Monday, December 28, 2009

Mike's Story

I asked one of our patients to describe the journey that brought him to The Coleman Institute for an Accelerated Opiate Detox. This is what he wrote for me:

“After sustaining injuries during college football I was introduced to opiate painkillers. During my senior year of college I progressed to using Oxycontin without doctor’s prescribing them to me. After graduating and having free time on my hands my tolerance began to climb out of control. After getting married, I moved 600 miles away from home where I didn’t know anyone in an attempt to stop using. I didn’t use for about a year, but only because I didn’t know anyone to get it from. I slowly learned the difference between choosing to quit and being unable to use.

My wife was homesick and wanted to move back home and thought I was better but subconsciously I knew I was going to start using again, even feeling excited about it. I told myself everything would be ok and under control. I got high the day I moved back home.
I worked long hours fueled by being high all the time and built a successful business from the ground up. The business that I worked so hard to build ended up causing my addiction to grow even faster. I had complete flexibility with my schedule and I used the funds to buy large quantities of Oxycontin. At the worst point I was spending $10,000 a month on drugs while at home my wife struggled to pay the bills.

I had to beg investors for more money to make ends meet at my business. It all came to a head when my wife started catching me using at home and at my office. I knew I had to make the choice to get better or I would lose my wife and son, who is due in April.

After a brief unsuccessful stint with Suboxone therapy my counselor recommended The Coleman Institute. I had nothing else to lose so….why not. Today is Tuesday November 10th and here I lay, right before having my naltrexone pellet implant with high hopes for the future thanks to Joan Shepherd and Dr. Coleman. I can honestly say the first couple days of detox were not that bad, although today has challenged me. I’m ready to wake up tomorrow and start a new life.”

Thursday, December 24, 2009

Holiday Detox

To choose nursing or medicine as a profession usually means sometime in one’s career one will be covering weekends and holidays. So when my children were young, I had to take my turns doing shifts on Thanksgiving and Christmas for many years.

As much as I loved being home during a holiday, from the beginning I was always grateful to be the one ‘wearing the uniform’ rather than being the patient when I did have to work. Being in the position to help someone who has to be stuck in a hospital over the holidays was actually pretty gratifying.

We have patients at The Coleman Institute who are going through Accelerated Opiate Detoxes now, over this Christmas holiday. Clearly they would rather be elsewhere, not having this illness of addiction take over their holiday time. For these people, coming in over the holiday is the only way they can make it work into their schedules. For them, it’s become a life or death situation. They know they are losing their dreams, their families, their professions—their very lives--as long as they continue to use.

And once again, it is with lots of compassion Dr. Coleman, the staff at TCI, and I see these patients over the holidays. We already have patients booked over the NEw Year, so even while we won’t be seeing family practice patients, we will be working with patients going through a detox. If you need some help—we know the problems don’t stop during the holidays. We can be here for you.

Joan Shepherd

Sunday, December 20, 2009

Preliminary results for implants

We have been studying some new Naltrexone Implants for the last couple of months. These are 1.4 gram implants that seem to last at least 2 months. As such, they may be a considerable improvement over the old 6 – 8 week implants.

We have been drawing blood levels on our patients when they come back in 8 weeks for their next implant. So far all the patients have had very good blood levels, indicating that the implants reliably last 8 weeks. It looks like they may even last over 12 weeks in many patients. This would be fantastic. It is so much easier for patients to come back every 3 months – only 4 implants to get a whole year of coverage. We will continue to study these implants and we may even be able to work with the pharmacy to make them last even longer.

Dr Coleman

Thursday, December 17, 2009

Hard work does pay off

I have been just spent the last couple of months in intensive study for my Family Practice Board Exams. I was kind of dreading this because frankly I knew it would be a lot of hard work. And it was.

All Board Certified Family Practice physicians have to re-certify every 9 years. Of course this is a good idea – who wants to see a physician who has not kept up with the practice of medicine. It sure didn’t seem like 9 years since I last recertified. During that time quite a lot has changed. New drugs have been invented and come into practice. Some old ways of doing things have been determined to actually be harmful. In many situations research has determined the optimal ways to treat diseases that we used to treat in a less scientific manner. Brushing up on my family practice was especially important to me because I have been specializing in Substance Abuse more and more, so it was important for me to do some extra study.

