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Disease concept 041313 farley
This document discusses whether alcoholism and drug addiction should be considered diseases. It notes that chemicals can be considered addictive if they are mind-altering, reinforcing, and euphoric. It then examines various classes of drugs and their addictive potential. While illegal drugs and alcohol cause many deaths daily in the US, nicotine causes even more. The document explores how viewing addiction as a disease rather than a moral failing can help promote treatment. Brain imaging shows how drugs alter brain function and blood flow in ways that can hijack one's mind and life. Maintaining abstinence is important for recovery due to the chronic, relapsing nature of addiction.
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Disease concept 041313 farley
- 1. ARE ALCOHOLISM &DRUGARE ALCOHOLISM & DRUG ADDICTION REALLYADDICTION REALLY DISEASES, AND IF SO,DISEASES, AND IF SO, SO WHAT ?SO WHAT ? THE FARLEY CENTERTHE FARLEY CENTER 04/13/1304/13/13 WILLIAMSBURG, VAWILLIAMSBURG, VA
- 2. LYNNLYNN HANKESHANKES, MD,FASAM, MD, FASAM Clinical Professor EmeritusClinical Professor EmeritusClinical Professor EmeritusClinical Professor Emeritus Department of PsychiatryDepartment of Psychiatry and Behavioral Scienceand Behavioral Science University of WashingtonUniversity of Washington School of MedicineSchool of Medicine SeattleSeattle
- 3. ADDICTIONADDICTION ALCOHOLISMALCOHOLISM & ANY& ANYOTHEROTHER DRUG DEPENDENCYDRUG DEPENDENCY == CHEMICAL DEPENDENCYCHEMICAL DEPENDENCY
- 4. CHEMICAL IS ADDICTIVEIFCHEMICAL IS ADDICTIVE IF 1. MIND ALTERING1. MIND ALTERING--MOOD CHANGINGMOOD CHANGING1. MIND ALTERING1. MIND ALTERING--MOOD CHANGINGMOOD CHANGING 2. REINFORCING2. REINFORCING 3. EUPHORIGENIC3. EUPHORIGENIC
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- 6. CHEMICAL CLASSESCHEMICAL CLASSES OPIOIDSOPIOIDS SEDATIVESEDATIVE--HYPNOTICSHYPNOTICS STIMULANTSSTIMULANTS PERCEPTUALDISTORTERSPERCEPTUAL DISTORTERS CANNABINOIDSCANNABINOIDS INHALANTSINHALANTS
- 7. ADDICTIVE POTENTIALADDICTIVE POTENTIAL COCAINE/METHAMPHETAMINECOCAINE/METHAMPHETAMINE SYNTHETICOPIOIDS (FENTANYL)SYNTHETIC OPIOIDS (FENTANYL) HEROINHEROINHEROINHEROIN MINOR OPIOIDSMINOR OPIOIDS NICOTINENICOTINE ALCOHOLALCOHOL
- 8. ADDICTIVE POTENTIALADDICTIVE POTENTIAL OTHERSEDATIVESOTHER SEDATIVES OTHER STIMULANTSOTHER STIMULANTS PERCEPTUAL DISTORTERSPERCEPTUAL DISTORTERSPERCEPTUAL DISTORTERSPERCEPTUAL DISTORTERS CANNABINOIDSCANNABINOIDS CAFFEINECAFFEINE
- 9. U.S. MORTALITYU.S. MORTALITY ILLEGALDRUGSILLEGAL DRUGS ALCOHOLALCOHOL 10 PER DAY10 PER DAY 400 PER DAY400 PER DAYALCOHOLALCOHOL ?? NICOTINENICOTINE 400 PER DAY400 PER DAY 1000 PER DAY1000 PER DAY
