Author Archives: Summit Estate

College Students Ask: Is My Drinking Really a Problem? Do I Need Addiction Treatment for Alcohol?

college students sitting on bench

Summertime means different things for different college students. Some travel abroad, some take classes to catch up or get ahead, some stay busy with internships or jobs, and some take a well-deserved break from the school grind to chill, relax, and recharge their internal batteries. It’s a natural time to look back on the year, decide how it went, and make plans for the upcoming semester.

If your year went well, then you’re probably loving summer, but you’re also looking forward to getting back on campus. If your year wasn’t great, then maybe you have a little more on your mind. Maybe your grades weren’t what you wanted. Maybe you partied more than you should have. Maybe you drank a little too much.

Maybe you think your drinking affected your grades.

Maybe it’s more than that: you know you went way overboard with the partying and drinking and you’re sure that’s why your grades weren’t up to par. Then you kept up the partying through the summer, and now you think you may have a problem. Worse, you know when you go back to school – where the excessive drinking started – it’s going to be really hard to keep yourself in check.

Now you’re worried: what should you do?

Do you see a professional? Go to support group meetings? Get addiction treatment? Do you do all that before you go back to school, so you set yourself up for success?

Those are all valid questions. If you’re asking them of yourself, you should take them seriously. The first thing you need to do is figure out if your drinking really is a problem. In the language of treatment and recovery, it’s time for you to decide – and be brutally honest with yourself – if your drinking is within typical limits, or if you have what’s called an Alcohol Use Disorder (AUD).

What is an Alcohol Use Disorder?

The handbook used by mental health professionals to diagnose and classify mental health and substance abuse disorders is called the Diagnostic and Statistical Manual (DSM-V). If you think you have a problem with alcohol, then you can use the following questionnaire – as recommended by the DSM-V – to diagnose yourself.

In the past year, have you…

  1. Had times when you ended up drinking more, or longer, than you intended?
  2. More than once wanted to cut down or stop drinking, or tried to, but couldn’t?
  3. Spent a lot of time drinking, or being sick and getting over the after-effects of drinking?
  4. Wanted a drink so badly you couldn’t think of anything else?
  5. Found that drinking, or being sick from drinking, often interfered with taking care of your home or family, cause job-related troubles, or problems with school?
  6. Continued to drink even though it was causing trouble with your family or friends?
  7. Given up or cut back on activities that were important or interesting to you, or gave you pleasure, in order to drink?
  8. More than once gotten into situations while or after drinking that increased your chances of getting hurt?
  9. Continued to drink even after a memory blackout, and even though it was making you feel depressed or anxious or adding to another health problem?
  10. Had to drink much more than you once did to get the effect you want, or found that your usual number of drinks had much less effect than before?
  11. Found that when the effects of alcohol were wearing off, you had withdrawal symptoms such as trouble sleeping, shakiness, restlessness, nausea, sweating, a racing heart, sensing things that were not there, or seizures?

If you answer yes to two or more of the questions above, then the DSM-V indicates you have an AUD. AUDs can be mild, moderate, or sever:

  • Mild: positive answers to two or three of the diagnostic questions.
  • Moderate: positive answers to four or five of the diagnostic questions.
  • Severe: positive answers to six or more of the diagnostic questions.

Common Levels of Alcohol Use

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the Substance Abuse and Mental Health Services Administration (SAMHSA) offer simple definitions of alcohol consumption and how these levels affect general health and wellness. If you’re unsure where you fall on the continuum, use these guidelines to clarify your position:

  • Moderate Alcohol Consumption: Up to one drink a day for women and two drinks a day for men.
  • Binge Drinking: Five or more drinks for men and four or more drinks for women in a two-hour period on at least one day over the course of a month.
  • Heavy Alcohol Consumption: Binge drinking on five or more days over the course of a month.

These definitions align with what most people know through personal experience. Moderate consumption is what everyone would consider normal, social drinking. Binge drinking tends to happen in college or early adulthood. Heavy drinking is what happens when consumption gets out of hand and becomes an obvious problem.

However, these three categories beg the question: “What constitutes one drink?” Serving sizes and alcohol content can vary a great deal. Drinking at a bar or restaurant is not the same as drinking at a private party, and the amount of alcohol in a drink depends on what you’re drinking: beer, malt liquor, wine, and distilled spirits all contain different percentages of alcohol. Here’s how the NIAAA defines a standard drink:

  • 12 ounces of beer containing around 5% alcohol. Think of a regular can of beer.
  • 8-9 ounces of malt liquor containing around 7% alcohol. Think of a pint glass around half-full.
  • 5 ounces of wine containing around 12% alcohol. Think of a regular glass of wine you might get with dinner at a restaurant.
  • 5 ounces of distilled spirits (liquor like vodka, whiskey, gin, or tequila) containing around 40% alcohol (80 proof). Think of a regular-sized shot glass.

Are You at Risk of Developing an Alcohol Use Disorder?

Based on the figures above, the NIAA defines low-risk drinking as:

  • Less than three drinks a day and seven drinks a week for women.
  • Less than four drinks a day and fourteen drinks a week for men.

Only around 2% of people who drink within these limits – i.e. low-to-moderate drinkers – develop an AUD. Consumption above these levels increases the chance of developing an AUD. The NIAA College Fact Sheet reveals that the drinking habits of college students make them particularly vulnerable to developing an AUD. The facts speak for themselves:

  • Close to 67% of college students who reported drinking at least once a month also engage in binge drinking
  • Binge drinkers who consume alcohol at least three times a week are six times more likely to perform poorly on a test due to drinking, and five times more likely to miss a class due to drinking
  • Roughly 25% of college students report alcohol negatively impacts their academic performance
  • About 20% of college students meet the DSM-V established criteria for an AUD.

Now, re-read the NIAA definition of low-risk drinking. If your drinking habits exceed those parameters and put you in the at-risk category, then it’s time to face the facts: you may well be on your way to an Alcohol Use Disorder. And if you know you have a problem, then it’s time to consider treatment options. It’s not time to freak out, but it is time to do something about it.

Back to that initial question: should you do something about it before you go back, to set yourself up for success?

The answer is simple: yes.

Take the time you have now to lay down the foundation for a successful year. Call us at 800-701-6997 and we’ll do everything we can to help you get control of your drinking and get your life on track. Also, keep an eye on this blog: upcoming posts will discuss the Sober Dorm movement happening on college campuses across the country, and provide an extensive list of helpful resources designed specifically for college students struggling to make it through school while in recovery from alcohol and substance abuse.

 

Social Recovery: The Role of Support Groups in Relapse Prevention

people meeting to share experiences

Recovery from substance abuse is all about change. A person trapped in the cycles of addiction must take action in order to free themselves from those cycles. The hard bottom line in recovery is a change in behavior: addictive behaviors must be identified and replaced with non-addictive behaviors. This basic fact implies changes in thoughts, changes in beliefs, and changes in values. These changes, in turn, imply a fundamental restructuring of an individual’s perspective on themselves, the world, and their role in the world. If behavior is understood as the end result of a series of decisions based on thoughts, beliefs, and values informed by personal perspective, it follows that – as difficult a prospect as this may be – a person seeking to recover from addiction must change everything leading to the behavior in question. In short, a person in recovery needs to do more than simply modify behavior: they need to create a new identity.

But there’s a rub. No person exists in isolation. Individuals function as the central node in a network of relationships within which they carve out their place and establish their role. This role and place determines their social identity, which is reinforced through a mutual feedback loop created by the individual, their behavior, and the responsive behaviors of the people around them. This complicates the process of recovery, because it requires the recovering individual to change not only their internal sense of self – the sum total of their thoughts, beliefs, and values – but also their external manifestation of self, i.e. their role and place in their social network. A recent vein of empirical research in substance abuse treatment takes this concept one step further, concluding that sustainable, life-long recovery requires restructuring the social milieu of the recovering addict to fully support and ensure their success.

The research indicates it’s not enough to change only oneself; full recovery requires participating in groups that reinforce the new self, created during the process of recovery. Without this essential element, the chance of relapse increases, driven by external pressure: the power of the old social group associated with addictive behavior eclipses the nascent, vulnerable self of recovery, and the hard work of recovery is lost.  Whether you join an outpatient treatment program or go to a community support meeting, social connection is critical to long-term success.

This article will discuss the ideas presented in the paper “The Social Identity Model of Cessation Maintenance: Formulation and initial evidence” by Daniel Frings and Ian P. Alvery, published in the peer-review journal Addictive Behaviors in October, 2014. It will address the traditional role of social groups in addiction recovery, the way those groups impact social identity, and the positive effect the intentional restructuring of social groups and social identity have on long-term recovery from substance abuse and addiction.

Something Old, Something New

The idea that social support facilitates recovery is nothing new. In fact, social support groups are almost synonymous with recovery: ask a random person on the street what they know about quitting alcohol or drugs, and the likely response will be something like,

“Well, most people go to AA (Alcoholics Anonymous) or NA (Narcotics Anonymous) meetings, and if that doesn’t work, they go into rehab.”

