Tag Archives: Addiction Treatment

ERs Are Stepping Up to Help With Addiction

Addiction Treatment Centers

 

Leave it to California to take the lead when it comes to a group of hospitals trying a new way of helping those addicted to opioids—having ERs administer buprenorphine (aka Suboxone) when someone enters in the throes of withdrawal. (Lest anyone forget, buprenorphine is weaker than other opioids. It activates “the same receptors as other opioids, but doesn’t cause a high if taken as prescribed,” says the article in The New York Times.) A 2015 study by researchers at Yale-New Haven Hospital found that when ERs have done this, the people who get the buprenorphine are more likely (twice as likely, in fact) to be in treatment after a month than people who were only given an informational packet that included phone numbers related to treatment. As a result of the study, an ER specialist who heads the buprenorphine program at Highland Hospital in Oakland convinced the California Health Care Foundation to give his hospital a grant to try the novel method.

 

ER Departments

Out of the box idea? Sure. But it seems to be working. Now ER doctors are calling the lead author of the study every week, she said in August, and ER departments in Camden, NJ, Brunswick, Maine, Philadelphia, New York, Syracuse, and Boston are also offering buprenorphine.The doctors need training to prescribe the medication, as well as a license from the DEA to prescribe it unless someone is in withdrawal, so ER doctors are in a good position to treat those patients. “I think we’re at the stage now where emergency docs are saying, ‘I’ve got to do something,’” the lead author of the study said. “They’re beyond thinking they can just be a revolving door.”

 

Detox Centers in Northern California

 

Treatment in the ER

It’s a rare opportunity to meet people where they need help and get them started on medication for their addiction, the article notes. In some places of the country, it’s not easy to find a doctor who takes insurance AND prescribes buprenorphine. After their ER visit, ideally a person will follow a “wheel and spoke” approach, where they first go to a treatment clinic (the hub), adjust to the medication, and then see a doctor in a primary practice (the spoke). Treatment in the ER involves buprenorphine under the tongue, and usually, a prescription for Suboxone, in the form of strips that will dissolve in the mouth and thus are harder to abuse. Then the person is directed to meet with the head of the addiction program in his clinic, where he’s available one day a week.

 

Detox Centers

 

Even signs posted in the waiting area of Highland ER reaching out to those suffering from opioid use disorder are helping. A woman there for a respiratory infection saw one and told her brother about the signs, and he decided to enter the program. Recently released from prison, he was hoping to stay clean, especially because he had a job offer. Now he had “a stable source of treatment.” California was willing to provide the grants to have this program flourish. Two-thirds of Highland Hospital’s 375 patients in withdrawal accepted the medication and had an initial appointment at its addiction clinic. Not only that, but California has started to require detox centers and residential centers to allow residents to take either buprenorphine or methadone, medication-assisted treatment, which has had a history of controversy. That’s also ground-breaking.

 

For more information or to contact our Detox Centers in the Bay Area call (866) 596-9391.

 

Dopesick the Book

Opiod Crisis

By now you have likely heard of the new book Dopesick: Dealers, Doctors, and the Drug Company That Addicted America by Beth Macy. Reviews are everywhere, and Macy appeared on radio station NPR and a PBS episode on TV this month. A reviewer at the Roanoke Times, where Macy once worked, says the book “humanizes the opioid epidemic.” And here’s the reason why it’s making news: he says “It is difficult to imagine a deeper and more heartbreaking examination of America’s opioid crisis than this new book by investigative reporter Beth Macy of Roanoke.”

Dope Sick

A reviewer in the San Francisco Chronicle says: “Macy reports on the human carnage with respect and quiet compassion, but it is gut-check reading.” Dope Sick, for the uninitiated, “is the slang term for being in withdrawal from opiates such as narcotic painkillers (oxycodone, hydrocodone, [morphine, fentanyl, or prescription opioids]) and heroin and refers to the symptoms you experience after stopping or drastically reducing opiate drugs after heavy and prolonged use (i.e., several weeks or more),” according to this website. It’s one of the things about addiction that has users going back to drugs, to avoid the horrible symptoms: nausea, vomiting, stomach upset, diarrhea, leg cramps restlessness, cold sweets, loss of appetite, lack of energy, lethargy, dilerium and …other signs…,” according to the Urban Dictionary. So it’s an apt term to use in the title of a book about the opioid epidemic. And what’s so horrendous, Macy says in the PBS interview, is that epidemiologists say we haven’t even hit the peak of the scourge yet; that’s not due until after 2020. Macy traces the history of the problem, and if you think to yourself, here we go again, you’re in for a surprise.