So I was not looking forward to all the reading and extra study that I was going to have to do. But I have to say that embarking on the study program, and completing it was a great experience for me. I read a lot. I went to a very intensive conference in St Louis. I took a lot of practice tests. I made notes. I tested myself over and over. I really put a lot into it. And the benefits I got out of it have been awesome. I got to re-learn a lot of stuff that I had not thought about since medical school – there are a lot of very rare diseases that they want you to know about even though you will never see one in your lifetime. I got to remember just how much I love learning. I got to remember just how much I love studying medicine. I have always been so fascinated with how our bodies work - how absolutely marvelous they are. And studying diseases has always been fascinating. Little TB germs that get into our lungs and sit there for years until our immune system slows down and they come back to get us. Funguses that love to live between our toes. Autoimmune disease where our own antibodies start to destroy our thyroid gland. And sometimes our arteries get clogged up because we eat the wrong things and don’t exercise. I also got to remember just how much I love being able to practice medicine. It also felt good to realize that my brain is still quite good at understanding things and remembering things.

As I thought about my recovery, and what this study program experience has taught me, I realized that more and more I think the purpose of our lives is to learn and to love. We have all been given a marvelous mind and keeping it inquisitive and active is a real treasure. Loving ourselves, our neighbors and our communities is the second part of what we should be doing. In many ways studying and relearning medicine was an act of love - for myself, and for my patients.

So even though it was a lot of work, I sure did get a lot out of it. As my dear old mum used to say, “Peter, you get out of life what you put into it” I think she was right.

Peter C.

Expect the Unexpected

Life sure does throw us curveballs, doesn’t it? The unexpected gift from a friend. The kind word from the checkout clerk. The last minute touchdown by your favorite team. That song on the radio you haven’t heard in years that bring tears to your eyes. Your child crawling into your lap and snuggling up against your side for a long winters nap. All great things to celebrate. These types of curveballs are like wiffle balls…lightweight, easy to hit right out of the park.

Other times, though, life throws us bowling balls that crack our bat and break our wrists…the unexpected auto accident, that health crisis you didn’t expect, a death in the family, a storm that damages your house, that relapse you promised yourself and others would never happen again. These bowling balls often blow away our conception of a calm, peaceful world where all is right and good and true. We don’t expect it and often we don’t accept it.

It’s early December as I write this column. There is a palpable sense of expectation in the air. The seasonal lights are littering the landscape reminding me that this is a special time of year. Radio stations are playing Christmas music over and over and over again…and over again some more! Children are about to pass out with anticipation of what they will get on the big day in about two weeks from the bearded one from the north.

As I think back over 2009, it’s been a good year here at the Coleman Institute. We have been privileged to assist so many addicts struggling to reclaim their lives from the ravages of opiate, alcohol, and benzodiazepine dependence. We’ve walked with our patients as they experienced great victories and even bitter defeat. We’ve celebrated with support people once the light bulb goes on and the addict starts doing all the right things.

Furthermore, in the midst of the struggle, we have come to expect the unexpected. We’ve come to see that the human spirit is tough to crush. We’ve understood the power of compassion and affirmation to a hurting addict with nowhere to turn. We’ve felt frustration and grief over an addict who went back “out there” one more time and never returned. Conversely, we’ve become aware of the joy of success when a patient chooses to live sober one 24 hours at a time. And we’ve learned the power of hope when an addict breathes a sigh of relief and realizes that TCI is there home away for home for the few days they spend with us.

In this season of the unexpected (see Christmas morning and the gifts you didn’t expect to actually get), I invite you to expect the unexpected. Expect to be sober. Expect to be clean. Expect that sobriety is well worth the struggle. Expect the Promises to come true in your life. Expect to be amazed. Expect to be transformed. Expect to receive joy. Expect to receive love and friendship. Expect to experience the unexpected. And remember that to “get clean and stay clean” is the most unexpected gift of them all. Merry Christmas. Happy Holidays. Happy Kwanzaa. Happy Hanukah. Seasons Greetings. Expect the unexpected!