- 10. DEPENDENCYDEPENDENCY Loss OfLoss OfCControlontrol CCompulsive Useompulsive UseCCompulsive Useompulsive Use Continued Use DespiteContinued Use Despite AdverseAdverse CConsequencesonsequences
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- 17. DISEASEDISEASE A DYSFUNCTIONALA DYSFUNCTIONALADYSFUNCTIONALA DYSFUNCTIONAL STATE WITHSTATE WITH CHARACTERISTICCHARACTERISTIC FORMFORM
- 18. CHARACTERISTIC FORMCHARACTERISTIC FORM CAUSECAUSE SPECIFICDEFECTSPECIFIC DEFECT SXSX--SIGNSSIGNS--LAB TESTSLAB TESTSSXSX--SIGNSSIGNS--LAB TESTSLAB TESTS PREDICTABLE COURSEPREDICTABLE COURSE UNIFORM TREATMENTUNIFORM TREATMENT SIMILAR RESPONSESIMILAR RESPONSE
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- 20. DIABETESDIABETES CAUSECAUSE DEFECTDEFECT UNKNOWNUNKNOWN Insulin ImbalanceInsulin Imbalance YESYESSXSX--SIGNSSIGNS--LABLAB COURSECOURSE SAMETXSAME TX RESPONSERESPONSE YESYES YESYES DietDiet--PillsPills--InsulinInsulin YESYES
- 21. AIDSAIDS CAUSECAUSE DEFECTDEFECT HIV +/HIV +/--CoCo--FF T 4 CELLT 4 CELL SXSX--SIGNSSIGNS--LABLAB COURSECOURSE SAME TXSAME TX RESPONSERESPONSE YESYES YESYES UNKNOWNUNKNOWN N/AN/A
- 22. CHEMICAL DEPENDENCYCHEMICAL DEPENDENCY CAUSECAUSE DEFECTDEFECT UNKNOWNUNKNOWN CHEM/PSYIMBLNCECHEM/PSY IMBLNCE YESYESSXSX--SIGNSSIGNS--LABLAB COURSECOURSE SAME TXSAME TX RESPONSERESPONSE YESYES YESYES AAAA--OUT PTOUT PT--IN PTIN PT YESYES
- 23. “MEDICALIZE”“MEDICALIZE”-- IT’S AIT’SA DISEASE BECAUSE:DISEASE BECAUSE: BEING SICK IS LESS SHAMEFUL THANBEING SICK IS LESS SHAMEFUL THAN WILLFUL MISCONDUCTWILLFUL MISCONDUCTWILLFUL MISCONDUCTWILLFUL MISCONDUCT THEN INSURANCE WILL PAY FOR TXTHEN INSURANCE WILL PAY FOR TX HAVING AN ILLNESS ABSOLVES ONEHAVING AN ILLNESS ABSOLVES ONE FROM SOCIAL RESPONSIBILITYFROM SOCIAL RESPONSIBILITY
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- 25. CHRONICITYCHRONICITY PERMANENTPERMANENT NOT ALCOHOLNOT ALCOHOL--WASWAS--MM BUTALCOHOLBUT ALCOHOL--------ISIS--MM PRONE TO RELAPSEPRONE TO RELAPSE DIABETESDIABETES CORONARY INSUFFICIENCYCORONARY INSUFFICIENCY ALCOHOLISMALCOHOLISM
- 26. PRIMARYPRIMARY PRIMARY: Stands aloneindependentlyPRIMARY: Stands alone independently SECONDARY: To underlying primary ds.SECONDARY: To underlying primary ds. NEUROSISNEUROSISNEUROSISNEUROSIS PSYCHOSISPSYCHOSIS
- 27. PREDICTABLEPREDICTABLE Often progressive in4 Stages:Often progressive in 4 Stages: EARLYEARLY---->>EARLYEARLY---->> MIDDLEMIDDLE---->> LATELATE---->> TOO LATE +TOO LATE +
- 28. “CATCHING”“CATCHING” THE ________ IS“CATCHING”THE ________ IS “CATCHING” THETHE INSANITYINSANITY IS “CATCHING!”IS “CATCHING!”THETHE INSANITYINSANITY IS “CATCHING!”IS “CATCHING!” The stress of living with an alcoholicThe stress of living with an alcoholic produces dysfunctional coping behaviorproduces dysfunctional coping behavior similar to that in post traumatic stresssimilar to that in post traumatic stress syndrome !!syndrome !!
