false
Catalog
Strengthening Neuroplasticity in Substance Use Rec ...
View Presentation
View Presentation
Back to course
[Please upgrade your browser to play this video content]
Video Transcription
Great. I'm going to introduce Steve. Dr. Sugden is the Associate Professor and Associate in Addiction Fellowship Director at the University of Utah. He completed his medical school at the University of Utah, and later completed his residency in psychiatry at the University of California, Davis. He completed his MPH through the University of California, Berkeley, and his MSS through the United States Army War College. He works on an addiction medicine console service at the University of Utah Medical Center. Additionally, he's an Associate Training Director for Addiction Psychiatry and Addiction Medicine Fellowship. He was a part of leadership at ACLM for the Mental and Behavioral Health MIG, and he's been a colleague and friend for many years. I'm very excited to have him start off this monthly conversation about lifestyle psychiatry with our group. Steve. Thank you. I just need to click the right buttons. There we go. We all talk about how long have we been doing Zoom and then we get performance anxiety, and we push the wrong buttons. Thank you very much. We can't see it. No? Darn it. No. Okay. Now? Yes. Perfect. I'm going to be talking today. One of the pillars of lifestyle medicine is that of reducing risky substances. Today I'm going to be talking about how lifestyle psychiatry works very effectively as an augmenting strategy for the reduction of risky substance use. I have no disclosures to have. I think just as acknowledgment today is World Mental Health Day. It's sponsored exclusively by, I mean, the WHO has really been pushing this as something where we take pause. Mental health is a universal human right, and really want to advocate that we take the moment and think about our own mental health, those of our close friends, and continue this hard work that we do. Also, as I go with our outline, yesterday was indigenous population, indigenous person day, and want to acknowledge. I'm here at the University of Utah and would like to acknowledge those here who were in the native communities here in Utah. Apart from this, we will then talk about an introduction. We'll be talking about the addiction pathways. We'll talk about why lifestyle psychiatry, and then we'll talk about the lifestyle psychiatry interventions. If there's any questions, we'll go to that point as well. Many who are on this call have been working with substance use and know that the numbers of prescription opioid death, fentanyl, the numbers continue to keep growing. Most of our numbers that we have are pre-COVID, and they were not good before COVID, and they're getting progressively worse even after COVID. Pre-COVID, we were looking at about 21 million people that had been diagnosed with a substance use disorder. Ten percent are receiving some type of treatment. Ninety-two thousand people died from an overdose of use in 2020. These numbers, again, are quite familiar, and they go as far as what we've had through 2020. When we look at data that's come from a recent Kaiser Family Poll tracking from July of 23, their data shows again that the increased use of alcohol and opioid use has been increasing. Even though we had an opioid crisis before the pandemic, they're yet further calling it an epidemic. Two-thirds of Americans here within the United States can identify somebody who's personally associated with who has a substance use disorder. More specifically, when they look at this, more than 50 percent of people feel that it's had a major impact with their personal families. More than 50 percent of people say that it's impacted their own mental health. More than 50 percent said these substance uses have also affected their family's financial situation. Again, when we look at how much worry this is causing, many people are very worried or somewhat worried with regards to their mental health, with the increasing growth of fentanyl, with increasing growth of alcohol use disorder. These numbers are fairly consistent whether they are across ethnicity or they are across those with financial means or not. If we step back and even look larger within the global picture, the numbers are equally staggering. Where we have high numbers of it, especially within South America, Central America, even in Europe and Australia. Cannabis seems to be the substance of use of choice that is highest used. We've seen numbers of here on the left, which is fairly common within the United States, and this refers to the world. When they take in substance use with regards to amphetamines, cocaine, opioids, the indirect cost, the worldwide trend is very on a similar trajectory that we see within our opioid use disorder. Where again in 2019, more than a half a million people had a death due to substance use. When we look here on the right with the effect of DALI and substance use, these numbers are also continue to increase to show that there's significant disability throughout the world related to the substance use. When we think about substance use, many of us are focused or think immediately on dopamine and receptors within our midbrain and our