For if you remain silent at this time, relief and deliverance for the Jews will arise from another...

transcript

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

Integrating Science and Faith to Renew Your Mind

What God taught me through my psychiatric training and my own addiction

Karl Benzio, MD

HELP! I prayed, took meds, and love

my mother!I’m DYING

Psychological Defect-Tell me about your

mother!

Sin- Have more Faith!

Disease- Take your MEDS!

Science and FaithScience 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?

Science and FaithScience and Faith

Science is:• The study of what God made

• Understanding how He designed it to work

• Learning how to maximally steward it for God’s glory and our abundant living

God’s Great God’s Great GiftsGifts

MindFree Will: Decision Making

Science is a tool.Science is a tool.So let’s not ignore the science.

What is Addiction?

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

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

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)

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+

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.

American Society of Addiction Medicine

•Inability to consistently Abstain;•Impairment in Behavioral control;•Craving•Diminished recognition of problems with one’s behaviors and interpersonal relationships; and•A dysfunctional Emotional response.

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 can’t “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.

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,

Bible Definition

• Mark 12:30 – Greatest Commandment

• Ezekiel 14 Idols of the heart lead to destruction. God condemns

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 2013 - 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.

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

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

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

HELP! I prayed, took meds, and love

my mother!I’m DYING

Psychological Defect-Tell me about your

mother!

Sin- Have more Faith!

Disease- Take your MEDS!

KarlKarl’’s s StoryStory

Why did I become a

psychiatrist?

Karl’s First Karl’s First BeerBeer

Hardware!

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 from “Images Into Human Behavior - A Brain SPECT Atlas” by

Normal Brain-Top

Normal Brain-Bottom

Normal Brain-Active Views

Motorcycle Accident

Alzheimer’s Disease

25 year Heroin Addiction - 39 yo

10 yr Heroin then 7 yr Methadone - 40 yo

16 Years of Daily THC (Tetrahydrocannibinol) Use 32 yo

2 Years of Daily Marijuana Abuse - 16 yo

10 Years of Mostly Weekend Marijuana Use 28 yo

2 Years of Frequent Cocaine Use - 24 yo

8 Years of Heavy Methamphetamine Use 28 yo

17 Years of Heavy Weekend Alcohol Use 38 yo

27 Year Daily Heavy Cigarette and Coffee Use 45 yo

PolySubstance Abuse and then 1 yr Clean

Depression

Anger and ADDBefore/After Treatment with Depakote and Adderall

Paranoid SchizophreniaBefore and After Medication/Therapy

PTSD, Depression, and Anxiety Before and After St. John’s Wort and EMDR

Images of PMS

Day 10 of Cycle (Best Time)

Hardware SummaryHardware SummaryDisease AspectDisease AspectOur brains are dynamic organsOur brains are dynamic organs

• Our brains can be injured or diseased easily

• Our brains can be strengthened or renewed

Hardware SummaryHardware Summary

How does the brain malfunction?

We need a system that addresses all three spheres:

SpiritMindBody

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

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

Spirit, Mind, & Body Integration

• Spirit – inner/outer; Owner/Designer

• Mind – Operating System

• Body – Physical Hardware

• External Events – Software, Viruses

Romans 12:1-2Romans 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

BrainWorks – My Brain

Based on new scientific research, my brain does 2 things

1. Perceives2. Responds

BrainWorksBrainWorks Research Research

GI / Cardiac

Panic Disorder Study

Heart Heart of Transformation: of Transformation: Decision-MakingDecision-Making

• No biological Intervention• But Brain Chemistry Improved/Renewed

Decision-making is exercise for brain• Good decisions = stronger brain• Bad decisions = injured brain

What determines accurate Perception and Response?Holy Bible – God’s Instruction Manual

DM: Science and Faith Meet

Integration and DM are Key!Integration and DM are Key!

SpiritBody

Decision-Making Decision-Making ==

Spirit, Mind, & Body

IntegrationIntegration

The Most Important Spiritual Discipline:

AddictionAddiction• 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 Creator’s

Manual

• Psychological Issue– Poor decision: Looking in the wrong place

SummarySummary• 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,

Any Questions?Any Questions?