Until next year,

Chris Newcomb - Aftercare Coach / Coordinator

Monday, December 14, 2009

Dumping the Loser

Beth came in with her Mom for a follow up implant. Two months ago she’d gone through an Accelerated Opiate Detox from heroin. Several years earlier her sister had gone through an Utra-Rapid Detox with The Coleman Institute (we are no longer doing those).

Beth is smart and beautiful. She finished high school and was headed for college when heroin got in the way. She’d been extremely involved in her church and left that behind for a while.

Since her detox she’s signed up for school again and has become extremely active in a recovery program for young adults at her church. One pesky little problem she’s having is losing the boyfriend. I couldn’t help but point out to Beth the ‘victim’ language she was using during our visit.

Me: Are you still seeing Evan?
Beth: Yes.
Me: is he still using?
Beth: well, yes….some.
Me: why are you still hanging out with him?
Beth: I feel responsible that he’s on heroin. Before he met me he was just using pills, so I’m trying to help him by taking him to church meetings.
Me: So, he’s using heroin because of you, and you are absolutely positive this is true?
Beth: Well, maybe he’d have tried it with someone else if he hadn’t met me.
Me: You feel like you are responsible to help him, to save him?
Beth: Yes. He makes me feel guilty if I don’t hang out with him and take him to these meetings.
Me: No, you are choosing to feel that way. He can’t make you feel anything.
Beth: I guess so.
Me: how do you feel—in your gut—when you close your eyes and imagine going to his place, seeing him use, taking him to church.
Beth: my stomach goes into knots and my head aches. I feel like I’m shackled.
Me: And take a minute to imagine who you would be if you could let go of the thought that “I am responsible for Evan’s recovery”…
She was quiet for several minutes. When she opened her eyes, they were teary, but she was smiling...
Beth: I’d be free. I’d be hanging out with fun people and laughing a lot. I’d be making plans to go to college.

Clearly, it’s time for Beth to be that person; to believe the truths that set her free, and not the lies that shackle her. We’ll see where Beth is in two months when she returns for her next implant. Hopefully she’ll be examining her beliefs daily and dumping the ones that no longer serve her.

Friday, December 11, 2009

Family Reunion

I know perfectly well that going through a detox isn’t supposed to be fun. But…what the heck? What if it is a little fun?

We just had a group of 9 people take over the detox wing of The Coleman Institute earlier this week. Three of the family members were clients detoxing from heroin or pills; the other 6 were various family support members.

They should have had t-shirts printed up—it was like a raucous family reunion! By night they played cards in the hotel, by day they hung out and had meals together. On the final day of detox, they played guitar with Chris and moved from room to room being incredibly grateful for the opportunity to reclaim their ‘lost’ family members.

Three weeks prior to their arrival, one family had lost a son to a heroin overdose. His parents, step-parents, cousins and remaining brother are committed, together, to recovery and all three signed up for The Freedom Plan, ensuring a year’s worth of naltrexone implants; a year’s worth of peace of mind.

Tuesday, December 8, 2009

Doing the thing we think we can't

“We gain strength, and courage, and confidence by each experience in which we really stop to look fear in the face... we must do that which we think we cannot.”

I was a little concerned when my yoga teacher started our class with this quote by Eleanor Roosevelt. My mind went running: Must be some pretty hard poses she’s got in store for us today…I hope I can balance….my elbow feels a little sore….I’m the oldest one here, I shouldn’t be doing these challenging poses… sure would have been nice to stay in bed on this rainy morning…wonder what I’ll eat when I’m done…and blah blah blah…

The funny thing about looking fear in the face is that often there isn’t much there. I remember once as a kid, I woke up in the middle of the night terrified to see a snake on the floor in my bedroom. I screamed for my father who sleepily came to my door, turned on the light, revealing my socks. My brain had created an entirely different, horrifying scenario.