limbic system. Primarily, our dopamine is manufactured in our brain within the ventral tegmental area. Historically, when our brain is working right, it has a pulsating release of dopamine to our nucleus accumbens. Our nucleus accumbens is like our shipping center, where then it ships dopamine out throughout the rest of our brain. In a good day, when we wake up in the morning, we want a little dopamine to get us motivated because it helps us when it gets to our prefrontal cortex that it gives us our concentration, organization, focus, reward. We talk about if this reward pathway is so damaging, why was it evolutionary important that we developed it? Really, when we look at from an evolutionary perspective, to promote our species, we needed to have rewards for food, water, sex, child rearing. These were the initial things that produced this reward, and it kept the human species viable. However, as stimuli have become in more excess, usually in a lot of these same areas, we then have this pathway that has become so altering for us. When we look again, if this was a study by Dachar et al, where they placed electrodes in mice, this came back in the 1980s, and they could monitor that if they gave food to these rats, that their baseline dopamines increased, and then so it rewarded behavior. If it had sex, it increased it by twofold. Then when they started looking at the impact of substance use, I'm going to start here on the bottom left with nicotine. The nicotine is almost a 2.5 fold increase. Morphine is a 2.5 increase. Cocaine is almost a fourfold increase. Then when we get into the amphetamines, this is between a 10 to 11 fold increase. If we come back to our model, this was again the nucleus accumbens. When you have that much trigger of dopamine, now all of a sudden, the nucleus accumbens starts releasing a cortisol releasing factor to the amygdala, to create this idea of salience. In response, this process reinforces neural inflammation within the nucleus accumbens, so that then there's change structures within the nucleus accumbens, and it now, instead of wanting a pulsating fashion, it's wanting to have this continuous amount of dopamine release. Whenever there is less dopamine, an individual then starts having withdrawal symptoms. Once we have more dopamine within the nucleus accumbens, then it's able to help us focus, concentrate, and organize, and usually more times than not, this initial focus, concentration, organize is helping us, how do we obtain more of those stimuli to keep this positive, this circle going forward? Unfortunately, this then requires more dopamine, because the nucleus accumbens tries to downregulate the amount of dopamine receptors because dopamine can be neurotoxic. As it's downregulating more dopamine receptors, the whole system wants more dopamine, so then it requires the intake of higher dopamine, or we have more extreme behaviors, to then have more release of dopamine, but at higher levels of dopamine, this prefrontal cortex concentration, organization, and focus that we initially were getting, essentially comes offline, and the dopamine then starts reinforcing only short-term rewards, and it dampens the long-term reward process. And so then for those of us who've been working with individuals who have substance use disorders, and we try to ask our patients, can you think about the long-term effect? It's so hard for people because they just get this short-term focus, short-term focus only, and a lot of this is the reward, the pathway of the dopamine. So why lifestyle psychiatry? Well, how do we rewire our brains? You know, from those of us who grew up in the 80s, we know about this campaign of just say no, we say no to crack, we say no to drugs, or we say, let's have more willpower, because if we can just have more willpower, we can have the fortitude to be able to say no, but in the end, these strategies just reinforce shaming tactics, and by reinforcing the shaming, it propagates our ability to not say no, and it propagates us to want to have higher uses of our substances. So now the next idea is maybe we should look for the magic solution, and many people want a one-time remedy, whether it is a one-time experimentation of this agent, or a one-time treatment of that agent, or we feel it's we need to get on the right combination of psychiatric medications, or we need to be able to have that one-time rock-bottom experience or consequence, that once this happens, that then that's going to make us, so then we will automatically want to change. There is a role for pharmaceuticals within substance use. We know that people die if they get into withdrawals. We know that there are good FDA-approved medications for this, for substance use, and I often look at it that this is a series of we need the scaffolding around us to be able to protect our brains so we can then be able to make the lifestyle changes. How many too many times people focus on the medications without wanting to do any of the lifestyle corrective changes? Really, it's this combination of where lifestyle psychiatry works is we use what is then as appropriate medication when needed, and we augment it with these lifestyle changes, and now we can promote, have a growth mindset, and we can promote