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 – 1st 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.• 1879 – Dr Leslie Keeley opens 120 Keeley Institutes. For

profit treatment facilities

Treatment History• 1880’s cocaine and other addicting drugs used to help

rehab goals.• 1900 – 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

Treatment History• 1935 Shadel Sanatorium – aversive conditioning• 1935 Bill W and Dr Bob meet AA birthed• 1939 AA published• 1940 EAP started• 1940’s research and definitions emerge• 1940’s Carl Rogers – client centered approach• 1948 Alcoholics Victorious – Christian AA• 1948-50 Minnesota Model born• 1950 Antabuse• Hollywood depicting alcoholism

Treatment History• 1952 AMA defines alcoholism• 1954 ASAM forms• 1958 – Synanon: 1st ex-addict directed therapeutic

community. Many thru 70’s• 1960 Jellinek Disease Concept of Alcoholism• 1960’s: many legal and healthcare organizations adopt disease

model• 1965 – insurances start to fund• 1970’s explosion of treatment facilities, JCAHO regs• 1974 – licensing criteria for D/A counselors• 1985 specialty tracks for age, GLBT, women, chronics, Dual

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

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

12 Steps of AA

1. We admitted we were powerless over alcohol—that 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.

12 Steps of AA7. 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.

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

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,

ASAM Levels of Care0.5. Early interventions, Opioid Maintenance1.Outpatient Treatment• 1-D Ambulatory Detox

2.Intensive Outpatient(IOP) and Partial Hospital Treatment (PHP)• 2-D Ambulatory Detox

3.Residential/Inpatient Treatment4.Medically-Managed Intensive Inpatient Treatment

ASAM Assessment Dimensions

1. Acute Intoxication/Withdrawal Potential2. Biomedical conditions/complications3. Emotional/Behavioral/Cognitive Issues4. Readiness to Change5. Relapse/Continued Use/Continued Problem6. Recovery Environment

Dimension 1: Intoxication/Withdrawal

• Past history of serious, life-threatening withdrawal

• Currently having similar withdrawal symptoms

Dimension 2: Biomedical conditions and complications

• Any current severe health problems• Any chronic ones exacerbated by addiction

Dimension 3: Emotional/Behavioral/Cognitive

• Imminent danger of harm to self/others • Unable to function ADL’s - imminent danger

• Dangerousness driving or with erratic and impulsive actions at home, work, school.

Dimension 4: Readiness to Change

• Ambivalent or feels treatment unnecessary• Coerced, mandated, required assessment/Tx

Dimension 5: Relapse/Continued Use/Continued

Problem potential

• Currently under the influence• Continued use/problems imminently

dangerous

Dimension 6: Recovery Environment

• Immediate threats to safety, well-being, sobriety

ASAM Assessment Dimensions

1. Acute Intoxication/Withdrawal Potential2. Biomedical conditions/complications3. Emotional/Behavioral/Cognitive Issues4. Readiness to Change5. Relapse/Continued Use/Continued Problem6. Recovery Environment

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

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

Secular Treatment Goals:Life Management Strategies

• Psychological Strategy– Relaxation– 12 Steps– Community– Behavior modification– No deeper equipping or reproducible strategy– Not Divinely empowered

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

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• Don’t have to sort through different tools or strategies

– Slows life down– Every thought captive to obedience of Christ– Emotion management– Reflection and Self-Assessment

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)

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

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– Treatment’s have many subtleties that are

hard to quantify

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

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

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 won’t even accept psych meds– Trouble getting to the core issues underlying the

addictive coping skill– Problem with CAC being the primary therapist as

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

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

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

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

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

Perfect Treatment Option

• Doesn’t exist• Have to triage needs • Understand the $ resources available• Piece together the realistic treatment options

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

Client Intake Form

The Basics to Help Determine Next Step

Lighthouse Network Lighthouse Network HelplineHelpline

• 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

877-562-2565 x:101

LighthouseLighthouse NETWORK NETWORK ResourcesResources

• 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• kbenzio@lighthousenetwork.org• www.LighthouseNetwork.org• Stepping Stones Daily Devotional - Free

Any Questions?Any Questions?

For if you remain silent at this time, relief and deliverance for the Jews will arise from another...

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