The whole idea of yoga is joining the body and mind. It comes from a Sanskrit word meaning yoke or union. The type of yoga that I practice most is Vinyasa, so every movement is connected with either an inhalation or an exhalation. The idea is that the postures are more like breathing exercises than gymnastics. The breathing keeps one in the present. There is no space for worrying about the past, nor anticipating the future. Only breath, where you are, at the moment. No place else to be.

The lessons learned ‘on the mat’ at yoga class are intended to be taken ‘off the mat’ every bit as much as the message from the preacher doing Sunday services, or the pearls gleaned from an AA or NA meeting.

Many people who are anticipating an Accelerated Opiate Detox are stuck in the fear of painful experiences from previous attempts to stop. Many are obsessed with what the future will bring.

Creating new pathways for the addictive brain starts with being present and showing up. Breath by breath, fears dissolve and transformation happens. Churchill once said “…I remember the story of the old man who said on his deathbed that he had had a lot of trouble in his life, most of which had never happened.” Call The Coleman Institute if you are ready to do ‘that which you think you can’t’. You can, and we can help.

Saturday, December 5, 2009

Bring your Baby

When I gave birth to my two daughters many years ago, I was in a pretty nice room at a local hospital. Since then birthing suites have evolved into very peaceful, beautiful, homey yet functional settings.

So I just couldn’t seem to help myself from hovering in Suite B at The Coleman Institute earlier this week. A young couple from North Carolina was here with their 3 week old son. Dad is detoxing from opiates. The lighting is soothing, Mom is nestled in a big comfortable reclining chair nursing her baby. Dad is snoozing in bed. It feels as warm and cozy a nest as any respectable birthing room.

A few months ago we had twin 8 month old girls. We borrowed a playpen and everyone took turns holding them so their Mom could focus on being a support person for their Dad, her husband. It worked seamlessly.

Just wanted to mention how accommodating we can be regardless of your circumstances. …and it’s sooooo nice to have a baby or two around.

Tuesday, December 1, 2009

Rebalancing the Brain

When we meet a patient for the first time at TCI for an accelerated opiate detox, our main focus is helping him or her detox from the drug of choice. Because Dr. Coleman has been doing this for many years, most detoxes go smoothly; in fact a patient recently described his experience as “an elegant detox”. It’s true—the techniques and medications have been tweaked and refined over many years, and our patients have a 99% completion rate. We know, however, that this is just the beginning of a new life for our patients.

A person who has been abusing opiates will have a brain very depleted in dopamine, the neurotransmitter that reigns in the pleasure center. Production of dopamine essentially shuts down after prolonged use of opiates. Often patients describe feelings of depression and exhaustion and boredom in the first few weeks after completing a detox.

Studies show that if a person can remain free of opiates, the dopamine in the pleasure center of the brain will return. How quickly the dopamine returns varies from person to person, and this is an area of growing interest to us.

Many treatment centers around the world are responding to patients’ interest in restoring health without depending solely on drugs. Instead they are focusing on an integrative approach that includes using the 12 Step model as well as replenishing the depleted neurotransmitters to rebalance the brain chemistry.

The Coleman Institute has relationships with such addiction treatment centers. All of our patients are assessed to determine aftercare treatment needs, and if this type of treatment following your detox is of interest to you, we can connect you with the appropriate people.

Be on the lookout later this week for a questionnaire to get an idea of how your own dopamine levels are looking. And as always, don’t hesitate to call if you or a loved one needs some help.

Wednesday, November 25, 2009

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.

If you or someone you love needs some help getting off narcotics, benzos or alcohol, please—just show up with your dog—don’t call ahead to get permission. There may be some sort of regulation if we have to ask.

Thursday, November 19, 2009

Happy birthday to me

This month I was very grateful and delighted to be picking up my 25 year medallion to celebrate my 25th sobriety birthday. On October 28, 1984 I had a near fatal overdose and was forced to enter treatment. Since that time I have been blessed to be able to stay clean and sober. As this birthday has come around it has got me thinking about why I have been so fortunate to be able to have 25 years of sobriety without any relapses. For me this is an especially interesting question, since I work with patients - many of whom have difficulty staying clean and sober.

