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THE DOCTOR’S OPINION An explanation of addictive illness found in the “Big Book” of Alcoholics Anonymous Dawn Farm Lecture Series November 15, 2011
Herbert Malinoff, MD, FACP, FASAM Specialist in Chronic Pain and Addictive Illness  Medical Director, Pain Recovery Solutions, PC Attending Physician, Saint Joseph Mercy Hospital, Ypsilanti, MI Clinical Faculty, University of Michigan Medical Center, Dept. of Anesthesiology Consultant to Michigan Pain Specialists, Ann Arbor, MI Secretary, American Society of Addiction Medicine 4870 Clark Road W. Suite 201 Ypsilanti, MI 48197 734/434-6600
Declarations of Potential Conflicts of Interest ,[object Object]
Objectives ,[object Object],[object Object],[object Object],[object Object]
BORING
 
 
Alcoholism 101, Revisited
[object Object],[object Object],[object Object],[object Object],[object Object],Alcohol Prevalence
>Regard Addiction as a moral problem >1% of medical school curriculum >Fail to adequately screen >Believe interventions are ineffective JAMA, 2003:290, 1299
 
William Silkworth, M.D. ,[object Object],[object Object],[object Object],[object Object]
 
 
The Problem Determines the Solution
The Solution makes no sense without an understanding of the problem
What is the problem…..NOT  ,[object Object],[object Object],[object Object],[object Object]
The Problem: Lack of Willpower (weak)
The Solution: “Just Do It” ,[object Object],[object Object],[object Object],[object Object]
 
 
 
The Solution: ,[object Object],[object Object],[object Object],[object Object]
 
The Problem: Lack of Knowledge (dumb)
 
 
 
 
The Problem: Deep Psychological Problems (crazy)
The Solution: ,[object Object],[object Object],[object Object]
 
 
10,000 Pounds of Insight Isn’t Worth 1 Ounce of Behavior Change
The Problem: Lack of Character (bad)
The Solution: ,[object Object],[object Object],[object Object],[object Object]
 
The Problem: Alcohol & Drugs ,[object Object],[object Object]
The Solution: Abstinence (Dry) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Alcohol Problem vs. Alcoholism
Then What  IS  the Problem? ,[object Object]
Allergy to Alcohol
 
Definition of Allergy ,[object Object]
The Brain’s Design ,[object Object],[object Object],From the work of David Linden, Ph.D., described in  The Accidental Mind
The Reward Circuit
 
 
What is the “Abnormal Reaction?”  ,[object Object],[object Object],[object Object],This does not happen to “social drinkers”
“ The only relief we have to suggest is entire abstinence” “ The Doctor’s Opinion”,  Alcoholics Anonymous  p. xxx
Can’t start drinking Rx: “entire abstinence”
Alcohol vs. Carrots
 
 
 
Obsession “ Compulsive preoccupation with a fixed idea”
“ They are restless, irritable and discontented, unless they can again experience the sense of ease and comfort…..” The Doctor’s Opinion,  Alcoholics Anonymous  pp. xxviii-xxix
How do we manage primitive drives? ,[object Object],[object Object],[object Object]
Insanity : ,[object Object],“ Being unable to judge or comprehend the consequences of ones actions.”
 
Can’t stop starting Rx: “Personality change sufficient to recover…”
Allergy + Insanity = ,[object Object],[object Object],Powerless
 
 
 
 
Robert Holbrook Smith, MD “Dr. Bob” UM Med (1908-10) ,[object Object],[object Object],[object Object],[object Object],[object Object]
 
Step 1: THE PROBLEM ,[object Object],[object Object],[object Object],“ We admitted we were powerless…
 
Step 2: THE SOLUTION ,[object Object],[object Object],“ Came to believe”
 
The Actions Which Bring About the Solution  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
 

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The Doctors Opinion on Alcoholism – Revisited (November 2011)

Hinweis der Redaktion

  1. I, however, am eager to test Wilde's description of absinthe's effects: "After the first glass, you see things as you wish they were. After the second glass, you see things as they are not. Finally you see things as they really are, and that is the most horrible thing in the world."
  2. Summary; addictive drugs activate the reward system via increasing dopamine neurotransmission In this last slide, the reward pathway is shown along with several drugs that have addictive potential. Just as heroin (morphine) and cocaine activate the reward pathway in the VTA and nucleus accumbens, other drugs such as nicotine and alcohol activate this pathway as well, although sometimes indirectly (point to the globus pallidus, an area activated by alcohol that connects to the reward pathway). While each drug has a different mechanism of action, each drug increases the activity of the reward pathway by increasing dopamine transmission. Because of the way our brains are designed, and because these drugs activate this particular brain pathway for reward, they have the ability to be abused. Thus, addiction is truly a disease of the brain. As scientists learn more about this disease, they may help to find an effective treatment strategy for the recovering addict. LIPOPROTEIN RECEPTOR AND OPIATE RECEPTOR FAT AND OPIATES IN DIET.