And that random person would be right. Support groups have long been an accepted component in the recovery process. They function in many ways: they may be an individual’s first exposure to recovery, they may be part of a residential rehab or intensive outpatient program, or they may be a key element of transition from rehab back to day-today life. While AA meetings and the Twelve-Step approach to recovery are widely recognized as the dominant support group paradigm, non-Twelve-Step programs such as SMART Recovery and Refuge Recovery are now widespread and offer equally viable social support options for recovering addicts.

The intriguing aspect of “The Social Identity Model of Cessation Maintenance” study is not that social support plays a big part in recovery, but the detailed discussion of the how and why social support groups work, combined with data to support the assertion that in the absence of a social system to support the newly formed sober identity, the chances of cessation maintenance – a fancy way of saying staying sober and avoiding relapse – decrease dramatically.

Why Support Groups Work for People in Recovery

A person with a serious addiction or substance abuse disorder creates a social identity that’s inextricably intertwined with their addiction. They self-identify with their substance of choice: smokers readily say “I’m a smoker,” and drinkers readily say, “I’m a drinker.” When it won’t get them in legal trouble, people who smoke marijuana readily say, “I’m a pot smoker.” The social groups associated with these behaviors reinforce these identities. People who drink hang around other people who drink. Smokers take smoke breaks at work with other smokers, and people who smoke marijuana tend to spend time with other people who smoke marijuana. The person with the addiction may be many other things in life, as well. They may establish aspects of their identity in terms of family, work, or other activities. They may be a mom or dad, a lawyer, teacher, a cyclist, or a musician. When they decide to stop drinking, smoking, or using drugs, however, they’ve usually reached a point where their addict-identity has achieved primacy, interrupted their other identities, taken control of most of their behavior, and made their life as moms, dads, lawyers, or teachers unmanageable.

The addict-identity, supported by social groups that validate and reinforce the addictive behavior, does not simply disappear when the addict decides to enter recovery. Nor do the social groups magically blink out of existence. The drinkers are there, drinking. The smokers are there, smoking. And the drug users are still there, using drugs. A person in the early stages of recovery who tries to maintain old social habits and networks fights an uphill battle: the strength of habituated social reinforcement can easily overwhelm the sober-identity they’re trying to create. The social groups may not be consciously or maliciously hostile to the sober identity, but by definition and in practice, they do not help its formation or foster its growth, either: these social groups and the behaviors that signify membership are self-perpetuating. They – meaning the collective will of the individual members – help maintain the status quo. Through sheer inertia, they have the ability to crush dissent and non-conformity without even noticing its happening.

That’s where support groups come in: they offer a social system that reinforces both sober behavior and the formation of a new sober identity. They offer shared norms, values, and life-strategies that encourage the sober-identity to flourish. They create a set of standards that protect the newly sober individual in their efforts to escape addiction. Their members offer advice, encouragement, and a sense of belonging. They form a protective shield behind which an individual new to recovery can gather themselves and lay the foundation for a new approach to life. In the words of Frings and Alvery,

“Much of group [support] revolves around strengthening the salience of a new social identity of ‘recovery’ and demonstrating its applicability to situations beyond the treatment setting. This involves a transition between an addict identity and a recovery addict identity. Social identity re-search suggests that the transition between identities often leads to a reevaluation of values and behaviors and is potentially a period of stress. Moderators of this stress include social support, continuity (over time) with other identities and a perception that relevant identities are compatible. Relative to addicts quitting on their own, group therapy [or a support group environment] provides these protective factors.”

Support groups work because humans are social animals and individual human identity never develops in a vacuum. Human identity is the result of practice, and recovering addicts need a place to practice their new recovery identity until they’ve got a firm grip on what it takes to maintain sobriety. They also need concrete, specific examples to guide them through the tenuous, initial stages of recovery. Experienced members of support groups provide all that, and more. It’s one thing for an addiction counselor to dispense advice on how to handle trigger situations; it’s quite another to sit in a meeting a hear fellow group member say, “I was triggered this morning, and here’s how I successfully handled the situation.”

Social Support and Recovery: Key Points

A revised, retooled, and restructured social network is a crucial component of recovery, but there’s a very interesting point to be made regarding the size and scope of social restructuring necessary to stay sober. First, it’s important to define exactly what recovery means. According to the Betty Ford Consensus Panel on Recovery, recovery is defined as “…voluntary maintained lifestyle characterized by sobriety, personal health, and citizenship.” The Ford Panel further identifies three aspects of recovery:

  • Functional Recovery: Remission of symptoms.
  • Personal Recovery: Getting a job and coping with daily life demands.
  • Social Recovery: Developing strong and supportive social networks.

The first two aspects are obvious: recovery requires the addict to cease the addictive behavior and handle the typical demands of life. It’s also obvious that elements of the previous social network must be eliminated: if you’re a recovering alcoholic, hanging out in bars is not a good idea: eliminate that aspect of your social life. If you’re a pot smoker, hanging around the smoke shop is not a good idea: eliminate that aspect of your social life. The interesting point to be made involves “strong and supportive social networks.” When rebuilding a social world, one may think the new social networks need to be as large – by number – as the old social networks. While it’s true that the bigger and more robust the new social network is, the more support it can offer, a study on social support for recovering alcoholics published in 2009 reveals that size does not matter:

“Those who added at least one non-drinking member to their social network showed 27 percent increase at 12 months post-treatment in the likelihood of treatment success, and sustaining abstinence.”

This insight is critical: it proves that social interactions are a small hinge capable of swinging an enormous door. The addition of only one abstinent member to a recovering addict’s social network can drastically increase their chances of maintaining sobriety. This is important because individuals in recovery can get overwhelmed by the apparent difficulties of the path they’ve chosen, and reading an article like this, which seems to say “I have to get a whole new social life or I’m never going to make it” might add a layer of difficulty they’re not ready to tackle. But adding one non-drinking, non-drug taking person is not scary. On the contrary, of all the challenges of recovery, it may be the most do-able.

The Path to Change

The role of social identity in addiction is impossible to ignore. We grow, develop, and become experts at particular types of behavior because they serve us well at some point in our lives – even the behaviors of addiction originally developed as survival mechanisms. The addict-identities we create to support these behaviors also served us well at some point in our lives, as did the social networks we participated in that reinforced and perpetuated these identities. If they hadn’t, we never would have developed them, and we would never have sought out the associated social groups that reinforced them. When an individual chooses recovery over addiction, it’s like hitting a reset button on all of the above. Negative, addictive behaviors must be identified and replaced, but that’s not all: the addict-identity behind the behaviors must be identified and replaced, as well. The new identity – the sober-identity, the recovery-identity, former-addict-identity – needs a safe place to grow and thrive. That safe space is a community of sober, social interactions, filled with people united by common purpose working toward a shared goal. Support groups and group therapy are effective spaces for just that: they give the recovering addict a forum in which to practice their new identity and work out the kinks before they take it out for a drive. And you don’t have to be a social butterfly, flitting from one support group to the next: one person can make all the difference.

Non-Opioid Pain Management

back painThe Human-Opioid Connection

The relationship between humans and opioids goes back thousands of years. From the time we first cultivated Papaver somniferum over 5,000 years ago to the present day, the properties of the opium poppy have been a blessing and a curse. Opioids contain the most powerful pain-relieving molecules known to medical science, but they also carry a heavy, destructive, and deadly potential for addiction and abuse. Blessing and curse dovetail in a quirk of human physiology: the endogenous opioid system present in the human nervous system. Opioids relieve pain by leveraging this naturally occurring system; opioids lead to abuse by hijacking this naturally occurring system. Opioids become problematic because this internal pain-relief network is linked, at the cellular level, to how humans experience feelings of pleasure, satisfaction, and reward. Humans wrestle with this de facto paradox daily. It’s a cruel irony of nature that the most effective pain medication on earth is also the most dangerous; it’s a test of our ingenuity and scientific responsibility to find ways to use opioids without becoming victims to them – and if we can’t, to find alternative methods of managing pain without exposing ourselves to the risks inherent in opioid use.

No population has a greater stake in the search for alternative pain management than those who are in recovery from substance abuse disorders. People in recovery work for years to free themselves from cycles of addiction and abuse. Yet when they’re faced with injuries, surgeries minor and major, or develop medical conditions characterized by chronic pain, their options are limited, and they’re often presented with a false dilemma: live with the pain, or risk sabotaging the hard work and progress gained in recovery by ingesting substances that increase risk of relapse or lead to a new substance abuse disorder.

The Problem(s) With Opioids

Long-Term Effectiveness

Setting aside issues related to individuals with a history of addiction and abuse, opioid pain medications have a significant set of limitations and complications that are neither widely known nor publicized. While they’re incredibly effective at relieving acute pain and there are many situations for which opioids are the logical and appropriate choice for pain management, the effectiveness of long term use of opioids for chronic pain management is not supported by medical research.

