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 • For if you remain silent at this time, relief and deliverance for • 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? Copyright 2012 - Lighthouse Network 1

Copyright 2012 - Lighthouse Network 2 Copyright 2012 - Lighthouse Network 2

PROFESSIONAL RESPONSIBILITY/S TEWARDSHIP Copyright 2012 - Lighthouse Network 3 PROFESSIONAL RESPONSIBILITY/S TEWARDSHIP Copyright 2012 - Lighthouse Network 3

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

Disease? Sin? ADDICTION Personality Defect? Copyright 2013 - Lighthouse Network Disease? Sin? ADDICTION Personality Defect? Copyright 2013 - Lighthouse Network

HELP! I prayed, took meds, and love my mother! I’m DYING Sin- Have more HELP! I prayed, took meds, and love my mother! I’m DYING Sin- Have more Faith! Disease- Take your MEDS! Psychological Defect. Tell me about your mother! Copyright 2012 - Lighthouse Network 6

Science and Faith • Darwin and Freud • Faith: the assurance of things hoped 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 2012 - Lighthouse Network 7

Science and Faith Science is: • The study of what God made • Understanding 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 God’s glory and our abundant living Copyright 2012 - Lighthouse Network 8

God’s Great Gifts Mind Free Will: Decision Making Science is a tool. So let’s God’s Great Gifts Mind Free Will: Decision Making Science is a tool. So let’s not ignore the science. Copyright 2012 - Lighthouse Network 9

What is Addiction? Copyright 2013 - Lighthouse Network What is Addiction? Copyright 2013 - Lighthouse Network

DSM 4 TR… Substance Abuse One or more of the following: • Failure to 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 2013 - Lighthouse Network

DSM 4 TR… Substance Dependence (Addiction) Three or more of the following: • High 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 2013 - Lighthouse Network

DSM 4 TR… Substance Dependence (Addiction) Three or more of the following (cont): • 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 2013 - Lighthouse Network

DSM 5: Substance Use Disorders Not using the word ‘addiction’ Behavioral Category – gambling(was DSM 5: Substance Use Disorders Not using the word ‘addiction’ Behavioral Category – gambling(was Impulse DO) Considered Sex, Eating, Caffeine, 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 2013 - Lighthouse Network

American Society of Addiction Medicine § Addiction is a primary, chronic disease of brain 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 2013 - Lighthouse Network

American Society of Addiction Medicine • • Inability to consistently Abstain; Impairment in Behavioral 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. Copyright 2013 - Lighthouse Network

5 Levels of SA/Addiction • EXPERIMENTAL USE: trying substance or twice. • RECREATIONAL USE: 5 Levels of SA/Addiction • EXPERIMENTAL USE: trying substance 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. Copyright 2013 - Lighthouse Network

Bible Definition • Exodus 20: 3 You shall have no other gods before Me. 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 2013 - Lighthouse Network

Bible Definition • Mark 12: 30 – Greatest Commandment • Ezekiel 14 Idols of Bible Definition • Mark 12: 30 – Greatest Commandment • Ezekiel 14 Idols of the heart lead to destruction. God condemns Copyright 2013 - Lighthouse Network

Real Addiction • Rom 7: 15 For what I am doing, I do not 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 • 17 So now, no longer am I the one doing it, but sin which dwells in me. 18 For 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. 19 For the good that I want, I do not do, but I practice the very evil that I do not want. 20 But 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 • 21 I find then the principle that evil is present in Real Addiction • 21 I find then the principle that evil is present in me, the one who wants to do good. 22 For I joyfully concur with the law of God in the inner man, 23 but 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. 24 Wretched man that I am! Who will set me free from the body of this death? 25 Thanks 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 2013 - Lighthouse Network

Real Addiction • Goes deeper than behavior or brain chemistry. • Worship is: Perceiving 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 2013 - Lighthouse Network

Real Addiction • Why Addiction: coping skill to ‘help’ deal with life/stress – Circumstantial 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 • We’re ALL addicted to ………. . Copyright 2013 - Lighthouse Network Comfort

Real Addiction • Addiction Role = Coping skill for stressor management • Addiction Goal 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 2013 - Lighthouse Network