Alcohol and Drug Addiction Treatment Center

Addiction Treatment

What she says is really interesting. She points out that middle class Americans were able to hide what was happening longer. Parents didn’t want to tell their neighbors what was going on in their house, so the trouble was allowed “to fester and grow.” If you haven’t heard about some of the early heroes, she mentions a doctor named Art Van Zee who saw what was happening in Appalachia as more people got addicted and tried to get the attention of those in power. They didn’t listen. Macy also discusses the controversy over medication-assisted treatment (M.A.T.), and the TV viewer immediately understands how the “national divide” is not helping in fighting the problem. The PBS program stops in at an M.A.T program run by a former heroin addict to help make her point. Here’s how Macy explained the divide in a 2016 article: “Among public health officials, the effectiveness of M.A.T. has become an article of faith; after all, treatment with buprenorphine and methadone has been found to cut opioid overdose deaths in half when compared to behavioral therapy alone, and it’s hard to argue with that. An addict treating his opioid disorder with Suboxone, many argue, is no different from a diabetic taking insulin.

Addicts & Their Families 

But increasingly, law enforcement officials — and many former addicts and their families — are lining up on the other side, arguing that Suboxone only continues the cycle of dependence and has created a black market that fuels crime.” Here is a more recent article Macy wrote about part of her book. She starts with a call she got from a mother whose addicted daughter was found murdered. Macy had been following the daughter’s story for a couple of years. The woman was taking Suboxone again and was supposedly on her way home to Roanoke from Las Vegas, but was found dead in a dumpster after she didn’t arrive. As the mother had said on the PBS program, it’s hard to know when to offer help to an addicted child and when to push away, for your own good and for the good of others. There’s always a story about a mother and a child in this epidemic, and it never gets any easier. At the end of the program, Macy says that she’d like to mobilize people to care. There have been a number of books written about the opioid epidemic, but if you read just one book about it this year, make it this one.

To receive help or for more information please contact Summit Estate, an alcohol and drug addiction treatment center, at (866) 569-9391. 

Addiction and Depression, and Apps and Podcasts

Ask someone why people take drugs, and they may say to try and escape or get relief from the emotional pain they’re feeling, or because they’re depressed. That may be two ways of saying the same thing. You may have also heard people question what comes first. Does someone turn to drinking or other drugs because they’re depressed, or does addiction make someone depressed?  The Mayo Clinic says that alcohol abuse or use of recreational drugs is one of the factors that seems to “increase the risk of developing or triggering depression.” CBS News has a Q&A on the subject with the Assistant Medical Director of a treatment center associated with McLean Hospital who says “there are a number of drugs that people use and abuse that can directly affect the brain and cause depression. For example, marijuana slows down brain functioning and diminishes cognitive abilities and can cause depression in a significant number of individuals. Alcohol can do the same thing. Cocaine tends to elevate people’s moods, but when they come off it, they often experience a crash into depression.”

Alcohol and Drug Treatment Programs 

In any event, Richard Tate, the co-author of “Ending Addiction for Good,” says in Psychology Today that depression is probably the most common co-occurring disorder among substance abusers.  The Mayo Clinic website also points out there are different types of depression, various causes, and several types of medications to treat it.Depression may require long-term treatment,” the organization notes, “but don’t get discouraged. Most people with depression feel better with medication, psychotherapy or both.” Depression is a serious condition and one blog post is not sufficient for thoroughly delving into such an involved disease. However, some people find that besides therapy and medication, apps and podcasts can be helpful.  A few are below.

alcohol and drug treatment Programs

 Apps and Podcasts

 One woman wrote about her depression on Buzzfeed and mentioned that listening to podcasts on mental health work for her because they let her and others know they’re not alone in feeling sad. They also allow for listening in private, where there is no stigma about mental health conditions. One podcast she mentioned is The Mental Illness Happy Hour, which has interviews with comedians, doctors and others that explore mental illness, trauma, addiction, and negative thinking. Don’t let the slick title turn you off before you try it; the podcaster is a comedian. Another writer has compiled a list of apps designed to make people feel happier, such as Aura, which offers Mindfulness Meditations, short stories, music, sounds of nature, and a gratitude journal, for example.

 Regarding mindful meditation, the July issue of Health magazine offers three apps:

Headspace, which teaches the basics of meditating at no cost, followed by for pay meditations from one to 20 minutes. There’s also Meditation Studio, advertised as having meditations for everyone, no matter their situation. Finally, Stop, Breathe, and Think allows you to log your daily meditation to track your practice. A dual diagnosis treatment organization offersApps for Addiction Recovery and Mental Health.” Here’s one that looks interesting:

Pacifica

 

For many, addiction is as much a symptom as it is an illness in and of itself. This makes addressing the core issues that may be fueling the need to escape a central part of recovery. For those with depression and/or anxiety, relief and support can be found through Pacifica. In addition to offering a mood tracker and guided meditations, this app uses principles based on Cognitive Behavioral Therapy to help smooth over distorted thinking patterns and overcome anxiety by breaking it down into bite-sized daily challenges.

 

For more information on Summit Estate’s alcohol and drug treatment Programs please call (866) 569-9391, help is only a phone call away.

