For if you remain silent at this time, relief and deliverance for the Jews will arise from another place, but you and your fathers family will perish. And who knows but that you have come to your royal position for such a time as this? Copyright Lighthouse Network1

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Integrating Science and Faith to Renew Your Mind What God taught me through my psychiatric training and my own addiction Karl Benzio, MD

ADDICTION Sin? Disease? Personality Defect? Copyright Lighthouse Network

HELP! I prayed, took meds, and love my mother! Im DYING Psychological Defect- Tell me about your mother! Sin- Have more Faith! Disease- Take your MEDS! Copyright Lighthouse Network 6

Science and Faith Darwin and Freud Faith: the assurance of things hoped for, the conviction of things not seen. Science: Hard Data, Measurables Definitions Collide Do they work together? Copyright Lighthouse Network7

Science and Faith Science is: The study of what God made Understanding how He designed it to work Learning how to maximally steward it for Gods glory and our abundant living Copyright Lighthouse Network8

Gods Great Gifts Mind Free Will: Decision Making Copyright Lighthouse Network9 Science is a tool. So lets not ignore the science. Science is a tool. So lets not ignore the science.

What is Addiction? Copyright Lighthouse Network

DSM 4 TR… Substance Abuse One or more of the following: Failure to fulfill major obligations at work, school or home Use when physically hazardous Recurrent legal problems Recurrent social or interpersonal problems Copyright Lighthouse Network

DSM 4 TR… Substance Dependence (Addiction) Three or more of the following: High or increased Tolerance Withdrawal Consumption of larger amounts over longer period of time than intended Copyright Lighthouse Network

DSM 4 TR… Substance Dependence (Addiction) Three or more of the following (cont): Unsuccessful efforts in cutting down Significant time spent obtaining, using, thinking about or recovering from the substance Substance time replaces social, occupational, or recreational activities Continued use despite adverse consequences physical, psychological (spiritual) Copyright Lighthouse Network

DSM 5: Substance Use Disorders Not using the word addiction Behavioral Category – gambling(was Impulse DO) Considered Sex, Eating, Caffeine, Internet Internet Gaming and Caffeine Use DO will be in the appendix Use same 11 Criteria but: Craving will be added, Legal issues dropped 0-1, 2-3, 4-5, 6+ Copyright Lighthouse Network

American Society of Addiction Medicine 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 circuitry and resultant manifestations lead to the individual pursuing reward and/or relief by substance use and other behaviors. Copyright Lighthouse Network

American Society of Addiction Medicine Inability to consistently Abstain; Impairment in Behavioral control; Craving Diminished recognition of problems with ones behaviors and interpersonal relationships; and A dysfunctional Emotional response. Copyright Lighthouse Network

5 Levels of SA/Addiction EXPERIMENTAL USE: trying substance once or twice. RECREATIONAL USE: using a substance socially, only with friends or at a party CIRCUMSTANTIAL USE: using a substance to escape or avoid personal problems or life circumstances OR using a substance to get through a challenging situation (e.g.: taking caffeine-laced pills to stay awake to study for exams). INTENSIFIED USE: increasing over a long period of time. This describes the regular user who experiences on-going symptoms because of their drug use (physical, psychological, emotional, spiritual). COMPULSIVE USE: True addicts who cant voluntarily give up their substance abuse. They can no longer choose not to use, and suffer significant life and heath disruption because of their addiction. Copyright Lighthouse Network

Bible Definition Exodus 20:3 You shall have no other gods before Me. Exodus 20:4,5 You shall not make for yourself an idol, or any likeness of what is in heaven above or on the earth beneath or in the water under the earth. You shall not worship them or serve them; for I, the Lord your God, am a jealous God, Copyright Lighthouse Network

Bible Definition Mark 12:30 – Greatest Commandment Ezekiel 14 Idols of the heart lead to destruction. God condemns Copyright Lighthouse Network

Real Addiction Rom 7:15 For what I am doing, I do not understand; for I am not practicing what I would like to do, but I am doing the very thing I hate 17So now, no longer am I the one doing it, but sin which dwells in me. 18For I know that nothing good dwells in me, that is, in my flesh; for the willing is present in me, but the doing of the good is not. 19For the good that I want, I do not do, but I practice the very evil that I do not want. 20But if I am doing the very thing I do not want, I am no longer the one doing it, but sin which dwells in me. Copyright Lighthouse Network

