Thursday, January 29, 2015

Painkiller Use Down – Heroin Use Up


by
Peter R. Coleman, M.D.
It is a case of good news – bad news. A medical journal article published this month reports what appears to be the beginning of the decline in the abuse of painkillers. This is great news but, and there is a but, the evidence is very strong that the major reason for this drop in pain killer abuse is that many people are simply switching to Heroin. That is certainly what we have been hearing from our patients.
Until recently, there has been strong evidence that narcotic painkiller abuse has been steadily increasing for the last 10 years or so. U.S. sales of painkillers tripled from 1999 until 2008. Deaths from prescription overdoses have also increased three fold during this period. 
The situation got so bad that by 2010 more than 12 million Americans were abusing narcotic painkillers and, in 2010, over 16,000 Americans died from an overdose. 
The new study found that this may be changing. The study was published in the January edition of the New England Journal of Medicine. The researchers looked at five different data bases to evaluate the amounts of painkiller abuse. In four out of the five databases, there was good evidence that showed the beginnings of a decrease of painkiller abuse. 
They found that overdose deaths from painkillers have started to dip slightly since 2009. They also found that the number of people who enter treatment and reported abusing opiate painkillers has decreased about 26%.
The surge in painkiller abuse that started in the late 1990's, has many causes. One of the biggest causes, was simple unawareness. Physicians were not fully aware of just how easy it was for their patients to become hooked on narcotic painkillers, and patients were also uneducated on how quickly and easily these medicines caused physical dependence. 
There was a lot of pressure on doctors to “adequately treat pain” and not make patients suffer. Many of these messages to physicians were strongly promoted by the drug companies, like Purdue Pharma, who were making billions of dollars from drugs, like OxyContin. 
Physicians were also not aware of how much diversion was going on. As more people became addicted, painkillers became very valuable and a lot of people started faking pain and visiting doctors in order to get prescriptions for painkillers, then, sell them on the street. Some people were making thousands of dollars every month. 
It is not very easy for doctors to distinguish between real pain and exaggerated pain, so, a lot of time, the doctors got fooled into writing prescriptions. Added to this, there was outright criminal behavior. Some unscrupulous doctors had “pill mills” where they would see patients for cash, prescribe very high doses of painkillers, and then, sell them the drugs, all on the same visit. There was a lot of money being made – on both sides of the transaction.
Now the tide is turning. The DEA and other regulators are much more aggressively looking at physicians who over-prescribe. Most states have shut down the pill mills and have set up a database where physicians can check online and see all of the recent prescriptions that any patient has filled. It is very easy to see if a patient is “doctor shopping”.  Perhaps, most importantly, physicians and patients and are starting to understand that narcotic painkillers are powerful drugs and should only be prescribed for severe pain. Narcotic painkillers are, in reality, not a very effective treatment for chronic pain.

That is the good news – the tide is turning on painkiller abuse. But, the bad news is the number of Heroin overdoses has more than doubled in the last 3 years. 
Many people have simply switched to Heroin. We hear this from our patients over and over again. As the supply of painkillers goes down, the cost and lack of availability goes up. Heroin, then, becomes much more attractive. Most patients tell us that Heroin is so cheap that switching to it can reduce the cost of their drug habit by 75%. That is such a huge temptation that we are seeing people from all walks of life using street Heroin. 
It is a horribly dangerous situation. Heroin is unregulated and much more dangerous. People have no idea what other drugs may be mixed into it and, they have no idea of what is the strength. It makes the chance of overdosing so much more likely. And, even worse, once people start using Heroin, it is a very short and slippery slope to begin injecting it. We are seeing it every day. 
When it comes to Heroin and its impact, I fear we are in for even worse statistics down the road.

Tuesday, January 27, 2015

FIGHT OR FLIGHT?


By Joan R. Shepherd, FNP

It’s no surprise that the majority of patients who come to The Coleman Institute for an Accelerated Opiate, Benzo or Alcohol detox have long been trying to get rid of, avoid or escape from unpleasant feelings. These are “control strategies” because they are attempts to directly control how one feels. You can divide control strategies into a couple of main categories: fight or flight.

Fight strategies involve fighting with or trying to dominate your unwanted thoughts and feelings. Flight strategies involve running away or hiding from those unwelcome thoughts or feelings.

Leah is a young woman who always felt anxious in social situations. The way she coped was by taking a couple Vicodin and drinking beer. In the short term, this reduced her anxiety. But of course, the next day she felt hung over and tired and often regretted the money she spent or worried about the embarrassing things she did while under the influence. While she escaped her anxious feelings for a little while, the price she paid was a lot of other unpleasant feelings in the long run, and ultimately an addiction to opiates. Now, when she finds herself in a situation where she is unable to use, her anxiety is greater than ever.