change. Lifestyle medicine is based upon six pillars which were developed back in 2004, which a lot of this was developed out of the cardiac rehabilitation research that some of the founding fathers of this was Dean Ornish and various of the various luminaries who worked within the cardiac health science, and they came up with six pillars to help promote improved lifestyle from chronic illness, and these include regular physical activity, having primarily a whole food plant-based diet, having restorative sleep, improving stress management, positive social connections, the avoidance of risky substances, and that this is an adjunct modality that when used together can help prevent and often reduce the effects of chronic illnesses, and I would propose especially substance use. And so here on the left is a model that Dr. Molo developed, an idea that when we're talking what is lifestyle psychiatry, we're talking more than just wellness or positive psychology. We're talking more than just mental health. We're really including the whole aspect of brain health, and many times when we talk about brain health, we often talk about that this is the neurology folks where we're talking about the Alzheimer's literature, and the concept that Dr. Molo has really pushed forward that this is really all of our work here should be focusing on the health of the brain, and when we look at what is for the health of the brain, and we look at the six pillars of lifestyle, really at the heart of all of that is lifestyle psychiatry, because how much behavioral change occurs without the right type of lifestyle psychiatry or the motivational interviewing skills that often comes, and really the argument through lifestyle psychiatry is that lifestyle psychiatry is really at the pillar of all of the lifestyle medicine chain, the lifestyle medicine pillars. So when we have lifestyle change, we're actually able to decrease the neuroinflammation, which was some of the facts that occurs from the substance use. It promotes serotonin, and as we see, serotonin is one of the agents that promotes synaptic plasticity and neurogenesis, and if you look at the serotonin tracts within the brain, they overlap in all of the places where we have the dopamine targets, and this is one of those agents that actually helps promote the neurogenesis within these regions. It also enhances mitochondrial biogenesis. it promotes the sense of contentment. So, let's look at the remaining part of the talks. We're going to talk about the six pillars of lifestyle medicine and talk about them specifically with regards to substance use and the dopamine model that we've been talking about. So, for years, most people, when we've talked about substance use, one of the first areas that we talk about is that of having people increase their physical activity. And there have been several meta-analyses that have advocated this, that this has been a very effective form of not only helping with substance use, but it's also been able to show that it reduces anxiety and reduces depression. However, further meta-analyses have shown that, in fact, exercise does not reduce the amount of consumption for most in, for many individuals, like it was originally thought in some of those studies when they tease out the actual anxiety part and the depressive part. And perhaps where they find that it is most effective is that the use of that, the exercise use, it perhaps is a tickler within the dopamine network, because when we have high rates of exercise, it also can produce, you know, the endogenous opioid receptors. It has also been shown to help increase BDF concentrations within the hippocampus, and it helps restore better memory. More importantly, physical activity has been very, has been leaned to decreasing neuroinflammatory markers, specifically the IL-6 markers within astrocytes and microglia, which helps restore a lot of the limbic brain circuitry. This has also decreased, if we decrease our adipose tissue, it also affects the IL-6 markers. Very interestingly, if we have regular physical activity, it also massages, for lack of better words, the raffinuclei, where it is then more effective release of serotonin. It also helps improve our sleep quality, which is one of the defining markers of individuals who are prone to relapse is when their sleep deteriorates. The second pillar, which I want to talk about is that of eating healthier. And so we know individuals who have substance use disorders have higher rates of malnutrition. They have decreased protein consumption. They have decreased fiber consumption. They have decreased vitamin consumption, especially with our B1s, 12s, and B1, 2, and 12. They have decreased mineral consumption with iron and magnesium. They have a higher likelihood of food insecurity, and they have a higher utilization of ultra-processed foods, which again, when we think about all of these, have many ongoing health consequences of themselves. To get a healthier gut microbiota, we want to be able to feed it again with the things that are really what individuals with high substance use disorder are not having, and that is plants and fibers with short chain amino acids. It's interesting because it's through a healthy gut, we're able to get