Drugs and Alcohol in the Workplace, and Companies That Hire People in Recovery

Alcohol Addiction

You may have seen news segments about companies that allow—even encourage— employees to drink at work. According to a 2012 article on ABCnews.go.com, ad agencies do, or at least they did at that time. One firm’s employee said that it “incentivizes and enthuses” employees, and another said it helps the creative process. Tech companies were mentioned as allowing drinking, too, especially after a “win.” The article even quoted a study that found a little alcohol enhances the creative process.To allow drinking at work brings up a host of issues. Take employees in recovery, for example. These people are often counseled on how to handle the question “Why don’t you drink?” or the taunt, “C’mon, have just one with us” in social situations, but they shouldn’t be placed in this situation at work. Also, what if someone gets in an accident on the way home? Isn’t the company wholly or partially at fault, like a bar is? (The situation is different for people in dangerous jobs; there are strict workplace rules about drinking on the job.)

In most jobs, it’s not easy trying to perform when suffering from alcohol use disorder (although people who are on the road a lot, or executives who aren’t accountable can get away with it easier, it seems). When employees are found to have a problem, however, it’s often strongly suggested that they attend rehab with the help of an Employee Assistance Program. Drinking while at work is such a touchy subject that the government includes the rules in their handbook for supervisors: Alcoholism in the Workplace: A Handbook for Supervisors. Here is a succinct explanation of guidelines and laws around drinking at work: 

“Federal legal protections for alcoholics in the workplace are designed to encourage them to seek help without jeopardizing their employment. However, those protections do not extend to alcoholic behavior in the workplace.

Two federal laws impact employment decisions related to alcohol use, abuse and alcoholism. The first, the Americans With Disabilities Act, requires employers to grant accommodation to disabled employees; it defines disabilities as conditions or disorders that substantially limit a major life activity. If your employee can prove that alcoholism prevents him or her from performing the job properly, you may be required to grant an accommodation for the purpose of rehabilitation. The second law, the Family and Medical Leave Act, prohibits employers from discharging employees who take extended absences to treat their alcoholism.

Accommodating alcoholic employees means giving them time to seek treatment for their condition. It does not mean reducing an alcoholic’s workload or otherwise changing their terms and conditions of employment. It also does not mean forgiving misconduct induced by alcohol or alcoholism. If, after receiving rehabilitation treatment, the employee continues to underperform, the law’s protections no longer apply. Likewise, the recidivist alcoholic is not entitled to FMLA-protected leave for subsequent breaches. The employer may reasonably expect that after a leave of absence for rehabilitation, more will not be required. In addition, no accommodation is required for the employee who denies having a problem.”

Drug and alcohol rehab programs

Drug Addiction

According to a headline in the Washington Post, “Drugs in the workplace are at their highest level in a decade.” Quest Diagnostics reports that opioids in the bloodstream and urine are down, but the incidence of other drugs is up. (And that’s only related to people who went for testing!) Cocaine and methamphetamine use is up in certain states, as well as marijuana in those states that have legalized marijuana for recreational use. Unfortunately, in three states, pot use is up in safety-sensitive jobs, which include truck driving, rail, and those in nuclear power plants, to name three industries. Federal contractors and recipients of federal grants, and “safety- and security sensitive industries” are legally required to have a drug-free workplace policy as under The Drug-free Workplace Act of 1988, but other industries are not. To protect workers’ rights, four acts lay out the limits on steps an employer can take in investigating and setting consequences for employee drug use. SAMHSA (the Substance Abuse and Mental Health Services Administration) advises companies to seek legal representation when deciding their policy on drug testing to avoid being sued for invasion of privacy, for example.

Check Out These Companies 

Here are four companies that hire people in recovery (which often means they’ve served time, too): Venturetech Drilling Technologies in West Knoxville, Texas, Envirosafe Stripping Inc. in Carnegie, PA., Creative Matters in Los Angeles, and Dave’s Killer Bread in Milwaukie, Ore. There are also federal and state programs that help formerly incarcerated people get jobs. For example, the U.S. Forest Service has a program that links non-profit organizations that employ these people with companies that need reclaimed lumber. For more information on our Drug and Alcohol rehab programs please contact us at (866) 569-9391. 

 

Marijuana and Opioids—What’s the Link?

The Marijuana and Opioids Relationship

What’s the relationship between pot and opioids? According to a May article in the Poughkeepsie Journal in New York, part of the USA Today Network, smoking marijuana has the ability to decrease the use of opioids. Specifically, some states that allow the use of medical marijuana and recreational pot have seen declines in opioid prescribing. Medicaid patients are getting fewer prescriptions filled, and in the states where recreational pot is legal, the declines are even greater. The implication, of course, is that if you smoke pot, you don’t need pain relief at the level that opioids provide and don’t seek it.  

The author of the report by the Rockefeller Institute of Government that cited these numbers called marijuana “a potential tool for addressing the opioid crisis.” Additional studies in this area, such as an upcoming one by the National Institute of Health, are on the horizon.

 

Marijuana and Chronic Pain

This latest one will test “whether medical marijuana reduces opioid use among adults with chronic pain, including those with HIV.”

There have also been negative reports about using marijuana for medical reasons, however, such as one in the American Journal of Psychiatry indicating that pot use “increases the risk of an opioid-use disorder.”

