THE DOCTOR’S THE DOCTOR’S OPINION OPINION An explanation of addictive An explanation of addictive illness found in the “Big Book” of illness found in the “Big Book” of Alcoholics Anonymous Alcoholics Anonymous Dawn Farm Lecture Series Dawn Farm Lecture Series November 15, 2011 November 15, 2011
The Doctors Opinion on Alcoholism – Revisited (November 2011)
Dec 17, 2014
This program describes a physician's view of alcoholism, as presented in the literature of Alcoholics Anonymous and updated with the modern neurobiology of addictive illness. It includes a discussion of Dr. Silkworth’s explanation of alcoholism as a twofold disease, affecting mind and body, how Dr. Silkworth's opinion relates to the modern neurobiolgy of addictive illness, and identification of therapy for alcoholism as promoted by Alcoholics Anonymous and its relationship to Dr. Silkworth’s opinion. The program is presented by Dr. Herbert L. Malinoff, MD; addictionologist. This program is part of the Dawn Farm Education Series, a FREE, annual workshop series developed to provide accurate, helpful, hopeful, practical, current information about chemical dependency, recovery, family and related issues. The Education Series is organized by Dawn Farm, a non-profit community of programs providing a continuum of chemical dependency services. For information, please see http://www.dawnfarm.org/programs/education-series.
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THE DOCTOR’S THE DOCTOR’S OPINIONOPINION
An explanation of addictive illness found in the An explanation of addictive illness found in the “Big Book” of Alcoholics Anonymous“Big Book” of Alcoholics Anonymous
Dawn Farm Lecture SeriesDawn Farm Lecture SeriesNovember 15, 2011November 15, 2011
Herbert Malinoff, MD, FACP, Herbert Malinoff, MD, FACP, FASAMFASAM
Specialist in Chronic Pain and Addictive Illness Specialist in Chronic Pain and Addictive Illness
Medical Director, Pain Recovery Solutions, PCMedical Director, Pain Recovery Solutions, PC
Attending Physician, Saint Joseph Mercy Hospital, Ypsilanti, MIAttending Physician, Saint Joseph Mercy Hospital, Ypsilanti, MI
Clinical Faculty, University of Michigan Medical Center, Dept. of Clinical Faculty, University of Michigan Medical Center, Dept. of AnesthesiologyAnesthesiology
Consultant to Michigan Pain Specialists, Ann Arbor, MIConsultant to Michigan Pain Specialists, Ann Arbor, MI
Secretary, American Society of Addiction MedicineSecretary, American Society of Addiction Medicine
4870 Clark Road W. Suite 2014870 Clark Road W. Suite 201
Ypsilanti, MI 48197Ypsilanti, MI 48197
734/434-6600734/434-6600
Declarations of Potential Conflicts Declarations of Potential Conflicts of Interestof Interest
The content of this presentation is The content of this presentation is non-commercial and does not non-commercial and does not represent any conflict of interestrepresent any conflict of interest
ObjectivesObjectives
Discuss Dr. Silkworth’s explanation of Discuss Dr. Silkworth’s explanation of alcoholism as a twofold disease, affecting alcoholism as a twofold disease, affecting mind and bodymind and bodyRelate Silkworth to the modern Relate Silkworth to the modern neurobiolgy of addictive illnessneurobiolgy of addictive illnessIdentify therapy for alcoholism as Identify therapy for alcoholism as promoted by Alcoholics Anonymous and promoted by Alcoholics Anonymous and its relationship to Dr. Silkworth’s opinionits relationship to Dr. Silkworth’s opinionStill have time for questionsStill have time for questions
BORING
Alcoholism 101, Revisited
90% Ever drank60% Current drinkers>40% Temporary problems10-20% Abuse3-10% Dependence
Alcohol PrevalenceAlcohol 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.William Silkworth, M.D.
Psychiatrist at Towns Hospital 1930’sPsychiatrist at Towns Hospital 1930’s
Thought alcoholism a twofold illness (mind Thought alcoholism a twofold illness (mind & body)& body)
Gave Bill W. Step 1 (the problem)Gave Bill W. Step 1 (the problem)
Published in Published in Journal-LancetJournal-Lancet, 1939, 1939
The Problem The Problem Determines the Determines the
SolutionSolution
The Solution makes The Solution makes no sense without an no sense without an understanding of the understanding of the problemproblem
What is the What is the problem…..NOT problem…..NOT
Lack of willpowerLack of willpower
Lack of moral characterLack of moral character
Lack of understanding or Lack of understanding or educationeducation
Alcohol and/or drugsAlcohol and/or drugs
The Problem:The Problem:
Lack of WillpowerLack of Willpower(weak)
The Solution: “Just Do It”The Solution: “Just Do It”
Avoid barsAvoid bars
Avoid drinking buddiesAvoid drinking buddies
Avoid liquor storesAvoid liquor stores
Think of baseball Think of baseball
The Solution:The Solution:
LecturesLectures
BooksBooks
Tapes & VideosTapes & Videos
Self-Knowledge Self-Knowledge
The Problem:The Problem:
Lack of KnowledgeLack of Knowledge
(dumb)
The Problem:The Problem:
Deep Psychological Deep Psychological ProblemsProblems
(crazy)
The Solution:The Solution:
CounselingCounseling
PsychotherapyPsychotherapy
Medication (tranquilizers) Medication (tranquilizers)
10,000 Pounds of Insight 10,000 Pounds of Insight Isn’t Worth 1 Ounce of Isn’t Worth 1 Ounce of
Behavior ChangeBehavior Change
The Problem:The Problem:
Lack of CharacterLack of Character(bad)
The Solution:The Solution:
A solemn oathA solemn oath
A better code of moralsA better code of morals
A better philosophy of lifeA better philosophy of life
Organized religionOrganized religion
The Problem:The Problem:
Alcohol & DrugsAlcohol & DrugsI have a “drug problem”I have a “drinking problem”
The Solution:The Solution:Abstinence (Dry)Abstinence (Dry)
RestlessRestless
IrritableIrritable
DiscontentDiscontent
ResentmentResentment
FearFear
Shame & GuiltShame & Guilt
Alcohol Problem vs.Alcohol Problem vs.AlcoholismAlcoholism
Then What Then What ISIS the the Problem?Problem?