tryptophan and have better tryptophan metabolism, which is then the source of serotonin through the chinerion system that we're able to then have that transferred to our brain. Where do we get our sources of tryptophan? Again, the best sources are through plant-based products. To see this done again, another form of this is healthy gut bacteria leads to increased short chain amino acids, which when it's broken down, gives us increased serotonin production, which leads to the improved neuroprotection. We'll talk now about restorative sleep. What happens when we have poor sleep? We know that we have increased phosphodiesterase 4A. This changes the gene expression and neural excitability and ultimately results in decreased hippocampal volume. We also know that we have poor sleep. It promotes us to have an over-consumption of ultra-processed foods. We have increased impulsivity. Conversely, when we know that individuals with substance use disorder, when it affects their sleep, we know that it has impaired REM sleep. It affects the duration and quality of sleep. It has increased inflammation of the airway. We've increased daytime irritability and headaches with people who have substance use disorders and poor sleep. It's like this vicious cycle. The rates are fairly staggering that about a third of adolescents with substance use disorder have poor sleep. They say the numbers vary between 36 to 91% of adults with substance use disorder have poor sleep. There's really this bidirectional relationship that individuals with poor sleep have a higher likelihood of substance use and individuals with substance use almost guaranteed have poor sleep. Individuals who are working on sobriety, if they have episodes of poor sleep are highly correlated with return to sleep. We know that two factors that are very effective in helping restore sleep is one is cognitive behavioral therapy I, which is really related to the insomnia and helping people learn their triggers of sleep. The other one that has been shown to be very effective of improving sleep is that of meditation. Now we'll talk about stress management. This was a review article that was by Garland and Howard and were big advocates of a mindful-based treatment for addiction. The reason why they felt that this has been such an effective solution is instead of working within the limbic system, in the dopamine system, the mindfulness treatment starts from the top more of within our cerebral cortex and works downward and influences from kind of a top-down approach. What is the mindfulness-based cognitive therapy approach? We see here on the left, it involves six steps, which includes meditation, mindfulness, the mindfulness practice, a body scan exercise, a three-minute breathing space, high uses of yoga, as well as mindfulness, mindfulness stressing, excuse me, mindfulness stretching. What it's been able to show is we have decreased cue reactivity. If I see a trigger that may promote me to have urges to use, and one of these cues that we'll talk about subsequently is loneliness, it helps manage those cues more effectively. It is able to help us shift our values from a drug reward pathway to a natural reward salience. So when we talked about with dopamine that it shifts us from being able to have short-term values only, this mindful-based cognitive therapy approach reverses that to where we're able to have more long-term thinking. It also improves our executive control. And again, in an ideal world, our executive control is through our prefrontal cortex. When we have this altercation of dopamine, those high rates of dopamine take our executive control over. So let's talk now about positive social connections, which is the fifth pillar. For those who haven't, our surgeon general put out in March of this year, a landmark document called our Epidemic of Loneliness and Isolation. I'm going to be taking a few facts and figures from that document. And please, his document is phenomenal. And for those who haven't read it, I highly encourage you to read it. As a result of COVID, before COVID, these numbers are staggering. About one in two people reported loneliness. And so if we have 12 individuals here on our call today, that would mean six of the 12 of us have experienced some degree of loneliness. These trends are higher among teenagers and elderly. And this source of loneliness is really one of those huge cues for risk return to use or substance use. And due to this loneliness, many people turn to social media or internet, and this becomes a yet another addictive pattern that people use, which then is a precursor to oftentimes to their return to substance use. Again, our surgeon general talks about loneliness needing structure, function, and quality. And when we talk about having lasting memories or lasting experiences, it needs to be structured, it needs to have function, it needs to have quality. And the quality part is really ideally with more people, that it isn't an activity by oneself, but it's within a group of people. And so again, he shows the trends of what this has looked like over the past 20 years within the United States of how all these indices have shown decrease or worsening within the United States. So what does this look like within our