It doesn’t take a lot of It doesn’t take a lot of sense to stay sober….it sense to stay sober….it

just takes all you’ve got!just takes all you’ve got!

Dr John Mooney1910 -1983

I would like to thank the staff of CAPTASA for allowing me the opportunity to present this information. I continue to believe that CAPTASA represents the finest gathering of committed addiction professional in existence today.

( Sandy P. – you know Burns can’t help it !!)

Robert W. Mooney, MD

I would like to thank District 32 of the Florida AA community for the willingness to request information on a subject that will become more important as newcomers become old-timers, then become really old-timers.

I am employed at Vista Taos Renewal Center in Taos, New Mexico as Medical Director and Addiction Psychiatrist. They have supported my attendance at this presentation but have declined to present any information considered to be marketing materials. I will have contact information available for anyone having questions about information presented today.

The information presented is considered The information presented is considered by Alcoholics Anonymous to be an outside by Alcoholics Anonymous to be an outside

issue. AA encourages cooperation with issue. AA encourages cooperation with medical and psychiatric professionals medical and psychiatric professionals

when needed. However, the number of when needed. However, the number of medications that have the potential to medications that have the potential to

threaten recovery has increased threaten recovery has increased dramatically over the past several dramatically over the past several

decades. This presentation is meant to be decades. This presentation is meant to be informative informative onlyonly. Please see your . Please see your

personal physician about any questions personal physician about any questions which may be raised concerning your which may be raised concerning your

medical conditionmedical condition..Thank YouThank You

Bill Wilson 1895 - 1971

“Morphine, codeine, chloral hydrate, Luminal, Seconal, Nebutal, amytal, these and kindred drugs have killed many alcoholics. And I once nearly killed myself with chloral hydrate. Nor is my own observation and experience unique, for many an old-time AA can speak with force and fervor on the subject of “goof balls”. Language of the Heart 1945

“Some of us, perfectly sober for months or years, contract the habit of using sedatives to cure insomnia or slight nervous irritability. I have the impression that some of us get away with it, year after year, just as we did when we first began to drink alcohol. Yet experience shows, all too often, than even the “controlled” pill taker may get out of control. The same crazy rationalizations that once characterized his drinking begin to blight his existence. He thinks that if pills can cure insomnia so may they cure his worry.” Language of the Heart 1945

“Our friends the doctors are seldom directly to blame for the dire results we so often experience. It is much too easy for alcoholics to buy these dangerous drugs, and once possessed of them the drinker is often likely to use them without any judgment whatever.”

Grapevine 1945

“More often than not it is imperative that a man’s brain be cleared before he is approached, as he has then a better chance of understanding and accepting what we have to offer.”

William Silkworth, MD Alcoholics Anonymous

“…Try to remember that though God has wrought miracles among us, we should never belittle a good doctor or psychiatrist. Their services are often indispensable in treating a newcomer and in following his case afterward.”

The Family Afterward

Alcoholics Anonymous

Traditional Psychiatric Approach

Excessive drinking is a deviant pattern of behavior Excessive drinking is a deviant pattern of behavior which is secondary to an underlying emotional or which is secondary to an underlying emotional or mental disorder…..mental disorder…..

Traditional Psychiatric Approach

…………if the underlying emotional or mental disorder is if the underlying emotional or mental disorder is properly diagnosed and treated, then the deviant properly diagnosed and treated, then the deviant behavior pattern of drinking will resolve and normal behavior pattern of drinking will resolve and normal drinking behavior will ensue.drinking behavior will ensue.

Traditional Psychiatric Approach

Excessive drinking is a deviant pattern of behavior Excessive drinking is a deviant pattern of behavior which is secondary to an underlying emotional or which is secondary to an underlying emotional or mental disorder…..mental disorder…..

…………if the underlying emotional or mental disorder is if the underlying emotional or mental disorder is properly diagnosed and treated, then the deviant properly diagnosed and treated, then the deviant behavior pattern of drinking will resolve and normal behavior pattern of drinking will resolve and normal drinking behavior will ensue.drinking behavior will ensue.

“ “ The idea that somehow, someday he will The idea that somehow, someday he will control and enjoy his drinking is the great control and enjoy his drinking is the great obsession of every abnormal drinker.” obsession of every abnormal drinker.”

Alcoholics Anonymous Alcoholics Anonymous Chap 3 Page 30Chap 3 Page 30

An almost allergic like response in roughly 1 out of 10 individuals to chemicals which change brain activity and reward systems. This response can be immediate, such as cravings. Or, it can be more gradual where thinking and perceptions become altered such that motivation for sobriety decreases and they return to previous patterns of behavior linked to drug of choice.