That may come as a surprise to most people, but it’s true. In 2016, the Centers for Disease Control (CDC) released CDC Guideline for Prescribing Opioids for Chronic Pain, a comprehensive and systematic review of existing scientific evidence “to identify the effectiveness, benefits, and harms of long-term opioid therapy for chronic pain.” The study defines long-term as use of opioids for over three months. The conclusion as to the effectiveness and benefits of opioid therapy for chronic pain management is concise and unequivocal:

“…no study of opioid therapy versus placebo…evaluated long-term (≥ 1 year) outcomes related to pain, function, or quality of life. Most placebo-controlled randomized studies were ≤ 6 weeks in duration. The body of evidence…is rated as insufficient.”

Risks and Harms

The absence of clinical support for long-term opioid therapy in chronic pain management may come as a shock, but the complications of long-term opioid use are well-known and broadly publicized in online, print, and television media. The statistics reveal a pattern which, taken at face value, should cause a complete re-evaluation of the long-term use of opioids for chronic pain:

Profit Motive 

Prescription opioids are big business. Experts estimate the value of the North American opioid market at $12.4 billion for 2015, a figure which quadrupled between 1999 – 2014, and is projected to grow to over $17 billion by the year 2024. This enormous increase occurred even though the amount of pain reported by Americans during the same period did not change.

In the January 2017 study “What are the advantages of non-opioid analgesic techniques in the management of acute and chronic pain?” published in Expert Opinion on Pharmacology, Dr. Paul F. White, MD, identifies potential explanations for this counter-intuitive phenomenon:

  • Aggressive marketing tactics of the pharmaceutical industry
  • Overstated risks of non-opioid analgesics
  • Reimbursement issues related to alternative pain-management therapies
  • $880 million spent lobbying politicians to block legislation aimed at curtailing the use of opioids.

Rather than collaborate with patients to discover pain-management methods that carry less risk of harm than opioid medications, pharmaceutical companies and groups of vocal physicians did the opposite. White cites an article published in 2007 in which an international group of pain experts advocated for an increase in opioid prescription with this remarkable assertion:

“If only we [physicians and nurses] could overcome our ‘opiophobia’, we would improve pain management.”

When correlated with CDC data indicating a dramatic surge in opioid prescribing between 2007 – 2012, and the steady increase in abuse, overdose, and opioid-related fatalities since 1999, a clear picture of the past decade and a half emerges. Profit, expediency, and our cultural tendency to trust physicians and the prescriptions they write combined to create a perfect storm in which medication developed to alleviate suffering has arguably done more harm than good, and likely caused more pain than it has relieved.

Chronic Pain Management: Alternatives to Opioids

The Biopsychosocial Model

We’re in the midst of an opioid epidemic – that’s common knowledge. What’s not common knowledge is the existence of safe and effective alternatives for chronic pain management. To date, the most complete and effective approach to the management of chronic pain is the biopsychosocial approach, which entails understanding illness and disease as a result of the active interplay of physiological, psychological, and social factors. In their 2007 article “The Biopsychosocial Approach to Chronic Pain: Scientific Advances and Future Directions”, Gatchel, Peng, et al. conclude “the emergence of the biopsychosocial model of chronic pain has led to the development of the most heuristic approach to chronic pain—the interdisciplinary pain management approach.” 

The interdisciplinary approach suggests that in order to treat chronic pain effectively, physicians and patients must work together to see the big picture. Since people who suffer from chronic pain show increased risk for a wide range of additional emotional and physical pathologies, treating one symptom in isolation from the others is ineffective. It’s imperative to adopt a multi-modal approach that includes – in addition to physical symptoms – strategies that consider behavior, emotion, cognition, and environment.

Viewing chronic pain as more than a physical condition is the first step in managing symptoms without the use of opioids. The second step is the use of non-opioid medications.

Alternative Medications for Chronic Pain

Chronic pain is often the result of poorly managed acute pain, and opioid abuse is often the result of the over-prescription of opioid medications after minor or major surgery. Mounting evidence shows that two widely used oral analgesics, when administered intravenously, are effective for managing acute pain:

  • Intravenous (IV) Acetaminophen decreases post-operative pain scores and post-operative opioid usage.
  • Intravenous (IV) Ibuprofen also decreases post-operative pain scores and post-operative opioid usage.

In addition, several non-opioid pain medications are effective in treating chronic pain, and thus decrease the risks associated with opioids:

  • Anti-convulsant medications such as Gabapentin and pregablin are considered effective, first-line treatments for managing chronic neuropathic (nerve) pain.
  • Antidepressant medications (serotonin and norepinephrine reuptake inhibitors) are approved by the FDA for the treatment of chronic neuropathic conditions such as diabetic nerve pain, fibromyalgia, and chronic musculoskeletal pain.
  • Tricyclic antidepressants can help manage general nerve pain, diabetic nerve pain, and post-stroke pain. Note: because of the side effects of these drugs, they are not typically advised for elderly patients.
  • Topical NSAIDs (Nonsteroidal Anti-Inflammatory Drugs) are an effective treatment for chronic musculoskeletal conditions such as osteoarthritis.

After a change in mindset from a strictly material point of view (diagnose-prescribe-take pill) to a holistic one (biopsychosocial), and a shift from opioid medications to non-opioid medications, the third step in managing chronic pain without opioids is the pursuit of complementary and alternative medical therapies.

Complementary Therapies for Chronic Pain Management           

Complementary therapies are defined as treatments that exist outside mainstream medical science but can be effective when used either in place of or in conjunction with traditional therapies. Complementary therapies attract patients struggling with chronic pain who don’t want to use opioid medication for a variety of reasons. Some may avoid opioids because of pre-existing substance abuse disorders; some may have developed substance abuse disorders as a result of prescription opioid use; some may have been unsuccessful managing chronic pain with opioids; some may be averse to physicians and traditional medical science altogether.

This list details complementary approaches supported by scientific research for the management of chronic pain:

  • Cognitive Behavioral Therapy (CBT) is a type of talk therapy which helps a patient make connections between emotions, thoughts, and actions. While CBT itself does not relieve pain, it’s considered effective in improving mood and decreasing catastrophizing. Pain management experts recommend CBT to address the psychological component of pain within the biopsychosocial model of chronic pain management.
  • Physical Exercise improves overall quality of life, mood, physical functioning, and reduces risk of developing co-occurring chronic diseases such as cardiovascular disease, type 2 diabetes, osteoporosis, and obesity. Low, moderate, and high-intensity aerobic exercise, strength training, and flexibility training all have positive impacts on the management of chronic pain. Any exercise plan should be tailored to accommodate individual needs and capabilities.
  • Yoga, Tai Chi, and Qigong are low-intensity movement-based physical activities that have positive impacts on chronic pain associated with rheumatoid arthritis and fibromyalgia. Evidence shows these activities also improve strength, balance, flexibility, cognitive function, and help manage symptoms of anxiety and depression.
  • Acupuncture is a traditional Chinese medical technique used to treat a wide range of disease and illness. Research verifies acupuncture as an effective treatment for osteoarthritis, neck pain, back pain, chronic headache, and shoulder pain.
  • Massage is proven effective in reducing chronic musculoskeletal pain and mitigating associated symptoms such as insomnia, depression, anxiety, and stress.
  • Chiropractic therapy – the direct manipulation of the spine – is proven effective for the treatment of chronic spinal pain syndromes.
  • Mindfulness and Meditation practices serve as an effective complement to CBT in managing chronic pain, decreasing stress, and treating opioid misuse. Pain researchers assert that these techniques operate by increasing emotional awareness and intelligence, skills which lead to greater self-efficacy and a subsequent decrease in the subjective experience of pain.

Managing Chronic Pain Without Opioids

The relationship between humans and opioids goes back thousands of years – but that’s not the whole story. While it’s true that our relationship with exogenous opioids goes back thousands of years, our relationship with endogenous opioids is deeper. It goes back millions of years, to the very origin of our species, because our opioid system evolved as an integral part of our nervous system. We can neither avoid nor ignore its presence and power in our lives. We can, however, identify when this system works against our overall health and well-being, as in the case of opioid medications used for chronic pain. We can mitigate the negative effects of exogenous opioids by pursuing evidence-based therapies which are equally effective, and in some cases, superior to opioids for chronic pain management. Individuals in recovery and treatment for substance abuse disorders can find comfort in the fact that opioids are not their only option and sidestep the potential for relapse and misuse. They no longer have to fear the effect of injuries or surgeries on the recovery process, or operate under the false notion that living a sober life means they don’t have access to effective pain management strategies or medication that works. Holistic, interdisciplinary approaches, paired with non-opioid medications and the right combination of complementary therapies, empower patients – including those in recovery – to take control of their pain experience and improve quality of life without exposure to the preponderance of risks associated with opioids.

Mindfulness and Recovery: Theory and Mechanisms

woman practicing mindfulness by the seaThe practice of mindfulness is no longer considered an experimental approach in the treatment of mental health and substance abuse disorders. Once a novelty without much data or evidence to verify its benefits, research into the mechanisms and efficacy of mindfulness practices on health and wellness began in the 1970s, gained momentum in the 1980s and 1990s, and surged in the 2000s. Between 2000 and 2010, the sheer volume of mindfulness studies published in peer-reviewed scientific journals piqued the attention of the traditional medical establishment and forced a shift in the way doctors, therapists, and health scientists view techniques once considered interesting but unverified fluff. Since 2010, wide-ranging surveys and meta-analyses have addressed and verified the scientific basis for mindfulness. The current consensus is that practices such as meditation, yoga, taiji, and basic breathing exercises are practical and effective components in the treatment of mental health disorders of all sorts, and substance abuse disorders in particular.