brain? So on the top is what we see is our normal dopamine pattern. We've been seeing this and talking about this quite often. If one has fear that is many, many times due to the loneliness, and it's an initial response, we know that our amygdala starts our HPA axis, and on a good day, the cortisol kicks in, and this starts our fight or flight response. And our fight or flight response decreases our initial dopamine, and this then has this pulsating response to our prefrontal cortex, so we can have an organized response. However, when we have this chronic loneliness, these chronic stressors, the fear of abandonment, what we see is when we have, instead of having the normal response or the normal pulsating response, we have a sustained cortisol response. And so instead of turning off the HP axis, it reinforces and has this positive loop. This results in having continuous cortisol to the nucleus accumbens, and instead of down-regulating dopamine, it up-regulates the dopamine. It also has a continuous response to cortisol, and so now we have two things that are really taking our prefrontal cortex offline. And so this chronic stress of loneliness really decreases our prefrontal cortex. It has this auto-repeat loop within our amygdala, and it really affects people's ability to think and to have positive social isolation, I mean, positive connections because of the brain circuitry. So again, back from the surgeon general, we often talk about the impact of what substance use might be, and many of us saw how the degree of sitting was as impactful as smoking 15 cigarettes a day. Well, if we look here, the lack of social isolation is even more significant than smoking 15 cigarettes a day, about drinking six alcohol drinks a day, our physical inactivity, obesity, and air pollution. And so it's really, it's worsening our mental health. It increases this community mistrust. In a sense, when we have social mistrust, oftentimes we turn to our substance use. We rely upon more on social media. We decrease our physical activity. We have unpredictable sleeping patterns. We have a poor diet, and we can see where this goes. The final thing that I'm going to talk about is the avoidance of risky substances. And yes, we've been talking about this as a whole talk on opioids perhaps, but the risky substance that I'd like to end on is that of ultra-processed foods. And so this was a study that looked at our dietary patterns during the early 2000s, the 2000s and 2010s. And it looked at the percentage, where we were eating. And I will kind of gear you to where I would like between 50 to 60% of our diets with males or females are with ultra-processed foods. When we break this up into our ethnicities, non-Hispanic white, non-Hispanic black or Hispanics. Again, we see this trend that about 50 to 60% of our diets comprises of ultra-processed food. What does that look like? Our sugars we're getting from sweetened beverages and dietary snacks. Our saturated fats we're getting from sandwiches and snacks. Sodium we're getting from sandwiches and snacks. And so this is really where we're getting a lot of our ultra-processed foods. We've talked about this pathway quite a bit. One thing that we haven't talked about is where endogenous opioid peptides trigger this. And this is significant because this is where opioids enter into the system. What is equally staggering is this is the same spot where ultra-processed foods trigger our brain. And so there's been a lot of discussion of those of us who've been working within substance use populations, that what is the gateway drug we talk about? Is it cannabis? Is it tobacco? Is it this? And really what a lot of experts are predicting that it could very well be the ultra-processed foods as our gateway drug to this risky behavior of substances. And if we really are trying to make a difference, perhaps this is one of the discussions that we need to start having with our population. And so again, ultra-processed foods have no fiber. It is very damaging to our gut microbiota. And so when we look at this in a perfect world, our guts are healthy, we get good neural protection. If we take out dietary fiber of this, we decrease our serotonin, and now we take out our neural protection as well. And we are really setting up our brains for unhealthiness. So on why we need to have this lecture and why we really are excited that all of you have joined this is what's happened on lifestyle due to COVID. When we look at what our eating habits have been, this was a study that surveyed our friends in the UK, and essentially four out of five people had changes in one of these areas. So they had worse eating, healthy eating, they had increased binging of food, they had worse exercising, they had worse sleep, and they had increased alcohol consumption. With regards to physical activity, women were less physically active than men, likely because they had more of the child education processes, they reported more barriers, and they reported to have significantly more anxiety. A lot of times it's because they weren't able to exercise, which was one of their coping skills to deal with that, to deal with their anxieties. With regards to sleep, more than half the population reported that they had poor sleep