HELP! I prayed, took meds, and love my mother! I’m DYING Sin- Have more HELP! I prayed, took meds, and love my mother! I’m DYING Sin- Have more Faith! Disease- Take your MEDS! Psychological Defect. Tell me about your mother! Copyright 2012 - Lighthouse Network 25

Karl’s Story Why did I become a psychiatrist? Copyright 2012 - Lighthouse Network 26 Karl’s Story Why did I become a psychiatrist? Copyright 2012 - Lighthouse Network 26

Karl’s First Beer Copyright 2012 - Lighthouse Network 27 Karl’s First Beer Copyright 2012 - Lighthouse Network 27

Copyright 2012 - Lighthouse Network 28 Copyright 2012 - Lighthouse Network 28

Copyright 2012 - Lighthouse Network 29 Copyright 2012 - Lighthouse Network 29

HARDWARE! Copyright 2013 - Lighthouse Network HARDWARE! Copyright 2013 - Lighthouse Network

Copyright 2013 - Lighthouse Network Copyright 2013 - Lighthouse Network

Copyright 2013 - Lighthouse Network Copyright 2013 - Lighthouse Network

S. P. E. C. T. Scans • Single Photon Emission Computerized Tomography • A 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 Daniel Amen, M. D. © Copyright 2000 Copyright 2013 - Lighthouse Network

Normal Brain-Top Copyright 2013 - Lighthouse Network Normal Brain-Top Copyright 2013 - Lighthouse Network

Normal Brain-Bottom Copyright 2013 - Lighthouse Network Normal Brain-Bottom Copyright 2013 - Lighthouse Network

Normal Brain-Active Views Copyright 2013 - Lighthouse Network Normal Brain-Active Views Copyright 2013 - Lighthouse Network

Motorcycle Accident Copyright 2013 - Lighthouse Network Motorcycle Accident Copyright 2013 - Lighthouse Network

Alzheimer’s Disease Copyright 2013 - Lighthouse Network Alzheimer’s Disease Copyright 2013 - Lighthouse Network

25 year Heroin Addiction - 39 yo Copyright 2013 - Lighthouse Network 25 year Heroin Addiction - 39 yo Copyright 2013 - Lighthouse Network

10 yr Heroin then 7 yr Methadone - 40 yo Copyright 2011 - Lighthouse 10 yr Heroin then 7 yr Methadone - 40 yo Copyright 2011 - Lighthouse Network

16 Years of Daily THC (Tetrahydrocannibinol) Use 32 yo Copyright 2013 - Lighthouse Network 16 Years of Daily THC (Tetrahydrocannibinol) Use 32 yo Copyright 2013 - Lighthouse Network

2 Years of Daily Marijuana Abuse - 16 yo Copyright 2013 - Lighthouse Network 2 Years of Daily Marijuana Abuse - 16 yo Copyright 2013 - Lighthouse Network

10 Years of Mostly Weekend Marijuana Use 28 yo Copyright 2013 - Lighthouse Network 10 Years of Mostly Weekend Marijuana Use 28 yo Copyright 2013 - Lighthouse Network

2 Years of Frequent Cocaine Use - 24 yo Copyright 2013 - Lighthouse Network 2 Years of Frequent Cocaine Use - 24 yo Copyright 2013 - Lighthouse Network

8 Years of Heavy Methamphetamine Use 28 yo Copyright 2013 - Lighthouse Network 8 Years of Heavy Methamphetamine Use 28 yo Copyright 2013 - Lighthouse Network

17 Years of Heavy Weekend Alcohol Use 38 yo Copyright 2013 - Lighthouse Network 17 Years of Heavy Weekend Alcohol Use 38 yo Copyright 2013 - Lighthouse Network

17 Years of Heavy Weekend Alcohol Use 38 yo Copyright 2013 - Lighthouse Network 17 Years of Heavy Weekend Alcohol Use 38 yo Copyright 2013 - Lighthouse Network

17 Years of Heavy Weekend Alcohol Use 38 yo Copyright 2013 - Lighthouse Network 17 Years of Heavy Weekend Alcohol Use 38 yo Copyright 2013 - Lighthouse Network

27 Year Daily Heavy Cigarette and Coffee Use 45 yo Copyright 2013 - Lighthouse 27 Year Daily Heavy Cigarette and Coffee Use 45 yo Copyright 2013 - Lighthouse Network