This article offers a brief history of mindfulness in the U.S., a discussion of the neural mechanisms mindfulness training targets, and a general theory to explain why mindfulness plays an important role in any treatment and recovery plan for individuals struggling with substance abuse and addiction disorders.

Mindfulness in the U.S.

While a majority of the population may view mindfulness as a relatively new phenomenon, history tells a different story. Mindfulness arrived in the U.S. over a century ago, when renowned Indian guru Swami Vivekananda addressed the Parliament of World Religions in Chicago in 1893. Vivekananda represented India, Hinduism, and yoga, but his speech triggered national interest in spiritual and physical practices from Tibet, China, and Japan. In the decades that followed, the secular aspects of Hinduism, Taoism, and Buddhism – yoga, taiji/qigong, and meditation, respectively – slowly worked their way into American culture. The 1960s saw an explosion of interest in yoga with the publication of a popular series of books by Richard Hittleman, and in 1970 yoga made it to television: the show Yoga for Health proved yoga, and by extension, mindfulness practices in general, were here to stay.

Dr. Jon Kabat-Zinn, a researcher at the University of Massachusetts, conducted the first scientific studies on the mental health benefits of mindfulness. He began by examining the effect of mindfulness on chronic pain management, then widened the scope of his research to include stress, anxiety, and depression. He synthesized his work into a system known as Mindfulness Based Stress Reduction (MBSR). MBSR is now a default therapeutic technique in use by therapists, treatment centers, and addiction experts worldwide. It’s been combined successfully with a variety of traditional psychotherapeutic modes, such as Cognitive Behavioral Therapy (CBT), Dialectical Behavioral Therapy (DBT), Acceptance and Commitment Therapy (ACT), and Relapse Prevention (RP). Evidence for the complete integration of MBSR with these techniques – and its acceptance by the scientific community – is reflected in a new family of acronyms: MBCBT (Mindfulness-Based Cognitive Behavioral Therapy), MBDBT (Mindfulness-Based Dialectical Behavioral Therapy), MBACT (Mindfulness-Based Acceptance and Commitment Therapy), and MBRP (Mindfulness-Based Relapse Prevention). Thankfully, a simpler way of labeling mindfulness-related therapies has supplanted the acronym avalanche: they’re now collectively known as Mindfulness Training, or MT.

Mindfulness Training: Neurochemical Mechanisms

For generations, both the neuroscience community and the general public lived with the belief that after a certain point early in life, neurogenesis, or the formation of new brain cells, stopped. This misconception was debunked in the late 1990s, first by identifying the formation of new brain cells in songbirds and finally by identifying the formation of new brain cells in adult humans in the early 2000s. A growing body of research proves definitively that mature humans can not only produce new brain cells, but the new brain cells can be produced in a relatively short amount of time – as little as eight weeks – by the practice of mindfulness techniques.

Mindfulness training results in an increase in brain matter density (neurogenesis) in the following brain regions:

Hippocampus: The hippocampus is an essential structure in the limbic network, the part of the brain primarily responsible for emotional regulation. The hippocampus also contributes to the formation of memory and cognitive functions like self-awareness, compassion, and reflection.

Amygdala: Part of the limbic network, the amygdala is known to be associated with sensations of stress and anxiety.

Posterior Cingulate Cortex (PCC): The PCC is involved in the process of assessing the relevance of external stimuli to oneself, and contributes to placing these self-referential stimuli in an individual’s emotional and autobiographical context.

Cerebellum: The cerebellum is primarily known for its function with regards to sensory perception and motor control, but it also contributes significantly to the regulation of cognitive and emotional processes.

Temp-parietal Junction (TPJ): The TPJ facilitates the integration of internal and external sensory information, social cognition, and the ability to interpret the desires, intentions, and goals of others. Activation of the TPJ is linked to feelings of empathy and compassion.

The brain structures stimulated and strengthened by mindfulness training combine to form a functional group uniquely relevant to the treatment substance abuse and addiction. Substance abuse disorders compromise and lead to deficits in emotional regulation, stress response, anxiety, self-awareness, social intelligence, and empathy. While these deficits manifest in different ways for different people, their cumulative effect leads to dysfunctional behavior in the form of counter-productive coping skills. Self-medication suppresses powerful emotions, disproportionate stress-response and exaggerated anxiety increase desire for self-medication, distorted perception of the self-in-context normalizes the denial of the self-destructive consequences of substance abuse, and diminished social intelligence and empathy contribute to the tendency of addicts to lose sight of the consequences of their actions on the people around them. Mindfulness training reinforces the neural mechanisms necessary to bolster the perceptive skills required to bring these deficits back into balance, enabling individuals to see and understand their behavior, which in turn allows them to build the healthy and life-affirming coping skills that lead to sustainable recovery.

A Mindful Model of Addiction

A deep dive into the scientific literature available on the effects of mindfulness training on mental health disorders, including addiction treatment and recovery, leads the diligent reader to mountains of data describing positive benefits related to well-being, mood, self-efficacy, stress tolerance, the ability to gain non-judgmental perspective on behavior. However, only one study elucidates the connection between Buddhist philosophy – the theoretical basis of most practical mindfulness techniques – and contemporary theories of addiction. In “Craving to Quit: psychological models and neurobiological mechanisms of mindfulness as treatment for addictions”, a 2012 paper published in Psychology of Addictive Behaviors, researchers apply the Buddhist theory of human suffering to substance abuse disorders, calling it “an early model of addiction.”

The Buddhist Model

The Buddhist theory of suffering is relatively simple. It states that desire causes all human suffering, and therefore, the path to enlightenment – or in the case of regular people living 21st century lives, the path to health and wellness – lies in releasing attachment to objects of desire. Buddhist philosophy also asserts that personal identity is formed, in part, by associations created by habitual behavior. An individual desires an object or subjective sensation and connects fulfillment of that desire to a concept of identity, which reinforces both the habitual fulfillment-seeking behavior and concept of self to the sensations and attendant emotional states achieved by fulfilling the desire. In the case of an individual struggling with substance abuse, pleasurable sensations that follow substance use are the objects of desire. Those sensations become an aspect of identity. When those sensations fade, so fades the habituated sense of identity. The fulfillment of desire, therefore, becomes the search to maintain identity, and identity becomes inextricably intertwined with substance use. 

Mindfulness Training: Interrupting the Craving Cycle

The way to break this cycle is to separate the habituated sense of identity from the cycle of desire. Substitute the idea of craving for the phrase cycle of desire, and addictive behavior can be understood by recognizing that what addicts do is logical: they crave reinforcement of their sense of identity. More simply put, they crave being themselves. In the case of an individual struggling with addiction, the created self is counter-productive and damaging to long term health, function, and survival. When the cycle continues in unchecked, iterative repetition, the self of addiction undermines the true self by distorting emotion, perception, memory, and cognitive function. It supplants and ultimately destroys the original self and becomes the default state of identity.

Buddhist scholars call this cycle “the chain of dependent origination.” Craving is what connects identity to the chain; therefore, breaking the cycle of craving may enable an individual to escape the cycles of addiction. Mindfulness training teaches the skills required to see the cycle as it is – a self-destructive one – and replace it with constructive patterns of behavior. Dr. Lawrence Peltz, author of “The Mindful Path to Addiction Recovery: A Practical Guide to Regaining Control over Your Life”, describes mindfulness training as

“… a powerful accompaniment to the recovery, psychotherapy, and medicine an alcoholic or addict needs. In essence, mindfulness is the quality of awareness that sees without judgment, shining a light on each moment just as it is. This includes physical sensations, feelings, thoughts, and the nature of our experience continually shifting and changing. With practice, it is a skill that can be developed by anyone.”

The first step in developing this important recovery skill is learning to slow the mind down, relax, focus, and “shine a light on each moment just as it is.” There are many paths to this mind-state, such as seated meditation, walking meditation, breathing exercises, and the practice of yoga postures. What all these techniques have in common is their ability to grant the practitioner the ability to clearly see what drives their actions, and the perspective to decide whether those actions help them or hurt them.

Mindfulness allows an individual to observe, for instance, that stress triggers a cascade of emotion that leads to a particular behavior, i.e. substance use. Mindfulness further allows the individual to understand that though substance use temporarily alleviates the symptoms of stress, that same stress, anxiety, and tangle of uncomfortable emotions returns when the substance of abuse clears their system. The clarity of mindful perception can lead to the insight that substance use does nothing whatsoever to mitigate the underlying cause of the stress. This insight may lead to greater and greater levels of understanding. The authors of “Craving to Quit” summarize the benefits of mindful perception in this way:

“By decoupling pleasant and unpleasant experience from habitual reactions of craving and aversion, careful attention to the present moment can function to bring a broadening or spaciousness of awareness that allows new appraisals of life situation. A possible result of this…is the ability of mindfulness to facilitate positive reappraisal.”

