Honor Your Choices

If you folks who are doing an accelerated detox with us weren’t mildly sedated, I’d probably try to get you to do some yoga. Not so much for the physical stuff, although it wouldn’t hurt to get a little good natural juice to your brains and limbs, but mostly for the philosophy. Today at class while we were all balancing precariously in half-moon pose, Ellie reminded us not to judge where we were. If we fell, that’s what we needed in our practice today; if the pose was strong and steady, own that without judgment as well. It is always the journey, the process that is important in yoga.

My friend Amy who’s an amazing person, being a school nurse these days sent me the following story. Although it was written by a guy in 1980 who probably never practiced yoga, the messages are strikingly similar:

THE STATION

By Robert J. Hastings

TUCKED AWAY in our subconscious minds is an idyllic vision in which we see ourselves
on a long journey that spans an entire continent. We're traveling by train and, from the
windows, we drink in the passing scenes of cars on nearby highways, of children waving at
crossings, of cattle grazing in distant pastures, of smoke pouring from power plants, of row
upon row upon row of cotton and corn and wheat, of flatlands and valleys, of city skylines and
village halls.

But uppermost in our conscious minds is our final destination--for at a certain hour and on a
given day, our train will finally pull into the Station with bells ringing, flags waving, and bands
playing. And once that day comes, so many wonderful dreams will come true. So restlessly, we
pace the aisles and count the miles, peering ahead, waiting, waiting, waiting for the Station.

"Yes, when we reach the Station, that will be it!" we promise ourselves. "When we're
eighteen. . . win that promotion. . . put the last kid through college. . . buy that 450SL
Mercedes-Benz. . . have a nest egg for retirement!"

From that day on we will all live happily ever after.

Sooner or later, however, we must realize there is no Station in this life, no one earthly
place to arrive at once and for all. The journey is the joy. The Station is an illusion--it
constantly outdistances us. Yesterday's a memory, tomorrow's a dream. Yesterday belongs to a
history, tomorrow belongs to God. Yesterday's a fading sunset, tomorrow's a faint sunrise. Only
today is there light enough to love and live.

So, gently close the door on yesterday and throw the key away. It isn't the burdens of today
that drive men mad, but rather regret over yesterday and the fear of tomorrow. Regret and
fear are twin thieves who would rob us of today.

"Relish the moment" is a good motto, especially when coupled with Psalm 118:24, "This is
the day which the Lord hath made; we will rejoice and be glad in it."

So stop pacing the aisles and counting the miles. Instead, swim more rivers, climb more
mountains, kiss more babies, count more stars. Laugh more and cry less. Go barefoot oftener.
Eat more ice cream. Ride more merry-go-rounds. Watch more sunsets. Life must be lived as we
go along. The Station will come soon enough.

Ellie finished the class with this thought: Honor the choices you make. Minute by minute, day by day. Call if we can help or if you have any questions.

Joan Shepherd

Comparison of oral and implant Naltrexone - Colquhoun – 2005

Dr Colquhoun recently published a nice paper on the effectiveness of Naltrexone implants. The study was performed in Australia and it was in a very real world setting similar to the clinics and physician’s offices in this country.

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The study involved 83 patients who had all been recently detoxified off Heroin and other opiates. The patients wanted to use Naltrexone to help them stay off Heroin and other opiates. Half of them took oral Naltrexone daily with the help of a support person who agreed to witness the medication everyday. This group of patients agreed to take the oral Naltrexone for 6 months. The other half had Naltrexone implants made by George O’Neil’s group. The O’Neil Implants are a bit larger than the ones we use here in the US. Some patients got a single implant which has been shown to last 3 months and some got a double implant that delivers adequate Naltrexone levels for 5 months.

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The patients were followed and outcomes were determined by self report with corroboration from their support persons. Relapse was defined as when patients used more than 1 or 2 times (they determined that some patients used one or two times to test out the implant). Patients who couldn’t be contacted were assumed to have relapsed.