The Poughkeepsie Journal article raised also asked about the general harm, or potential risks, in smoking marijuana, and then attempted to answer it. For example, the National Academy of Sciences published a report in 2017 which found that for people who smoke while driving, the odds of being in a motor vehicle accident rose by 20 to 30 percent. (But you already knew about this; you read something similar in this blog about driving and smoking in a May post.)

Outpatient Addiction Treatment

Marijuana and Mental Health

Heavy marijuana use also increases the risk of being diagnosed with a psychosis, and there’s a small risk of developing bipolar disorder. However, the author notes that it’s “hard to establish causality.” He asks, “Are people who smoke pot more likely to develop mental health problems or are people with mental health problems more likely to smoke pot?”

The author summed up by saying that the findings are of questionable significance because almost all risks cited are relative, and overall, the risks are quite low. We need more research, he said, and we may then find more harms. For now, he’s in the camp that points out (believes?) pot’s effects are less harmful than those associated with tobacco or alcohol.

With the legalization of medical marijuana, doctors have another option in providing pain relief besides opioids OR medical marijuana: prescribing a combination of the two. A 2015 article in Forbes reported that “using medical marijuana along with prescribed opioids does not increase the likelihood of a patient abusing alcohol or other drugs.” However, “subjects did report higher rates of alcohol and other drug use than the general population.”

 

Outpatient Addiction Treatment Center

Not many addiction counselors seem to speak publicly about their personal feelings about marijuana for treating pain and other conditions, or about recreational marijuana, for that matter. Yet I’ve heard of one counselor who told the parents of a young man addicted to heroin that he didn’t have a problem with the man smoking pot if it helped him stay off heroin. You wonder if this view is widely held among addiction professionals when a number of them say that pot is still a drug, and it’s possible to become addicted to it. For example, a noted golfer once went to rehab because he couldn’t stop smoking. Wouldn’t it be interesting to see results of a poll that questioned addiction professionals about their personal feelings? For more information contact our outpatient addiction treatment center at (866) 569-9391

 

CA, NY, and Safe Injection Sites

Substance Abuse and Treatment

There is a lot that’s controversial about substance abuse and treatment, such as various issues related to marijuana and whether medication-assisted treatment is the best way to go. For example, one of the more polarizing questions is whether or not people suffering from opioid addiction should be offered safe injection sites, where they would find clean needles and be supervised. These sites are not a new idea; CNN reports that in addition to Canada, Australia and some European countries already have them. In 2017, a California bill proposing safe injection sites in eight counties and certain cities such as Los Angeles failed to pass the state Senate. Had it passed, the state would have been the first in the nation to have them. San Francisco was hoping to start one modeled after the one in Vancouver. One senator said they’d be “shooting galleries for street heroin,” yet another implied they centers would be a heck of a lot better in helping people “get off drugs and lead healthy, successful lives” than what’s happening now.

 Supervised Consumption Facilities 

Yet this year it looks as if cities are taking matters into their own hands, according to the CNN article. In February, The San Francisco Department of Public Health “unanimously endorsed a task force’s recommendation” to open a center. About 22,000 people have overdosed in the city, and in 2017, 100 people died of an overdose there. The mayor said that the sites aren’t ideal, but they’re a necessity with the current opioid epidemic. Two are scheduled to open in San Francisco in July. For people wanting statistics on the likelihood of these centers’ “success,” the article has this: “More than 100 peer-reviewed studies on safe injection sites — otherwise known as supervised consumption facilities — have consistently shown them to be effective at reducing overdose deaths, preventing transmission of HIV and viral hepatitis, reducing street-based drug use and linking people to drug treatment and other services.They can also save cities money, which is not to say they’re a good solution to an overwhelming problem.

 top rehab center in California

Injection Sites 

The video accompanying the CNN article showed an overdose victim being revived with Narcan. It was rewarding to see her “come to,” but on the other hand, it was quite upsetting to see her so out of it initially. The video also explained (and showed) what happens to your body during an overdose, which makes a viewer wish that those hooked on opioids would watch it and consider rehab. New York is having its own its own problems trying to get injection sites, as this headline indicates: De Blasio’s Plan for Safe Drug Injection Sites Faces Substantial Hurdles. The mayor would like four initially, but according to the articles, the federal government may determine that the plan “violate(s) the nation’s drug laws.” A spokesperson pointed to what happened in Vermont, where the U.S. Attorney for the state cautioned officials who want the centers about legal repercussions  (see below).

Rehab Centers in California 

Besides New York, other cities such as Seattle and Baltimore, are moving toward opening sites. Philadelphia has publicly announced that they’d like private companies to set up shop in their city. The Vermont federal prosecutor decreed that using illicit narcotics and managing and maintaining sites on which drugs are used and distributed, is illegal, and would expose workers and drug users to criminal charges. Not only that, but the properties where the centers were located could also be forfeited. De Blasio practically pleaded for the centers, saying they would save lives (and prevent up to 130 overdoses a year). (Last year, the city had over 1,400 overdose deaths.) Around the same time as he appeared on TV, a woman reported that she got clean with the help of a safe injection site but didn’t go into detail. It’s difficult to fully understand the politics, or the weight different government bodies hold in the dispute. How could California try to pass a bill in favor of the sites, when the federal government would likely swoop in as it did in Vermont? And how are cities inviting the centers in when they likely would be stomping on federal law, too? You wonder, as the opioid epidemic rages on, what will happen. For more information contact our top rehab center in California at  (866) 569-9391.

