Friday, April 17, 2015

Forgiveness & Nonexistent Apologies

by Gabi Pinto-Coelho

For most people making positive change in their lives, there usually comes a time when you start looking at your relationships. You celebrate the ones that are positive influences in your life, you let go of long-gone relationships that kept you down in the past, and you start to examine (and re-examine) the rest. That gray area can be pretty ugly, but that’s where the real growth happens, in my opinion.

This gray area includes relationships with people that have hurt you (for the purposes of this blog, I am only talking about emotional/psychological pain). Some people stay in relationships feeling constantly hurt, but keep trying to make things work for any number of reasons. Others might respond to the pain they feel by holding a grudge. In reality, neither of these options is “moving on” from the situation.

If you are continuing to hold onto a relationship that keeps bringing you down emotionally, there are some important questions to ask yourself. In this case, you’ve got to consider:
  • ·         Is this relationship worth my time, my emotions, and my energy?
  • ·         What would my life be like without this relationship, as it stands now?
  • ·         If you are trying to change this relationship, is it just you that wants change or is the     other person invested in change, too? 
  •        Has this other person demonstrated his/her willingness to change or have they only     talked about it?

You get the picture here - you have to decide if the other person deserves you and everything you have to offer.

I’m certainly not a therapist, a psychologist, or a psychiatrist. But, I am a human being who has had to cut people out of my life. An ex-boyfriend that I dated for several years was caring but extremely depressed. Much of our relationship involved me trying to “fix” him and make him feel better. My lack of “success” in this endeavor made me feel like I wasn’t enough. The idea of breaking up with him because he couldn’t be an equal partner in the relationship seemed cruel and cold. But after three years, I realized that it is not my responsibility to fix someone else. 

Everyone comes to their own conclusions in their own time, and it is never easy. However, if you decide that someone not worth your energy, you’ve got to cut the cord. If you decide it is worth it, then you need to set some boundaries for yourself. How do you know when you are giving too much? What does the other person need to do to demonstrate a change in behavior? There are no easy questions or simple answers, that’s for sure.

Sometimes this whole “cutting of the cord” can happen way too rigidly, and that’s how grudges happen. I have an incredibly strong, insightful, loving, intelligent, and funny father. But he will be the first to admit that he is a grudge-holder. His current record for grudge-holding is a whopping 13 years. When he thinks someone has “wronged” him, he is so adamant about cutting ties that he refuses to forgive. In his attempt to prevent putting effort into unworthy relationships, he is actually spending more energy on being angry. An oft-mentioned quote on grudges says, “Holding a grudge is like drinking poison and waiting for the other person to die.”

Ultimately, it’s not only about cutting the cord, it’s about how you cut it. Too often in the process, we get hung up on whether someone else apologizes and if it’s sincere or adequate. In reality, the apology is irrelevant. After you’ve decided something is not worth your energy, anything else remotely positive is gravy. 

It seems a little radical, but what you should really be focused on is forgiveness. Without forgiving the offending party, you end up holding a grudge. Forgiveness is not an admission that the other person is “right” or “deserving.” Forgiveness has nothing to do with the other person and everything to do with you and your own peace & happiness. 

Forgiveness is a gift that you give yourself so that you can let go and move on. 

Tuesday, March 31, 2015

CAUTION - Contaminated Heroin in VA!

by Peter R. Coleman, MD

Last month, we received an urgent appeal from the Virginia Department of Health to be on the lookout for patients who may be suffering with contaminated heroin. It turns out that a increasing number of people have been showing up in emergency rooms with severe reactions after using heroin. Many have had to be admitted to the ICU. And, it is likely, that without treatment, this contamination can be fatal.

It appears the heroin has been cut with a powerful stimulant, similar to adrenaline. The addicts start to show symptoms of chest pain, anxiety, panic, sweating, fast heart rate and trouble breathing. 