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The results were very impressive:

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Contacted and had not relapsed

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At 6 months -

Naltrexone Implant 81%

Supervised Oral Naltrexone 45%

At 12 months -

Naltrexone Implant 61%

Supervised Oral Naltrexone 40%

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These are very impressive results – actually in both groups. Compared with traditional treatment without any Naltrexone the results are very good. The strong results held up even after the Naltrexone was stopped after 6 months. A large number of patients were still able to maintain their abstinence.

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Some of the other data from the study is quite interesting. The patients who relapsed in the group taking oral Naltrexone usually stopped their oral Naltrexone within 2 weeks. It could be that they were unable to deal with their Post acute withdrawal symptoms or perhaps they weren’t very motivated in the first place.

The patients who relapsed in the implant group were more likely to have had a history of selling Heroin, and were more likely to have a history of previous physical or sexual abuse. They often tried to use with the implant in place and reported that they would try to get over the blockage or if they couldn’t feel anything they liked to try anyway.

Dr Coleman

Chad's Story

Chad came in today for his 5th naltrexone implant. He’s been clean since his Accelerated Opiate Detox in February. He is a big burly bear of a guy. Here’s how he’s doing in his own words:
Day in day out we think about using. When we get clean we see things differently. But yet we have to go on about our life and now deal with it. I used to use whatever it may be to escape reality for just awhile; maybe a day or a weekend. Smart enough knowing that my problems and whatnot would still be there when I came around..but just wanting that release and free time. Now I deal with in constructively making use of my time, improving my home, time with kids, working etc. Yet, daily stress, anger, aggravation of normal life makes me want that release and escape. I find myself now dealing with it in what works for me as before mentioned. Not craving it-is so much freedom! But if I was to go back that is only existing and not living. I like living life. It’s not fair and it can be hard, but living life is wonderful.

Phase 2 Naltrexone Implant Study is Underway

Last year we began studying some Naltrexone Implants that were compounded for us by a pharmacy in New Jersey. These were 1.4 gram implants. The results were quite encouraging because 80% of the implants lasted at least 2 months. However we realized that the ideal implant lasts at least 3 months or even longer. So, in consultation with the pharmacy, we have helped them to modify the implants to make them have a longer duration. We have now begun the phase 2 study on these new improved implants.

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The study is to draw blood levels in 5 patients with the new and improved implants. The patients will come in every 2 weeks and have blood drawn. We have already enrolled 3 patients and should have final results in the next few months. This is very exciting for us because as we get better and better implants it becomes a lot easier for patients to stay in recovery. Our goal of course is to help patients get clean and stay clean. We want to make sure that patients have an alternative that works - so they don’t have to use Methadone or Suboxone.

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Dr Coleman

Boundaries: Drawing a Line in the Sand

The year was 1987. A curious event took place at a local Richmond, VA high school. I remember it as if it was yesterday. The high school I attended was a Catholic Military School. Part of the “fun” of military school is the experience of being hazed as a freshman to include things like excessive push-ups, cleaning the school bus with your nose, and eating in absolute silence during lunch. However, on this day, lunch did not remain silent for long. Allow me to explain…

As some of you may remember through your high school experience, people tend to sit in groups based on social status. For example, there are several diverse groups such as jocks, popular kids, geeks, emo kids, science nerds, stoners, and artsy kids, to name a few. True to the norm, I sat in my social group which, much to my dislike, was the “geek” section. I remember another “geek” section across the room that included a high ranking member of the “jock/popular group”. I never understood why he would denigrate himself to sit with those of less social status than himself. I came to find out that he lived near those kids so he could get away with sitting next to them. But, to save face, he had to verbally berate them daily to keep them in their places. But, on this particular day, the Geeks rose up in defiance and would have none of it!