Real Addiction 21I find then the principle that evil is present in me, the one who wants to do good. 22For I joyfully concur with the law of God in the inner man, 23but I see a different law in the members of my body, waging war against the law of my mind and making me a prisoner of the law of sin which is in my members. 24Wretched man that I am! Who will set me free from the body of this death? 25Thanks be to God through Jesus Christ our Lord! So then, on the one hand I myself with my mind am serving the law of God, but on the other, with my flesh the law of sin. Copyright Lighthouse Network

Real Addiction Goes deeper than behavior or brain chemistry. Worship is: Perceiving God accurately and responding appropriately Addiction: Misplaced Worship, Worshipping the wrong thing Addiction: Promoting something other than Jesus to the center of your life/heart Solomon: all is vanity, under the sun Copyright Lighthouse Network

Real Addiction Why Addiction: coping skill to help deal with life/stress – Circumstantial Use We all have behaviors to help us cope with life/stress that qualify as addictions that grow out of the idols in our heart Benzio Definition of Addiction: – Choosing or pursuing something other than God (or Him + the healthy solution He provides) in a habitual, patterned, or repetitive way to get a particular need/needs met – A Coping mechanism not focused on God Comfort Were ALL addicted to ……….. Comfort Copyright Lighthouse Network

Real Addiction Addiction Role = Coping skill for stressor management Addiction Goal = COMFORT Addiction Object = the element we turn to thinking it delivers the comfort we desire – Usually a process rather than a concrete object Trading addictions Treatment: Needs to get at the root issues that cause discomfort Copyright Lighthouse Network

HELP! I prayed, took meds, and love my mother! Im DYING Psychological Defect- Tell me about your mother! Sin- Have more Faith! Disease- Take your MEDS! Copyright Lighthouse Network 25

Karls Story Why did I become a psychiatrist? Copyright Lighthouse Network 26

Karls First Beer Copyright Lighthouse Network27

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HARDWARE! Copyright Lighthouse Network

S.P.E.C.T. Scans Single Photon Emission Computerized Tomography A sophisticated nuclear medicine study that looks directly at cerebral blood flow and indirectly at the brain activity (or metabolism) All of the following slides are used with permission fromImages Into Human Behavior - A Brain SPECT Atlas by Daniel Amen, M.D. © Copyright 2000 Copyright Lighthouse Network

Normal Brain-Top Copyright Lighthouse Network

Normal Brain-Bottom Copyright Lighthouse Network

Normal Brain-Active Views Copyright Lighthouse Network

Motorcycle Accident Copyright Lighthouse Network

Alzheimers Disease Copyright Lighthouse Network

25 year Heroin Addiction - 39 yo Copyright Lighthouse Network

10 yr Heroin then 7 yr Methadone - 40 yo Copyright Lighthouse Network

16 Years of Daily THC (Tetrahydrocannibinol) Use 32 yo Copyright Lighthouse Network

2 Years of Daily Marijuana Abuse - 16 yo Copyright Lighthouse Network

10 Years of Mostly Weekend Marijuana Use 28 yo Copyright Lighthouse Network

2 Years of Frequent Cocaine Use - 24 yo Copyright Lighthouse Network

8 Years of Heavy Methamphetamine Use 28 yo Copyright Lighthouse Network

17 Years of Heavy Weekend Alcohol Use 38 yo Copyright Lighthouse Network

17 Years of Heavy Weekend Alcohol Use 38 yo Copyright Lighthouse Network

17 Years of Heavy Weekend Alcohol Use 38 yo Copyright Lighthouse Network

27 Year Daily Heavy Cigarette and Coffee Use 45 yo Copyright Lighthouse Network

PolySubstance Abuse and then 1 yr Clean Copyright Lighthouse Network

Depression Copyright Lighthouse Network Before Treatment After Treatment

Anger and ADD Before/After Treatment with Depakote and Adderall Copyright Lighthouse Network

Paranoid Schizophrenia Before and After Medication/Therapy Copyright Lighthouse Network After Treatment

