“WHAT IS NEEDED, AND WHAT WORKS IN

TREATMENT FOR ADDICTION”(A Humanitarian Crisis in the United States)

GARRETT O’CONNOR, M.D.Medical Director, The Elaine Breslow

Institute forPurposeful Living at Beit T’Shuvah, Los

Angeles

WHAT IS NEEDED? a National Summit to identify and reduce conflict between warring factions in the Rx. field.

1. Urgent Education for ALL Physicans, Clergy and other

Addiction “First Responders” to understand and even

admire the mind, soul, shame and survival behaviors of

alcoholics and other addicts.

2. Promote Community-based Recovery Oriented Systems

of Care (ROSC).

3. Re-consider MAT (Methadone & Suboxone) as the # 1

Option for Treatment of Opioid Dependence.

4. A MASSIVE barrage of co-ordinated Outcome

5. Hold studies to compare different Treatment Modalities

• INTEGRATING TEN CULTURES!

ACTIVE ADDICTION

INTERNAL MEDICINE & NEUROLOGY

ABSTINENCE AND FAITH-BASED TREATMENT

12-STEP SPIRITUAL RECOVERY

PHARMACOTHERAPY & HARM REDUCTION

BEHAVIORAL & DYNAMIC PSYCHIATRY

TRANSLATIONAL CLINICAL NEUROSCIENCE

CORPORATE/ NON-PROFIT/ PUBLIC HEALTH

DRUG AND ALCOHOL INDUCED SUFFERING

• SEVERE WITHDRAWAL SYNDROME* • COMPREHENSIVE LOSSES* • DESPAIR, COPELESSNESS* • EXTENSIVE COLLATERAL SOCIAL DAMAGE* • FAMILY DESTRUCTION WITH RUINED KIDS* • SERIOUS LEGAL CONSEQUENCES*• DISMISSAL, DEMOTION OR

UNEMPLOYMENT* • FINANCIAL COLLAPSE* • PHYSICAL, MENTAL, SPIRITUAL

SICKNESS*• SOUL-ROTTING MALIGNANT SHAME* • BECOMING DE-HUMANIZED* • PSYCHACHE LEADING TO SUICIDAL IDEAS*

SOME SURVIVAL BEHAVIORS IN THE CAMPS • HEROIC COURAGE• ALTRUISM• SELFLESS

GENEROSITY• BEGUILING CHARM• DENIAL• MORAL DECLINE• NUMBED FEELINGS

& AVOIDANCE • INTER-PERSONAL

TERRORISM• BLAMING OTHERS

• DEVIOUSNESS• LYING• LOSS OF

CONTROL• VINDICTIVENESS• THEFT• THREATENING

BEHAVIOR• SERIOUS

VIOLENCE• TREACHERY• BETRAYAL• ABANDONMENT

Some Survival Behaviors in the Camps

SOME SURVIVAL BEHAVIORS IN ADDICTION

• HEROIC COURAGE• ALTRUISM*• SELFLESS

GENEROSITY*• BEGUILING CHARM*• DENIAL*• MORAL DECLINE*• NUMBED FEELINGS

& AVOIDANCE* • INTER-PERSONAL

TERRORISM*• BLAMING OTHERS*

• DEVIOUSNESS*• LYING*• LOSS OF CONTROL*• VINDICTIVENESS*• THEFT• THREATENING

BEHAVIOR*• SERIOUS

VIOLENCE*• TREACHERY*• BETRAYAL*• ABANDONMENT*

LIBERATION(FREEDOM FOR THE PRISONERS)

•CULTURE SHOCK•DEPERSONALIZATION•DISILLUSIONMENT•ANGER MANAGEMENT PROBLEMS•AMBIVALENCE & INDECISION•TRUST! TALK OR NOT? AND TO WHOM?•SURVIVOR’S SILENCE, GUILT AND SHAME! •++PTSD SEQUELAE (INSOMNIA, PSYCHO-SOMATIC DISORDERS,, COPELESSNESS ETC.)•++PHYSICAL & MENTAL DISORDERS•++RELATIONSHIP/MARITAL AND WORK PROBLEMS•++PSYCHIATRIC PROBLEMS INCLUDING -DEPRESSION AND SUICIDE

LIBERATION RECOVERY OF THE CAMPS(SOBRIETY FOR THE ADDICTS)

•CULTURE SHOCK*

•DEPERSONALIZATION*

•DISILLUSIONMENT*

•ANGER MANAGEMENT PROBLEMS*

•AMBIVALENCE & INDECISION*

•TRUST! TO TALK OR NOT? AND TO WHOM?*

•SURVIVOR’S SILENCE, GUILT AND SHAME!*

•++PTSD SEQUELAE (INSOMNIA, PSYCHO-SOMATIC DISORDERS,, COPELESSNESS* ETC.)

•++PHYSICAL* & MENTAL DISORDERS

•++RELATIONSHIP/MARITAL* AND WORK PROBLEMS*

•++PSYCHIATRIC PROBLEMS INCLUDING

•++DEPRESSION* AND SUICIDE

THE

DOCTOR’S OFFICE

MAY BE THE

MOST DANGEROUS PLACE

FOR AN ADDICT OR ALCOHOLIC

TO SEEK HELP!

What Works in Treatment?

• 1. AA (Humphries, Laudet, Kaskutas, et al.)

• 2. 90+ days In-Pt. Rx. w/ 5 years of Mandatory Monitoring (DuPont, McClellan,) et al.

• 3. ROSC – Outcome Research ongoing

• 4. Long-term (6+ mo.) Faith-based In-Pt. Rx.

• 5. Medication-Assisted Rx. (Harm Reduction)

• 6. 12-Step Facilitation w/CBT + Mindfulness

•