this concept we see
a much higher compliance and a much greater interest from the client in his/her own well
being, health issues and brain/body repair and also a greater awareness of life on Earth.
bittensaddiction.com