This is quite different from the usual picture of someone who has had an overdose. The symptoms of an opiate overdose are the opposite of this – sleepiness, lethargy, and slow breathing, and if severe, the breathing stops completely. The usual treatment of an overdose is to give an immediate injection of Narcan® (Naloxone Hydrochloride)
to reverse the opiate effects, but Narcan® has not been helpful in these recent cases of contaminated heroin. These patients need to be admitted to the hospital and stabilized.

This is a very serious problem and, unfortunately, is only too predictable. Many people are now switching from painkiller pills to street heroin because it is so much cheaper. When people buy street drugs, they have no idea of what they are actually getting. 

Recently, there have been clusters of overdose deaths because sometimes a batch of heroin is contaminated and/or much more potent than usual. 

Let’s all work together to combat this horrible and deadly disease.

Friday, March 27, 2015

Why Do People Use Drugs?

by Peter R. Coleman, M.D.
I have been pondering this question for many years. On the surface, it seems kind of obvious - because you feel good when you drink alcohol or take drugs. But this is a little simplistic.

It seems to me that there are three main categories of the reasons why people use addictive drugs, including alcohol:

1.     They produce a euphoria
2.     They relieve emotional distress by changing our moods
3.     They promise some spiritual relief

The first category is the one that I have predominately focused on in the past. It is an effect that all addictive drugs have - namely releasing a surge, or an increase, in Dopamine in the brains reward pathways. Dopamine is the brain molecule that is released when we eat food or have sex. It is a very powerful driver of behavior - just look at how many overweight people there are - and how hard it is for many people to control those impulses. 

All addictive drugs release extra Dopamine and this is one of the big reasons why we like to take them - they produce a euphoria. Addictive drugs release more Dopamine and produce more of a euphoria than our brains were ever meant to get. No wonder we like taking them. No wonder prohibition did not work. Cocaine is probably the most powerful example, but all drugs do it.

The second category is also very important. Addictive drugs are called “mood altering drugs” for a reason - they alter our moods (emotions). We all have emotions and many of the emotions we have are not very pleasant -  fear, anger, sadness, loneliness, boredom. 

Our emotions are not necessarily supposed to be pleasant. They are a form of pain, and pain is meant to be painful because it helps us to stop doing something. Our emotions should be our best guides for future behavior. They tell us what to avoid so that we can make some different, and hopefully, better choices in the future. But, many times, we want to avoid these negative feelings. We don’t want to feel shy or lonely. We don’t want to feel awkward at a party, so we have a couple of drinks and before you know it we are not feeling so bad. We have enough courage to start up a conversation with a stranger. Drugs are very powerful at altering our mood. The most powerful in this category are the sedative drugs, like Valium, Xanax and alcohol.

The third category is the most interesting, and one that has become more apparent to me lately. We like taking drugs, including alcohol, because they alter our reality. Drugs plunge us into a new world, a kind of magical world where there seems to be endless possibilities. Under the influence of drugs, we can enter "Alice’s Wonderland" and talk with rabbits. Under the influence of pot, music seems better than it actually is, and jokes can seem funnier than they actually are. Under the influence of alcohol, we can believe we are actually very good looking and can dance really well. If we take pain killers, we can believe that we have superhuman energy, physical and emotional pain are lessened, and some of the rules of other mere mortals don’t really apply to us.  But, unfortunately, these perceptions under the influence of mind altering drugs are not quite real. 

At some point, all of us have to confront and ultimately accept reality. Part of this acceptance of reality process is a spiritual one. As we grow up and mature, we all have to ask ourselves some of those ultimate questions. Who am I? Why am I here? Is this all there is? How can I be happy? Drugs can seem to give us a short cut to the answers to some of these questions, but of course, they are providing a distortion of reality. It is never possible to see something clearly when you are looking through distorted glasses.

In order to have a shot at recovery, patients need to first get clean off the drugs and wait for the brain to heal and be able to function normally. But, then, we need to be thinking about the above three reasons we use drugs so that we can fill up the holes that they leave when we stop. 