Mindfulness in Action

In the context of treatment and recovery, the power of mindfulness lies in its ability to support, complement, and functionalize more traditional modes of therapy. While methods such as Cognitive Behavioral Therapy (CBT), Dialectical Behavioral Therapy (DBT), Acceptance and Commitment Therapy (ACT), and Relapse Prevention (RP) help individuals identify patterns of behavior which undermine health and well-being, they do not offer specific techniques with the strength to arrest craving cycles during the critical moments in which cravings occur. When craving hits, habituated patterns of addiction drive behavior towards that which reaffirms the distorted sense of self and identity caused by addiction. Traditional therapies based on talking and thinking often fail to interrupt these patterns, whereas mindfulness training – through breathing exercises, somatic practices, and the cultivation of non-judgmental detachment – teaches skills to stop the cycle of craving in its tracks, allow the moment of craving to pass without acting upon it, and create the internal space to replace the negative patterns of addiction with the positive patterns of recovery.

For decades, mindfulness training has helped individuals struggling with substance abuse and addiction disorders achieve balance and harmony in their lives. In the early days of the mindfulness movement, these techniques were regularly devalued, ignored, or ridiculed by the scientific establishment. Those days, thankfully, are over. Advances in neuroimaging have allowed researchers to identify discrete changes in brain structure following mindfulness training, offering clear data on the mechanisms by which mindfulness supports recovery. Coupled with a compelling, logical theory to elucidate the role of mindfulness vis a vis identity, choice, action, and behavior, mindfulness training has shed the baggage of unverified novelty and assumed its proper place in the mental health community as an effective, practical, and evidence-based mode of treatment for substance abuse and addiction disorders.

 

 

 

 

 

 

 

 

The Dangers of Alcohol Self-Detox: Is It Safe to Detox on Your Own?

man in bed detoxing

When to Stop Drinking 

The question of whether to quit drinking alcohol or not is a serious one. Fortunately, there’s a rule of thumb to follow if you think you need to take a break from alcohol or stop drinking altogether. It’s simple. If you’ve ever asked yourself either of these two questions:

“Should I lay off alcohol for a while?” or “Should I quit drinking?”

The answer is yes.

That’s not direct medical advice; only your doctor can give you that. Nor is it a suggestion to stop drinking cold turkey right now without consulting a medical professional or addiction specialist; that’s dangerous and can have serious repercussions. Yes is the universally appropriate answer to these questions for two common-sense reasons. First, if you don’t have an alcohol problem – called an Alcohol Use Disorder (AUD) by mental health and substance abuse experts – and your alcohol consumption is low-to-moderate with a minor risk of developing an AUD, then a period without alcohol will do absolutely no harm. You’ll get a first-hand reminder of how much social activity in our culture revolves around alcohol and alcohol-related activities. Second, if you do have an AUD, a yes answer to these questions can be the impetus you need to get sober and live a life without the pain and suffering associated with substance abuse.

This article addresses questions which necessarily follow the yes answers. It defines and discusses the different types of alcohol use, the risk factors for developing an AUD, the health complications caused by excessive drinking, and the dangers of attempting to detox from alcohol without professional guidance and monitoring.

What is an Alcohol Use Disorder?

The fifth edition of the American Psychological Association’s authoritative publication, the Diagnostic and Statistical Manual (DSM-V), is the gold-standard reference handbook used by mental health professionals to diagnose and classify mental health and substance abuse disorders. The DSM-V identifies the presence of an AUD by posing the following eleven questions to a patient:

In the past year, have you…

  1. Had times when you ended up drinking more, or longer, than you intended?
  2. More than once wanted to cut down or stop drinking, or tried to, but couldn’t?
  3. Spent a lot of time drinking, or being sick and getting over the after-effects of drinking?
  4. Wanted a drink so badly you couldn’t think of anything else?
  5. Found that drinking, or being sick from drinking, often interfered with taking care of your home or family, cause job-related troubles, or problems with school?
  6. Continued to drink even though it was causing trouble with your family or friends?
  7. Given up or cut back on activities that were important or interesting to you, or gave you pleasure, in order to drink?
  8. More than once gotten into situations while or after drinking that increased your chances of getting hurt?
  9. Continued to drink even after a memory blackout, and even though it was making you feel depressed or anxious or adding to another health problem?
  10. Had to drink much more than you once did to get the effect you want, or found that your usual number of drinks had much less effect than before?
  11. Found that when the effects of alcohol were wearing off, you had withdrawal symptoms such as trouble sleeping, shakiness, restlessness, nausea, sweating, a racing heart, sensing things that were not there, or seizures?

Positive answers (yes) to two or more of these questions indicates the presence of an AUD. The DSM-V further clarifies the scope of the AUD by identifying three categories, or levels of severity:

  • Mild: positive answers to two or three of the diagnostic questions.
  • Moderate: positive answers to four or five of the diagnostic questions.
  • Severe: positive answers to six or more of the diagnostic questions.

The DSM-V, published in 2013, alters the diagnostic criteria from those presented in the DSM-IV, published in 1994 and revised in 2000. The DSM-V eliminates two distinct diagnoses – alcohol abuse and alcohol dependence – and replaces them with the single diagnosis, Alcohol Use Disorder, which is then divided into mild, moderate, and severe sub-classifications. 

Common Levels of Alcohol Use

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the Substance Abuse and Mental Health Services Administration (SAMHSA) offer easy-to-understand definitions of alcohol consumption and how different levels of consumption affect general health and wellness. If you’re unsure where you fall on the continuum, use these guidelines to help understand your level of use:

  • Moderate Alcohol Consumption is defined as drinking up to one drink a day for women and two drinks a day for men.
  • Binge Drinking is defined as drinking five or more drinks for men and four or more drinks for women in a two-hour period on at least one day over the course of one month.
  • Heavy Alcohol Consumption is defined as binge drinking on five or more days over the course of one month.

These definitions are straightforward and align with what most people know through direct personal experience or typical social contact. Moderate consumption is synonymous with the default notion of responsible, social drinking; binge drinking largely occurs during college years or early adulthood; heavy drinking is what happens when consumption gets out of hand and becomes a relatively obvious problem.

Clear as these delineations may be, they beg another question: “What constitutes one drink?” This is important to understand, because serving sizes and alcohol content vary depending on a variety of factors. Drinking at a bar or restaurant is not the same as drinking at a private party, and the amount of alcohol in a drink depends on the drink in question: beer, malt liquor, wine, and distilled spirits all contain different percentages of alcohol. Here’s how the NIAAA defines a standard drink:

  • 12 ounces of beer containing around 5% alcohol. Think of a regular can of beer.
  • 8-9 ounces of malt liquor containing around 7% alcohol. Think of a pint glass around half-full.
  • 5 ounces of wine containing around 12% alcohol. Think of a regular glass of wine you might get with dinner at a restaurant.
  • 5 ounces of distilled spirits (liquor like vodka, whiskey, gin, or tequila) containing around 40% alcohol (80 proof). Think of a regular-sized shot glass.

Are You at Risk of Developing an Alcohol Use Disorder?

Based on the figures above, the NIAA defines low-risk drinking as:

  • Less than three drinks a day and seven drinks a week for women.
  • Less than four drinks a day and fourteen drinks a week for men.

NIAA research shows that only around two percent of people who drink within these limits – i.e. low-to-moderate drinkers – develop an AUD. Consumption above these levels increases the chance of developing an AUD.

The 2015 SAMHSA Survey on Drug Use and Health estimates that 15.1 million adults and 623,000 adolescents have crossed the threshold and developed alcohol use disorders. The same survey reveals another disturbing fact: of those 15.1 million adults and 623,000 adolescents, less than 10% receive professional treatment in a specialized substance abuse facility.

If you fall into the at-risk category, it may be time to consider treatment options – but before you follow through on the decision to quit drinking and seek help, it’s important to understand both the health risks of drinking and the dangers of detoxing without the assistance of a qualified substance abuse professional.

Health Risks of Alcohol Abuse: The Big Picture

The Centers for Disease Control (CDC) report that alcohol is the fourth leading cause of preventable death in the United States, accounting for around 88,000 fatalities per year. A study published by the American Journal of Preventive Medicine estimates the economic burden of excessive alcohol use at $249 billion for the year 2010. Data from The World Health Organization indicates that alcohol consumption contributes to around 3.3 million deaths per year – roughly 6% of all global fatalities.

Alcohol and The Human Body

Ongoing patterns of excessive alcohol consumption have significant negative health consequences. Heavy consumption over a long period of time can damage the brain, the heart, the liver, and the pancreas. This NIAAA list details the effect of alcohol on each organ:

Brain: Heavy alcohol consumption disrupts key chemical communication pathways – called neurotransmitter systems – such as GABA, glutamate, serotonin, and dopamine. This disruption can affect cognitive function, mood, behavior, hormone regulation, and movement.

