St Marys and Arch Angel Mikhail Church, Houston Tx Servants
meeting June 2013 Slide 2 All things are lawful to me but I will
not be brought under the power of any 1 Corinthian 6:12. Slide 3
What is addiction : Definition of abuse Definition of addiction
Definition of pseudo addiction. Difference between abuse and
addiction. Differences between addiction and dependence. What can
we be addicted to. Slide 4 Before we define addiction We need to
talk about some psychodynamic theories that will help us. What is
transference ? What is counter-transference? Slide 5 Lets do a
challenge. What is transference? when a person transfers old
feelings from his/her past to current situation usually towards an
authority figure. it can be positive, negative or going to the
extremes. How about counter-transference. Is the feelings that is
from an authority figure to the patient, Very similar, but legally,
ethically and spiritually It can be very disturbing to the
children. Slide 6 Is our counter transference The same from person
to person ?. Anba Makarious talked about this 2 weeks. Any person
you talk to especially physician will elaborate on equality of
treatment and Human rights and so on. As mentioned because of
ethical, cultural and legal aspects. What do you think ? Slide 7
This is your 1 st challenge. Any guesses? How equal people are
treated ( I mean medical treatment) in the most civilized country,
with the best medical system in the world and with . The best Slide
8 Slide 9 Here is the reality: From real retrospective studies: In
the 21 st century. African American patients are prescribed
antidepressants, antipsychotics, anti anxiety, pain medications in
much lower doses than their Caucasian counter parts. Even the
quality of medications they receive ! higher doses of old
generation generic meds compared to new generation medications !!!
Slide 10 This study was shocking To some audience but some audience
response was Can you guess? How can we face such a challenge?
Ignore it completely ( suppress it ) or will attempt to face it?
Your call. Slide 11 Everyone ask himself How do I feel about
addicts and addiction ! Any hope? I will give you hope before we
start. Success rate of treatment of patients with addiction. what
do you think, any thoughts ! Slide 12 Treatment is successful. 1 st
year 30%. 2 nd year 60% 3 rd year 90% The percentage plateau (
continue to stay that high) after the 3 rd year. Slide 13 I took
such a substance and I didnt get addicted to it. Or I smoked for
such a period and I stopped in a day. Or my relative drank ETOH
heavily and stopped when he wanted to. And so on This is called
egocentric view of the effect of the substance and helps no one.
Anyone came to his mind this question? Slide 14 So what can we be
addicted to: Nicotine. Alcohol. Drugs ( uppers or downers). Food
Internet. Play station. Gambling Sex. Pornography. Or basically
anything. Slide 15 Substance Abuse DSMIV-TR One or more of those
criteria present for 12 months period : Failure to fulfill major
obligations. Recurrent use in Physically dangerous situations.
Recurrent substance related legal problems. Continued use despite
social or interpersonal problems. Has never met criteria for
dependence. Slide 16 Addiction or dependence A term referring to
compulsive drug use, psychological dependence, and continuing use
despite harm. Addiction is frequently and incorrectly equated with
physical dependence and withdrawal. Pseudo-addiction is when we
think a patient is addicted to pain medications, and he/she is not.
Slide 17 Substance dependence DSM IV-TR Three or more of the
following criteria in 12 months period. Tolerance. Withdrawal. Use
of larger amounts for a longer periods than intended. Unsuccessful
efforts to cut down or control use. Great deal of time spent
related to the substance. Important activities given up. Continued
use despite knowledge of problems. Slide 18 As you noticed Patient
doesnt have to experience tolerance and or withdrawal symptoms.
Patient doesnt have to use the substance or gamble daily. Patient
needs to be aware of the problem. But it is surely compulsive use,
continuous use in spite of harm and psychological dependence. Slide
19 Specifies of substance dependence With or without physiologic
dependence. Early full remission: 1 12 months. Early partial
remission: 1 12 months. ( less symptoms present). Sustained partial
remission: 12 months or more. Sustained full remission: 12 months
or more. Partial remission applies for patient that are prescribed
meds in the same family!!! Slide 20 Addiction And mental illness (
dual diagnosis). Are we hoping for recovery or a complete cure
Recovery and relapses is the rule. 10% rule. Prognosis and success
of treatment. Slide 21 What are we dealing with? Is addiction a
disease or a sin. No answer is needed to that question. Addict has
no choice to be addicted but on the other hand he/she struggles
with sobriety. 5 elements: genetics, pleasure, memory, stress,
choice. Choice and treatment: how and when an addict engages in
treatment ? Slide 22 Cage questionnaire for ETOH as an example for
screening test: Cutting down. Annoyed by others. Guilt feeling
because of drinking. Eye opener. The least common. 25% chance with
each question. Keep in mind that ETOH is the most common used
sleeping aid in the country, without a prescription ! Meaning that
so many people drink daily and they might have developed tolerance
throughout the years. Slide 23 Effect of addiction on the brain.