as a result of COVID-19 and the lockdown. And when the COVID-19 lockdowns were improved, people did not return to having healthier sleep patterns because they adopted poor sleep during this pattern. And finally, our children, they started this where they had increased consumption of ultra-processed food, whether it was from junk food, snacking, they had decreased consumption of fresh foods, oftentimes because there was increased barriers of getting them, they reported having increased boredom and anxiety, and the cycle continued. With this, we thank you all here who've come to join our MIG, knowing that, excuse me, our new caucus, and this awareness of advocating for change, and we'd be happy to have any questions that come up and know how, as a caucus, we can address your concerns and your interests and areas for promote growth within this wonderful new arena that we have. So thank you, Dr. Merlot, for this opportunity. Oh, thank you, Steve. This was amazing. Oh, it's Dr. Sutton, sorry. Sorry, we're gonna be formal today. All right, so I would love to start this off with everyone, you know, discussion. Let's do a discussion, not questions, unless there are questions. What, I saw people agreeing with things that you were saying, so yes, go for it. Mardoshe. Yeah, just fascinating. Woody, thank you. This is extremely powerful presentation and inspiring as well, and very informational. You see, you know, I wear many hats. As an addiction psychiatrist, you're right, and as a child, adolescent psychiatrist, we've been talking about marijuana, marijuana, but truly, that's the first time I hear about the concept of ultra-processed food as perhaps the new gateway drug, and I have to say, just went straight to my heart because, you know, as a physician educator where I actually teach a lot of the mental health clinicians, we've been talking a lot about food, and then as a geriatric psychiatrist, I'm always paying attention to food, food, food, food, food, but number one, I really don't, I feel like we don't pay enough attention to that. Obviously, this is really preaching to the choir. I'm talking in general, and number two, there's a question there. I'm wondering whether we may think of ideas for our colleagues, of course, specialties, particularly the primary care physicians whom really our patients really trust a lot and go to, could really be paying closer attention to what can be done just like Hippocrates says, you know, let thy food be thy medicine, thy medicine be thy food. So it's very powerful, and I'm always, I'm curious to hear what others think, and Woody, thank you for that. That's been really, really wonderful. No, thank you for your attentiveness. The lifestyle medicine movement has been trying to reach different specialties, and fortunately, or fortunately, there's a lot more traction within our family practice, internal medicine colleagues, and many times individuals within psychiatry have been less likely to, because many times we're very focused on medications as the first line of treatment. Our colleagues in New Zealand and Australia, however, are leading us, and they've really been advocating and saying that all mild and moderate depression and anxiety should be first addressed with lifestyle medicine, and then it's really for the severe that we then start introducing to, where we start just introducing the pharmaceuticals. This caucus is housed within, under the education branch within the APA, and it's really one of those branches that we feel very privileged because they've actually given it, because we're under the educational arm, we're hoping to be able to leverage that to be able to have more of these conversations and to be able to change curriculum. Going back to what Molly was suggesting, if we, we've got to get it on our boards because if we don't get it on the boards, it gets so easy to kind of blow it off of any type of curriculum reform, but once we say it's part of our boards, our recertification boards, then people have to study it. I don't know, Gia, if you want to mention more about that, but that's really important. I mean, you can talk about our positioning of where we are within the APA better. Yeah, no, absolutely, and I think, you know, next month I'm going to do a presentation that's going to go onto this a little bit more, so I'm presenting next month. So we're going to talk a little bit more about this and talk a little bit about the origins and where we're going with it, but I think that, you know, you did a great job, Steve. So I want to hear from other people, I don't want to talk to this time, Christina. Yeah, you know, I think that in a lot of medicine we operate in silos, right? And so you have a lifestyle psychiatry course, I'm trying to create one, Molly, you're teaching it as well, but I think that I'm just astounded at like having med students, residents, fellows coming through that have never heard about these concepts before, and that I'm telling them they need to be, you know, asking about social media and they've never heard of it. So I think that the foundation for this is that we need to be getting it like into training programs and some type of unified front and into not just training programs, but into medical schools. And