Heart: Heavy alcohol consumption can contribute to problems that lead to hypertension, stroke, arrhythmia, and cardiomyopathy.

Liver: Heavy alcohol consumption leads to pathologies such as cirrhosis, fibrosis, alcoholic hepatitis, and steatosis.

Pancreas: Heavy alcohol consumption results in the production of toxic chemicals that can lead to pancreatitis.

Long-term heavy alcohol consumption also compromises the immune system, making it easier to succumb to diseases like tuberculosis and pneumonia, and elevates the risk of developing cancers of the mouth, esophagus, throat, liver, and breast.

Acute Alcohol Withdrawal Syndrome (AW) 

The human body is an incredibly adaptive and resilient group of complex and complementary physiological systems. One characteristic of the body is its ability to achieve homeostasis – a.k.a. balance – in the face of extreme stress, the presence of harmful toxins, and despite the self-destructive behaviors common to humans, some of which persist for decades before damage disrupts day-to-day living.

With regards to long-term exposure to alcohol due to chronic heavy drinking, the body adjusts over time and finds a way to keep functioning. When alcohol is abruptly removed from the system, however, the body does not have time to adapt, and things can turn very bad very quickly. In 1998, a group of physicians on the faculty of Yale University published the article “Complications of Alcohol Withdrawal”  which describes the dangers of acute alcohol withdrawal in no uncertain terms:

“Disease process or events that accompany acute alcohol withdrawal (AW) can cause significant illness and death. Some patients experience seizures, which may increase in severity with subsequent AW episodes. Another potential AW complication is delirium tremens, characterized by hallucinations, mental confusion, and disorientation. Cognitive impairment and delirium may lead to chronic memory disorder (i.e. Wernicke-Korsakoff Syndrome). Psychiatric problems associated with withdrawal include anxiety, depression, and sleep disturbance. In addition, alterations in physiology, mood, and behavior may persist after acute withdrawal has subsided, motivating relapse to heavy drinking.” 

In plain language, this means alcohol detox can kill, cause brain damage, and lead to extreme psychiatric disorders. Further, the likelihood of these negative effects increases with each withdrawal episode and may lead to relapse.

The onset AW symptoms can occur as quickly as six hours after the cessation of alcohol consumption. For some, mild tremors, anxiety, nausea, and insomnia form the totality of AW and can resolve untreated after several days. In approximately 10% of cases, severe AW includes seizures, delirium tremens (DTs), Wernicke’s Encephalopathy (WE), Wernicke’s-Korsakoff Syndrome (WKS), and “disturbances of thought, mood, and perception.” Among patients who experience DTs, the mortality rate is 5-25%. Among those who develop WE/WKS, approximately 80% experience permanent brain damage resulting in chronic amnesia and the inability to learn new information.

Medically Assisted Alcohol Detox

This article began by claiming that the question of whether to quit drinking alcohol or not is a serious one. The potential complications associated with alcohol withdrawal discussed above underscore the gravity of the question and all it implies. Most people, even those in recovery, don’t know that alcohol detox is more dangerous and has more severe complications than detox from almost all other drugs of abuse, including opiates, narcotics, benzodiazepines, and amphetamines.

Detox from heroin, for example, can be extremely uncomfortable, but it won’t kill you, whereas detox from alcohol most certainly can.

It doesn’t have to, though.

It’s possible to avoid the life-threatening complications of alcohol detox by consulting a medical professional with specific experience in addiction and medically-assisted detox protocols. A qualified physician can formulate a safe detox plan and prescribe medications to prevent seizures, DTs, and alleviate the psychological and psychiatric side-effects of withdrawal. Medically assisted detox can also successfully treat Wernicke’s Encephalopathy and prevent the onset of Wernicke’s-Korsakoff Syndrome.

Alcohol Detox at Summit Estate

You can detox from alcohol without suffering permanent brain damage or killing yourself – but you should not try it alone. Summit Estate offers custom-designed, individual detox programs managed by highly skilled substance abuse and addiction experts. State-of-the-art luxury facilities, peaceful surroundings, and healthy, delicious food keep you as comfortable as possible while on-site staff monitor your vital signs and self-reported symptoms to mitigate health risks, ensure the efficacy of the detox protocol, and create a solid foundation for sustainable, life-long recovery.

Drug Overdose Kills More Americans Than Car Accidents

Drug and opioid addiction recovery at Summit Estate Recovery CenterMore than 40,000 Americans die each year from drug overdoses and more than half of those overdose deaths involve opioids. Drug overdoses account for more deaths in the US than car accidents or gun violence.

In the most recent data available, 52,404 Americans died of drug overdoses in 2015 as compared to 35,092 people died (according to the National Highway Traffic Safety Administration) from motor vehicle accidents in the U.S. in the same period.

With all these deaths, what are opioids specifically and how to they work?

Opioids are compounds that bind to receptors in a person’s brain, which blocks pain and slows breathing. Opioid causes the brain to release the natural chemical dopamine and people typically feel a calm “happy” high. Addiction causes people to take opioids regularly, and as a result, they develop a tolerance to the drugs. This forces people to take more and more of the drugs to achieve the same effect. Therefore, if enough of the drug is taken it causes a person to stop breathing altogether, making overdoses often fatal.

Some opioids – heroin – are illegal. While others, hydrocodone or oxycodone are prescribed for pain relief – the two most common brand names are Vicodin and OxyContin. Prescriptions for the drugs have skyrocketed over the years, from 76 million in 1991 to over 260 million last year. To compound the issue the influx of fentanyl, a painkiller prescribed for acute pain that is up to 50 times more powerful than heroin, is leading to higher rates of overdose nationwide.

Opioid usage is high across the United States with many of the states hit hardest by the epidemic — West Virginia, New Hampshire, New Mexico, and Ohio. The epidemic affects both rural and urban areas equally.

Where Does Someone Get Their Drugs from?

Most often is it is believed that overprescribing is fueling the epidemic. A person gets injured and is prescribed painkillers, which quietly leads to addiction. However, according to federal data, most people start out by taking the painkillers of a friend or family member and become addicted quickly.

Experimentation typically starts during adolescence or young adulthood, but opioid addiction affects people of all ages equally and leads to devastating consequences. Those attempting to recovery by practicing abstinence alone when it comes to opioid addiction fail at a high rate, with roughly 90 percent of people relapsing.

That is why at Summit Estate, we understand that every addiction is unique. We are committed to helping our clients have a brighter future free from addiction. So, we have developed a personalized addiction treatment program to address our clients’ specific needs. Our exclusive rehab centers offer truly personalized care for total healing from poly-substance addiction and co-occuring disorders like depression and anxiety.

The luxurious facilities and beautiful grounds provide all of the important amenities individuals need to feel comfortable while undergoing drug and alcohol detox. Our innovative recovery programs are offered by highly credentialed treatment professionals who aim to provide each client with the highest level of care possible. With a small client population, each individual receives the one-on-one attention needed to overcome addiction and go on to live a happy, balanced life.

Grey’s Story – A Road of Hope and Recovery at Summit Estate

Grey’s Story – A Road to Hope and Recovery
“Alcohol was my primary demon,” says Grey. At 59 years old, Grey looks back on his long struggle with alcoholism and is able to reflect back on a life that was almost cut short because of his addiction.

For decades, Grey’s life was unmanageable and was causing his family pain as they bear witness to his slow path of self-destruction. Over the years he had unsuccessfully tried several times to quit. “I tried different things to quit, I tried Alcoholic Anonymous meetings, harm reduction programs – it just wasn’t enough,” he says. His addiction affected his self-esteem and his business as well. He also had to confront underlying issues of anger, which made it difficult for Grey to seek or receive help.

His wife and two teenage daughters experienced the agony and pain of Grey’s blackouts and hospital visits. Grey’s addiction was tearing his family apart as he continued down the path of self-destruction. At one point, Greys wife threaten to leave and file for divorce. It was one of the lowest points in Grey’s life. “I felt ‘broken,” he says. “My addiction made me lose sight of everything around me,” says Grey.

His therapist suggested he go to rehab. “It was obvious and clear, but denial was in the room,” says Grey. The breakthrough and willingness to get the help he needed was the change of attitude that saved Grey’s life. “I looked at recovery facilities state wide,” Grey says. “When I walked through Summit Estate’s doors, the atmosphere was excellent, very open and informal, well-staffed,” he says. Grey took the first step and entered Summit Estate’s 5-week residential treatment program. “It was nerve racking to take time off of work to take care of myself – it was either that or go down the drain, but I was stepping away from danger and into helpful hands,” says Grey.

“My father was an alcoholic and I didn’t have a concept of modern recovery,” he says. This compounded the issue of starting recovery difficult.

The road to recovery is seldom an upward trajectory, as in life it can be filled with the occasional setbacks and disappointments. “Looking back it was the best decision I made, although reluctantly at first. My experience at Summit Estate was very positive and I couldn’t have imagined doing what I do now – living life sober and happy” says Grey.