Autism, Asperger’s and Addiction in the High-Tech Industry

 Illustration with word cloud on disease AutismIllustration with word cloud on disease AutismA February post postulated that substance abuse may be more prevalent in the high-tech industry in Silicon Valley than is generally known. Anecdotal evidence from Silicon Valley addiction experts who treat a number of clients from the industry suggested that this is true. Why? The stress involved in working in such a competitive environment — trying to be the first to launch a product.

Those with normal and above-average intelligence are said to have high-functioning autism. Asperger’s syndrome is closely related.” The Autism Society explains that people with Asperger’s exhibit “less severe symptoms and the absence of language delays [in childhood]”. WebMD also holds that high-functioning autistic people as well as people with Asperger’s are “good fits for technically demanding jobs. Not only does the internet downplay autistic social deficits, but the language of computers also allows some people with autism to give full expression to their exceptional abilities.”

Perhaps you’ve known or seen someone on the spectrum who seems intensely interested in how things work. One of the experts WebMD quoted said that these people’s brains are wired differently. They “pick out patterns in information and to discern the logical rules that govern systems. That means people with Asperger’s and high-functioning autism often have great talents for creating and analyzing mechanical systems, such as engines, or abstract systems, like mathematics and computer programs.” Gawker reported that “cases of Asperger’s and autism … exploded in Silicon Valley over the past 20 years, according to state-funded outreach workers — an assertion that will come as no shock to users familiar with pedantic, apathetic, tight-lipped and self-serving tech companies.”

To be fair, Silicon Valley isn’t the only area cited as having a high incidence of these conditions. There’s Redmond, Washington, where Microsoft is located, and the northwest Rochester, where IBM is located, is also mentioned as a possibility. Gawker also noted that there are no statistics surrounding the number of programmers and engineers, for example, that are on the spectrum, but “popular belief holds that places like NASA and Silicon Valley are havens for them.” Even Computerworld, one of the industry bibles, has weighed in, with an article titled “Asperger’s: the IT industry’s dark secret,” in which several techies on the spectrum commented. Temple Grandin, who has Asperger’s, says we wouldn’t even have computers without techies with Asperger’s. So where does substance abuse and recovery come in, you might ask. Do people on the spectrum have substance abuse problems like others?

Maia Szalivitz, a “neuroscience journalist” who often writes about addiction, details her thoughts in an article in The Atlantic (which originally appeared in a publication called Spectrum). It opens with the story of a man addicted to heroin who finally got clean. Afterward he was diagnosed with autism, although the signs were there all along. Szalivitz says that for years, the commonly held belief was that addiction among people with autism is rare, since they follow rules and are usually isolated from their peers, for example. But a study in Sweden found the opposite to be true — people on the higher end of the spectrum are “more than twice as likely to become addicted,” and it’s worse if they also have ADHA. Experts in the article say that people on the spectrum find that alcohol eases social anxiety, and they may become addicted. The same holds true of marijuana. Impulsive behaviors in this population are also a problem and can lead to gambling or internet shopping addiction. An article about autism and addiction in Psychology Today by a person who runs a California treatment center included research from the Washington University School of Medicine, where experts studied Australian twins. The findings were that “people with autistic traits were no more likely to drink or use marijuana than people without these traits, but that people with autistic traits who drank or smoked pot were more likely to become addicted to or otherwise abuse these substances.” The writer noted the difference between a person exhibiting autistic symptoms and actually having a diagnosis, however. He posits that “a diagnosis is likely to accompany a more extreme form of the disorder. And it seems from this research as if a more extreme form of the disorder may keep autistic people from even experimenting with substances.” A psychiatrist he interviewed said “it could be that some traits related to autism are protective, while others elevate the risk for alcohol and substance-abuse problems.” If anything, the information in these articles shows a need for more study between autism and addiction.

