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St Marys and Arch Angel Mikhail Church, Houston Tx Servants meeting June 2013.

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Presentation on theme: "St Marys and Arch Angel Mikhail Church, Houston Tx Servants meeting June 2013."— Presentation transcript:

1 St Marys and Arch Angel Mikhail Church, Houston Tx Servants meeting June 2013

2 All things are lawful to me but I will not be brought under the power of any 1 Corinthian 6:12.

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.

4 Before we define addiction We need to talk about some psychodynamic theories that will help us. What is transference ? What is counter-transference?

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.

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 ?

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


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 !!!

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.

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 !

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.

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?

14 So what can we be addicted to: Nicotine. Alcohol. Drugs ( uppers or downers). Food Internet. Play station. Gambling Sex. Pornography…. Or basically anything.

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.

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.

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.

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.

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!!!

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.

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 ?

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.

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:

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

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.

26 Anterior cingulate gyrus response to cocaine cues

27 Prefrontal cortex glucose metabolism compared to control. Especially for Dopamine receptors ( self wellbeing related receptors).

28 No red at all in pet scan.!!!!



31 Correlation Depression PanicAnxiety

32 Quick overview of depression: Classification of Depressive D/Os Major depressive D/O. Dysthymic Disorder. Depressive D/O NOS.

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.

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.

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.

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).

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.

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.

39 Nucleus Accumbens is the brain center that was identified to reinforce addictive behavior.


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.

42 Who can make the treatment referral Family Friends Clergy Church helpers or servants. Co-workers. Healthcare professionals. Any suggestions ?

43 Treatment The individual/ the group Treating the family as a whole. Including codependence and abuse victims.

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.


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.



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