Grey is on a solid road to recovery and is facing the daily challenges of staying sober with a new mindset and recovery tools learned at Summit Estate. “The road to recovery has been rocky at times, but Summit Estate is one of the healthiest places to get your head together – they have their client’s best interest in mind,” says Grey.

“Summit Estate is a safe place, where I was taken care of, given a chance to relax, to think, to reflect. Sacrifice a little to gain recovery, it’s only a few weeks,” says Grey.

Gene’s Story

gene“I grew up in a household filled with alcoholism and co-dependency,” says Gene. When he was 13 years old his parents divorced and he moved to Northern California from Southern California. He began using alcohol and drugs in his early teens. “I was introduced to marijuana at 13 years old and from that point I did all type of drugs,” says Gene.  For the next decade he was abusing alcohol and drugs regularly.

In an attempt to quit, he entered military service in his early 20s. But, that proved ineffective as the urge to use drugs was more powerful than military life. “I was asked to leave because of cocaine use,” says Gene.

In the mid-1980s, Gene’s family and friends staged an intervention and he went into a treatment program.  “I was able to stay sober for 13 years and I got my life back on track,” says Gene.  But, Gene relapsed “while sober I didn’t take care of the underlying issues that caused my addiction and expand my spiritual life,” he says.

During an especially difficult life changes – divorce and job layoff – Gene slipped into taking prescription pain pills and illegal narcotics. For the next decade Gene went through the darkest moments of his life. “I dealt with alcohol blackouts, started using cocaine again, and overdosed,” says Gene.  “I was tired of living this way.”

A few friends of Gene found Summit Estate.  In summer of 2015, they encourage him to give it a try. “Summit Estate’s approach to recovery was different – a holistic view of overall health,” says Gene. Summit Estate introduced him to healthy ways to deal with his addiction and how to live differently – without drugs and alcohol. “Summit Estate thought me how to just sit with myself, how to breathe when confronted with difficult situation, how to mediate, and I even started practicing yoga – simple steps that helped a lot,” says Gene.

“Summit Estate introduced me to a holistic approach to recovery – it felt like recovery 2.0 – they taught me to take care all the aspects of life to gain true recovery,” says Gene.

Gene is continuing with his recovery and he is also helping others who are on their own journey of recovery. “At Summit Estate I learned to identify those triggers that would cause a relapse and how to deal with them without jeopardizing my recovery,” he says.

Now 55 years old, “I am in a good place spiritually, mentally, emotionally, and physically,” says Gene. His sense of humor also continues to be a source of strength by living life on life’s terms. “I am in the 3rd quarter of my life and looking forward to overtime,” jokes Gene.

Joyful Gen: A Story of Recovery

Joyful Gen A Story of Recovery

Genevieve now looks back at her years of drug addiction with a sense of “I couldn’t have imagined a life without addiction.” Her addiction started in her late teens when a family member first introduced Genevieve to marijuana. She continued getting high for nearly a decade, sometimes smoking up to 5-6 times a day.

By the time Genevieve left for college she was fully ingrained in the “smoking culture.” She was a good student and never got into trouble, but at night she would sneak out to get high. “I lived a second life, where no one judged me,” says Genevieve. As a result of the continued smoking, she dealt with depression, panic attacks and paranoia. Genevieve entered a college sponsored outpatient program to help her to quit using marijuana, but her sobriety didn’t last long and she relapsed.

Genevieve tried to quit off and on for the next six years, but she kept relapsing. She would go as far as flushing the weed down the toilet, yell at herself to stop getting high, entertaining thoughts of getting into a car accident or even experience a stroke all to stop smoking. “I wondered how I would ever get out of this addiction,” she says.

In her late 20s, Genevieve finally had reached a point where she knew she needed help. One day on a whim she Googled drug recovery centers and came across Summit Estate’s website. Genevieve picked up the telephone and began dialing the toll-free hotline. On the other end of the phone was Mike, one of Summit Estate’s staff members. Genevieve shared that she needed help and “Mike said come in right now and had he said come in tomorrow or another day, I wouldn’t come in at all,” she says.

“Summit Estate’s counselor Dee made it easy to make it, by just focusing on one thing at a time,” says Genevieve. Dee sat down with Genevieve and created a personalized recovery plan. “It was Dee’s simple tools and positive affirmation that helped me overcome my addiction. When those negative ‘voices came out of my head’ – it felt like lead weights that were holding down my soul were lifted and I started healing,” she explains.

Genevieve learned to express herself through art, music, poetry, and other activities at Summit Estate. “it made my soul sing,” she says. The nurturing atmosphere and caring staff created an environment where Genevieve felt safe to keep working on her recovery. “I wasn’t critical and didn’t judge myself anymore, I felt free to be who I am,” says Genevieve.

Joyful Gen, as she affectionately became to be known at Summit Estate, was experiencing true joy and happiness for the first time in her life – Genevieve began to see a life free from addiction. “My word of advice is to continually work on your recovery, be open and willing to break through,” she says.

Heroin And Opioids Continue To Be A Runaway Problem In Northern California

Heroin And Opioids Continue To Be A Runaway Problem In Northern CaliforniaHeroin and opioid addiction continues to be a growing problem around the globe. Prescription pain relievers are incredibly addictive, damaging lives and increasing overdose death tolls in nearly every state. Opiate and heroin abuse affects the welfare of all societies, including Northern California. The problem in California has reached an all-time high due to low drug prices, easy access to drugs, and lack of awareness. Exploring the drug problem in Northern California can help our community find a solution.

Heroin And Opioids In NorCal: Surprising Statistics

Heroin And Opioids In NorCal- Surprising StatisticsIn 2013, California hospitals treated over 11,500 people suffering an overdose of opiates or heroin – the equivalent of one overdose every 45 minutes. This statistic shows a shocking 63% increase in overdose cases since 2002. Researchers believe this rise is partially due to consistently low prices and plentiful amounts of black tar heroin in California pipelined from Mexico. Every office in the Drug Enforcement Administration (DEA) in San Francisco reports the dominance of black tar heroin and that it’s easy to obtain.

According to data gathered by the Sacramento Bee, hospitals in rural superior California have the highest rate of opioid overdose patients. The county averages for overdoses per 10,000 residents were the worst in Northern California. Here’s an overview of the greatest county averages in overdoses per 10k residents from 2006 to 2013:

  • Plumas County: 9.1
  • Lake County: 8.8
  • Humboldt County: 8.4
  • Shasta County: 8.1
  • Tuolumne County: 7.5

Local counties faired slightly better on the scale but still had high overdose numbers:

  • Nevada County: 5.1 (400 total overdoses)
  • Yuba County: 4.1 (234 total overdoses)
  • Sacramento County: 3.3 (3,723 total overdoses)
  • Placer County: 3.3 (918 total overdoses)

Overdose Deaths In California

Heroin And Opioids In NorCal- Surprising StatisticsShasta County hospitals helped more than 1,150 overdose patients between 2006 and 2013—more than triple the average for the entire state. The rates of overdoses were also higher than the statewide average in Sacramento County, Placer County, and El Dorado County.

In 2013, there were a total of 6,108 ER visits due to opioid overdoses—a rise from 3,517 in 2006. The number has steadily increased each year, as have the number of hospital stays. The number of overdose deaths has risen since 2006, but there was a slight drop in 2012. This may be due to people seeking help before their problem gets out of control or advances in how hospitals treat patients suffering opioid overdoses. Still, an average of 1,752 people die from opioid overdoses in California every year.

The Relationship Between Opioids And Heroin Abuse

Recently, there’s been a statewide switch from prescription opioids to heroin, with a particularly high increase among young people. Evidence suggests that as prescription drugs become less available and more difficult to obtain, drug users are shifting to heroin. For example, a downward trend in OxyContin abuse directly correlated with an increase in heroin use in a study by the National Institute of Drug Abuse.

Additionally, drug users will build a tolerance for opiates and prescription painkillers, making them more likely to find heroin, which is easy and cheap to purchase in most major cities in California. In some communities, heroin costs less to purchase than prescription opioids. Between 2005 and 2012, the number of known heroin users in the United States almost doubled, from 380,000 to 670,000.

Unfortunately, the risk of overdosing is increased with heroin when compared to prescription opioids. Heroin addicts can’t control the purity of the drugs they purchase, leading to heroin that may be contaminated or mixed with other, unknown drugs. Previously, heroin use was a problem almost strictly in urban areas. Now, the DEA frequently encounters heroin in small towns and suburbs in California.

Sources Of The Heroin And Opioid Problem In Northern California

California officials attribute the ongoing problem to a number of different variables that have changed over the years. An increased patient awareness of the right to pain relief, various organizations that support the use of large doses of opioids, and aggressive marketing from the pharmaceutical industry have all contributed to the issue. Some doctors prescribe opioids loosely without properly educating patients on the addictive nature of such drugs.

Easy Access To Prescription Meds Through Family

Based on a survey by the National Institute on Drug Abuse, the majority of people (54.2%) aged 12 and older who used pain relievers non-medically say that they obtained the drugs from a friend or relative for free—whether by consent or theft. Reducing the number of unused painkillers improperly disposed of may help prevent people, especially young people, from developing a drug addiction. Keeping prescribed pain medications hidden or counting them carefully can also help.

