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Addiction & the Devil's Battleground: Knowledge is Power

Angeline D. Brauer DrPHMHSRDN

Presenter

Angeline D. Brauer DrPHMHSRDN

Health Ministries Director for the North American Divison of SDA

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Conference

Recorded

  • June 19, 2019
    8:30 AM
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PRESENTER

Angeline David DrPHMHSRDN

Health Ministries Director for the North American Division of SDA

RECORDED

June 19, 2019
8:30 AM

 

Father in Heaven, Lord we're so grateful that you are a God of answers. That you know what is needed and when it is needed and how it is needed and Lord, we're so thankful that you haven't given up on any one of us. But your arm of mercy is stretched out. So we invite you here in this room, we invite your Spirit to soften our hearts and we invite your angels to enjoy our presence with them here and we pray Lord that you will rebuke the devil, that we will hear the message that you want us hear. We thank you for your healing power and we thank you for being with us, in Jesus name, amen. 

So, as we talk about the issue of addiction, I wonder… I asked the question already, how many of you are addiction professionals, or help support others who are going through addiction. I wonder how many of you know someone who is struggling with an addiction. Can I just see your hand? You know someone.  Now, that might be mean you know yourself, okay. But the majority of you, raised your hand, and said that you know someone who's dealing with addictions. Of those people that you are thinking of, how many know someone who is in the Adventist Church who is struggling with an addiction? Ok, yeah, almost the same number of hands.  So, this is very relevant to us, to the church, on multiple levels. One, because God did say go into all the world. And so, we have a responsibility to everyone in the world. And also, because we're connected to people who struggle with this issue. We know them! They probably sit behind us in the pew at church or we associate with them in other ways, so this is a really important concept that I think it's important to understand with addictions, is that it's very real, it's very personal and these are human beings. These are children of God. They may not know it yet, but they are children of God and I think it's really important that we put that human face on the issue of addiction because so often what we do is we kind of separate ourselves from them, we kind of say ‘oh you're the addict. You're the problem.’ That is one of the most dangerous things that we can do, is put that label on them and to kind of unintentionally though it may be, to kind of separate ourselves from them. So what a lot of what I will be doing is trying to connect us back to the humanity of what the issue of addictions is about. You know we could probably spend the rest of our time talking just about that video and going point by point about what that young boy discovered about the issue of addictions, and we can learn a lot. But, you know, some of the key things that I picked up was when the young boy said ‘did you want to become addicted’ He said ‘no’, and I can probably, I've not talked to every single person who's ever been addicted, but I could probably guarantee that nobody ever wanted to become addicted to whatever it is. And I think that's really key as we think about, well, how do we think about these people? This was not a path that they intended. So, let's look at what was it that really took them down that road. 

So, first of all, some key terms as we talk about the area of addictions. There is substance misuse. Substance misuse, which isn't technically an addiction but it's using a substance and as will see it could be also a behaviour. That using something inappropriate, to an extent where it's starting to harm you, but you may not necessarily be dependent on the drug or the behaviour, the person, whatever it is. So, it's good to know that there is a distinction because the earlier we start intervention, when they haven't reached the point of addiction or dependency, the earlier we can help them the better their chances of recovery and the less damage that they have to recover from. Substance use disorder is a technical definition. Recurrent use of substance causes clinical and functional significant impairment.  So, this is where it's really causing problems for you in your life. They look at impaired control, so you no longer have control. When you have substance misuse, you often still have control over your life! You actually can still make the decision; you have that decision-making power. When we get into use disorder, that's where you get to a place where you can no longer control it, it controls you. Their social impairment, with a substance misuse, you may not realize that people are actually having problems because they seem to be fine. They're acting just as normal, they're coming to church regularly, they're going to work regularly, they have ‘all the normalcy of life’. But with a ‘disorder’, that's when you see they’re reclusive, they're starting to pull away, there's erratic behaviour that you can’t explain. Also, there's pharmacological criteria, there's certain chemical dependencies, there are also physiological things happening that are deeper. Now, Opioid use disorder. Anybody hear about opioid recently? It's a huge issue, right. So, we are going to spend some time at the end of today, hopefully, to talk a little bit more about the opioid issue as well because I know it's such a massive issue right now. Also, understanding the difference between dependence and addiction is important. A dependence is when you have a physiological adaptation. In other words, your body physically needs whatever that is. But with an addiction, it's much more severe. The intensity is greater.  The dependency often leads to an addiction and depending on a number of different issues whether or not the dependency actually transitions to an addiction. Addiction involves changes to your brain, we’ll talk about. Compulsive seeking of the drug or whatever it is, in spite of negative consequences, and we’ll see a little bit about why that happens as well. It's difficult to distinguish between dependence and addiction. You do need thorough assessment for this. So, our goal is to get the people help. It’s to help them recognize that, you know what, whatever the situation, just to see if you can get them help. This is very difficult because it is difficult for any of us to accept help when we're not ready for it, isn't it?  All the more so when there's an addictive process happening. There's a lot of denial that's happening. Tolerance and withdrawal are two important aspects to keep in mind. Tolerance is where you need more and more of the substance, let's just use alcohol for example. You need more and more of it to get the same kind of effect, those happy euphoric effects. Withdrawal is when you take it away and those terrible symptoms happen. Sometimes the withdrawal process is so painful, that individuals are not able to stay on withdrawal, they go back to the drug because they may not have the type of support surrounding them to help them in that process. I've listed on here some of those symptoms. Stress, anxiety, depression, nausea, vomiting, muscle aches, cramping. Those sound like things that anybody can be going through, but all the more intense for individuals who are going through withdrawal. So, can you imagine, stop drinking, have seizures. I mean, what are your choices here? You know, it's a life and death issue either way! Either way! So definitely needing very intensive care for that situation. 

