Flagstaff Medical Center Wellness Program · Introduction 2 “A GRADUATE SPEAKS” Wellness Video 3 . PANEL DISCUSSION . Philosophy of the Wellness Concept. 4 . Philosophy of the

Flagstaff Medical Center

Wellness Program

C H R IS TIN E C H IS H O L M , M S W , LC S W

C L I N I C A L MA N A G E R

C R A IG D A V IS , M S W , LA S A C

P R O G R A M C O U N S E L O R

B E N N E TT E D G E R LY , M . A . , LA C

P R O G R A M C O U N S E L O R

P H D S T U DE N T I N C O U N S E L I N G P S Y C H O L O G Y , N A U

D D C S T A T E C O N F E R E N C E M A Y 1 4 , 2 0 1 3

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COL L EAGU ES

AGEND A OVER VIEW

ACTIVITY

Introduction 2

“A GRADUATE SPEAKS”

Wellness Video 3

PANEL DISCUSSION

Philosophy of the

Wellness Concept 4

Philosophy of the Wellness Concept

High failure rate for chemical dependency/substance abuse

treatment programs

Dilemma: If client can’t use AOD while in the DDC program, risk of

relapse is high if client can’t replace the “feel-good” mood altering

and calming neurochemicals in some other way

What legal “feel-good” mood altering and calming neurochemicals

exist? Serotonin (mood) Dopamine(well-being) Endorphins (calming opioids) Norepinephrine (energy/alertness)

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If not accessing calming hormones, one is likely flooded with

stress hormones (cortisol, adrenaline, etc.) Corticotropin-

releasing factor (CRF) in the addicted brain blocks dopamine

receptors. All this lessens ability to:

1. Think clearly 2. Use good judgment 3. Consider consequences of behavior 4. Accurately interpret social cues and interactions 5. Regulate mood and affect including experiencing pleasure 6. Learn new skills!

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How can “feel-good” mood altering and calming

neurochemicals be accessed? Caffeine (Increase Dopamine/wellbeing, Adjusts Serotonin/mood) Sugar (creates peaks/feel good and troughs/feel bad in glucose) Balanced diet stabilizes body chemistry Exercise (produces Endorphins) Mindfulness (increases Serotonin and Dopamine)

What if we designed a program built upon the hypothesis:

If prohibit AOD, need to replace what is missing!

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Wellness Exercise

BREATHING

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Research supporting the FMC Wellness Model

TH R E E C O M P O N E N TS TO TH E F M C W E LLN E S S P R O G R A M .

1. Exercise 2. Nutrition 3. Stress management using Mindfulness-Based Stress Reduction

(MBSR).

Department of Justice Key Components of a Treatment Program.

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Research: The drug-brain paradigm

Addiction is associated with numerous neurobiological and psychosocial variables. But certainly, the neurobiological reinforcement system plays a role.

Often called the “reward center” for dopamine.

Depending on drug used, other neurobiological

reinforcement systems may also be activated:

Serotonergic, opioid, or GABA systems

Drug use typically trumps natural pleasurable activities.

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Research: The drug-brain paradigm

Drug use typically trumps natural pleasurable activities.

“I’m sober…Now what?”

How to replace the feel good component or even just feel normal?

The National Institute of Mental Health (NIMH) maintains

chemical dependence is a brain disorder that is also

responsive to changes in behaviors of exercise and diet.

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Research: Exercise

Exercise as an adjunct for treating dependence to

chemicals is well researched (Brown et al., 2010).

Read and Brown (2003) noted, “The dopaminergic

reinforcement mechanisms in the neural system that

are activated by substances such as alcohol are also

activated during exercise” (para. 3).

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Research: Exercise

Ussher et al. (2004) studied the effect of exercise on

alcohol urges and mood using a quasi-experimental

design with two groups of patients that had just

completed alcohol withdrawal in the hospital (mean of 3

days from detox).

The author’s concluded that a brief bout of moderate intensity

exercise may provide some short-term relief from alcohol urges

during exercise.

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Research: Exercise

Some evidence for positive benefits of exercise in treating

a variety of substances:

Tobacco (Scerbo, et al., 2010);

Marijuana (Buchowski, et al., 2011);

Alcohol (Ussher et al., 2004);

Cocaine (Smith et al., 2008);

Opioids (Weinstock, Wadeson, & Vanheest, 2012);

Methamphetamines (O’dell, Galvez, Ball, & Marshall, 2012).

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Research: Exercise

Williams and Strean (2004) provided guidance on

how to implement exercise into treatment.

6 recommendations for how to include exercise into treatment

program.

Consistent with the FMC approach to implementation.

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Research: Exercise

Other benefits of exercise that indirectly support recovery

from addiction:

Mamen and peers (2011) noted improvement in oxygen uptake, and

reduction in depression, anxiety, social phobia in 33 participants.

Foret and Clemons (1996) that suggests that “Physically

active people maintain and improve their physical

functioning and are also able to handle stress more

efficiently” (para. 2).