There are several places where a vicious cycle like this can be broken, but once a physical dependency has been established, stopping the opiates can be extremely difficult and stopping the alcohol (depending on the person’s tolerance) can be dangerous.

We were able to get Leah comfortably off her Vicodin and alcohol, place a Naltrexone pellet, and steer her into appropriate treatment. She has begun to learn the triggers for her anxiety and is developing some great techniques for co-existing with, defusing-and even laughing at—her anxiety.

If you have any questions about how we could help you take that first step toward safely removing the physical barrier of withdrawal, please give us a call at 877-773-3869 and talk with Jennifer or Amy.


Wednesday, January 21, 2015

LOVE THOSE CRACKED POTS


by Joan R. Shepherd, FNP

There’s an old story about an elderly Chinese woman who has two large pots, which she carries with a pole balanced across her neck.  One of the pots had a crack in it while the other pot was perfect and always delivered a full portion of water. At the end of the long walk from the stream to the house, the cracked pot arrived only half full. Precious water always dripped onto the ground.

For a full two years this went on daily, with the woman bringing home only one and a half pots of water. Of course, the perfect pot was proud of its accomplishments.  But the poor cracked pot was ashamed of its own imperfection, and miserable that it could only do half of what it had been made to do.

After 2 years of what it perceived to be bitter failure, it spoke to the woman one day by the stream.  'I am ashamed of myself, because this crack in my side causes water to leak out all the way back to your house.'  The old woman smiled, 'Did you notice that there are flowers on your side of the path, but not on the other pot's side?

I have always loved this story, probably because of all my own “cracks”. The older I get, the more I accept them. When I see this quality in patients, accepting and loving themselves as they are, their recovery is a continual unfolding.

I’m thinking of Penney, who fits the profile of many people who become addicted to opiates and alcohol: she was sexually abused as a child and continued to repeat the pattern of abuse in her own marriages and relationships. After the third stormy marriage and some broken bones as the result of physical abuse resulting in chronic pain due to permanent hardware placed in her hip, something else happened to Penney. 

The years of therapy and the commitment to a sometimes painfully slow, courageous process of learning to love herself allowed Penney to let go of self destructive behaviors. She told me instead of looking for another person to ‘treat her right’, she asks herself daily: if I was going to treat someone as the perfect date, what would I do? And then, she does it for herself.  For Penney, that could mean shopping for and cooking a great seafood meal, spending time with her grandchild, going to a movie, or cutting off the world for a little while and watching her favorite TV show.

Her life is by no means without problems….she lives with some degree of physical pain, but has found without the opiates, her own endorphins which help block pain are kicking in. Becoming physically active has helped her lose some pounds and further reduced her pain. There are financial stresses and family members with health problems. But today Penney is living her life as the wonderful, imperfect person she is, without the need to shut down every painful emotion with a drink or a pill.

The path of flowers that Penney’s cracked pot has produced includes a great sense of humor and the ability to laugh at herself, real friendships, a son with a steady job who is buying his own home, 2 beautiful grandchildren, the opportunity to care for her dying mother, and so much more.


It’s the cracks that give us our uniqueness and character, and embracing them requires honest self-inquiry. This is only possible without the mind numbing effects of drugs and alcohol.

Friday, January 16, 2015

Beyond the Brain - Part 2


by Courtney Harden, FNP

Last week, we dove into how opiate and alcohol dependency can affect your gastrointestinal system. In keeping with the theme, today, we will look at the effect of drug and alcohol abuse on your endocrine system which regulates hormones.

Hormones are the master communicators in our bodies - they send messages between organs   and tissues - and are responsible for just about every bodily function you can think of, i.e. sleep, digestion, behavior, mood, reproduction. That being said, it is not a surprise when before and after detox, our patients report fatigue, irritability, mood swings, low sex drive, and, of course, weight loss or weight gain.

When we think of hormones, estrogen and testosterone jump to the front of our minds. These are just the tip of the hormonal iceberg. Adrenaline hormones - epinephrine and norepinephrine are stress hormones that signal our body to go into "fight or flight" mode. These are cranked up before detox as patients experience the highs and lows of drugs and alcohol. 

The constant fluctuation of hormones and neurotransmitters, particularly dopamine, affects the way our body produces all other hormones, including the big two mentioned above, estrogen and testosterone, as well as thyroid stimulating hormone (TSH). As a result, we commonly see fatigue, women with irregular or no periods and men with low sex drive or even the development of male breast tissue which is called gynecomastia. 

During detox, adrenaline production spikes and we often use medications like Clonidine, essentially an adrenaline-blocker, to keep patients relaxed. In early recovery, keeping your stress level low is imperative to keep your adrenaline levels stable. Yoga, meditation, sleeping 8 hours nightly, taking a walk or a bath at the end of a work day, watching a funny movie are all great ways to recharge your adrenal batteries. I highly recommend "8 Minute Meditation" by Victor Davich as a way to jump start a new meditative practice. For additional reading, I recommend "The Mood Cure" by Julia Ross or "Mindfulness for Beginners" by Jon Kabat-Zinn.

