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Christopher S E Wurm MB BS, FRACGP, FAChAM Specialist in Addiction Medicine,

Meaning, purpose and self-transcendence – respectful, holistic responses to the “Brain Disease Model of Addiction”. Christopher S E Wurm MB BS, FRACGP, FAChAM Specialist in Addiction Medicine, Visiting Fellow, Discipline of Psychiatry, University of Adelaide, South Australia

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Christopher S E Wurm MB BS, FRACGP, FAChAM Specialist in Addiction Medicine,

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  1. Meaning, purpose and self-transcendence – respectful, holistic responses to the “Brain Disease Model of Addiction” Christopher S E Wurm MB BS, FRACGP, FAChAM Specialist in Addiction Medicine, Visiting Fellow, Discipline of Psychiatry, University of Adelaide, South Australia IMEC, London, 2019 M3.2.2 Sunday July 14 christopher.wurm@adelaide.edu.au

  2. With Frankl in Vienna

  3. “Beyond the disease concept of addiction.” “Those of us who have contributed to the literature about models of drug dependence, have indulged in irrelevances. We have pursued an abstract scientific course rather than responding to existential needs. • Drew, L. R. H. (1986).

  4. Drug use as a way of life leading to predicaments. “We have produced a psycho-bio-social model of drug dependence that excludes the essence of human existence - options, freedom to choose and the centrality of human values.” • Drew, L. R. H. (1986). "Beyond the disease concept of addiction. Drug use as a way of life leading to predicaments." Journal of Drug Issues 16: 263 – 274.

  5. Is Addiction a Useful Concept? “The dominant “bio-psycho-social” model does not address freedom, motivation or spirituality and some common terms and ways of working offend or alienate drug-takers, indirectly perpetuating their problems.” • Wurm CSE. Is Addiction a Useful Concept? An Existential View. European Psychotherapy. 2003;4(1):153-60.

  6. “Addiction Is a Brain Disease” “Scientific advances over the past 20 years have shown that drug addiction is a chronic, relapsing disease that results from the prolonged effects of drugs on the brain.” Leshner Alan I. Addiction Is a Brain Disease, and It Matters. Science. 1997;278:45-7. http://www.sciencemag.org/content/278/5335/45.full.html

  7. ”Essentially, all models are wrong, but some are useful”. • Box, G. E. P., and Draper, N. R., (1987), Empirical Model Building and Response Surfaces, John Wiley & Sons, New York, NY. P. 424

  8. “Saving Normal” “Anyone living a full, rich life experiences ups and downs, stresses, disappointments, sorrows, and setbacks. These challenges are a normal part of being human, and they should not be treated as psychiatric disease.” Frances A. Saving Normal: An Insider's Revolt Against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life 2013.

  9. Drug use as a response to existential problems • Before I ever had a drug problem, I, like many people had an existential problem. • The phrase: “There is no meaning in my life” dogged me constantly. • Marsh A. What makes treatment work? A client’s perspective. Drug and Alcohol Review. 1992;11:94-6.

  10. Towards a meaning-centered approach “People with addiction … usually manifest existential struggles that could account for the development and maintenance of their addiction.” Carreño DF, Pérez-Escobar JA. Addiction in existential positive psychology (EPP, PP2.0): from a critique of the brain disease model towards a meaning-centered approach. Counselling Psychology Quarterly. 2019:1-21.

  11. Which conditions are seen as diseases? • Random sample: 3000 lay people, 1500 physicians (10% were psychiatrists), 1500 nurses and all 200 members of Finnish parliament • Psychiatrists are more inclined to consider alcohol, drug and gambling problems as diseases compared with other physicians, while MPs and lay people least likely. • 48% of laypeople, 64% of non-psychiatric physicians and 74% of psychiatrists considered alcoholism to be a disease. • Tikkinen KAO, Rutanen J, Frances A, Perry BL, Dennis BB, Agarwal A, et al. Public, health professional and legislator perspectives on the concept of psychiatric disease: a population-based survey. BMJ Open. 2019;9(6):e024265.

  12. “Nowhere in the field of medicine is treatment less grounded in modern science.” • “<1% of people treated for alcohol problems in USA are prescribed naltrexone or any other drug shown to help control drinking.” Gabrielle Glaser, The Atlantic APRIL 2015 https://www.theatlantic.com/magazine/archive/2015/04/the-irrationality-of-alcoholics-anonymous/386255/

  13. Many states require little more than a high-school diploma or equivalent Most USA treatment providers are addiction counselors or substance-abuse counselors, with minimal training. Gabrielle Glaser, The Atlantic APRIL 2015 https://www.theatlantic.com/magazine/archive/2015/04/the-irrationality-of-alcoholics-anonymous/386255/

  14. Confronting the disease concept “Clients frequently misinterpret the “disease model” as meaning that they are powerless victims of addiction.” Ford GG. An existential model for promoting life change - Confronting the disease concept. Journal of Substance Abuse Treatment. 1996;13(2):151-8.

  15. Frankl on Intoxication • “The essence of intoxication... is the turning away from the objective world of being towards subjective experience.” • Frankl, V. E. (1967). Psychotherapy and Existentialism. New York: Simon and Schuster (Touchstone) p. 117

  16. Self-transcendence “Man’s primary concern does not lie in the actualization of the self, but in the realization of values and in the fulfilment of meaning potentialities which are to be found in the world rather than within himself or within his own psyche as a closed system.” • Frankl, V. E. (1967). Psychotherapy and Existentialism. New York: Simon and Schuster (Touchstone) p. 68

  17. Spiritual Transcendence • “Spiritual Transcendence, especially the facets of Universality and Connectedness, appears to play a significant role in substance abuse recovery.” • Piedmont, R. L. (2004). Spiritual transcendence as a predictor of psychosocial outcome from an outpatient substance abuse program. Psychol Addict Behav, 18(3), 213-222.

  18. Self-transcendence and Aboriginal Australians • Some authors refer to “spontaneous remission” when people stop drinking without formal treatment. • It is referred to as a “remission” because researchers viewed the previous pattern of alcohol use as a disease. • Brady, M. (1993). Giving away the grog: an ethnography of Aboriginal drinkers who quit without help. Drug and Alcohol Review, 12(4), 401-411

  19. Alcohol and Existential Vacuum

  20. Rat Park • “The view of addiction from Rat Park is that today’s flood of addiction is occurring because our hyper-individualistic, hyper-competitive, frantic, crisis-ridden society makes most people feel social and culturally isolated. Chronic isolation causes people to look for relief.” • www.brucekalexander.com/articles-speeches/rat-park/148-addiction-the-view-from-rat-park

  21. Building a meaningful and satisfying life • “… recovery is about building a meaningful and satisfying life, as defined by the person themselves, whether or not there are ongoing or recurring symptoms or problems” • Andresen, R., Oades, L. G., & Caputi, P. (2011). Psychological recovery: Beyond mental illness. London: John Wiley & Sons.

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