PTSD, Depression, and Anxiety Before and After St. Johns Wort and EMDR Copyright Lighthouse Network

Images of PMS Copyright Lighthouse Network Day 2 of Cycle (Worst Time) Day 10 of Cycle (Best Time)

Hardware Summary Disease Aspect Our brains are dynamic organs Our brains can be injured or diseased easily Our brains can be strengthened or renewed Not just born this way Copyright Lighthouse Network 56 Hardware Summary

How does the brain malfunction? We need a system that addresses all three spheres: Spirit Mind Body Copyright Lighthouse Network

Body, Mind, & Spirit Body – mechanical, physical, and biochemical functions – Above and below the neck Mind - mental processes and behavior, the mind, heart, will, personality, cognitions, emotions, executive functions Copyright Lighthouse Network

Body, Mind, & Spirit Spirit – Inner – immaterial – our eternal part – allows relationship with God – encodes our uniqueness – differentiates us from other animals – allows unique relationships with others Spirit – Outer – Trinity, angels, Satan, Heaven, Hell Copyright Lighthouse Network

Spirit, Mind, & Body Integration Spirit – inner/outer; Owner/Designer Mind – Operating System Body – Physical Hardware External Events – Software, Viruses Copyright Lighthouse Network

Romans 12:1-2 I therefore urge you, brothers, in view of God's mercies, to offer your bodies as living sacrifices that are holy and pleasing to God, for this is the your spiritual act of worship. Do not be conformed to this world, but continually be transformed by the renewing of your minds so that you may be able to determine what God's will is- what is proper, pleasing, and perfect.

Mind of Christ! Jesus Brain = Perfection! 1.Perceived everything from a Godly perspective 2.Responded with Biblical skills Copyright Lighthouse Network

BrainWorks – My Brain Based on new scientific research, my brain does 2 things 1.Perceives 2.Responds Copyright Lighthouse Network

BrainWorks Research Skin GI / Cardiac Panic Disorder Study Copyright Lighthouse Network 64

Heart of Transformation: Decision-Making No biological Intervention But Brain Chemistry Improved/Renewed Decision-making is exercise for brain Good decisions = stronger brain Bad decisions = injured brain Copyright Lighthouse Network65

What determines accurate Perception and Response? Holy Bible – Gods Instruction Manual DM: Science and Faith Meet Integration and DM are Key! Copyright Lighthouse Network 66 Mind SpiritBody Decision-Making = Spirit, Mind, & BodyIntegration

The Most Important Spiritual Discipline: Copyright Lighthouse Network

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Addiction Everyone struggles – Addicted to comfort Everyone has a Go-To coping skill Everyone has an object, or 2-10, they go to instead of going to God first and often Spiritual issue – Processing stress poorly, not using Creators Manual Psychological Issue – Poor decision: Looking in the wrong place Biological circuit damage Copyright Lighthouse Network69

Summary BH Revolution Society, Life Mngmt Revolution You are a catalyst Science and Faith need to be combined Addiction is a deep issue, not just a behavior Everyone has an addiction or 2 SMB Integration is key to understanding DM is the intersection of Science and Faith, as well as SMB Copyright Lighthouse Network70

Any Questions? Copyright Lighthouse Network

Treatment History 1784 Benjamin Rush, MD – disease, temperance movement 1810 – Rush: Sober House 1825 Rev Lyman Beecher Six Sermons on Intemperance – Addicted to sin 1864 – 1 st Inebriate Asylum treating alcohol, opium, morphine, cocaine, chloral, ether, and chloroform 1867 Martha Washington Home – women only 1872 – Jerry McAuley opens Water Street Mission in NYC. Start of urban mission movement spread by Salvation Army – Dr Leslie Keeley opens 120 Keeley Institutes. For profit treatment facilities Copyright Lighthouse Network

Treatment History 1880s cocaine and other addicting drugs used to help rehab goals – inebriate asylums close and more legal placement than treatment 1906 – Emmanuel Clinic – lay therapists 1907 – sterilization of alcoholics and addicts 1910 – 1930 Most recovery homes and treatment facilities close 1914 – Harrison Act – opiates and cocaine under federal control. MD only 1919: Webb vs US. Supreme Court declares MD must be lowering dose or it is a crime. – Morphine maintenance clinics close Prohibition Copyright Lighthouse Network