Clean eating, drinking plenty of water and exercise should be high on your priority list to repair your gut, but it will also help to restore hormonal homeostasis. Junk food produces very similar affects in the brain that drugs and alcohol do. Things that are high in sugar and carbohydrates will artificially excite dopamine and adrenaline, followed by an inevitable crash. Sticking to a balanced diet and engaging in regular exercise will help your weight get back to its natural state. The return of normal menstrual cycles, improvement in energy level, and increased sex drive are all good indicators of hormonal balance.

Persistent symptoms beyond the first two to three months in recovery may warrant a visit to your primary care provider for additional tests. Visit www.hormone.org for more information about the endocrine system.




Wednesday, January 7, 2015

Beyond the Brain - Part 1


by Courtney Harden, FNP

Drug and alcohol abuse significantly affects our brain’s ability to think and feel. It disrupts the way we process emotions such as fear, pain, happiness, and anxiety. As a result, it is common to see depression, panic disorder, insomnia, and generalized anxiety co-exist with substance abuse.

In early recovery, we teach people to tackle these issues in counseling, NA or AA meetings, or group therapy. We tell them to keep their stress levels low, get enough sleep, and avoid other harmful substances such as marijuana or cigarettes to allow their brain to heal.
While these are all great steps toward successful recovery, the buck doesn’t stop with the brain. Drug and alcohol abuse leaves lasting footprints in many other places in the body. This three-part series will address some of these areas, offering solutions to restore function to those body systems.

This week, we will look at affects on gut health. A properly functioning gastrointestinal (GI) system is important for many reasons. For one, the gut houses approximately 70% of our immune system. It also communicates with our nervous system – the brain – and vice versa. (You have heard of a “nervous stomach”, right?)  Constipation and abdominal pain are commonly seen with narcotic use, whereas alcohol abuse can cause severe ulcers, acid reflux, and in severe cases, life-threatening gastrointestinal bleeding.
   
In early recovery, appetite changes, nausea, alternating diarrhea or constipation are common. The gut is taking steps to re-establish homeostasis. Below, you will find some easy-to-use gut health tip to help this process along.  
  • First and foremost, food matters. “Let food be thy medicine and medicine, be thy food”. Thanks, Hippocrates, but what does that mean?! While eating is only part of the solution to  repair the GI system, it is the most important one.
  • Clean eating is extremely beneficial to patch up a leaky gut. Eat a rainbow variety of fruits and vegetables. Avoid processed and fast foods as much as possible by sticking to the periphery in grocery stores – steer clear of the aisles that harbor all of those products that don’t have an expiration date. Highly processed and inflammatory foods can poke small holes in the lining of our gut that will invariably delay the healing process.
  • Do your best to not skip meals. Hunger can spike adrenaline – a stress hormone – which may lead to increased anxiety. Additionally, you are more likely to overeat at your next meal. Keep a fruit and nut bar handy to eat in a pinch.
  • As mentioned above, gut health is essential to a properly functioning immune system. Probiotics help restore proper types and amounts of gut bacteria. They improve digestion and promote regular elimination. You can find these in supplement form or in certain fermented foods such as pickles, sauerkraut, cod liver oil, and, of course, yogurt.
  • You may have heard this already, but quit smoking! Cigarette smoking can wreak havoc on your digestive system. It can cause ulcers to form or worse and nicotine suppresses hunger cues.

Next week, we will look at how drug and alcohol abuse affects the endocrine system, namely estrogen and testosterone. For additional reading on gut health, pick-up Dr. David Perlmutter’s “Grain Brain” or browse through the Whole 30 website, www.whole30.com, for clean eating recipes and meal plans. 

Monday, January 5, 2015

Resolutions: Disconnecting to Reconnect

by Gabi Pinto-Coelho

Resolutions have never been my thing. While I might ponder on some informal goals at the beginning of each year, I have never taken the time to reflect on and write down what I want to accomplish in the coming year. To me, the idea of making resolutions on New Year’s never made much sense - anyone can make a goal at any point during the year. However, this morning I decided to mix it up. I started a new tradition with my significant other and we sat down to reflect on 2014, highlighting areas that we were proud of and also opportunities for growth in 2015.

What started off as a seemingly silly tradition turned into a very valuable exercise. We began by discussing things we were proud of from 2014, then moved to brainstorming areas for improvement, both individually and as a couple. Much to my surprise, my fiancee said, “For both of us, I think we can do better with our phones.” I couldn’t agree more. On more occasions than I care to admit, the first thing we both do in the morning is check our phones - email, social media, you name it. And it got me thinking - I think the vast majority of us can do better with our phones.

