Friday, January 19, 2018

How to help Nancy

Nancy is a “frequent flyer” at the hospital ER. She appears about once a week to demand narcotics, a meal and a room for the night. She is offered a ride to the homeless shelter and a bagged lunch. She refuses them and refuses to leave, becoming verbally abusive and then physically abusive. http://bit.ly/2Dk4pGl

Neither the hospital nor the staff caused this. In fact, Nancy didn’t cause it. Neither did her parents or caregivers. Nobody is at fault. Nobody is guilty. Nobody can be blamed. And nobody takes responsibility.

Over the years, our attempts to stop drug use included stronger law enforcement, then jailing the users and treating them in prison, then stronger punishments and mandatory treatment. The problem with all addiction treatment is that, afterward, we put them back on the street in the exact same environment that supports the addiction. Now, we’re trying to improve by intensifying these same failed approaches.

How can we fix this?

Instead of trying to stave off the flood after the dam has broken, we can address the root cause.

Today, we understand addiction and have ways to prevent it, ways that cannot be implemented as long as the medical community ignores cutting-edge research showing genetic predisposition (Reward Deficiency Syndrome) to substance abuse, and childhood trauma as the activation of that predisposition. The interaction of the two is the first essential steps toward Substance Use Disorder.

PREVENTION IS IMPORTANT AND POSSIBLE.

Prediction is now possible.Genetic Addiction Risk Score (GARS) … is a [demonstrated] identifier of polymorphic variances which predispose an individual to Substance Use Disorder, and other impulsive–compulsive behaviors and their root cause Reward Deficiency Syndrome (RDS) …. [It has] provided a critical tool in stopping the cycle before it begins.” “We now have entered a new era in addiction medicine that embraces the neuroscience of addiction and RDS as a pathological condition in brain reward circuitry that calls for appropriate evidence-based therapy and early genetic diagnosis and that requires further intensive investigation.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4225054/

Prevention is possible. “Dr. Kevin McCauley’s documentary Pleasure Unwoven defines addiction as a “stress induced defect, acting on a genetic vulnerability in the reward learning area of the mid-brain and the emotion choice area of the Frontal Cortex. …. [C]hildhood trauma alters genetic expression, and the interactive variance results in increased substance use and/or abuse.”  - https://www.omicsonline.org/open-access/integrating-the-science-of-addiction-and-the-science-of-wellbeing-2329-6488-1000275.php?aid=92330  (This is a great review of a well-being approach to addiction treatment, including the needed and overdue change in public attitude and stigmatization.)

So, the First Level essential cause is Childhood Trauma that activates the genetic predisposition (RDS). After progressing through five levels – mostly a biological cascade effect in the brain – the result is Substance Use Disorder: A disease.

To prevent the First Level cause (trauma) is a DCS assignment, one that our DCS is failing at. The recent Indiana DCS director – in her letter of resignation – pointed out that prevention is possible, but not under inadequate funding. http://www.journalgazette.net/news/local/indiana/20171226/holcomb-faces-big-test-with-dcs 

Using the GARS instrument to predict RDS, we can flag individuals for trauma prevention and early treatment, thus avoiding genetic activation of RDS. This can only be done by fostering healthy families and, failing that, community connections to substitute for the warm relationships developed in healthy families. Known connection points that are also currently failing to provide preventative support outreach and support programs in church, employment, clubs and other community organizations.

Legislative research, action and funding can thus direct funds to prevent Substance Use Disorder by fostering healthy families (the ideal DCS function) and promoting community connection points. 

This is really condensed, so there are links to supporting articles that will lead you deeply into the research on this matter.