CEU Webinarswith Karen Allen CCHand Alex Zaphiris MD

Adjuncts In Constitutional CareOpiate Addiction:

Recognition and Recovery

Roadmap for OurTraining Session Today

● Opiate Prescriptions – An Epidemic– Presentation by Josie Briggs, MD (NIH/NCCAM)– We Got Issues, Getting Worse

● Recognition of Opiate Addiction in Clients● Elements of Addiction Recovery● What Are Our Options– Appropriate Referrals for Addiction Support (in/after)– Considering Homeopathic Options– Advocacy for Homeopathy in Chronic Pain

● Questions?

Josie Briggs MD NIH / NCCAMPresentation September 2014

Josie Briggs MD NIH / NCCAMPresentation September 2014

● Let's own our societal biases – drug addicts are losers and it is their own fault.... your biases?

– “Just Say No” = drug users are morally flawed, weak, and if they just wanted to, they could get over it

– Despite adequate research to the contrary, this view is still widely held, at least unspoken in law enforcement, punitive legisla-tion, media, societal views

– Family members of addicts experience great disruption – how can he/she do this to me??? if he/she really loves me then why doesn't he/she stop using???

– Attitude supports a TREATMENT GAP (8.4% of population in need and < 1% receives)

We GotIssues...

● To get rid of our biases, we need to REALLY UNDER-STAND THE PROCESS OF ADDICTION IN THE BRAIN

– Chronic, often relapsing brain disease that causes compulsive drug seeking and use

– Drug use continues despite harmful consequences to self and loved ones

– Drug use causes brain changes that disrupt self con-trol, decision making, reward mechanisms

– Drug use often overlaps with other mental health issues

Let's Define It?

● Normal brain chemistry includes healthy regulation of pleas-ure stimulation

– All pleasures register the same way (food, touch, sex, money, smile, drug) – pleasure is a biological incentive to assure survival!

– Pleasure releases dopamine in the nucleus accumbens– Healthy people seek pleasurable experiences in balance

with all experience; they have regulation over desire and motivation

– Normal mechanisms of appetite / satiety– Managed by the limbic system

Normal Brains and Human Pleasures

● Latin Limbus meaning border or edge, sitting on the edge of the cortex where it meets the subcortical struc-tures... maybe outmoded concept? but useful for us

– Collection of structures including hypothalamus, which sits atop the neuro-endocrine chain

– Functions include emotion, behavior, motivation, long term memory and olfaction

– Primary responsibility for emotional life, formation of memories

– Functional influence of endocrine system and autonomic nervous system

Say Hello to Your Limbic System

● All drugs of abuse cause a surge of dopamine (2-10x) through some mechanism (different for each drug)

● The likelihood of addiction from a substance or activity is directly linked to how fast, how intense, and how reliable the dopamine release generated

● Methods of use that create a larger, more reliable surge of dopamine are addictive

● Once the pleasure / reward mechanism in the brain has experienced this, other mechanisms record memory of rapid satisfaction and conditioned response to stimuli

Say Hello to Your Limbic System

● It's not just about pleasure● Dopamine facilitates learning and memory● Drug use hijacks the 'reward' mechanism in the brain and

then remembers how GREAT it was, and motivates repetition● The separate experiences of taking pleasure in something

and seeking it out become intertwined, and the mechanisms of motivation center on seeking out pleasure

● The DRUG TEACHES THE PERSON TO REPEAT THE REWARDING BEHAVIOR OF DRUG ABUSE

● Opioid peptides act on pain and emotional centers – some anal-gesic and some that induce pleasure or euphoria

Say Hello to Your Limbic System

● Way too much dopamine overwhelms brain receptors– Brain produces less dopamine or eliminates dopamine receptors

– Addict must take more of the drug to get the same response (developing drug tolerance / habituation)

● Compulsion begins– Pleasure associated with the substance or activity wanes

– The memory of the pleasure, and the motivation to recreate it continues / conditioned response drives intense craving

– Conditioned responses respond to environmental cues that still trigger after many years of abstinence

Your Limbic Systemon Drugs

● Addiction criteria – answer yes to any of these?– Do you use MORE of the substance or engage in the

activity MORE OFTEN than in the past?

– Do you have withdrawal symptoms if you omit the sub-stance or activity?

– Have you ever lied to anyone about your use of the substance or participation in the activity?