Patient becomes ( slave to the addictive substance or habit). If
functioning addict( is only to continue having the money to support
it). The whole life evolves around it. They are striving for
freedom from slavery but either afraid or doesnt know how.
Psychological conflicts are a huge burden. Examples: Slide 24 Quote
Every time I go to the movie theater I eat large amount of pop corn
in spite that I dont like pop corn. It is a habit that is
associated with watching movie or with watching football game. I
know that pop corn is bad for my health. The key word here is I
dont like it, but I cant stop it Slide 25 Study by Nora Volkow, MD
She specializes in the biological effect of addiction on the brain.
Using Pet scans to monitor brain cells firing( increased
metabolism) in response to substance use or cues. Decreased
Dopamine transports in striatum possibly secondary to
neurotoxicity. Dopamine transporter is hyperactive during
pleasurable stimuli: a son graduating, love words, a new house or
car. Slide 26 Anterior cingulate gyrus response to cocaine cues
Slide 27 Prefrontal cortex glucose metabolism compared to control.
Especially for Dopamine receptors ( self wellbeing related
receptors). Slide 28 No red at all in pet scan.!!!! Slide 29 Slide
30 Slide 31 Correlation Depression PanicAnxiety Slide 32 Quick
overview of depression: Classification of Depressive D/Os Major
depressive D/O. Dysthymic Disorder. Depressive D/O NOS. Slide 33
DSM IV TR Criteria of Major depressive D/O 5 or more of SIGECAPS
for 2 weeks. S Sleep disturbance. I Interest and pleasure decrease.
G Guilt or worthlessness feelings. E - Energy loss or fatigue. C
Concentration gets poor. A Appetite changes. P Psychomotor
agitation or retardation. S Suicidal or recurrent death thoughts.
Slide 34 Specifies for MDD 1) MDD with psychotic features. 2) MDD
with atypical features. 3) MDD with melancholic features. 4) MDD
with Post partum onset. 5) MDD With seasonal pattern. 6) MDD with
catatonic features. Slide 35 Differential diagnosis. Bipolar d/o.
Mood d/o 2ry to GMC. Substance related mood d/o. Dysthymic d/o.
Dementia. ADHD. Adjustment d/o. Slide 36 Depressive D/O NOS. Minor
depressive disorder. Recurrent brief depressive disorder.
Premenstrual dysphoric disorder. Post psychotic depressive
disorder. Depressive disorder NOS ( 2ry to GMC or a psychoactive
substance). Slide 37 DSM IV-TR Criteria For Dysthymic Disorder
Depressed or irritable mood for 2 years. at least 2 of the
following aschews: A Appetite changes. S Sleep disturbance. C
Concentration and decision making. H Hopelessness. E Energy level.
W Worthlessness. S Self esteem is poor. Slide 38 We saw the brain
chemistry changing with substances What are the centers that are
involved with the addicted substance or habit behavior, reward and
memory. You will be surprised how close they are to each other.
Slide 39 Nucleus Accumbens is the brain center that was identified
to reinforce addictive behavior. Slide 40 Slide 41 VTA cognition,
motivation, addiction as well. Amygdala fight and flight
Hippocampus memory ( pleasurable drug effect eg: cocaine. You could
see how they are all connected. Every patient has his favorite
substance even he might be addicted or dependent on multiple
depends on the pleasure memory stored in Hippocampus. Slide 42 Who
can make the treatment referral Family Friends Clergy Church
helpers or servants. Co-workers. Healthcare professionals. Any
suggestions ? Slide 43 Treatment The individual/ the group Treating
the family as a whole. Including codependence and abuse victims.
Slide 44 The very 1 st step in helping. Spotting early, or the
First, signs. Screening ( random urine analysis). Motivational
interviewing. compassionate confrontations ( confronting a Godly
ego) Be always prepared for resistance that is a sign of the
disease. Slide 45 Slide 46 Who should start the help? Interventions
can be done as well by anyone Professional interventions are done
by health care professionals. When should we convert to
professional interventions. Signs of danger to self and or others.
Slide 47 Slide 48