Imagine a quiet lunch room and the only sound is forks against plates and the sounds of dishes being washed in the kitchen when all of a sudden you hear a loud CRASH that pierces the silence like a gunshot that echoes through the woods. I looked up from my otherwise dull lunch to see the popular kid’s head covered in spaghetti with a mixture of sauce, meatballs, and blood running down his face. Across from him, the nerd he berated for days on end was standing up defiantly and held the remnants of his lunch plate now snapped in two that he used to encourage the young man to leave him alone. The whole place broke out in applause! And, I, for once, breathed a sigh of relief and flashed a victory sign in my mind seeing that we just might be able to take back our social dignity and get through this thing called high school!

I tell this story because it is relevant to our topic of discussion this month which is the book Boundaries: Where You End and I Begin by Anne Katherine. Katherine makes the point that each of us deserves basic human dignity and respect. We maintain that dignity with the use of boundaries. There are 5 main boundaries that we all get to keep regardless of who we are or where we came from. They are physical, mental, emotional, spiritual, and sexual boundaries. Maintaining our boundaries is important because, as Katherine notes, it helps us realize our love and acceptance of ourselves. It teaches us that we have value and deserve the best for ourselves.

Properly setting boundaries can help addicts to stay sober. Boundaries keep them from going back to unsafe people, places, and things which can result in a relapse. They also help replace bad behaviors with good ones. For example, you can choose to set the boundary of a 10pm bedtime instead of pulling all-night drug binges!

The hard work of setting appropriate physical, emotional, mental, spiritual, and sexual boundaries can seem daunting and pointless at first. However, in time most addicts realize that a boundary kept is oftentimes a life saved!

Chris Newcomb - Aftercare Councelor / Coordinator

New Webinar for Doctors

In March we will be starting our series of internet seminars for primary care docs. We recognize that most primary care physicians see a lot of patients who are suffering with alcohol and other addictions, but they often don’t feel very comfortable bringing it up or talking about it. They often report that they don’t really know what to do.

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There is quite a lot of evidence that physicians don’t often make a diagnosis of a disease, or even explore a problem, when they don’t have a readily available solution to that problem.

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So we decided we could help close this gap. If we can help physicians know what to do with alcoholics and patients with other drug addictions then they will be more likely to look for these problems. Hopefully more patients will be able to get the help that they need.

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The first seminar will be in March and will deal with the causes of addictive diseases and how to make the diagnosis in an office setting. In subsequent seminars we will discuss specific drugs including opiates, sedatives, alcohol, cocaine and other stimulants.

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If anyone has any comments or questions please feel free to comment.

Dog Therapy

OK, sometimes I admit I go for forgiveness rather than permission.

Last week the CEO of The Coleman Institute saw a large boxy head with dangling tongue sticking out from the door of one of our beautiful treatment rooms. He’s a smart guy and recognized instantly it was not a human, but a very large dog’s head.

A charming patient (I’ll refer to her as Melissa from Minnesota) was here to detox from oxycodone. She wasn’t taking as high a dose as we have seen many patients take. Nonetheless, she was unable to get free from the 40-60mg a day she’d escalated to after a fairly routine knee surgery two years prior to her contacting us.

Melissa-like all of the clients we serve at TCI-had several reasons for wanting to be opiate free. Most everyone who comes through is just sick of the lifestyle of being a slave to the addiction. Work, money, relationships, and general vitality all take a toll when a person is physically dependent on narcotics. But the other thing driving Melissa was a deadline looming two weeks from her detox: she had a book signing with Barnes and Noble as her first novel is being published.

She had traveled across the country with her husband and Butch, her well behaved canine to do a detox with us and get a naltrexone implant.

It is so fun to come into a room all day long and see a sweet dog! And even though our detox process makes things very tolerable, I think it really helps to have your beloved dog with you. In the two years I’ve been at TCI, I’ve seen a toy poodle, 2 mastiffs, a beagle, a bull terrier and a couple others I can’t identify. I wish someone would come in with a Bernese Mountain Dog.
I suspect Butch will be accompanying Melissa on her book signing tour; he’s that kind of dog.

Joan Shepherd - FNP