- 29. WHO ?WHO ? EVERYONEEVERYONEEVERYONEEVERYONE FROM“YALE TO JAIL”FROM “YALE TO JAIL”
- 30. QUESTION ?QUESTION ? A.A.YOU’RE ALCOHOLICYOU’RE ALCOHOLIC BECAUSE YOU DRINK TOOBECAUSE YOU DRINK TOO MUCHMUCHMUCHMUCH B.B. YOU DRINK TOO MUCHYOU DRINK TOO MUCH BECAUSE YOU’REBECAUSE YOU’RE ALCOHOLICALCOHOLIC
- 31. ANSWER !ANSWER ! B.YOU DRINK TOOB. YOU DRINK TOOB. YOU DRINK TOOB. YOU DRINK TOO MUCH BECAUSEMUCH BECAUSE YOU’RE ALCOHOLICYOU’RE ALCOHOLIC
- 32. OLD THEORYOLD THEORY HEAVYDRINKINGHEAVY DRINKING------>> ABUSEABUSE------>> ALCOHOLISMALCOHOLISM
- 33. ALCOHOL ABUSEALCOHOL ABUSE MEDICATESTRESSMEDICATE STRESS MEDICATE MENTAL ILLNESSMEDICATE MENTAL ILLNESS MOST TEENAGERSMOST TEENAGERSMOST TEENAGERSMOST TEENAGERS MOST COLLEGE STUDENTSMOST COLLEGE STUDENTS SOCIOPATHSSOCIOPATHS
- 34. NEW THEORYNEW THEORY SOCIALDRINKINGSOCIAL DRINKING (NORMAL)(NORMAL) ABUSEABUSE (DISORDER)(DISORDER) ALCOHOLISMALCOHOLISM (DISEASE)(DISEASE)
- 35. NEW THEORYNEW THEORY SOCIALDRINKINGSOCIAL DRINKING (CAN STOP)(CAN STOP) ABUSEABUSE (MIGHT STOP)(MIGHT STOP) ALCOHOLISMALCOHOLISM (CAN’T STOP)(CAN’T STOP)
- 36. DOUBLE MARTINIDOUBLE MARTINI TESTTEST HEAVYDRINKERHEAVY DRINKER ABUSERABUSER ALCOHOLICALCOHOLIC
- 37. “…the addicted brainis, in fact,“…the addicted brain is, in fact, different in its neurobiologydifferent in its neurobiology from the nonfrom the non--addicted brain.”addicted brain.” Alan Leshner, Ph.D.Alan Leshner, Ph.D. Director, NIDADirector, NIDA
- 38. DRUG ADDICTION ISA COMPLEX ILLNESSDRUG ADDICTION IS A COMPLEX ILLNESSDRUG ADDICTION IS A COMPLEX ILLNESSDRUG ADDICTION IS A COMPLEX ILLNESS www.drugabuse.gov
- 39. “ …a drughijacks one’s brain,“ …a drug hijacks one’s brain, thereby hijacking one’s mind, andthereby hijacking one’s mind, and then one’s life.”then one’s life.” Alan Leshner, Ph.D.Alan Leshner, Ph.D. Director, NIDADirector, NIDA
- 40. BASIC BRAIN FUNCTIONBASICBRAIN FUNCTION All systems in balanceAll systems in balance Chemical messengers:Chemical messengers: ––act fastact fast ––short durationshort duration ––small amountssmall amounts
- 42. ALCOHOL & DRUGSALCOHOL& DRUGS Alter the balance of the systemAlter the balance of the system Change the messengers:Change the messengers: ––slowed downslowed down ––prolonged actionprolonged action ––decreased responsedecreased response
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- 46. SPECT/PET SCANSSPECT/PET SCANS ALTERSBRAIN BLOOD FLOWALTERS BRAIN BLOOD FLOW ––INCREASEDINCREASED to areasto areas––INCREASEDINCREASED to areasto areas required for drug userequired for drug use –– decreaseddecreased to areas of thinking,to areas of thinking, learning, and memorylearning, and memory
- 48. controlcontrol on cocaineoncocaine www.drugabuse.gov
- 49. SPECT / PETScansSPECT / PET Scans Reduced brain glucoseReduced brain glucose (70(70--80% of brain energy)80% of brain energy)(70(70--80% of brain energy)80% of brain energy) Decreased brain functionDecreased brain function
- 51. WHY LOSS OFCONTROL ?WHY LOSS OF CONTROL ? ALTERED BLOOD FLOWALTERED BLOOD FLOW ALTERED MESSENGERS & EFFECTSALTERED MESSENGERS & EFFECTS DECREASED BRAIN GLUCOSEDECREASED BRAIN GLUCOSEDECREASED BRAIN GLUCOSEDECREASED BRAIN GLUCOSE DECREASED BRAIN DOPAMINEDECREASED BRAIN DOPAMINE CELLULAR CHANGE OR DAMAGECELLULAR CHANGE OR DAMAGE
- 53. SPECT / PETScansSPECT / PET Scans Cellular damageCellular damage
- 56. SO IT’S ADISEASE !SO IT’S A DISEASE ! SO WHAT ?SO WHAT ?SO WHAT ?SO WHAT ?