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Research: Nutrition

Nutrition therapy as an adjunct to substance abuse

treatment.

Nutrition and substance abuse treatment outcomes

(Grant et al., 2004, Cadogan, 2011; Watts, 2011).

Nutrition interventions are traditionally a missing

component (Roberts, 2011).

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Research: Nutrition

Many people are not nutrition-savy while using

harmful substances.

Some people eat more during abuse (Nolan & Stolze, 2012) ,

while many others do not get sufficient nutrition.

The American Dietetic Association defends

nutrition’s role in recovery.

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Research: Nutrition

How can nutrition be effective?

Abnormal Neurobiochemistry, Neuroplasticity, Neuronal

signaling and Neurophysiology can be improved or

normalized with the help of nutritional interventions and

nutritional therapy (Cadogan, 2011).

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Research: Nutrition

Lingley (2012) offers nutrition therapy for chemical

abuse as a three stage process:

1. Education about the effects of the substance of the body;

2. Teaching proper nutrition and how certain foods support

recovery;

3. Teaching the participant to shop and prepare.

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Research: Nutrition

Chance of recovery is “Significantly increased by

adding nutritional therapy and exercise therapy” to

traditional substance abuse recovery treatment

(Shuman, 2000).

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Research: Stress Management

Diet and exercise are both shown to positively impact

mental health outcomes (Foret & Clemons , 1996),

and are clearly related to the final element of our

treatment program: stress.

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Cognitive level:

Stress increases the risk of developing drug

addiction

Triggering relapse

Changes in the brain’s ability to mitigate stress once

the person begins using (Schwabe, Dickinson, &

Wolf, 2011).

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Sinha, Shaham, & Heilig (2011) maintain that relapse

is often associated with stress exposure, which can

provoke a subjective state of drug craving that can

also be demonstrated under controlled laboratory

conditions.

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Most effective model of stress management

Mindfulness-Based Stress Reduction (MBSR).

Derived from Buddhist Vipassana meditation (Kabat-zinn)

Bowen (2009)

Repeated studies shows significant reductions in participant’s

Self reported stress

Craving to use substances.

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We modeled our MBSR approach

Marcus (2007) studied the effectiveness of a MBSR

approach in a residential chemical dependency

treatment programs.

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Wellness Exercise

RAISIN

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P h a s e I : 3 t ime s a w e e k f or 3 h ou r s

Includes wellness program one a week

P h a s e II : tw ic e a w e e k f or 3 h ou r s

P h a s e III : on c e a w e e k f or 2 h ou r s

Focus on relapse prevention

Treatment Program Structure

O p e n - e n d e d In ta k e

M u l ti - d is c ip l in a r y Tr e a tm e n t Te a m

M ixe d G e n d e r

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Wellness Program Structure

Session 1: Nutrition

Cravings and Nutrition

Session 2: MBSR

Sitting Meditation & Mindful eating of raisin

Session 3: Exercise

Neurobiological basis for recovery

Session 4: MBSR

Body Scan

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Planning a recovery diet

Session 6: MBSR

Mindful Walking

Session 7: Exercise

Stretching/Yoga

Session 8: MBSR

“Seeing” meditation & visualization

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Shopping for recovery diet

Session 10: MBSR

S.T.O.P.

Session 11: Exercise

Examples/Barriers/Plan

Session 12: MBSR

Nonjudgmental Forgiveness

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Sustainability of Program Gains/Behavior Changes

D D C THR EE-PHAS E TR EATMENT PR OGR AM

COMMU NITY PAR TNER S HIPS

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DDC Three-Phase Treatment Program

Nutrition: Phase 1 (3 months) Registered dietitian presentation (3 times) Once a week clients are served a nutritious snack (12 times) Sustainability of gains/behavior change every time client shops

Mindfulness: Phase 1-3 (9 months) Phase I yoga instruction (3 times) Mindful breathing every group Phase 1-3 (72 times) Sustainability of gains/behavior change every time client comes to group

Exercise: Phase 1 (3 months) Once a week 30 minutes Cardiac Rehab Gym (12 times) Sustainability of gains/behavior change in question Need for Community Partnership

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Community Partnerships: Sustainability of Exercise Gains/Behavior Change

Partnership with Flagstaff Family YMCA resulted in a

no cost or reduced cost for a nine month membership

for the client and family members living in the home

(duration of DDC program). For most clients it is at no

cost.