The addiction problem. This is a research study that was published in 2011. Titled ‘Prevalence of Addiction. The problem of the majority or the minority?’  What do we think? Are addictions really rare, like, really, really rare? (Audience answers ‘No’). Ok, you already know! So, they looked at 11 types of addictions. Addiction to tobacco, alcohol, illicit drugs. Those are the ones we think of, right? Those are addictions! But also, addiction to eating, gambling, the Internet, addiction to love or sex, addiction to exercise, to work, or shopping. Shopping addiction? Yeah, it's possible! Exercise addiction, absolutely! Now let me ask you this question, ‘How many of those things on the list are necessarily evil, inherently bad?’ Yeah, really just the first three right? I mean, the other things are, well, the internet's not necessary for life although it has become that way. Well, Ok, gambling we can put that on the not good for you list. But the other things are normal parts of life, and yet they can become addictive, truly addictive! We're not talking about just throwing out the word addiction, right. ‘Oh, I'm addicted to chocolate.’ Or ‘oh, I'm addicted to …. you know. I just love this so much!’ We're talking about real ‘cool in the coal’ issues here. So, as they did this study, what they found was that 47 percent of adult suffer with any one of these over a given 12 month period. 47! So, I hate to say this, but 47 percent of the people in this room, at some point in the past 12 months, have struggled with an addiction. That's how real and that’s how close to home this really is. Think of 47 percent of the people in your church, don't think of specific people, just think about 47 percent of the people. Think about 47 percent of the people at the shopping mall, or at your child's school. Of course, this research was done with adults, not children, but just think about what that really means and what that looks like. This was published 8 years ago. I don't think things have gotten better since then. 

Types of addictions. We are very familiar with the substance abuse ,right? We know about them; we've been hearing about these. You know, the Adventist Church has a strong history of working in this area. We had our five day plan to stop smoking. We were very strong proponents of prohibition. We worked with the women's temperance movement. The Adventist church really recognized the need to be working in this area. But we also have what are called process or behavioural addictions. Now, these are the ones that are a little bit more difficult to identify and they're a little bit more sensitive because anybody can fall under any one of these. This is a short list by the way, it's just about anything. In fact, this is what we can get addicted to – anything we feel we cannot live without and that leads us to live an unbalanced life regardless of the harm it causes us or others. We can be addicted to anything. We can be addicted to our cars, our computers, to our friends, co-dependent relationships. We could be addicted to our phone! Now, I want to pause here and say that this doesn't mean that because we check our phone first thing in the morning, that doesn't necessarily mean you're addicted to it. We kind of throw that out there, we want to be careful because sometimes that minimizes the actual addiction, and the people who are truly suffering and struggling, we don't want to do that. But we also want to recognize that basically any one of us are prone, we're all prone to forming addictions. So, what is an addiction? Now this is the definition from the American Society of Addiction Medicine, they define it as ‘a primary chronic disease of brain reward motivation memory and related circuitry.’ Let's tease that apart a little so we understand a little bit more. So, it's ‘primary’- that means in medical terminology that it does not have an underlying other health problem that's causing it. The addiction is the main problem. So, for example, if someone has diabetes. Obesity maybe the thing that that is pushing the diabetes or maybe hypertension started it off and they got to other diseases. They're sort of like this one disease causing another, but they’re saying that with addiction, there were no other medical problems that were really causing it.  Makes you wonder, well, what was the cause? Is there a cause? We'll talk about that. 