that's what I'm seeing and I'm passionate about, but I feel like people can't do it alone and why are we recreating the whale over and over and over again with the same material. Christina, so we're gonna need your leadership and everyone else that's in this call in helping to do that, because part of the pitch that we had to make to get it under the educational committee within the APA was that was what, when I spoke to them, that was what they asked me, can you help getting this course and getting this curriculum into UME and GME across the country? I said, absolutely. Our caucus, once we start increasing our numbers, we are the leaders and we're gonna be developing that curriculum. So yes, you're here, I have your names down, you're the founding first people that have come to this caucus meeting. So guess what? We're all in there. And I think that they were very excited and in order to get this caucus form, it usually takes a few years to get caucuses form. We have some people up in the higher ups in the APA that are very excited about what we're doing. So they were very supportive of that. And it did still take us a couple of years, but we pushed it through. So Steve and I wrote the original proposal to get this caucus done. And then fortunately we just got formed last month. But yes, that's the goal. That's why we're in the education arm of APA, so that we can move this forward within all of the education in UME and GME. And then when we mentioned it, then the next question that they asked me is, what about the rest? I said, yes, we'll do CME as well for practicing psychiatrists. You know, we will absolutely do that. Molly, you were gonna say something or was there somebody else? Yeah, no? I know we have a few more minutes. Anybody else? So Christine, I would like to, I mean, I think the other part where you're at Denver already, your med school has already transitioned to the LIC model. Yeah. I know my medical school at the University of Utah is following that. And that's kind of the new buzzword. It's exciting, but it's also at least my school, I won't get started on it, but they, because now everybody focuses so much on step two. Yeah. A lot of the curriculum is if it's not covered on USM, step two, we don't want it even whispered in the first two years of med school. And it's frustrating because then at least in our school, the way we've implemented it, step three and step four are all electives and we're losing that opportunity to have it for all med students because then you might only get it as an elective rotation, you know, an elective didactic. And so I think just to echo that reiterating the importance of doing what we can to get it on that step two. So it forces all schools to have to be able to teach it. And so if you have some experience with this LIC model, I think that that would be phenomenal. Yeah, I definitely, I don't have great experience thus far as they were only wanting the rotation on psychiatry to be one week. So we're feeling a little upset by that as we think that it, like you said, I think it's at the core of the rest of medicine and lifestyle medicine. And so we're slowly navigating that and we'll have our first students back this year. We're down to one didactic. Okay. So that's what we've got down to. So I mean, this is why we as a group really need to advocate for this just for our own field, but also for really for lifestyle. Yeah, certainly. Can I ask one more question just about the documentation of this right now? Just because I'm trying to like create documentation for an inpatient unit for screening for this. And I'd love to hear if anybody has experience with like creating lifestyle psychiatry kind of screeners or how you're doing that. So there, we wrote a couple of, Steve, there's a couple of papers that we did on this. So Christina, I have a book coming out that's gonna be out in December called Lifestyle Psychiatry. Yeah, perfect. Yeah, but so Steve has written a chapter, I've edited the volume with a health psychologist that's an NIH health psychologist. So trying to bridge that silo of behavioral medicine with lifestyle psychiatry. Steve has written a couple of chapters in there, right? So what I'm trying to say is we have, you're gonna have a lot of stuff coming out very soon. There are a few papers and we do have, did we publish that paper, Steve? Or did we do a presentation on that? I'm trying to remember, but I have a list of screening tools that we recommend. And I don't know if that would be helpful, but we can have somebody, you know what, let me put my email, let me do this. I'm going to put my email in the chat or I don't know if you get it in the caucus, but if you send me an email, I can try to send it to you. How about that? That would be awesome, thank you. And anybody, you know, wants to start that conversation so we can start talking about that. But I don't know if anybody else has some. So Liza, do you have any idea of other resources for Christina? You're muted, Liza. Sorry, I don't. I mean, I was just thinking back, you know, one of the core textbooks that we were using in school was Dr. Frady's handbook of lifestyle medicine. And so I remember that there were actually a bunch of assessments, but I don't know that