Poly. Substance Abuse and then 1 yr Clean Copyright 2011 - Lighthouse Network Poly. Substance Abuse and then 1 yr Clean Copyright 2011 - Lighthouse Network

Depression Before Treatment Copyright 2013 - Lighthouse Network After Treatment Depression Before Treatment Copyright 2013 - Lighthouse Network After Treatment

Anger and ADD Before/After Treatment with Depakote and Adderall Copyright 2013 - Lighthouse Network Anger and ADD Before/After Treatment with Depakote and Adderall Copyright 2013 - Lighthouse Network

Paranoid Schizophrenia Before and After Medication/Therapy Copyright 2013 - Lighthouse Network After Treatment Paranoid Schizophrenia Before and After Medication/Therapy Copyright 2013 - Lighthouse Network After Treatment

PTSD, Depression, and Anxiety Before and After St. John’s Wort and EMDR Copyright 2013 PTSD, Depression, and Anxiety Before and After St. John’s Wort and EMDR Copyright 2013 - Lighthouse Network

Images of PMS Day 2 of Cycle Copyright 2013 - Lighthouse Network (Worst Time) Images of PMS Day 2 of Cycle Copyright 2013 - Lighthouse Network (Worst Time) Day 10 of Cycle (Best Time)

Hardware Summary Disease Aspect Our brains are dynamic organs • Our brains can be 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 2012 - Lighthouse Network 56

How does the brain malfunction? We need a system that addresses all three spheres: How does the brain malfunction? We need a system that addresses all three spheres: Spirit Mind Body Copyright 2013 - Lighthouse Network

Body, Mind, & Spirit • Body – mechanical, physical, and biochemical functions – Above 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 2013 - Lighthouse Network

Body, Mind, & Spirit • Spirit – Inner – immaterial – our eternal part 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 2013 - Lighthouse Network

Spirit, Mind, & Body Integration • Spirit – inner/outer; Owner/Designer • Mind – Operating Spirit, Mind, & Body Integration • Spirit – inner/outer; Owner/Designer • Mind – Operating System • Body – Physical Hardware • External Events – Software, Viruses Copyright 2013 - Lighthouse Network

Romans 12: 1 -2 I therefore urge you, brothers, in view of God's mercies, 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 iswhat is proper, pleasing, and perfect.

Mind of Christ! Jesus’ Brain = Perfection! 1. Perceived everything from a Godly perspective Mind of Christ! Jesus’ Brain = Perfection! 1. Perceived everything from a Godly perspective 2. Responded with Biblical skills Copyright 2013 - Lighthouse Network

Brain. Works – My Brain Based on new scientific research, my brain does 2 Brain. Works – My Brain Based on new scientific research, my brain does 2 things 1. Perceives 2. Responds Copyright 2013 - Lighthouse Network

Brain. Works Research Skin GI / Cardiac Panic Disorder Study Copyright 2012 - Lighthouse Brain. Works Research Skin GI / Cardiac Panic Disorder Study Copyright 2012 - Lighthouse Network 64

Heart of Transformation: Decision-Making • No biological Intervention • But Brain Chemistry Improved/Renewed Decision-making 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 2012 - Lighthouse Network 65

Integration and DM are Key! What determines accurate Perception and Response? Holy Bible – Integration and DM are Key! What determines accurate Perception and Response? Holy Bible – God’s Instruction Manual Decision-Making = Mind Spirit, Mind, & Body Integration Body Spirit DM: Science and Faith Meet Copyright 2012 - Lighthouse Network 66

The Most Important Spiritual Discipline: DECISION-MAKING Copyright 2013 - Lighthouse Network The Most Important Spiritual Discipline: DECISION-MAKING Copyright 2013 - Lighthouse Network

Copyright 2012 - Lighthouse Network 68 Copyright 2012 - Lighthouse Network 68

Addiction • Everyone struggles – Addicted to comfort • Everyone has a Go-To coping 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 Creator’s Manual • Psychological Issue – Poor decision: Looking in the wrong place • Biological circuit damage Copyright 2012 - Lighthouse Network 69