After we give up drugs and alcohol, we need to find solutions and answers to replace what the drugs were doing for us. We need to find pleasure in things other than drugs. We will still get a Dopamine feeling from pleasurable activities, but we need to get that Dopamine in healthy ways - things like spending time with loved ones, hiking, hobbies, eating a good meal. We also need to get used to the amounts of Dopamine that these experiences can realistically give us - not the exaggerated amounts that drugs produced. We need to find ways of dealing with our emotions without just covering the feelings up with alcohol or drugs. 

This is where one of the biggest payoffs of recovery lies. Once we learn how to really feel and identify our emotions, we can learn how to change our behavior so that life goes more smoothly. We can avoid future problems and stop making the same mistakes over and over again. And, we need to grow spiritually. We need to learn and practice honesty, acceptance, love, and tolerance. We need to find things we are passionate about and bring meaning to our lives. 

As we explore and grow in each of these areas of our lives, we can find true happiness - not some drug induced sham of happiness.


Monday, March 23, 2015

Let The Genie Out!


by Joan R. Shepherd, FNP

It was so gratifying to see Chris (name changed for patient privacy) today! He had detoxed from Oxycontin a couple months ago and came to The Coleman Institute for a Naltrexone implant.

We have the expectation that when people return for their 2nd implant, many aspects of their lives will be better. If they were skinny and scrawny, they have probably gained back some of the weight they needed. If they were a little chunky, they have often lost a few pounds. Their eyes, skin and hair are “brighter”. Their energy is better, they are sleeping more, and their problems with anxiety and depression are slowing improving. Money is in the bank again, relationships-if not easier-are infused with more honesty.

So, I was not surprised when Chris reported all the above to me on this 2 month return trip. What is even vastly cooler (my English professors would roll in their graves at that turn off phrase; mea culpa) for Chris is his phenomenal re-connection to his creative self. It is like the opiates were bonds that shackled his artistic soul—once they were cut away—OMG—the Genie has catapulted out of the bottle!

His day job is web design, and I can only imagine how that has improved.  His love is water coloring and he has started again.  

He described a painting he did for a friend who wanted some kind of an angel image. Chris painted an angel hovering over a tree, loosening the noose on a guy attempting to hang himself.
Chris is also the creator of some of the most beautiful tattoo art I have seen. He is currently working on having the names of his four children tattooed on various parts of his body, each name drawn in a unique, original calligraphic style.

Creativity is a gift we all have access to, whether in the form of  artwork, inspiring people with your preaching, masterfully operating heavy equipment, designing a birthday battle party for your children complete with homemade shields and swords or doing whatever it is that speaks to our hearts. Chris is convinced that this surge of creativity is directly related to his ability to FEEL again. Without the opiates on board, his heart is again receiving messages.

Please contact us if you have compromised your creativity by allowing opiates, booze or benzo's to take over; who knows how your Genie will respond.

Friday, March 13, 2015

Glamorizing a Product with Notions of Drugs, Seduction, Sensuality, and Addiction... Really?

by Rachel North, MSW

Recently a popular, couture, and high-priced fashion company, Yves Saint Laurent (YSL), offered a product to consumers: a perfume branded ‘Black Opium.’  The newest advertisement, produced in 2014, featured mostly the advertising norm—a young, thin, empirically attractive model turning an inanimate object, (in this case, the perfume), into something sexualized.  What stands out in this advertisement as additionally upsetting is the sexualization and glorification of something dangerous and in many cases lethal: opium.

The website advertisement reads:

“Discover Black Opium, the new feminine fragrance by Yves Saint Laurent. With a glam rock aesthetic, this addictive gourmand floral entices with notes of black coffee for a shot of adrenaline, white florals to instantly seduce, and vanilla for sweetness and sensuality.”  See more here.

The problems regarding the advertisement run the gamut.  The name of the product itself, the highlighting of the words “addictive,” “adrenaline,” and “seduce” in the advertisement, and connecting the product and opiate use to “glam rock,” an industry devastatingly inundated with drug overdoses.