Nutrition and Recovery

When people suffering from addiction enter treatment and stop using, they often develop a more intense interest in food – often sugary, high-carb, or high-fat choices like doughnuts or mac and cheese. Usually, before they know it, they’re packing on the pounds. Those who have abused alcohol and other drugs likely had a poor relationship with food at the same time, eating whatever pleased them, and some were malnourished. Addiction experts know that what these people are really doing is substituting one drug for another. Both substances make the brain’s pleasure and reward centers light up, which explains why food takes on added importance for them. Many treatment centers promote the idea of healthy eating, and treating people with substance use disorders holistically, but it’s an integral part of the program at Summit Estate Recovery Center. Angela Goncalves, Director of Operations at Summit, even brought a cookbook targeted to those in recovery from her former center, Malibu Beach Recovery Center, to Summit. “I was the Director of Operations at [the former] Malibu Beach Recovery Center from September 2007 to September 2014,” she says. “I saw how effective our diet was for clients struggling to recover from drugs and alcohol. The food was not only delicious, but it boosted dopamine levels.  When I became Director of Operations at Summit Estate Recovery Center in the Silicon Valley, I immediately distributed copies of our cookbook, then known as Dopamine for Dinner, to the chef and staff. It’s the basis of the wonderful meals we serve, and our clients look and feel super healthy.” The basis of the cookbook is the approach to food taken by a French executive in the pharmaceutical industry who developed a diet for himself based on low-glycemic foods. It’s noteworthy that even the chefs who cook the recipes — and contributed to the book — noticed how much healthier the clients look since consuming the foods in the book. There’s this from the Introduction: “….[A]ddicts of all sorts (illicit drugs, prescription drugs and/or alcohol), can recover more easily by following a version of [this diet]. The goal was not weight loss, but regaining emotional balance and health, restoring chronically low dopamine levels and expediting brain repair. The diet also makes recovery more probable for diabetics.” and “Although we call this a ‘diet,’ his is not a diet in the traditional sense. There are no calories to count, and we don’t ask that our clients memorize the values of the Glycemic Index. There are no long lists of forbidden ingredients. Rather the recipes are based on an abundance of allowable products that will enrich and enhance culinary possibilities, and may introduce ingredients that had not been a habitual staple in their nutritional habits.” The cookbook is also for alumni of the two programs (MBRC and Summit), and the “hundreds of thousands of Americans just like them – alcoholics and addicts seeking to achieve long-term recovery through a lifestyle change.” Note: The Barnes and Noble version of Dopamine for Dinner (now called the Malibu Beach Recovery Diet Cookbook by Joan Borsten) can be purchased from Amazon at this link: https://tinyurl.com/ydafq33h

 

 

Defining Recovery: Reconciling Mental Illness and Positive Mental Health

mental health A curious and dynamic dance revolves around the definition of recovery from mental health disorders in the 21st century. On the one hand, consumers of mental health services tend to define recovery as the presence of positive behaviors and mental states – known as the salutogenic model – while members of the scientific and medical communities tend to define recovery as the absence of disease and negative mental states – known as the pathogenic model. In order to reconcile and synthesize these two disparate points of view into a workable, useful, and inclusive definition, a group of researchers, spearheaded by Helene Provencher of Laval University (Quebec City, Quebec, Canada) and Corey L.M. Keyes of Emory University (Atlanta, Georgia, USA) propose a comprehensive definition of recovery under the label complete mental health. First explored in the 2005 article “Mental illness and/or mental health? Investigating Axioms of the Complete State Model of Health” and expanded over the course of the past decade in close to a dozen related, follow-up studies, the idea of complete mental health – and its relationship to recovery from mental health disorders – is novel in that it recognizes the following:

  1. The absence of the symptoms mental illness does not automatically mean positive mental health.
  2. Positive mental health does not require the total absence of the symptoms of mental illness.

Instead of viewing positive mental health and mental illness as mutually exclusive states of being, Provencher and Keyes consider them as “two separate continua rather than the opposite ends of a separate continuum.” It’s important to note that while these initial studies focus on mental health disorders such as depression, schizophrenia, PTSD, and mood disorders, the value of the complete mental health model applies with equal validity to recovery from addiction and substance abuse disorders. Professor James Jackson (University of Michigan) elucidates the transfer of this Provencher/Keyes model to include recovery from addiction and substance abuse disorders in the 2016 publication Measuring Recovery from Substance Use or Mental Disorders: “…one commonality between substance abuse and mental disorders…is that people with substance abuse problems often have cravings that could be described as conceptually similar to symptoms. In both cases, such a craving may be fine as long as the person is not acting on it.” Both professional substance abuse counselors and individuals in active recovery from substance abuse disorders know cravings are not the only persistent symptom-like phenomenon challenging successful recovery. Counter-productive psychological coping mechanisms such as denial, anger, and rationalizing not only contribute to continued substance abuse prior to recovery, but also follow the recovering addict throughout life and often lead to relapse. Recovery does not mean the total absence of these life-interrupting coping mechanisms; rather, recovery means having the awareness, self-efficacy, and practical tools to identify and counter these mechanisms as they recur over time.

Substance Abuse Recovery: Process and Outcome

Recovery from addiction and substance abuse disorders is complex. It’s tempting to measure recovery with a single, yes/no criterion wherein abstinence signifies recovery and indulgence in intoxicants signifies non-recovery or abuse. However, substance abuse counselors and individuals in recovery alike identify this black-and-white approach as a reductive oversimplification that ignores the subtleties and nuanced challenges involved in creating a life free of substance abuse. Relapse is a reality, yet relapse does not always mean a total collapse of the recovery effort. Nor does it mean a return to square one. The functional truth is that recovery is a non-linear process filled with advances, setbacks, successes, and failures. It includes in-between periods that are neither highs nor lows. The lifelong process of recovery happens on a dynamic continuum, and the precise location of an individual in recovery on that continuum rarely remains fixed. A recovering individual responds to the stresses and gifts of daily life with relative degrees of efficiency. Hard days are as much a part of recovery of good days. Navigating the extremes while maintaining a commitment to the process is the hallmark of a sustainable approach, as opposed to a static mindset that relegates an individual to a restrictive binary with sobriety on one side and substance abuse on the other.