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Community Partnerships: Sustainability of Exercise Gains/Behavior Change

Benefits:

Continued opportunity for exercise and yoga instruction

Family involvement addressed child care issues

Opportunity for pro-social behavior in the community

Northern Arizona College Resource Center (resume and

scholarship application help)

Funding source: Private donations to YMCA and FMC

Foundation (each pays 50% cost)

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Community Partnerships: Health Improvement

Need to insure safety exercising in Cardiac Rehab Gym

Health Risk Appraisal Form is completed

Health issues are reported

Need for medical clearance for exercise by a Primary Care Provider

Client is linked to a Primary Care Provider for medical care

FMC forms partnerships with community-based health care providers for no or low cost medical care

(Native Americans for Community Action, Sacred Peaks, Poore Clinic)

Integration of Behavioral and Physical Health allows for improved health for both client and the community

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Wellness Exercise

BODY SCAN

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Practical Applications Panel Discussion

PR ACTICAL EXER CIS ES THAT CAN BE U S ED

COL L ABOR ATE

S OL ICIT COMMU NITY S U PPOR T

IMPR OV ED COMMU NITY WEL L NES S

Our dream/hope reduces cost globally, while maximizing use of existing providers/resources.

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References

Buchowski, M. S., Meade, N. N., Charboneau, E., Park, S., Dietrich, M. S., Cowan, R. L., & Martin, P. R. (2011). Aerobic Exercise Training Reduces Cannabis Craving and Use in Non-Treatment Seeking Cannabis-Dependent Adults. Plos ONE, 6(3), 1-6. doi:10.1371/journal.pone.0017465

Brown, R. A., Abrantes, A. M., Read, J. P., Marcus, B. H., Jakicic, J., Strong, D. R., & ... Gordon, A. A. (2010). A pilot study of aerobic exercise as an adjunctive treatment for drug dependence. Mental Health And Physical Activity, 3(1), 27-34. doi:10.1016/j.mhpa.2010.03.001

Cadogan, O. (2011). Perspectives on the neurobiochemistry of addiction and implications for nutritional management. In M. Watts (Ed.) , Nutrition and addiction: A handbook supporting recovery from food and substance misuse with nutritional and lifestyle interventions (pp. 21-50). Brighton: Pavilion Publishing (Brighton).

Grant, L. P., Haughton, B., & Sachan, D. S. (2004). Nutrition education is positively associated with substance abuse treatment program outcomes. Journal of the American Dietetic Association, 104(4), 604–610.

Mamen, A., Pallesen, S., & Martinsen, E. W. (2011). Changes in mental distress following individualized physical training in patients suffering from chemical dependence. European Journal Of Sport Science, 11(4), 269-276. doi:10.1080/17461391.2010.509889

Marcus, M. (2007). Behavioral Therapies Trials: A Case Example. Nursing Research, 56(3), 210-216. Nolan, L. J., & Stolze, M. R. (2012). Drug use is associated with elevated food consumption in college students. Appetite, 58(3), 898-906.

doi:1 0.1016/j.appet.2012.02.014 O'dell, S. J., Galvez, B. A., Ball, A. J., & Marshall, J. F. (2012). Running wheel exercise ameliorates methamphetamine‐induced damage to dopamine and

serotonin terminals. Synapse, 66(1), 71-80. doi:10.1002/syn.20989 Read, J. P., & Brown, R. A. (2003). The role of physical exercise in alcoholism treatment and recovery. Professional Psychology: Research and Practice, 34(1),

49–56. Roberts, M. (2011). Nutrition and drug treatment: An overview of drug policy. In M. Watts (Ed.) , Nutrition and addiction: A handbook supporting recovery from

food and substance misuse with nutritional and lifestyle interventions (pp. 7-19). Brighton: Pavilion Publishing (Brighton). Scerbo, F., Faulkner, G., Taylor, A., & Thomas, S. (2010). Effects of exercise on cravings to smoke: the role of exercise intensity and cortisol. Journal Of Sports

Sciences, 28(1), 11-19. doi:10.1080/02640410903390089 Shuman, S. (2000, June). Research into the place of nutritional therapy and exercise therapy in a program of recovery from substance addiction and process

addiction. Dissertation Abstracts International, 60, Ussher, M., Sampuran, A. K., Doshi, R., West, R., & Drummond, D. (2004). Acute effect of a brief bout of exercise on alcohol urges. Addiction, 99(12), 1542-1547.

doi:1 0.1111/j.1360-0443.2004.00919.x Watts, M. (2011). Nutrition and addiction: A handbook supporting recovery from food and substance misuse with nutritional and lifestyle interventions.

Brighton: Pavilion Publishing (Brighton). Weinstock, J., Wadeson, H. K., & VanHeest, J. L. (2012). Exercise as an Adjunct Treatment for Opiate Agonist Treatment: Review of the Current Research and

Implementation Strategies. Substance Abuse, 33(4), 350-360. doi:10.1080/08897077.2012.663327 Williams, D. J., & Strean, W. . (2004). Physical Activity as a Helpful Adjunct to Substance Abuse Treatment. Journal Of Social Work Practice In The Addictions,

4(3), 83-100. doi:10.1300/J160v04n03_06

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Flagstaff Medical Center Wellness Program · Introduction 2 “A GRADUATE SPEAKS” Wellness Video 3 . PANEL DISCUSSION . Philosophy of the Wellness Concept. 4 . Philosophy of the

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