Simply using the name ‘opium’ in the branding of a high fashion product is a gross testament to the ignorance of the YSL advertising campaign managers. We will be generous here, and offer that maybe they just do not know what they are dealing with.  YSL ad executives must not be aware that “opiates and opioids top the list of problem drugs that cause the most burden of disease and drug-related deaths worldwide”[1]. So that we don’t have to think of this campaign as barbaric, we have to assume that they also simply do not know that of the 183,000 global drug overdose deaths in 2012, the largest category was opioid overdose[2].  The Center for Disease Control reports that of the 22,767 deaths related to pharmaceutical drugs in the US in 2013, 71% were due to opioid analgesics or opioid painkillers[3], but this report must not have come across the desks of anyone at YSL. They could not have read that Canada’s rate of opioid overdoses increased by 242% between 1991 and 2010[4].  Or, sadly, that in Yves Saint Laurent’s home community of France, 81% of all drug-related deaths were opiate-induced[5].  We should hope that they are just not informed of these circumstances, because if they were, what would that mean for the advertisers?

It gets worse. The actual website features a video, which you can view by clicking here. The video highlights the same model—young and very thin—wearing all black.  She wakes up in the middle of the night and fumbles over the top of her nightstand looking for something.  When she can’t find it, she throws on a pair of stilettos, sprints through city streets and underground tunnels, and stops into a building where she finds a man.  She grabs the Black Opium perfume from his hand, leans against a wall, sprays herself, and leaves the audience staring at a facial expression of relief and gratification.  The video ends with the words: “Need your dose of fragrance?” 

There is clearly no hiding the parallel between this product and opiate drug use.  There is also no question that the intention is to make this product look sexy and enticing.  The problem is that while advertisers make the product sexy, they also make opiate drug use sexy.  Evidence abounds that it is anything but. 
As it turns out, the entire “Opium” line was introduced in the 1970’s and became subject to much criticism in following years. A group of Chinese Americans lashed back against YSL, describing the labeling of the product as insensitive to the opium epidemic that had enormous negative consequences for China.  However, no changes to the product name were made[6].  Later, in the early 2000’s, the product line was criticized for its over-sexualization of the model in the advertisement.  Since the backlash from a group of bold Chinese Americans nearly four decades ago, the product and its makers have never been brought to light because of their insensitivity to and minimization of the opioid epidemic occurring on a global scale. 
At a time when families and communities around the world continue to face devastating consequences associated with opiate overdose, it is dangerous and irresponsible to popularize a product that encourages and directly relates use of the drug with high fashion and beauty. 


Thursday, March 5, 2015


by Joan R. Shepherd, FNP

Recently, I attended a remarkable conference in Phoenix Arizona. Although the content was geared around helping clients with weight loss, the main presenter, Dr. Martha Beck, is doing extensive work with people addicted to heroin. It’s not such a stretch to see the connection between using food and using any other substance (or behavior) to separate one’s mind from one’s body.

Choosing not to feel is a protective mechanism that human’s have perfected beautifully. Constant avoidance of unpleasant emotions is easily dealt with by putting anything between the painful thought and the subsequent emotion.

The pesky little problem with doing that is that it consumes an inordinate amount of energy to always be in Avoidance Mode. Not only that, stuffing in food, alcohol or addiction has its own set of pretty nasty consequences.

What I want you to believe is that at the very core of your being, you can know peace. It is there, waiting for you. The process of finding it is simple, but not necessarily easy.

It begins with acknowledging, accepting and stopping one’s addictive behavior. Not medicating with food, drugs, sex, gambling or whatever--may seem terrifying, especially if you have you have been doing this behavior for a long time to cover up some painful experiences. 

Believe me, we have heard some truly tough stories. But, once you choose to own and embrace your painful story, you can start to move forward.

There really is a beautiful life waiting for you; it’s called Reality, and there is nothing funnier, more joyful or more rewarding than living in it.

We love helping people take that first step and ushering you to the next.

Friday, February 27, 2015

Is Suboxone® the Best Treatment?

by Peter R. Coleman, M.D.

Recently, The Huffington Post published a lengthy article by Jason Cherkis on the various methods to treat patients with opiate dependence. It was an excellent article that featured a number of personal cases from families who had lost loved ones to an opiate overdose. In almost all of the cases, the overdose had occurred shortly after the patient had tried to get clean and sober.