A few weeks ago we went out to brunch, and I insisted that I put both of our phones in my purse so we wouldn’t even be tempted to look. Five minutes into our meal I see another couple nearby. The woman was staring down at her phone, scrolling through Facebook, while her husband was talking to her. You’ll notice that I say talking to her, not with her - she may have been sitting across the table but she might as well have been sitting across the restaurant.

And it’s not just a perception. More and more research is illustrating the negative effects of our cell phones. Science has proven that our phones decrease our cognitive performance, diminish our ability to connect with others, and deteriorates our memories. One study demonstrated that even the presence of cell phones reduces our cognitive functioning on tasks, regardless of whether we use them or they go off. Another study asked participants who had never met to sit and discuss an interesting personal event. The group that had a cell phone in sight described their partner as less trustworthy and less understanding than those with a notebook in sight. As for memory, research has proven that constant connectivity interferes with memory formation. To convert short to long-term memory, the brain needs periods of rest. When we are constantly checking email, text messages, and social media, our brain is not resting as much and therefore has fewer opportunities to form memories. The disruptions caused by that text message alert or facebook notification exponentially increase our likelihood of making mistakes. When we are frequently faced with decisions, even small ones about responding now or later to that email, we start to fatigue mentally. It makes it hard for us to distinguish between what is important and what just feels urgent. Information overload.

Although our phones allow us to remain connected to friends and family near and far, respond to emails wherever we are, and much more, it is clear that this kind of connectivity comes at a price. What we use to help us control our lives has started to control us. While I enjoy using my smart phone just as much as the next person, I was eager to make a resolution about using my phone. Together, my fiancee and I agreed not to use our phones when eating, having conversations, and in the bedroom. The latter is especially important for good sleep hygiene, since the light from our devices can interfere with our ability to get into REM sleep. I think we could expand that rule to other situations but I think this is a good start.


This year, I challenge you to disconnect from your phone so you can reconnect with whatever you are doing and whoever you are with, from moment to moment. Start by instituting a no cell phone rule in just one context, and gradually institute the rule in more and more situations. While it could be challenging at first, you just might be pleasantly surprised with what it does for your mind, your memory, your relationships, and your well being.

Wednesday, December 31, 2014

NHL’s Scott Darling: A Comeback Story

by Gabriella Pinto-Coelho

Unfortunately, stories of public figures struggling with substance abuse issues are far from rare. Celebrities like Drew Barrymore, Robert Downey Jr., Angelina Jolie, Johnny Depp, and Samuel L. Jackson have struggled with substance abuse and bounced back to live full lives and have successful careers. We are used to hearing about actors and musicians struggling with substance abuse, and usually don’t hear much about professional athletes and addiction. It seems almost impossible that someone who relies on their body to make a living would or could have a substance abuse problem. But in reality, anyone can.

Scott Darling is one of those seemingly “unlikely” athletes who has overcome addiction.  Darling, now 25, grew up from an affluent and supportive family in the suburbs of Chicago. He left home at 16 to play junior hockey, and started developing a reputation as a partier. He began playing college hockey at the University of Maine, where that reputation followed him and intensified. At the end of his sophomore season, his coach kicked him off the team due to numerous conduct violations. 

Friends, teammates, and coaches began to suspect that Darling was not just a wild college kid, but someone suffering from alcoholism. He decided to leave Maine and take his chances on being drafted to the Arizona Coyotes of the NHL. When he showed up to their camp out of shape and uncommitted, the team cut him loose. From there he wound up in the SPHL, a semi-pro league, where he began drinking more and caring less about his life both on and off the ice. His annual summer stint at a goalie training camp was cut short when his coach Brian Daccord kicked him out due to his alcohol-induced behavior. Darling had begun drinking at such a young age as a way to escape from his problems with social anxiety. The more he drank the more he felt like he belonged. By his early twenties, his habit of self-medication had spiraled to a life of self-destruction.

Luckily for Darling, his coach Brian Daccord was the catalyst for change in his life. When Darling showed up at training camp the next summer, Daccord ordered him to the weight room to lose the extra 40 pounds he had gained. That was the first summer Darling decided to stop drinking. By the next summer, Darling was still not drinking and had worked his way up to the ECHL. His continued dedication took him from the ECHL to the AHL, and ultimately, he was called up to the NHL with the Chicago Blackhawks.


Now, Darling says that he feels in control of not only his addiction, but also his social anxiety. It seems like hitting rock bottom was what Darling needed to turn his life around; “People don’t want to change until they have to,” Darling said. “I really dug myself a hole before I woke up. I just busted a 180 turnaround and put my foot on the gas.”

Here's wishing your life is on a growth path as we move into 2015.  

Best wishes for a healthy and prosperous New Year!