Chronic disease, meaning just like diabetes, just like heart disease, just like high blood pressure, just like obesity (maybe not obesity, but it's long term). It's a disease that basically you're going to have to be careful with for the rest of your life. And it includes the brain we're going to talk about that. We'll talk about the brain a little bit. Dysfunction in the circuits leads to characteristic (I really appreciate what they put on this list) dysfunction, leads to biological, psychological, social and what? Spiritual manifestations. These are the official people who work in addictions, they're saying that addictions have spiritual implications! And I think this is really important because it means that we as a church have something to say about this. We have something to do about this, because we are a spiritual body. They're talking also about biology, that's our physical frame. Psychology, our mental functioning. Social, our connectedness, and spiritual. The Seventh-day Adventist Church believes that there are core components to our health, to our wellbeing. They are physical, mental, social, and spiritual. Addictions is all about that, and with addictions, every single one of those areas are hit - every single one. So, it's like addictions are the extreme, the worst-case scenario of health problems because every single one is. Going on they also say this and we talk about this addiction is characterized by the inability to consistently abstain, consistently. So, they may be able to get off her a couple of days, maybe even a week, but they fall back into it, so they are not able to be consistent, and stay away from the addiction. There's impairment in behaviour control, they're not able to control their behaviours, the cravings. There's the inability to recognize significant problems with your behaviour. ‘There's nothing wrong with me.’ ‘I don't know what you're talking about, I'm fine’. They may have lost their job, they may have lost their house, and have lost whatever else but their inability to see that that's a problem. There are problems with their interpersonal relationships. Dysfunctional emotional response, how they respond emotionally to the death of a loved one or bad news. The response is just ‘oh, that’s odd, you wouldn’t expect that’. Like other chronic diseases, addiction involves cycles of relapse and remission so they get off, they go back, they get off, they go back. A key point here again is that just like any other chronic disease it's a cyclical issue, so a key point with that is that if someone with say diabetes they do well they take care of themselves for a while they kind of decrease their medications they're doing well but then something happens tragedy strikes and then they have to go back on the meds. The same kind of situation is happening to someone who has an addiction and yet our response to the person with diabetes is very different from our response to the person who's struggling with addiction the way we think about that person is very different although there are things happening that that individual actually can't control. Addictions can result in disability or premature death. Usually, when an addiction is being diagnosed, what they look for are 3 or more of these things happening in a given twelve month period and the specific diagnosis really depends on the addictive substance or behaviour. It depends on the tools they're using, but what we look for is their tolerance in withdrawal, which we talked about earlier, they use in larger amounts than intended. Oh, I'll just take a little cup of this, just take one cigarette, I'll just spend 5 minutes on the computer, whatever it may be, but it ends up being much longer than they really intended. They have a desire or they have an unsuccessful attempt to stop, so they're trying really hard or they want to. ‘I really gotta stop’,’ I really wish I could stop’, or they've tried to stop or to or to just cut back. Spending a lot of time procuring the substance, there's a preoccupation - everything about life is all about I need to make sure I can get that. They planned the schedule, their whole life revolves around having to get whatever it is and a decline or elimination of social, occupational, and recreational activity. They become very isolated and that's one of the most dangerous things that could happen to someone in addiction.  We can alter chemical pathways in the brain. 

Let's talk briefly about the 5 stages of addiction. The way that you care for a person depends on where they are in these stages, and again the earlier we catch them, the better able we are to help them.  The 5 stages are: 

1. Experimentation: this is where, unfortunately, a lot of the time our children get this at school.  Someone is just passing it around on the playground and this is when they may just try it and they don't realize that they're kind of setting themselves up to unfortunately about the worst pathway. This is often not noticed, but it is really important to keep communication open with our teenagers, how easy is that? Sometimes the communication is just letting them know that you’re there when they need you. The communication doesn't always have to be telling them what they should or shouldn't do, because that may actually push them away, but letting them know that you are there to help them or to listen to them, that is one of the most important things that we can do is just letting them know I'm a safe place you can come to me whenever you need. 