Treatment History 1935 Shadel Sanatorium – aversive conditioning 1935 Bill W and Dr Bob meet AA birthed 1939 AA published 1940 EAP started 1940s research and definitions emerge 1940s Carl Rogers – client centered approach 1948 Alcoholics Victorious – Christian AA Minnesota Model born 1950 Antabuse Hollywood depicting alcoholism Copyright Lighthouse Network

Treatment History 1952 AMA defines alcoholism 1954 ASAM forms 1958 – Synanon: 1 st ex-addict directed therapeutic community. Many thru 70s 1960 Jellinek Disease Concept of Alcoholism 1960s: many legal and healthcare organizations adopt disease model 1965 – insurances start to fund 1970s explosion of treatment facilities, JCAHO regs 1974 – licensing criteria for D/A counselors 1985 specialty tracks for age, GLBT, women, chronics, Dual Copyright Lighthouse Network

Treatment History 1991: ASAM placement criteria 1992: Managed care dramatically reduces length of stay and step down IOP/PHP options formed 1993 – Beck cognitive model 1995 – Naltrexone marks new meds for harm reduction treatment 2000 – Holistic, Non 12-Step models Copyright Lighthouse Network

Treatment History Summary Adopting disease model and increased research Many agencies adopting view of helping and not just punishing the addict Minimal clinical treatment advances over last 50 years – most still 12 step/Minnesota Model Some Medical options last 15 years Christian/Medical split still significant but movement in last 15 years is exciting Copyright Lighthouse Network

12 Steps of AA 1.We admitted we were powerless over alcoholthat our lives had become unmanageable. 2.Came to believe that a power greater than ourselves could restore us to sanity. 3.Made a decision to turn our will and our lives over to the care of God (as we understand Him) 4.Made a searching and fearless moral inventory of ourselves. 5.Admitted to God, to ourselves, and to another human being the exact nature of our wrongs. 6.Were entirely ready to have God remove all these defects of character. Copyright Lighthouse Network

12 Steps of AA 7.Humbly asked Him to remove our shortcomings. 8.Made a list of all persons we had harmed, and became willing to make amends to them all. 9.Made direct amends to such people wherever possible, except when to do so would injure them or others. 10.Continued to take personal inventory, and when we were wrong, promptly admitted it. 11.Sought through prayer and meditation to improve our conscious contact with God (as we understand Him) praying only for knowledge of His will for us and the power to carry it out. 12.Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs. Copyright Lighthouse Network

Treatment System Karl Benzio, MD

Co-Occurring/Dual Diagnosis AOS – Addiction only Services – No Psych meds, coordination, groups, personnel DDC - Dual Diagnosis Capable – Can accept but relatively stable psych – Address in groups, policies, D/C planning, coordination of care, policies, and staff – Can give meds, and have psych visiting or arrangements off site DDE - Dual Diagnosis Enhanced Copyright Lighthouse Network

Co-Occurring/Dual Diagnosis DDE - Dual Diagnosis Enhanced – Can take very unstable psych – Specific psych staff in house on treatment team – All staff cross trained – High staff : patient ratios – Close monitoring – Policies, Procedures, Assessment, Treatment, D/C planning all accommodate Dual Dx Copyright Lighthouse Network

ASAM Levels of Care 0.5. Early interventions, Opioid Maintenance 1.Outpatient Treatment 1-D Ambulatory Detox 2.Intensive Outpatient(IOP) and Partial Hospital Treatment (PHP) 2-D Ambulatory Detox 3.Residential/Inpatient Treatment 4.Medically-Managed Intensive Inpatient Treatment Copyright Lighthouse Network

ASAM Assessment Dimensions 1.Acute Intoxication/Withdrawal Potential 2.Biomedical conditions/complications 3.Emotional/Behavioral/Cognitive Issues 4.Readiness to Change 5.Relapse/Continued Use/Continued Problem 6.Recovery Environment Copyright Lighthouse Network