An Multi-Faceted, Inclusive Model of Recovery

The complete mental health model advocated by Provencher and Keyes allows for the non-linear nature of recovery from addiction and substance abuse, and accommodates the formation of an analog for the two features of complete mental health previously described:

  1. Abstinence alone does not automatically mean complete recovery.
  2. Recovery does not require the absence of addiction-related symptoms.

Abstinence is, of course, the ultimate measure of sobriety, yet for individuals struggling with addiction, recovery means more than abstinence. It means the restoration – or in some instances, the discovery – of a way of life that supports happiness, health, and well-being. The model designed by Provencher and Keyes integrates a pre-existing model of mental illness described by Liberman and Koplewicz with their own model of positive mental health. The combination of these two models results in a multi-dimensional rubric containing six states of relative and interconnected positive mental health and disruptive mental illness, ranging from an initial state of being non-recovered from mental illness and languishing to a final state of being recovered from mental illness and flourishing:

  1. Non-recovered and languishing. This phase is characterized by severe impairments in mental health and extreme symptoms of mental illness.
  2. Non-recovered and moderately mentally healthy. This phase is characterized by fewer symptoms of mental illness combined with moderate levels of positive mental health.
  3. Non-recovered from mental illness and flourishing. This phase is characterized by the significantly reduced presence of the symptoms of mental illness, combined with concrete and identifiable attributes associated with positive mental health and flourishing.
  4. Recovered from mental illness and languishing. This phase is characterized by the absence of the symptoms of mental illness, combined with an absence of the attributes of positive mental health.
  5. Recovered from mental illness and moderately mentally healthy. This phase is characterized by the absence of the symptoms of mental illness, combined with moderate levels of positive mental health.
  6. Recovered from mental illness and flourishing. This phase is characterized by the absence of the symptoms of mental illness, combined with high levels of positive mental health.

[For the purposes of this article, the states are described here in sequence, whereas the rubric created by Provencher and Keyes situates them on an x/y axis, with the x axis representing the mental health continuum, and the y axis representing the mental illness continuum] Substance abuse therapists and individuals struggling with substance abuse will immediately recognize the value of this expanded view of recovery. It asks both to understand that the process of recovery – the goal of which is complete mental health – is neither wholly salutogenic nor wholly pathogenic, but a combination of the two. It also asks those therapists and individuals to understand that recovery is neither solely a process nor solely an outcome, but again, a combination of the two. It gives therapists the tools to identify a client who’s abstinent, yet displaying mental health behaviors that may lead to relapse, and provides the vocabulary to discuss what they see with their client. It gives individuals in recovery the means to understand that it’s possible to be sober, abstinent, and diligently following a recovery program, yet still experience negative emotions and signs of poor mental health.

The Intersection of Theory and Practice

The Provencher/Keyes model gives treatment professionals the groundwork for situating traditional and complementary therapeutic modes side-by-side in pursuit of a greater whole: complete mental health. Awareness and application of the model particularly benefits individuals with co-occurring disorders, in that an array of therapies can be deployed – with the six states of recovery as a guide – to address both addiction and mental health disorders simultaneously. For many therapists and individuals in recovery, the Provencher/Keyes model verifies what they know already: recovery can be a messy process, filled with peaks and valleys. What works for one individual might not work for another, and what works one day for one individual might not work the next day for the same individual. The ability to bolster a recovery plan in one area, ease off in another, and stay steady in still another is something experienced practitioners and those in recovery have cultivated for decades. Until recently, however, these types of tweaks, and the insights that instigate them, have been a matter of instinct and the result of experiential knowledge – not the result of standard prescriptive practice. The introduction and adoption of a model that integrates the salutogenic and pathogenic theories of recovery into an adaptive, holistic, inclusive, and seamless whole unites theory and practice in a way that gives individuals in recovery a greater chance of therapeutic success, and ultimately, more options on the path to personal well-being and total mental health.

Why is it so Easy to Get Addicted to Pain Pills?

Pain Pill Addiction Let’s get two things on the table right away. First, anyone can get addicted to pain pills. Anyone. Me, you, your doctor, your neighbor, and anybody in your family or circle of friends. Remember Brett Favre, NFL Hall of Fame quarterback, Super Bowl winner, star and starter for the Green Bay Packers? He got addicted to pain pills while recovering from a shoulder injury. How about music legend Prince? Yes, the Purple One, famous not only for his music, but for avoiding – and criticizing – the use of drugs by his peers during his thirty-five years in the celebrity limelight. He got addicted to pain pills while trying to manage problems with his hips. Then he died from an accidental overdose in his own home. How about Rush Limbaugh? Yes, the fiery, often-controversial conservative talk radio host. He got addicted to pain pills while trying to manage pain after back surgery. He battled the addiction for years, checking in and out of rehab, and even got tangled up in a criminal investigation related to obtaining prescriptions illegally. That’s the first thing, worthy of repeating: no one is immune to opioid addiction. Second, getting addicted to pain pills has absolutely nothing to do with your character. Getting addicted to pain pills doesn’t make you a bad person. Not getting addicted to pain pills doesn’t make you a good person. Addiction does not care about your good deeds or your bad deeds. It doesn’t care if you’re a good parent or a deadbeat dad. You could be as good as Mother Theresa, or as bad as Jack the Ripper. It doesn’t matter. It simply happens. That’s the second thing, worthy of repeating as well: getting addicted has nothing to do with your value as a human being.