2. The next stage is Regular Use: They're no longer experimenting it becomes maybe a daily or weekly use. It becomes part of their everyday life. This could be difficult to discover or this is when some of the signs start showing up. They may start lying a little bit about where they've been or what they were doing. You might see signs of things in their bedroom and you wonder what was that. And you're just not getting clear answers from them. 

3. The 3rd stage is Risky Use. This is tough because everyone has a different definition of what risky is but being aware that things could be escalating. Their behaviour alarms you when they do something that, well, I don't expect that from you! That's not usual, it's not normal. Clear signs that there could be something wrong and we want to discover ways to help at that point, we really want to get help at that point. 

4. Dependence: we talked about dependence, the 4th stage and they really need help at this point. We do not want them to go past this point, and this is challenging because they may not feel that they need help. This is the stage where they still are in control of their behaviour.  They're still making choices, but they are dependent and so it's very difficult to actually get them a place where they will get help. 

5. and finally the Addiction: And we really definitely need help at this time I want to say at this point that it's Ok to get help. I feel like we should all chant that. Well, not chant, but we should say it, ‘we should all be Ok with getting help.’ It doesn't matter if you're talking about an addiction or what, it's ok to get help. You know even Christ when he was in the garden of Gethsemane, he said to his friends ‘won’t you stay up and pray with me?’ He was crying for help and nobody was there for him. It's Ok to ask for help, and we need to let them know that too. It's Ok if you need help, but it's not Ok to not get help, because things only get worse. The process of addiction - it really depends on the user. What is going on in that person's life, their health, other health issues, their age of onset, personality. There are some genetic predispositions for addictions as well, so the genetics not only because your family does things certain ways so it's behaviour, but it's also what your family passes on to you in terms of what you like - the things that pull you. Those are all part of it. The drug itself - opioids have been around for how long? I'm sure you probably remember hearing stories from the East Indies, how they brought opioids and all of the smoky houses. Well the potency of those drugs was so little compared to what we have today. The dosage that we have today is enormous compared to what they were dealing with and so there's no wonder that we have such a problem today. It was a problem then too, but it's so much worse now. The environment, this is another component that we often forget. The environment that the individual is in effects their progression. The social setting, group expectations, cultural context. I look around the room and I see a number of different cultures represented here and every single culture has their own expectations but is there also a Christian culture expectation? Is there a cultural expectation within the Adventist church? Is there a cultural expectation within Adventists living in Michigan? Wherever you go, whatever pocket of people you're talking about, there is a culture. So, all of those are important to consider and sometimes what we need to do is advocate to break down that culture because it could be putting people at risk. There are good things about every single culture but there are some things that every single culture ought to maybe look at again and see if it's actually benefiting. Ok that's another soap box. 

