1. Treating Addiction as a Form of Internal Homelessness
Percy Menzies, M. Pharm.

2. Drive States (Biological Instincts)
Higher organisms have inherent instincts that are essential for the survival of the species
These instincts drive them to:
Seek/obtain food; Seek/make shelter
Seek/obtain water; Protect their young
Seek/have sex
These drive states are located in the specific part of the brain and are connected by complex neurocircuitry to the reward/pleasure centers

3. Drive States (Biological Instincts)
Each drive state has two aspects:
If the drive state is achieved the organism experiences ‘reward’, which is pleasure, satisfaction and a sense of well-being
If the drive state is frustrated or cannot be met, the organism experiences dysphoria, anxiety, irritability, and anger

6. How Do Drugs Work?
Psychoactive Drugs bypass the instinctual drives and cause an abnormal stimulation of the reward/pleasure system
Stimulation of the reward/pleasure system by drive states = PHYSIOLOGY
Stimulation of the reward/pleasure system by drugs = PATHOLOGY

7. What is Addiction?
Addiction is a disorder/disease of the REWARD/PLEASURE system of the brain. It is characterized by four primary symptoms:
1) Craving
2) Loss of Control
3) Tolerance
4) Continued use despite adverse consequences

9. Primordial brain involved in survival
Prefrontal cortex controls the primordial brain
Prefrontal cortex involved in thriving
Complex processing allows to grow, thrive – unique trait among humans

10. Drugs and behaviors that excessively stimulate the reward system weaken the control mechanism
Thriving Survival
Prefrontal cortex undergoes physiological and structural changes (synaptic pruning)
Decreased involvement in tasks associated with thriving, i.e. work, family etc.
Increased focus on obtaining drugs

11. Maslow’s Pyramid

12. Survival overwhelms the subject – existential threat
Do whatever it takes to survive
Lie, Cheat, Steal
Drug dealing
Prostitution

13. Examples of Survival Homelessness
Natural disaster – floods, hurricane, famine, earthquakes
Lost in mountains, deserts
Refugees due to war, famine, disease

14. Consequences of Survival Mode
Employment
Financial
Legal
Marital
Social/Relational
Housing
Medical

15. Limitations and Unintended Consequences of Current Treatment Models
Criminalization – incarceration and broken families and communities
Moralization – AA/NA, faith-based-only programs
Medicalization – substitution treatment, over-emphasis on pharmaceuticals
Commercialization
Episodic 28-day residential, Intensive outpatients (6 weeks)
Failure blamed on the patient
Treatment models are often not standardized and not based on science and evidence

16. Limitations and Unintended Consequences of Current Treatment Models
Palliation
Harm reduction is essential, but it should not the only treatment goal
Address both medical and psychosocial issues association with addictive disorder
Walk with patient across the spectrum
Harm reduction
Harm elimination
Harm avoidance

17. Challenges in Recovery
Extinguishing the Pavlovian Conditioning, when supply/access is essentially limitless in home environment
Righting the inverted pyramid
Creating stability in jobs, housing, and relationships
Sobriety is stressful
Easy to fall back to the survival mode
Sobriety is like learning a new language

18. Humanizing Recovery by Clarifying our Goals
Detox
Treatment
Recovery
Thriving

19. Clarifying our Treatment Goals and Defining Thriving
Righting the inverted pyramid in the home environment
Restoring self-autonomy
Restoring and/or creating the environment for positive relationship and healthy connections
Individualizing process and time for each step of healing

21. Seven Pillars of Successful Treatment
Treatment on demand (same day treatment) 1
Medical detoxification 2
Recovery maintenance 3
Recovery enhancement (in patient’s home environment) 4
Life-long primary care 5
Integrated bio-psychosocial care (back to the thriving mode) 6
Adequately trained workforce 7

22. Percy Menzies, M. Pharm Assisted Recovery Centers of America 6651 Chippewa Street, Suite 224 Saint Louis, MO