Summary • • BH Revolution Society, Life Mngmt Revolution You are a catalyst Science 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 2012 - Lighthouse Network 70

Any Questions? Copyright 2013 - Lighthouse Network Any Questions? Copyright 2013 - Lighthouse Network

Treatment History • 1784 Benjamin Rush, MD – disease, temperance movement • 1810 – 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 Mc. Auley 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 Copyright 2013 - Lighthouse Network

Treatment History • 1880’s cocaine and other addicting drugs used to help rehab goals. 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 • 1919 -1933 Prohibition Copyright 2013 - Lighthouse Network

Treatment History • • • 1935 Shadel Sanatorium – aversive conditioning 1935 Bill W 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 Copyright 2013 - Lighthouse Network

Treatment History • 1952 AMA defines alcoholism • 1954 ASAM forms • 1958 – Treatment History • 1952 AMA defines alcoholism • 1954 ASAM forms • 1958 – Synanon: 1 st 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 Copyright 2013 - Lighthouse Network

Treatment History • 1991: ASAM placement criteria • 1992: Managed care dramatically reduces length 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 2013 - Lighthouse Network

Treatment History Summary • Adopting disease model and increased research • Many agencies adopting 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 2013 - Lighthouse Network

12 Steps of AA 1. We admitted we were powerless over alcohol—that our lives 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. Copyright 2013 - Lighthouse Network

12 Steps of AA 7. Humbly asked Him to remove our shortcomings. 8. Made 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 2013 - Lighthouse Network

Treatment System Karl Benzio, MD Treatment System Karl Benzio, MD

Co-Occurring/Dual Diagnosis • AOS – Addiction only Services – No Psych meds, coordination, groups, 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 2013 - Lighthouse Network

Co-Occurring/Dual Diagnosis • DDE - Dual Diagnosis Enhanced – Can take very unstable psych 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 2013 - Lighthouse Network

ASAM Levels of Care 0. 5. Early interventions, Opioid Maintenance 1. Outpatient Treatment • 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 2013 - Lighthouse Network

ASAM Assessment Dimensions 1. 2. 3. 4. 5. 6. Acute Intoxication/Withdrawal Potential Biomedical conditions/complications ASAM Assessment Dimensions 1. 2. 3. 4. 5. 6. Acute Intoxication/Withdrawal Potential Biomedical conditions/complications Emotional/Behavioral/Cognitive Issues Readiness to Change Relapse/Continued Use/Continued Problem Recovery Environment Copyright 2013 - Lighthouse Network

Dimension 1: Intoxication/Withdrawal • Past history of serious, life-threatening withdrawal • Currently having similar Dimension 1: Intoxication/Withdrawal • Past history of serious, life-threatening withdrawal • Currently having similar withdrawal symptoms Copyright 2013 - Lighthouse Network

Dimension 2: Biomedical conditions and complications • Any current severe health problems • Any Dimension 2: Biomedical conditions and complications • Any current severe health problems • Any chronic ones exacerbated by addiction Copyright 2013 - Lighthouse Network

Dimension 3: Emotional/Behavioral/Cognitive • Imminent danger of harm to self/others • Unable to function 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. Copyright 2013 - Lighthouse Network

Dimension 4: Readiness to Change • Ambivalent or feels treatment unnecessary • Coerced, mandated, Dimension 4: Readiness to Change • Ambivalent or feels treatment unnecessary • Coerced, mandated, required assessment/Tx Copyright 2013 - Lighthouse Network

Dimension 5: Relapse/Continued Use/Continued Problem potential • Currently under the influence • Continued use/problems Dimension 5: Relapse/Continued Use/Continued Problem potential • Currently under the influence • Continued use/problems imminently dangerous Copyright 2013 - Lighthouse Network

Dimension 6: Recovery Environment • Immediate threats to safety, well-being, sobriety Copyright 2013 - Dimension 6: Recovery Environment • Immediate threats to safety, well-being, sobriety Copyright 2013 - Lighthouse Network

ASAM Assessment Dimensions 1. 2. 3. 4. 5. 6. Acute Intoxication/Withdrawal Potential Biomedical conditions/complications ASAM Assessment Dimensions 1. 2. 3. 4. 5. 6. Acute Intoxication/Withdrawal Potential Biomedical conditions/complications Emotional/Behavioral/Cognitive Issues Readiness to Change Relapse/Continued Use/Continued Problem Recovery Environment Copyright 2013 - Lighthouse Network