Dimension 1: Intoxication/Withdrawal Past history of serious, life-threatening withdrawal Currently having similar withdrawal symptoms Copyright Lighthouse Network

Dimension 2: Biomedical conditions and complications Any current severe health problems Any chronic ones exacerbated by addiction Copyright Lighthouse Network

Dimension 3: Emotional/Behavioral/Cognitive Imminent danger of harm to self/others Unable to function ADLs - imminent danger Dangerousness driving or with erratic and impulsive actions at home, work, school. Copyright Lighthouse Network

Dimension 4: Readiness to Change Ambivalent or feels treatment unnecessary Coerced, mandated, required assessment/Tx Copyright Lighthouse Network

Dimension 5: Relapse/Continued Use/Continued Problem potential Currently under the influence Continued use/problems imminently dangerous Copyright Lighthouse Network

Dimension 6: Recovery Environment Immediate threats to safety, well-being, sobriety Copyright Lighthouse Network

Focus Assessment and Treatment 1.Multiaxial DSM diagnoses 2.Multidimensional Severity/LOF Profile 3.Which assessment dimensions are most important to determine Tx priorities 4.Specific focus/target for each priority dimension 5.What specific services needed for each dimension Copyright Lighthouse Network

Focus Assessment and Treatment 6.What dose or intensity of these services needed 7.Where can these services be provided in least intensive, but safe level of care? 8.What is progress of Tx plan and placement decision; outcomes measurement? Copyright Lighthouse Network

ASAM Assessment Dimensions 1.Acute Intoxication/Withdrawal Potential 2.Biomedical conditions/complications 3.Emotional/Behavioral/Cognitive Issues 4.Readiness to Change 5.Relapse/Continued Use/Continued Problem 6.Recovery Environment Copyright Lighthouse Network

Treatment Principles Karl Benzio, MD

Necessary Treatment Ingredients Medical aspects – Detox/Psych/Medical/Meds Psychological Depth Spiritual Depth – Application, not just memorization Time Supervision/Accountability Copyright Lighthouse Network

Secular Treatment Goals: Life Management Strategies Living Basics Strategy: – Shelter, Food, Income, work/structure Treatment Logistics Strategy – Outpt Tx, ind, couples, fam, med mngmt – Meetings, Sponsor Physical – No subst, med regimen clear – Sleep, nutrition, exercise Copyright Lighthouse Network

Secular Treatment Goals: Life Management Strategies Psychological Strategy – Relaxation – 12 Steps – Community – Behavior modification – No deeper equipping or reproducible strategy – Not Divinely empowered Copyright Lighthouse Network

Christian Treatment Goals: Life Management Strategies Living Basics Strategy: – Shelter, Food, Income, work/structure Logistical Treatment Strategy – Outpt Tx, Ind, Couples, Fam, med mngmt – Christian Meetings, Sponsor, Church Physical – No subst, med regimen clear – Sleep, nutrition, exercise Copyright Lighthouse Network

Christian Treatment Goals: Life Management Strategies Psychological Strategy – Get at core issues – not just sobriety – Practiced regularly, – Have it as muscle memory default system – Use the same strategy no matter the situation Dont have to sort through different tools or strategies – Slows life down – Every thought captive to obedience of Christ – Emotion management – Reflection and Self-Assessment Copyright Lighthouse Network

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Considerations/Obstacles Complicated Clinical Issue – most difficult patient Poor Research Minnesota Model simplistic but entrenched CAC, CADC MH vs D/A – problem with specialization Christian vs. spiritual/holistic vs. traditional Complicated Healthcare system – Insurance – UR, Level of Care (LOC) Programming Issues Copyright Lighthouse Network

Consideration/Obstacles Complicated Clinical Issue – Most difficult patient – Excuses/Lying/Manipulation – Underlying Core issues pt really wants cover – Trauma – Brain damage, so cognitively challenged – Compromised resources Family Money/insurance Relationships Job/Legal Copyright Lighthouse Network

Considerations/Obstacles Poor Research – Patients are hard to find and get followup info – Followup needs to be over significant time – Disorder is multivariate in etiology – Treatments have many subtleties that are hard to quantify Copyright Lighthouse Network