they would probably have to be tailored to be a little bit more specific with the lifestyle psychiatry focus. Right, so I have those available. So I'll send them to her. That might be easier because I think we need to, yeah, though the book that's coming out is gonna be very academic, but I think that we can add to it. And one of the first things I think when we're starting to think about educational curriculum that we're gonna create is probably working on that. You know, starting to maybe write, I don't know if anybody's interested in academic papers or position statements that we can start working on together as a caucus. I would love to work on that. And I think, I'm not sure how easy it is to communicate within the caucus discussion groups, but please respond when I put them out there. And you have my email address as well. And what I'm gonna do is I'm gonna, as we start getting more people to attend these meetings, then we can start developing little subcommittees and subgroups. Oh, that's a great idea, Steve. We can have a presentation on screening tests. Maybe we can do that as well. That would be a great idea. Anybody else in the room that's here? I know we're running out of time and I'm really, really cognizant of that. Anybody else here want to present on something that they consider of their interest? Please throw it in the chat or unmute yourself. Small enough group here. I was just gonna mention, there is a document that I downloaded recently from ACLM. It's joint between ACLM and Loma Linda, which has a list of different assessments. Yeah, that's the one I was gonna share with her. That's the one. There's a long form and there's a short form. Yeah. Yeah, so there's two of them. So I'm gonna, yeah. So we can, that exactly it. Molly, do you want to share it with her or do you want me to do it? Do you have it? I don't have it right on hand. I have the printout because I just used it on a patient. Yeah, so there's two, there's two. There's a short form and there's a long form. And that's a collaboration between Loma Linda and ACLM. So I will absolutely send that to you. Thank you. No, I appreciate it. Yeah, it's exciting to think about and how to adapt it to an inpatient setting when you're doing really acute care with these kiddos. And then I'm trying to think through like other referral sources too and how to connect kids with the community for ongoing like lifestyle medicine support as well. And if I can partner with pediatricians or other parts of Denver Health. So that's where I'm thinking right now. The other person is Doug Nordsee will come and speak to us. I don't know if everyone- Doug Nordsee is, but he runs an inpatient unit in Stanford and he is a wealth of information. So he will come speak to us. I'm waiting till we have more people showing up in these monthly webinars before I have him come. So- The other thing, Christina, is the ACLM conference is actually in Denver. And so some of us are going to be in there. And so if you're in town, let's get together and we can talk in person too. I wish I'll be in New York for ACAP. So conflicting conferences. So I'll have to catch you at the next one but that's definitely on my radar for sure. Yeah, beautiful. All right, guys, it's eight o'clock. So out of respect for everyone's time, thank you so much for attending. And I will post it without the conversation in just this presentation, okay? All right, thank you guys. See you next month. Thank you. See you next month. Thank you. Bye-bye. Thank you, bye. All right.
Video Summary
Dr. Steve Sugden, an Associate Professor at the University of Utah, discussed the effectiveness of lifestyle psychiatry in mitigating risky substance use. Blending his extensive background in psychiatry, public health, and military studies, Dr. Sugden emphasized the significance of addressing addiction holistically through lifestyle modifications. He detailed the severe impact of substance use disorders, noting the increase in opioid and alcohol misuse exacerbated by the COVID-19 pandemic. Dr. Sugden also outlined the neurobiological pathways of addiction, specifically focusing on dopamine's role and the detrimental effects of excessive substances.<br /><br />To counteract addiction, he presented lifestyle psychiatry's six pillars: physical activity, a whole food plant-based diet, restorative sleep, stress management, positive social connections, and avoiding risky substances, including ultra-processed foods. These interventions aim to reduce neuroinflammation, promote neurogenesis, and improve serotonin pathways, offering a more sustainable approach to recovery compared to medication alone.<br /><br />The discussion underscored the need for integrating lifestyle psychiatry into medical education and practice, advocating for its inclusion in training programs and certification exams. Attendees expressed enthusiasm for collaborative efforts to develop relevant curricula and screening tools, highlighting the broader implications for both mental health and overall wellness.
Keywords
lifestyle psychiatry
substance use disorders
neurobiological pathways
dopamine
COVID-19 pandemic
six pillars
neuroinflammation
medical education
holistic addiction treatment
×
Please select your language
1
English