Methods Addicts Use To Obtain Drugs

While only 18.1% of respondents said that they obtained the drugs from one doctor, the 54.2% of people who got them from friends state that 81.6% of their sources got the drugs from one doctor. Patients with addictions can gain access to prescription pain medications relatively easily across the United States. In 2001, there was a movement toward prescribing more opioids, stating that doctors largely undertreated chronic pain. This led to the Pain Treatment Act and Bill of Rights. Since then, doctors have more openly prescribed pain medications for common health complaints without fear of retaliation.

One of the methods addicts use to get their hands on large amounts of opiates and painkillers is “doctor shopping.” Doctor shopping refers to the act of going to multiple doctors and complaining of the same symptoms. A patient may go to one doctor complaining of a health issue, either real or fake, and obtain a legitimate prescription for pain relievers. Then, the same patient will go to a different doctor and do the same thing. Doctor shopping allows addicts to consistently receive a high number of opioids with real prescriptions.

Opioids are available for purchase online, without the need for a prescription, through illegal online pharmacies. Law officials do their best to locate and shut down illegal Internet pharmacies, but they still exist. Online pharmacies may not sell customers prescription-grade opioids, posing an even greater threat to users.

Easy Heroin Availability And Low Prices

Los Angeles is a known collection and distribution point for black tar heroin from Mexico—the primary form of heroin the DEA encounters in Northern California. From there, tight-knit groups transport the drugs to locations in the Central Valley. San Francisco is a significant destination for this heroin, as are San Jose, Redwood City, and East Palo Alto.

Heroin availability has quickly spread throughout California, cropping up in counties such as Sacramento, Placer, Nevada, and Yuba that didn’t previously report heroin problems. The plentiful amount of heroin results in low prices. Prices vary across communities and depending on the purity of the drugs, but heroin typically is less expensive than other addictive drugs. The average cost of 0.1 gram (a single dose) of heroin on the street is only $15.

Effects Of Heroin And Opioid Addictions

Drug addictions can lead to a plethora of negative outcomes, and the price it costs the individual abuser, the community, and the nation as a whole is high. Many drug abusers don’t realize the extensive consequences of heroin and opioid addictions and each drug’s effect on daily life.

Not only do heroin and opioids have devastating mental and physical health effects, but they also cause damages to a person’s finances, employment, quality of life, and relationships. A drug addiction can take over literally every aspect of life until the user has nothing left except his or her addiction.

Effects On The Human Body

Doctors often prescribe hydrocodone and oxycodone in drugs such as OxyContin and Vicodin to treat moderate to severe pain. These medications attach to proteins (opioid receptors) found on nerve cells within the body and brain. These receptors reduce the perception of pain, producing a sense of peace. Opioids can also lead to mental confusion, drowsiness, and nausea. When someone abuses opioids, that person is at risk for serious medical complications such as coma and fatal overdose.

Heroin is well known as a drug with a high risk of overdose. Since there’s no regulation for the drug, most users have no way to know exact dosages or purity levels. Chasing the rush, or the feeling of euphoria, that typically comes with heroin leads users to increase their dosages more and more. Heroin can cloud mental function, slow breathing and heart function, and sometimes result in coma, permanent brain damage, and death.

Costs Of Addiction For The Addict And The Community

Opioid and heroin addictions can severely damage a user’s personal life. Addicts no longer express interest in achieving goals, education, working, or cultivating personal relationships. Relations with spouses, children, parents, and friends suffer—sometimes leading to damages that addicts may never be able to repair. Drugs take over every aspect of life, making it impossible for an addict to see past his or her addiction. With intervention and treatment, addicts can take their lives back. Without treatment, they risk eventually dying from overdose.

The community cost of providing healthcare, emergency services, and treatment programs for heroin and opioid addicts is remarkably high. The Centers for Disease Control ranks California as the number one state in the country for total health care costs from opioid abuse, exceeding $4,263 million in 2013. This was $2,299 million more than the number two state, Texas, which totaled only $1,964 million by comparison. The estimated total cost of opioid abuse in America is $25 billion annually.

California’s Lost Work Productivity

In 2010, illicit drugs cost California more than $15 billion in tangible costs, and though this statistic has yet to be updated, other stats suggest this number is much higher now. This includes $5.321 billion in wage work costs alone. Addicts lose productivity while using and abusing heroin and opioids, losing the desire to go into work, and eventually failing to show up at all. Illegal drug abuse also leads to incarceration, resulting in lost time at work and being terminated from jobs. Business costs also include increased employee turnover and higher insurance costs. The citizens and state economy bear 76% of all tangible costs of substance abuse in California.

Violent Crime Increases Across Counties

Violent crime and property damages are often related to street gangs in California who distribute heroin, among other drugs. Street gangs are involved in crimes such as burglary, assault, auto theft, carjacking, mugging, and home invasion. The U.S. Department of Justice states that much of the violent and property crime is in the Northern California region. This is due to trafficking, group rivalry, and drug abuse. Often, illicit drug abusers commit crimes like robberies to pay for their addictions.

The Northern California High Intensity Drug Trafficking Area program strives to reduce drug trafficking, lowering the impact of illicit drugs like heroin in the ten Northern California counties within its region. Part of the Northern California High Intensity Drug Trafficking Area’s goals is to reduce drug-related crime and violence throughout the area. This program locates major drug threats in each region and implements initiatives to put an end to drug trafficking.

Neonatal Abstinence Syndrome In California

One of the most tragic effects of opioid and heroin abuse in Northern California is the rising number of infants born with neonatal abstinence syndrome (NAS), or a dependency on drugs from birth. In 2015, doctors diagnosed about 1,190 California newborns with NAS—up more than 50% from 2014. NAS leads to withdrawal symptoms as the drugs leave the baby’s system, including tremors, vomiting, fever, and restlessness. Neonatal withdrawal is painful for babies, although it doesn’t typically have a long-term effect on their health.

NAS causes lengthy hospital stays compared with normal births, resulting in increased healthcare costs. The average length of stay for a baby without NAS is about 2.1 days, costing around $3,500. In contrast, a baby with NAS has to stay 17 days or longer, costing $66,700. This resulted in an estimated total of $1.5 billion for hospitals in 2012—8% of which state Medicaid programs pay. As the rate of babies born with NAS increases, so does the total cost to California.

Finding A Solution For Opioid And Heroin Addiction

Opioid and heroin have become runaway drugs in California in part due to lack of community awareness and initiative to stop drug abuse. Currently, there are a number of anti-drug campaigns and programs running throughout Northern California, including the Northern District of California Project Safe Neighborhood, a state agency that focuses on areas of high violent crime and drug activity.

Staying on top of the growing trend toward heroin in NorCal and learning what you can do to prevent drug addiction and help current addicts are important steps to take during this time of high drug activity.

Reduce Future Drug Abuse

Addictions can start at an early age, with kids snatching prescription opioids from their parents’ medicine cabinets. Early intervention programs can help put young adults back on the correct path before a drug problem gets out of control and leads to tragedy. Research intervention centers in your area, and learn how to discuss a drug problem with your teenager. Preventing drug-related death, crime, and other tolls starts with spreading awareness to the next generation.

Many Northern California counties have launched community coalitions against drugs. They bring together leaders from the medical sphere, public health department, clinics, law enforcement, and addiction treatment providers to collectively work to decrease drug use and the overprescribing of pain medications within the community. The California HealthCare Foundation recently began an initiative to support new opioid safety coalitions throughout the state. Joining your local coalition can be a fantastic way to support local efforts against addictive drugs.

Support Sufferers And Addiction Research

Research on how best to treat opioid and heroin addictions continues throughout America, leading national recovery center leaders to discover new, more effective ways to reduce withdrawal symptoms and help abusers recover for good. Donate to your local recovery or research center to help further the knowledge industry leaders have about this growing epidemic. Northern California is just one region out of thousands across the country that can benefit from more advanced treatment research.

If you know someone who has a problem with opioids or heroin, learn how you can help them on the road to recovery. Getting past a drug problem is 100% possible with the right mindset and resources. In many cases, your friend or loved one will need an intervention to recognize that he or she has a problem and that treatment is the only solution. Once the addict agrees to seek help, support his or her efforts to embrace treatment and continue on the path to a drug-free life.

Get Professional Help

Drug addictions are complex—especially since there’s a medical component to the problem. Addicts need therapists, recovery programs, support groups, and treatment centers with the right tools and resources to facilitate healing. Thousands of people who have struggled with substance abuse have successfully overcome addiction and led normal, happy lives. Recovery isn’t possible without support from friends and family. Be there for your loved one, and know when to call in a professional for help.

If you feel you’re at risk of becoming addicted to prescription medications, heroin, or any other substance yourself, seek help from a treatment center such as Northern California’s Summit Estate Recovery Center immediately. Treatment centers are no-judgment zones where you can obtain the help you need to prevent or end a drug dependency.

If you would like to learn more news about addiction and drug, read more Summit Estate blogs.

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