An allergy of the body and an An allergy of the body and an obsession of the mindobsession of the mind
Allergy to AlcoholAllergy to Alcohol
Definition of AllergyDefinition of Allergy
““An abnormal reaction to any An abnormal reaction to any beverage, food, or other beverage, food, or other substance” substance”
The Brain’s DesignThe Brain’s Design
Because the brain is so wondrous that Because the brain is so wondrous that most of us assume it has an elegant most of us assume it has an elegant design.design.
In fact, the brain is a kludge (A kludge in In fact, the brain is a kludge (A kludge in the words of Jackson Grandholm is “an ill the words of Jackson Grandholm is “an ill assorted collection of poorly matched assorted collection of poorly matched parts, forming a distressing whole”).parts, forming a distressing whole”).
From the work of David Linden, Ph.D., described in The Accidental Mind
The Reward CircuitThe Reward Circuit
What is the “Abnormal What is the “Abnormal Reaction?” Reaction?”
getting drunk repeatedlygetting drunk repeatedlygetting sick repeatedlygetting sick repeatedly
getting into all kinds of trouble getting into all kinds of trouble repeatedlyrepeatedly
This does not happen to This does not happen to “social drinkers”“social drinkers”
““The only relief we have to The only relief we have to suggest is entire abstinence”suggest is entire abstinence”
““The Doctor’s Opinion”, The Doctor’s Opinion”, Alcoholics AnonymousAlcoholics Anonymous p. xxx p. xxx
Can’t start drinkingCan’t start drinking
Rx: “entire abstinence”Rx: “entire abstinence”
Alcohol vs. CarrotsAlcohol vs. Carrots
ObsessionObsession
“ “Compulsive preoccupation Compulsive preoccupation with a fixed idea”with a fixed idea”
““They are restless, irritable They are restless, irritable and discontented, unless and discontented, unless
they can again experience they can again experience the sense of ease and the sense of ease and
comfort…..”comfort…..”
The Doctor’s Opinion, The Doctor’s Opinion, Alcoholics AnonymousAlcoholics Anonymous pp. pp.
xxviii-xxixxxviii-xxix
How do we manage primitive How do we manage primitive drives?drives?
The primitive parts of our brain control the The primitive parts of our brain control the less primitive (basic drives change our less primitive (basic drives change our thoughts, we are not rational beings)thoughts, we are not rational beings)
Thus, as long as they are in control our Thus, as long as they are in control our thoughts will not changethoughts will not change– ““Live your way into sober thinking rather than Live your way into sober thinking rather than
trying to think your way into sober living”trying to think your way into sober living”
InsanityInsanity::
Alcohol vs. a hot stoveAlcohol vs. a hot stove
““Being unable to judge or Being unable to judge or comprehend the comprehend the consequences of ones consequences of ones actions.” actions.”
Can’t stop startingCan’t stop starting
Rx: “Personality change Rx: “Personality change sufficient to recover…”sufficient to recover…”
Allergy + Insanity =Allergy + Insanity =
Can’t start drinking (allergy)Can’t start drinking (allergy)
Can’t stop starting (insanity)Can’t stop starting (insanity)
PowerlessPowerless
firm resolve
restless irritable discontent
THE CYCLE OF ADDICTION
one drink
Allergy Insanity
drunk sick all kinds of trouble
a spree
Robert Holbrook Smith, MDRobert Holbrook Smith, MD“Dr. Bob”“Dr. Bob”
UM Med (1908-10)UM Med (1908-10)Akron SurgeonAkron SurgeonCo-founder of Alcoholics AnonymousCo-founder of Alcoholics AnonymousTreated over 5,000 Alcoholics Treated over 5,000 Alcoholics Current AA membership 2.8 millionCurrent AA membership 2.8 million24+ million copies of 24+ million copies of Alcoholics AnonymousAlcoholics Anonymous sold since 1939sold since 1939
Step 1: THE PROBLEMStep 1: THE PROBLEM
HopelessHopeless
HelplessHelpless
IncurableIncurable
““We admitted we were We admitted we were powerless…powerless…
Step 2: THE SOLUTIONStep 2: THE SOLUTION
No human power could relieve No human power could relieve our alcoholismour alcoholismGod could and would if he were God could and would if he were soughtsought
““Came to believe”Came to believe”
The Actions Which Bring The Actions Which Bring About the Solution About the Solution
Don’t DrinkDon’t Drink
Go to meetings Go to meetings
Get a sponsorGet a sponsor
Work steps 4-9 Work steps 4-9
Prayer Prayer
One day at a time One day at a time
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