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.
Friday, March 27, 2015
Monday, March 23, 2015
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.
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
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”. 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. 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, 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. Or, sadly, that in Yves Saint Laurent’s home community of France, 81% of all drug-related deaths were opiate-induced. 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. 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
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.
Monday, February 23, 2015
By Joan R. Shepherd, FNP
Several people completed opiate detoxes last week, and we even bumped some along more quickly so they could get back to their home states before the “Blizzard of 2015” kept them trapped in Richmond.
All my patients move me in some way, but I was particularly touched by a young man this week from the New England coast. He is a commercial fisher; young, strong, already his body bears the marks of a man who has one of the hardest physical jobs there is. He will probably always have some degree of physical pain because a regular part of his day job is pushing his physical body to extremes.
He told me that he’s never run his boat without being high. I was kind of stunned-even though I thought I stopped being surprised by drug stories a long time ago.
“Never?” I asked incredulously.
He dropped his head for a moment, then looking me in the eyes. “Never.”
He has pretty much convinced himself that without being on opiates, he can’t do this job. I understand from a physiologic perspective what he’s saying. When a person has been using opiates for as long as he has, his brain no longer manufactures dopamine. It’s kind of like, why bother? The brain can’t manufacture enough dopamine to compete with the overload of dopamine that comes from using opiates. When a person who has regularly been using opiates stops, his energy is going to plummet until the brain restores itself.
And that can take a long time.
But, the truth is, this guy—battered as he is—is young and strong and has an incredibly specialized skill. He’ll be able to pull off anything he needs to do, physically. His muscle mass isn’t going to deteriorate just because his dopamine is low, as long as keeps exercising those muscles.
It’s the self-defeating thoughts that are going to be his big problem.
I suggested he get a tattoo across his left forearm so whenever he’s about to do anything at all on that boat (or anywhere else for that matter) and his crazy thoughts start harassing him, he can read on his arm the same simple question Zen Master Rinzai asked to a room full of monks long ago:
What at this moment is lacking?
If our fisherman can be in the precious present moment, not dwelling on choices made in the past, or anticipating future suffering, he can bear anything. It’s a matter of putting one moment after the next, then the next, and the next. And being there for each one.
Everything any of us need is present for us in this moment.
Friday, February 13, 2015
by Gabriella Pinto-Coehlo
Ah, Valentine’s Day. The holiday that people either love or love to hate. A holiday rooted in both Roman and Christian traditions, we now celebrate with greeting cards, chocolates, and flowers lovingly gifted to our significant others.
A tongue-and-cheek response to this holiday is the re-labeling of February 14th as Single’s Awareness Day, aptly abbreviated S.A.D. Whether you are single or not, most of us are missing a wonderful opportunity to do something for ourselves this time of year - cultivate self-love.
Our culture has primed us to believe that self-love is indulgent, perhaps arrogant, and certainly unnecessary. Of course, everything can be taken to an extreme - a little too much self-love can result in an inflated ego, but for most of us, this isn’t the case. I would even argue that most people who appear to have inflated egos have just the opposite - a deep-rooted feeling of inadequacy masked by the illusion of smoothly overdone self-assurance. But, the reality is, our societal beliefs that self-love is selfish has lead to an epidemic of self-loathing and low self-esteem. Many of us with low self-esteem seek external validation for a little boost, only to find compliments and praise uncomfortable and undeserved. And in an image-conscious world, we often seek self-love from external factors like our bodies, our careers, and our paychecks. Unsurprisingly, any boosts in self-esteem from these are minimal and fleeting.
Truth is, authentic and lasting self-worth comes from within. The only way that you can cultivate an enduring sense of self-love is through something else enduring - your own internal capacities, your heart and soul. In the words of Thich Nhat Hanh, “To be beautiful means to be yourself. You don’t need to be accepted by others. You need to accept yourself.”
So, in this season of commercialism targeted toward doting on others, why not offer yourself a little self-love? Consider trying these exercises:
· Change your focus to the positive. Every day, write down a list of all of your positive qualities. Force yourself to come up with at least one new quality each day, no matter how challenging this may seem. At the end of your “free write,” choose your favorite three to five qualities and write down examples of how you have exhibited these characteristics. Even doing this for a month will do remarkable things with how you view yourself - shifting your lens from the negative to the positive.
· Turn negativity on its head. Write down any negative beliefs you hold about yourself in a journal. Tackle this list one day at a time. At the top of a journal entry, write one belief, then draw two columns: one that demonstrates evidence to the contrary in the past and present, and one that demonstrates contrary evidence in the future. The first column is logical - write down anything about you in the past or present that disproves your negative core belief. The second column allows you the opportunity to identify actions you can take in the future to continue disproving your negative beliefs. Notice how you might feel a little lighter as you realize that your core beliefs are a distortion of reality.
· Hold yourself accountable for self-care. Keep a daily journal with a list of all you did in that day, and label each activity or task as one of the following: achievements, fun, or relaxation. Notice what you tend to be heavy on and what you are neglecting. This exercise shifts your mindset to realize that fun and relaxation are not luxurious or frivolous, but in fact a valuable use of your time and energy.
Consider doing at least one of these exercises everyday for a month, and then check in with how your self-esteem has shifted. There is no better time to change our habits than now.