Addiction in the brain we have just a few minutes left so we're going to go through this quickly and its late afternoon you don't want to hear a lot of science. Addiction in the brain. It's important to know that addictions do affect the brain there's something called the reward pathway and any time there's anything rewarding, that includes food, water and sexual relationships with your spouse. Those are good things that God gave in the Garden of Eden, so they're not bad in the right context and God programmed our brain that when we get those things that our brain actually gets happy and our whole body gets happy and in fact they can be healing to our bodies as well, but over time when we're looking at drugs they also affect the same reward pathway in the brain. Over time the person is not able to choose whether or not the drug is a good idea. Let's talk about why. So here's one area of the brain that that's affected, the nucleus accumbens.  It's very much involved in addiction and pretty much all addictions affect this area. We also have the orbitofrontal cortex. You've heard a lot about the frontal cortex I'm sure. The orbitofrontal cortex is just below the prefrontal cortex. It regulates the ability to appreciate consequences of your actions. It tells you whether or not that was a good consequence. It also helps you decide if something is a trivial or a critical decision. For example, you're out at a restaurant. You can't decide what to order. That's a trivial decision. But, you’re at a crosswalk and there's a sixteen-wheeler coming down the road. Whether or not you cross the road at that time is a critical decision. With drug use or with addiction that ability is diminished. You can't tell is this an important decision or not? It's a physiological effect on your brain, so it hinders your ability to make sound decisions. Another area in the brain is the anterior cingulate cortex and this tells you if the result of your decision matches what you were expecting to happen. For example, if you eat something that makes you get a bellyache, then most of us know, ‘Ok Don't eat that again’, but with someone with an addiction that ability is compromised and they're not able to judge that that was a bad decision and they shouldn't do it again. Their ability to make sound decisions is compromised. The prefrontal cortex is also involved with the addiction process. The brain activity in the prefrontal cortex is often diminished. I'm going to skip the brain because I want to get to talking about the opioid crisis a little bit. I want to again put a real face to this. This is an article that was published in The New York Times on May 31st. It's a story of a young girl whose mother struggled with an opioid and I'm going to just very quickly read you some excerpts from this story. Layla LecreckCaig, the young girl, she's a teenager, her Mother is back home after 3 weeks of who knows where. She says she's done with, she's ready for rehab and wants to be part of her daughter's life but Layla has heard all of this before and doesn't believe a word. Layla’s trust was broken long ago, after years of watching her mother cycle in and out of addiction and rehab. It goes on to say that she found needles in her Mom's car. Five days later, Layla’s Mom is gone again.  Oxycontin, is one of the opioids. The author of this article is saying that a generation is growing up amid the throes of a historic epidemic called them Generation O. We've heard about lots of generations, right? Every generation has a name. These are called Generation O. The children whose families are trapped in a relentless grip of addiction, rehab and prison. Here in this county, which is in Ohio, there's a mix of verdant farmland, old mill town where everyone appears to know someone who has struggled with dependency (Sounds a little bit like the drive I had coming up here. Verdant farmland, old mill town). In a nation where more than 130 people die every day from an opioid overdose and in a region in Ohio where the impact of addiction has taken a severe emotional toll on children, school is for many children, many students a refuge. A place where they attend classes but also have access to hot meals, hot showers and donated clothes. On Fridays, educators said students can take home backpacks full of food so they will not go hungry over the weekend. So, imagine a town where that is what they have to do for their children. The school has become the home the story goes on to say that the children come to school, they will shower at the school, they will put on fresh, clean clothes and then before they go home, which is usually at night dark before the school closes the doors, they will change back into their old clothes so that the parents don't take the new clothes and sell them, so they can buy the drugs. Now listen to this about the story of Layla's Mom. Not too long ago, Layla lived in a middle-class neighbourhood with her sister, her Step-Father and Mom. They sat down most evenings for dinner, cooked by her Mom, who worked then as a hospice nurse. The people who struggle with these addictions are not bad people. They're not people who have been just living a life of vice and crime and have just given their life over to whatever evil, the pleasures of the world. These are people who have had real jobs, real lives, real families. They've had everything in their life, but then something happens. In the case of Layla’s Mom, it was a job stress. As a nurse, she had access to painkillers and she just took one to help ease the stress. And now she's homeless. Her children have nothing. These are people who are just like you and me, but they've had something go wrong. Anyone, anyone, can go down that path. So, my question for us, as we close up. My question for us is ‘what are we going to do as a church? What are we going to do? Do you think this church can be a place for hope and healing? Do you think we could be that resource for those children? Layla wants to become a nurse or a nurse practitioner when she grows up, but look at the conditions she has to live through? Will she ever make it? We really don't know because everything is fighting against her. How are we going to take this and say ‘Well, this ia a huge problem, we’ve probably gotten ourselves into a mess, but we’ve got to help her.  Well tomorrow, we're going to talk about how. We'll look at what are the real true ways that we can recover and find healing for the individuals, but also for the community and you know what? We also need it for the Church. Let's close up with a word of prayer.  Dear Father in Heaven, Lord this problem of addictions is too great for us. Lord, it's a problem of sin in this world and the pain and the suffering. Oh Father, you have said, Christ said ‘If the son will set you free then you are free indeed!’ Then Lord, we want that freedom for ourselves, and the people around us. Lord, I ask that you give us that love in our hearts that you have for a sick and dying world, so that we will embrace them, and tell them ‘Can I help you?’ Lord, you are the true source of healing. You are the true source of help, we cannot do without you, so we pray that you teach us what we are to do. How we can serve. In that process Lord, we will experience healing ourselves. Thank you for that, we pray in Christ’s name, Amen.

 

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