Treatment Principles Karl Benzio, MD Treatment Principles Karl Benzio, MD

Necessary Treatment Ingredients • Medical aspects – Detox/Psych/Medical/Meds • Psychological Depth • Spiritual Depth Necessary Treatment Ingredients • Medical aspects – Detox/Psych/Medical/Meds • Psychological Depth • Spiritual Depth – Application, not just memorization • Time • Supervision/Accountability Copyright 2013 - Lighthouse Network

Secular Treatment Goals: Life Management Strategies • Living Basics Strategy: – Shelter, Food, Income, 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 2013 - Lighthouse Network

Secular Treatment Goals: Life Management Strategies • Psychological Strategy – Relaxation – 12 Steps Secular Treatment Goals: Life Management Strategies • Psychological Strategy – Relaxation – 12 Steps – Community – Behavior modification – No deeper equipping or reproducible strategy – Not Divinely empowered Copyright 2013 - Lighthouse Network

Christian Treatment Goals: Life Management Strategies • Living Basics Strategy: – Shelter, Food, Income, 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 2013 - Lighthouse Network

Christian Treatment Goals: Life Management Strategies • Psychological Strategy – Get at core issues 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 Copyright 2013 - Lighthouse Network

Copyright 2012 - Lighthouse Network 100 Copyright 2012 - Lighthouse Network 100

Considerations/Obstacles • Complicated Clinical Issue – most difficult patient • Poor Research • Minnesota 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 2013 - Lighthouse Network

Consideration/Obstacles • Complicated Clinical Issue – Most difficult patient – Excuses/Lying/Manipulation – Underlying Core 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 2013 - Lighthouse Network

Considerations/Obstacles • Poor Research – Patients are hard to find and get followup info 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 Copyright 2013 - Lighthouse Network

Considerations/Obstacles • Minnesota Model(Hazeldon) of alcoholism – Simplistic and outdated – Entrenched as the 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 2013 - Lighthouse Network

Considerations/Obstacles • CAC, CADC – Front line treatment personnel – Often run groups – 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 2013 - Lighthouse Network

Considerations/Obstacles • MH vs D/A – Which is primary – Not many therapists well 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 no classes in MH issues. Copyright 2013 - Lighthouse Network

Considerations/Obstacles • Christian vs. spiritual/holistic vs. traditional – Traditional – usually medical with Minnesota 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(10 w – 14 mos) • No psych/medical • Minimal psychological • Bible memorization, limited application – Christian Medical – out of network usually • Minimal psychological integration Copyright 2013 - Lighthouse Network

Considerations/Obstacles • Complicated Healthcare System – Voluntary vs. Legal Commitment – Third party managers 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 2013 - Lighthouse Network

Considerations/Obstacles • Programming Issues – Heterogeneous Population – Admitted on different days – Patchwork 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 2013 - Lighthouse Network

Holistic, Not Primary Disease, Approach Like an ED model WHY do you use – 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 Recovery Homes • • • Halfway House ¾ House Structure Supervision Tough to find in secure locations Copyright 2013 - Lighthouse Network

Recovery Groups • Many offshoots of AA – NA, CA, GA, Sexaholics A, Overeaters 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 2013 - Lighthouse Network

Perfect Treatment Option • • Doesn’t exist Have to triage needs Understand the $ Perfect Treatment Option • • Doesn’t exist Have to triage needs Understand the $ resources available Piece together the realistic treatment options Copyright 2013 - Lighthouse Network

What You Need To Know • What you can do – outsourcing is OK 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 2013 - Lighthouse Network

Client Intake Form The Basics to Help Determine Next Step Client Intake Form The Basics to Help Determine Next Step

Lighthouse Network Helpline • • • Finds addiction and MH treatment options. Expertise about 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 877 -562 -2565 x: 101 Copyright 2012 - Lighthouse Network 117

Lighthouse NETWORK Resources • Within Reach: Disciplines for Real Life Change – 10+ Hours 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 [email protected] org www. Lighthouse. Network. org Stepping Stones Daily Devotional - Free

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