Considerations/Obstacles Minnesota Model(Hazeldon) of alcoholism – Simplistic and outdated – Entrenched as the Gold Standard – Alcoholism is involuntary – Primary Disease – Not Curable, but arrestable – Tx – Spirit, psychological, social, medical – AA is essential component – Sometimes not approving of psychotropic medications for psychiatric issues Copyright Lighthouse Network

Considerations/Obstacles CAC, CADC – Front line treatment personnel – Often run groups – HS diploma or above – Equivalent of 5-6 college courses Often only 3-5 hour modules in superficial format not building depth of understanding – some supervised work in the field that is often unspecified and supervised by another CAC/CADC Copyright Lighthouse Network

Considerations/Obstacles MH vs D/A – Which is primary – Not many therapists well versed in an integrated and practical addiction/psychological paradigm – Patient has to coordinate the 2 different treatment areas - Problem with specialization – Some rehabs wont even accept psych meds – Trouble getting to the core issues underlying the addictive coping skill – Problem with CAC being the primary therapist as no classes in MH issues. Copyright Lighthouse Network

Considerations/Obstacles Christian vs. spiritual/holistic vs. traditional – Traditional – usually medical with Minnesota Higher Power of AA No Divine power – Spiritual / Holistic – yoga, equine, reiki, Medical model with Minnesota 12 step model – Christian Work farm/Discipleship(10w – 14mos) No psych/medical Minimal psychological Bible memorization, limited application – Christian Medical – out of network usually Minimal psychological integration Copyright Lighthouse Network

Considerations/Obstacles Complicated Healthcare System – Voluntary vs. Legal Commitment – Third party managers – Insurance – PPO, HMO, UR – Level of Care (LOC) – Addictions treatment nebulous – Outcomes often poor – Stigma Lack of full disclosure by patient Wait to long to access treatment – Lack of clinicians understanding of illness and system – Lack of lay person understanding of illness and system – Lack of SMB Integration from either side – medical or church Copyright Lighthouse Network

Considerations/Obstacles Programming Issues – Heterogeneous Population – Admitted on different days – Patchwork program – pt has to integrate and organize – Not enough programming each day – Not enough Homework or practicing skills – Not enough experiential implementation – Skill set of staff limited – Not addressing core issues because of above limits Most is behavioral mod and not insight oriented – Minimal practical equipping Copyright Lighthouse Network

Other Treatment Components Gender Specific Age Specific Newbys vs frequent fliers Opioid specific Harm Reduction Models Dual Diagnosis Copyright Lighthouse Network

Holistic, Not Primary Disease, Approach Like an ED model WHY do you use – faulty coping skill Not 12 Step More psychological Getting at core issues Customized Less behavioral mod and more transformational in goal and communicated approach Lots of room for Christian integration Curable

Recovery Homes Halfway House ¾ House Structure Supervision Tough to find in secure locations Copyright Lighthouse Network

Recovery Groups Many offshoots of AA – NA, CA, GA, Sexaholics A, Overeaters A Christian alternatives – Celebrate Recovery – Addictions Victorious – Overcomers in Christ – Reformers Unanimous – Christian Recovery Online Copyright Lighthouse Network

Perfect Treatment Option Doesnt exist Have to triage needs Understand the $ resources available Piece together the realistic treatment options Copyright Lighthouse Network

What You Need To Know What you can do – outsourcing is OK and necessary Who your patient is What your patient needs The system - as best as possible Who to call to help you with options Who is going to be the quarterback of the complicated and long treatment process Copyright Lighthouse Network

Client Intake Form The Basics to Help Determine Next Step

Lighthouse Network Helpline Finds addiction and MH treatment options. Expertise about all elements of the system Free to client Saves the clinician incredible amounts of time We find great options for struggling people x:101 Copyright Lighthouse Network117

Lighthouse NETWORK Resources Within Reach: Disciplines for Real Life Change – 10+ Hours of DVD – 140 Page Workbook Edging Forward: Godly Decision Making Parenting: Early Childhood and Teens (DVD) Can Psych Meds Help Christians? (DVD) Addiction: Sin vs. Disease DVD Stepping Stones Daily Devotional - Free

Any Questions? Copyright Lighthouse Network