Limbic SystemDrives Behavior

● Long term abuse impairs cognitive function– Dopamine interacts with another neuro-transmitter, glutamate

which is involved in ability to learn and rewards

– Disturbance of dopamine dysregulates glutamate

– When glutamate levels are not normal, then critical thinking, de-cision making, behavioral control, learning and memory are impacted

– In addiction, the healthy ability to perceive consequences and make choices in response is BROKEN

– The drive for the drug / activity REPLACES all other survival drives in the brain function

Your Limbic Systemon Drugs

● SF Bay area physician● www.360-md.com● Integrative Fellowship / University AZ● New England School of Homeopathy● Working with addiction● Author of a self guided program to sup-

port patients with addiction recovery● Free training for practitioners and clients

January 21, 2016 at noon PT● http://www.recoverysuperstar.com/

Introducing Alex Zaphiris MD

● In 2010, 1 in 20 people in the US (12 or older) reported us-ing prescription painkillers for non-medical reasons in the past year

● 32 million Americans report having used an opiate for a non-medical reason at least once in their lives

● Nearly 2 million Americans are opiate dependent (1:150)● YOU KNOW SOMEONE WITH THIS PROBLEM● 25% of people on chronic rx opiates become addicted

Stats about Addiction

● Addiction is the chief complaint● Not admitted – suspect when

● Physical or Emotional pain (addiction comes out of coping with the pain...)

● History of trauma (emo or phys)● PTSD symptoms (Flashbacks, numb, hyperarousal)● Depression● Anxiety● Family history of addiction (including alcohol)● Reported pain medication use

Recognition ofAddiction in Clients

● Shame and guilt● Approach most effective:

● Compassionate (NOT judgmental)● Pain as a bridge● Keeping yourself grounded in presence of pain● Client may talk about the pain, not the drug use

● How to elicit drug use:● Normalizing: Many people in your situation...● Benefits: How do the drugs help...● Downsides: Some people have trouble

● Motivational Interviewing (collaborating / curious / respecting autonomy)

DiscussingAddiction with

Clients

● Standard of Treatment: Therapy / 12 step / meds● Methadone, suboxone, naltrexone

● What does this NOT include:● Integrative approach, repair limbic system / dopamine● How to repair neurochemistry, not just treat symptoms● Food / diet / nutrients / neuro-nutrients● Mind / body

● Case Stories of Success● David and James

Standard Recovery Approach and What is Missing??

● Appropriate Referrals for Addiction Support– American Society of Addiction Medicine– American Academy of Pain Management– Narcotics Anonymous

● Local therapist with addiction specialty● Nutritional support similar to adrenal collapse / malnourish● Acupuncturists trained in NADA protocol (withdrawal)● Read David Sheff, author of Clean

What Are Our Options:Appropriate Referrals

Recovery Superstarwww.recoverysuperstar.com

● Look at the stage of addiction with the client– Still robust (early in the process of addiction)

● Nux vomica 200c or OP 200c daily 5 days, re-evaluate● Op or Morphinum or Heroinum 12c daily, re-evaluate 10 days

– Depleted / Long duration● Valerianicum 12c in oral spray as needed for distress● Apomorphia 3x 2-3 times daily for transitional support

– Constitutional Care adjust posology● Consider daily dose with weekly intercurrent for drug support

– Gemmotherapy Linden (Lime Tree) / Fig 30 drops 3 times daily

What Are Our Options:Homeopathic Remedies

● Speak Up when there is opportunity– Integrative Health Policy Consortium

● discussion with professional Pain Management organizations

– NH State Joint Task Force On Opioid Abuse ● Suzanne Smith CCH is a NH State Representative● 4 homeopaths testified in support of inclusion of homeopathy

– request to include homeopathy in NH Opioids Emergency treatment bill amendment, allowing all drug treatment programs to allow CCH homeopaths to provide homeopathic care as an adjunct to traditional drug treatment

● http://www.gencourt.state.nh.us/● http://nhgencourt.granicus.com/MediaPlayer.php?view_id=1&clip_id=383

What Are Our Options:Advocacy for Homeopathy in

Chronic Pain Conditions

SO... are you ready to begin?

● Get Informed and Create Resource Materials– Deal with your attitudes / judgements about addiction– Put indicators for opioid addiction into your clinic ref notebook– Check out RecoverySuperstar website– Identify local practitioners for referral / make a list

● Gather your tools– Some of the therapeutics we discussed are not available locally

and unlikely to be in your office. Get them on site so you will be ready.

– Read the reference materials and become familiar with likely remedies so that you will recognize them when they are indic-ated

– Your Questions?

Webinar Opioid Addiction:

Recognition and Recovery

January 7, 2016

This document serves as verification that :____________________

has completed 1 hour of training with Karen Allen CCH and Alex Zaphiris, MD in client assessment and homeopathic therapeutics.

These hours can be used to meet the pre-requisite formal training or continuing education criteria for the Council for Homeopathic Certification.

Please print and keep as your record of attendance.