The main message of the article seemed to be that traditional treatment programs don’t work well for opiate addiction and the only effective way to treat people who have this problem is to put them on agonist therapy, such as Suboxone®.

(An agonist is a chemical that binds to a receptor and activates the receptor to produce a biological response. Whereas an agonist causes an action, an antagonist blocks the action of the agonist and an inverse agonist causes an action opposite to that of the agonist.) 

The article indicated that Methadone, an agonist, could be a good treatment for opiate addiction, but Suboxone® seems to be better. Cherkis interviewed the Medical Director of the Hazelden Treatment Program – a traditionally abstinence-based treatment program – who implied that Hazelden had recently started putting all of their patients with opiate dependence onto Suboxone® and was recommending that patients stay on this medicine after discharge.

I have been working with patients who suffer from opiate addiction and studying this issue for the last 30 years. I have a number of observations and thoughts to share:

Recovery from opiate addiction is very difficult and success rates with traditional treatment are low. Opiate dependence seems to have a much higher relapse rate and the consequences of relapse can be devastating. For a long time, we have known that overdose can easily occur after any period of abstinence.  If an alcoholic relapses, it can be painful and difficult for all concerned, but if a heroin addict relapses, it can be fatal. 

It can be much easier to treat patients with alcoholism. Traditional treatment programs have a high success rate with alcoholics - around 60 – 70% - but, they have a much lower success rate with cocaine and/or opiate addiction/dependency. Some reports indicate treatment success with opiate dependence can be as low as 10%.

It is not entirely clear why the success rates are so much lower for opiate addiction. There are undoubtedly many factors. The main one seems to be the intensity and the length of time that individuals experience Post-Acute Withdrawal Syndrome (PAWS). When people stop using OxyContin or any other opiates, they go through a 7-10 day acute withdrawal period, followed by another period of time before they feel back to normal. During this Post-Acute Withdrawal Syndrome period, they have intense cravings, insomnia, and a profound lack of energy. The temptation to use “just a little bit” can be overwhelming and many people give in to the temptation.

Cherkis is correct. Traditional treatment programs do not do well. Even after 28 days in a treatment program, many people relapse as soon as they are back in their normal environment with all of its triggers, both emotional and physical. Outpatient programs have difficulty keeping people coming to their classes because opiate addicts usually relapse and stop showing up for appointments.

Cherkis advocates putting most patients on an agonist, such as Methadone or Suboxone®. These medicines are clearly the best answer for some people and are definitely better than using street drugs. However, these treatments have their own problems.

Many patients drop out of treatment and don’t make any progress. Many patients abuse the Suboxone®, continue to use other drugs, sell the drugs, and continue to use opiates. Most studies of Suboxone® and Methadone report up to 70% of patients in treatment continue to use opiates or other drugs. Many patients simply don’t like being on these Methadone or Suboxone®.  Most patients, given the choice, would much prefer to be completely free of drugs.

In order to help patients become completely drug free, many treatment programs are changing.  Over time, we have learned that the first six months of sobriety is the critical period when it comes to opiate dependence. We need and must help people through this period in order to get onto the road of long-term recovery. Many inpatient facilities are now referring patients to an outpatient counseling program directly after their inpatient treatment. Many patients are now moving into a halfway house for the first 6 – 12 months after treatment.

At TCI, our patients use Naltrexone implants or monthly Naltrexone injections. Naltrexone is a powerful antagonist that dramatically reduces cravings, prevents relapse, and allows patients the freedom to more fully participate in treatment. We have found that a combination of Naltrexone therapy and intensive treatment is very successful in helping patients stay clean for the long term.

I believe that all patients can achieve long term recovery if they work hard for it, but they often need some medication assistance to be successful. Rather than putting patients on another addictive drug, we believe many patients can achieve long term sobriety with the aid of Naltrexone.

Patients need a choice.

For some, Suboxone® can be a good maintenance treatment, but for many, the combination of Naltrexone therapy with a commitment to intensive and effective recovery work is very successful towards achieving abstinence.