Getting Addicted is Easy: The Biological Reasons

Let’s get another thing out of the way: when we talk about addictive pain pills, we’re talking about opioids. Here’s a short list of pain medications being prescribed today whose pain-relieving properties rely on our endogenous opioid system:

  • Codeine
  • Oxycodone
  • Oxycontin
  • Fentanyl
  • Percocet
  • Vicodin
  • Lortab
  • Lorcet
  • Dilaudid

These familiar drugs are the opioids that have been in the news so much lately. They’re the pain pills that are currently ravaging our nation, sparing no population. Rural, urban, suburban. White, black, Latino. Young people. Old people. Rich people. Poor people. The opioids that caused the new President of the United States to sign an Executive Order forming a Special Commission to handle the crisis – a commission which, in its first public report, recommended that the President declare national emergency because of the crisis. It’s that serious, and it’s happening to everyone, everywhere. Why? Because it’s natural. That’s right. Getting addicted to opioids is almost as easy as getting addicted to food, sex, exercise, or anything that feels good. Synthetic opioids contain the most powerful pain-relieving molecules known to medical science because of a quirk of human physiology: the endogenous opioid system present in the human nervous system. Synthetic opioids relieve pain by leveraging this naturally occurring pain-relief system, and they’re so easy to abuse because they hijack this naturally occurring system. Opioids are problematic because this internal pain-relief network is linked, at the cellular level, to how humans experience feelings of pleasure, satisfaction, and reward. When we do something that makes us feel good, our brain guides us back to that behavior. That’s how our neurobiological reward system works. Our brain remembers what feels good, and when the opportunity to experience that good feeling presents itself again, our brain tells us to go for it – even if another part of our brain knows we shouldn’t. This is an oversimplification, but it’s true: we get addicted to opioids because we’re hard-wired for them.

The Problem(s) With Opioids:

Long-Term Effectiveness

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:

Getting Addicted is Easy: The Problem with Prescriptions

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. 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. If you’re addicted to pain pills, it’s likely your addiction happened something like this: you had a surgery, an injury, or a condition that caused you so much pain your day-to-day life became difficult. Your doctor prescribed you an opioid pain medication, and you took it as ordered. You didn’t realize it, but by taking the pills every day, you built up a tolerance, meaning you had to take more pills, or a higher dose of the same medication, to achieve the same analgesic effect. You didn’t think much of it. You simply took an extra pill, or asked your doctor to prescribe something stronger. Then, after a few weeks, you started getting cranky between doses. You didn’t know it, but that crankiness has a medical term: anhedonia. Anhedonia is the opposite of euphoria, the pleasurable sensation that accompanies opioid pain relief. You probably didn’t know that anhedonia is an early symptom of opioid withdrawal. You didn’t make the connection because addiction probably wasn’t on your radar. Why should it have been? You trust your doctor, and you were following orders. Besides, your crankiness disappeared when you took your medication – as ordered by the doctor. After a couple of months, you crossed an invisible line: you started to need the pills just to feel normal. You tried to quit, but couldn’t. And now there you are: addicted to pain pills, and all you did was follow doctor’s orders. It’s an awful situation, and you’re not alone. It’s playing out every day across our country. The media attention and the new CDC guidelines for prescribing opioids have caused many doctors to scale back their prescription writing practices, which is a double-edge sword: of course, it’s a good thing that they’re not prescribing as many opioids as in the past decade, but they’re also leaving many people in the lurch. Their patients are addicted, and they’re cutting off their supply of drugs. People are quite literally left out in the cold. Sick, in withdrawal, with no idea what to do next. Desperate, they turn to street drugs like heroin or black-market knock-offs of the prescription medications they began with. The problems with street drugs and illegally produced pills are numerous, but can be distilled down to three basic issues:

  1. There’s no way to guarantee what you’re getting.
  2. There’s no way to be sure of your dosage.
  3. They’re illegal. If you buy them, you can get arrested and thrown in jail.

But that doesn’t have to be you. You don’t have to go down that road. There’s another option. A much, much better option.

You Can Get Help

At Summit Estate, we understand opioid addiction. We’ve spent years on the front lines, helping people detox, helping people rebuild themselves from the ground up, and helping people take control of their lives. We don’t want you to become a statistic. We want to offer you a way out. We want you to explore our Medical Drug and Alcohol Detox Center, our Residential Programs, our  Day Programs, and our Outpatient Programs. We want to work with you to create a custom treatment program that meets your needs. We’ll help you find your way back to a healthy, sustainable life, free from the cycle of addiction you find yourself trapped in – through no real fault of your own.