- 57. CHRONICITYCHRONICITY PERMANENTPERMANENT NO RETURN TOSOCIAL DRINKINGNO RETURN TO SOCIAL DRINKING NO RECREATIONAL DRUG USENO RECREATIONAL DRUG USE PRONE TO RELAPSEPRONE TO RELAPSE BUILD A DEFENSE VS. 1ST DRINKBUILD A DEFENSE VS. 1ST DRINK RECOVERY REQUIRES MAINTENANCERECOVERY REQUIRES MAINTENANCE
- 58. “There exists, therefore,outside of“There exists, therefore, outside of alkaloids and habit, a sense foralkaloids and habit, a sense for opium, an intangible habit whichopium, an intangible habit which lives on, despite the recasting of thelives on, despite the recasting of the organism. The dead drug leaves aorganism. The dead drug leaves a ghost behind. At certain hours itghost behind. At certain hours itghost behind. At certain hours itghost behind. At certain hours it haunts the house.”haunts the house.” JeanJean CocteauCocteau French AuthorFrench Author 18891889--19631963
- 59. “ We areunable, at certain times, to“ We are unable, at certain times, to bring into our consciousness withbring into our consciousness with sufficient force the memory of sufferingsufficient force the memory of suffering and humiliation of even a week or aand humiliation of even a week or a month ago.”month ago.” Alcoholics AnonymousAlcoholics Anonymous AA World Services, IncAA World Services, Inc New York,New York, 19391939
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- 62. MAINTENANCEMAINTENANCE ALCOHOLICS ANONYMOUSALCOHOLICS ANONYMOUSALCOHOLICSANONYMOUSALCOHOLICS ANONYMOUS AA is evidenced based, empirically validated, and scientifically established as the best form of maintenance treatment to date!
- 63. PRIMARYPRIMARY NO UNDERLYING DISEASETO TXNO UNDERLYING DISEASE TO TX TOTAL ABSTINENCE IS NECESSARYTOTAL ABSTINENCE IS NECESSARYTOTAL ABSTINENCE IS NECESSARYTOTAL ABSTINENCE IS NECESSARY
- 64. Willam Silkworth, MD:WillamSilkworth, MD: “…the action of alcohol on these chronic“…the action of alcohol on these chronic alcoholics is a manifestation of analcoholics is a manifestation of an allergyallergy.” (page xxviii).” (page xxviii) Alcoholics AnonymousAlcoholics Anonymous AA World Services, IncAA World Services, Inc New York,New York, 19391939
- 65. ALLERGYALLERGY TO PENICILLINTO PENICILLIN TOMILKTO MILKTO MILKTO MILK TO ALCOHOLTO ALCOHOL Therefore,Therefore, TOTAL ABSTINENCETOTAL ABSTINENCE
- 66. PATHOLOGYPATHOLOGY TARGET ORGAN=BRAINTARGET ORGAN=BRAIN DEFECT=CHEMICALIMBALANCEDEFECT=CHEMICAL IMBALANCE THEN:THEN: AVOIDAVOID THE CHEMICALTHE CHEMICAL AVOIDANCE=AVOIDANCE=ABSTINENCEABSTINENCE ABSTINENCE=TOTALABSTINENCE=TOTAL