Because this type of response does not occur in the other 90 per cent of the population, they will not be at risk for addictive complications, they usually won’t take what they are given anyway!

The previous 10 per cent is the focus of this presentation. What constitutes a hazardous substance for them?

Hazardous Drugs are those substances which in our experience have contributed to relapse. Our 50 years of experience have shown this to include most if not all CNS active substances.

Recreational/Street Drugs

Prescription/Pharmaceutical Drugs

Over The Counter/Dietary Supplements

Dental Procedures: Nitrous Oxide, local anesthetic with epinephrine, Rx

Diagnostic Procedures: Versed, propofol, Fentanyl

Surgery: Adverse brain effects last for about 3 months following general anesthesia.

Pregnancy: OB’s like their patients calm.

““In addicts, doses of drugs that In addicts, doses of drugs that are too low to produce any are too low to produce any conscious recognition that conscious recognition that they received drugs are still they received drugs are still capable of inducing changes in capable of inducing changes in the brain and influencing the brain and influencing behavior…behavior…””

Mark S. Gold, MDMark S. Gold, MD Dept of PsychiatryDept of Psychiatry University of FloridaUniversity of Florida

Willingway Tranquilizer RuleWillingway Tranquilizer Rule

There are two types of tranquilizers: habit-forming There are two types of tranquilizers: habit-forming and non habit-forming. The habit-forming ones are the and non habit-forming. The habit-forming ones are the old ones and the non habit-forming ones are the new old ones and the non habit-forming ones are the new ones. When the new ones become old, they become ones. When the new ones become old, they become habit-forming and are replaced by new non habit-habit-forming and are replaced by new non habit-forming ones.forming ones.

Antabuse Methadone Buprenorphine (Suboxone/Subutex) Naltrexone (Revia/Vivitrol) Acamprasate (Campral)

Increase MedsIncrease Meds Change MedsChange Meds Add MedsAdd Meds

Once you have committed to a Once you have committed to a chemicalchemical solution, it is almost impossible to revert solution, it is almost impossible to revert to a to a spiritualspiritual solution. solution.

Alcoholics and more recently drug addicts have been resistant to “cures” since earliest recordings of history. The Bible records cases of alcoholism but no “cure”. Early medical attempts included: Typhoid treatment, VD cures, ice baths, insane asylums, lobotomy and electro-convulsive therapy. Then something occurred in 1941 which has changed everything……

Prior to 1941 alcoholism relied primarily on psychiatristsPrior to 1941 alcoholism relied primarily on psychiatrists and mental institutions for treatment which wasand mental institutions for treatment which was mostly ineffective.mostly ineffective.

There is rush to develop strategies and pharmaceutical agents to treat alcohol/drug addiction at the expense of 12 step programs. The expectation of changes in delivery of healthcare will increase the pressure from pharmaceutical and insurance companies as a result of the billions of dollars which are at stake. The belief that 12 Step recovery is ineffective will push healthcare providers to encourage alternative approaches, which may in fact increase risks of failure in continued sobriety.

“ADial is developing compounds that affect the reward center of the brain, thereby decreasing the craving for alcohol and reducing alcohol consumption. Our medications appear to be effective based on a combination of an ability to leverage propriety targeted genetic efforts with synergistic treatment mechanisms –targeting multiple neurological pathways in the brain, thereby enhancing efficacy while reducing side effects. In addition, our compounds can be given to patients currently drinking, no abstinence prior to treatment required. This significant improvement not only increases access to treatment; it increases the likelihood of success, which can now be measured as a reduction in alcohol consumption and control over one’s drinking.

Adial PharmaceuticalsBankole Johnson, MD

“There are risks in leading the patient to believe that a pill or injection can save them from an illness where that patient mistakenly has believed that problems can be cured by taking something.”

““It doesn”t take a lot of sense to stay It doesn”t take a lot of sense to stay sober – It just takes all yousober – It just takes all you’’ve ve got !!!got !!!

Dr. John MooneyDr. John Mooney

Founder – Willingway HospitalFounder – Willingway Hospital

I would like to thank my parents, Dot I would like to thank my parents, Dot and Dr. John Mooney who believed in and Dr. John Mooney who believed in what they saw and gave me an what they saw and gave me an opportunity to be part of an amazing opportunity to be part of an amazing experience that one day may no experience that one day may no longer exist. longer exist.

I hope we never forget.I hope we never forget.

Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America by Robert Whitaker

Mad in America by Robert Whitaker

A Voice from the Wilderness by Andrew D. Bennett (Article in March/April issue of Addiction Professional)

“You can read, study and learn everything about

alcoholism but if you can’t laugh…you’re screwed!”

Vista Taos Renewal Center