- 67. TOTAL ABSTINENCETOTAL ABSTINENCE AVOIDALL LIKE DRUGS:AVOID ALL LIKE DRUGS: BARBITURATESBARBITURATES NONNON--BARBITURATE SEDATIVESBARBITURATE SEDATIVES BENZODIAZEPINESBENZODIAZEPINES ––ANXIOLYTICSANXIOLYTICS ––HYPNOTICSHYPNOTICS
- 68. TOTAL ABSTINENCETOTAL ABSTINENCE AVOIDALL ADDICTIVE DRUGS:AVOID ALL ADDICTIVE DRUGS: OPIOIDSOPIOIDS STIMULANTSSTIMULANTS PERCEPTUAL DISTORTERSPERCEPTUAL DISTORTERS CANNABINOIDSCANNABINOIDS INHALANTSINHALANTS
- 69. TOTAL ABSTINENCETOTAL ABSTINENCE CAUTIONOTHER DRUGS:CAUTION OTHER DRUGS: OTC DECONGESTANTSOTC DECONGESTANTS OTC ANTIHISTAMINESOTC ANTIHISTAMINESOTC ANTIHISTAMINESOTC ANTIHISTAMINES STEROIDSSTEROIDS MUSCLE RELAXANTSMUSCLE RELAXANTS “NON“NON--ADDICTIVE” ANALGESICSADDICTIVE” ANALGESICS “NON“NON--ADDICTIVE” SEDATIVESADDICTIVE” SEDATIVES
- 70. PREDICTABLEPREDICTABLE ONLY 3 OPTIONS:ONLY3 OPTIONS: LOCKED UPLOCKED UP COVERED UPCOVERED UP SOBER UPSOBER UP
- 71. “CATCHING”“CATCHING” ADDICTION IS AFAMILY AFFLICTIONADDICTION IS A FAMILY AFFLICTION THEREFORE: TX THE FAMILY AS WELL !THEREFORE: TX THE FAMILY AS WELL !
- 74. SPOUSE/ S OSPOUSE/S O COCO--DEPENDENCY TREATMENTDEPENDENCY TREATMENTCOCO--DEPENDENCY TREATMENTDEPENDENCY TREATMENT ALAL--ANONANON
- 76. CHILDRENCHILDREN FAMILY THERAPYFAMILY THERAPY ACOA(Adult Children Of Alcoholics)ACOA (Adult Children Of Alcoholics)ACOA (Adult Children Of Alcoholics)ACOA (Adult Children Of Alcoholics) ALAALA--TEENTEEN ALAALA--TOTTOT
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- 79. THEREFORE, ADDRESSTHEREFORE, ADDRESS NOTNOTMORALLYMORALLY BUTBUT MEDICALLYMEDICALLYBUTBUT MEDICALLYMEDICALLY WITH:WITH: ––DIGNITYDIGNITY ––PRIVACYPRIVACY ––CONFIDENTIALITYCONFIDENTIALITY
- 80. REFERENCEREFERENCE Lewis, DC: ADisease Model ofLewis, DC: A Disease Model of Addiction. In NS Miller & MCAddiction. In NS Miller & MC Doot (eds.)Doot (eds.) Principles ofPrinciples of Addiction MedicineAddiction Medicine (1994).(1994).Addiction MedicineAddiction Medicine (1994).(1994). Chevy Chase, Maryland,Chevy Chase, Maryland, American Society of AddictionAmerican Society of Addiction Medicine, section 1, Chapter 7,Medicine, section 1, Chapter 7, pages 1pages 1--8.8.
- 82. THE “MESSAGE”THE “MESSAGE” CD=ALCOHOLISM & ANYC D=ALCOHOLISM & ANY OTHEROTHER DDDD C D=A DISEASE STATEC D=A DISEASE STATE NO ONE IS IMMUNENO ONE IS IMMUNENO ONE IS IMMUNENO ONE IS IMMUNE DENIAL=CHIEF SXDENIAL=CHIEF SX----MAJOR OBSTACLEMAJOR OBSTACLE INTERVENTION IS NECESSARYINTERVENTION IS NECESSARY
- 83. THE “THE “MESSAGEMESSAGE”” TX= BIOTX = BIO--PSYCHOPSYCHO--SPIRITUALSPIRITUAL AA/NA IS ESSENTIALAA/NA IS ESSENTIAL MONITORING IS CRITICALMONITORING IS CRITICALMONITORING IS CRITICALMONITORING IS CRITICAL TX WORKS W/UNALTERED RXTX WORKS W/UNALTERED RX REHABILITATEREHABILITATE DON’T TERMINATEDON’T TERMINATE