It seems to me that I have been very lucky but I have also put in a lot of hard work. Some factors were out of my control and I was just plain lucky. At the time of my overdose I was a young medical family practice resident and in complete denial that I could have a problem. But fortunately I was forced to complete a 4 month treatment program so that I could continue to work as doctor. I didn’t want to go to treatment but it was the only way to save my career. During that time of very intense treatment, I learned a lot - about myself, the disease of addiction, and how to stay clean and sober. The treatment was long enough and intense enough for me to be able to totally believe that, if I stayed in recovery, my life would be very happy. After treatment, I was forced by the Board of Medicine to document my recovery. I had to go to 12 step meetings and have negative drug screens. I was forced to attend therapy and continue to grow and learn. This continued for about 3 more years, always with the reality that I could lose my license if I did not maintain my sobriety.

I didn’t try to short change my recovery. I followed advice and did what I was told. From the beginning I worked with a sponsor in my 12 step groups and also with a professional therapist. I sensed the importance of learning as much as I could about the beliefs and attitudes I had and how I could change them if they weren’t helpful. I was able to get feedback and advice on some of the decisions I needed to make.

I quickly came to believe in the disease concept that taught me that it wasn’t my fault that I had a drug problem but that it was my responsibility to take care of it. I also met a lot people who tried to give up one drug like opiates but keep drinking - they always failed and usually failed very quickly. I have not risked having even one sip of alcohol because I love my life now and I don’t want to take any chance of ruining it.

Early on, I decided that I would work with others who have addiction problems. It is very fulfilling when I see people get clean and sober and really turn their lives around. It also very quickly brings me back to reality when I see people suffer because they don’t take care of their disease.

Lastly, through my recovery I have been blessed to find a spiritual dimension to my life that I was always looking for. When I was using drugs I thought I had found happiness. What I found of course was just a short term pleasure experience in the brain that was never very fulfilling and always wore off. Now I have found a peace of mind, a sense of purpose and a road map for the future.

So, in all, I have been lucky. But it has not been all luck. I have taken my recovery very seriously. I have truly made my recovery the most important thing in my life. I have been, and am still, willing to go to any lengths to stay clean and sober. I have gone to meetings, worked on the 12 steps, worked with a sponsor and done all the things that people do if they want to maintain sobriety. I believe the path of recovery is actually fairly clear. It is a bit like riding a bike. After a while it is really pretty easy - but it is also fairly easy to fall off a bike if you take your eyes off the road. We have to maintain vigilance on this path of recovery, especially when there are road bumps or tricky spots.

And when we travel this path with friends and companions it sure is a fun journey. I wouldn’t want to be anywhere else.

Peter C.

“THANK YOU FA-LETTIN-ME BE MICE ELF AGIN” - ~Sly & the Family Stone~

I love a good song. As a matter of fact, I am “thankful” for music. It expresses what words can’t say. But sometimes the lyrics to a song can move you too. Take, for example, Sly & the Family Stone’s 1970 funk hit “Thank You Fa-Lettin-Me Be Mice Elf Agin” (yes, the title is purposely misspelled). The song speaks of the social struggles of the 1960’s & 70’s which included a whole lot of drugs and alcohol. Check out the lyrics to the first verse:

"Lookin' at the devil, grinnin' at his gun; Fingers start shakin', I begin to run; Bullets start chasin’, I begin to stop; We begin to wrestle, I was on the top”

If we take these lyrics and apply them to addiction recovery, it is striking what they can tell us. When people are out using, the drug is like a “devil” which means “accuser”. The drugs accuse the addict of being worthless, needy, imperfect, unlovable, and powerless. They call the addict to use. “Fingers start shakin’” is akin to getting the rush or “jonsing” for the drug. The body starts shaking and the mind starts racing. And the struggle not to use begins much like a “bullet chasin’” you because you know if you use it’s like getting shot in the back with a shotgun, painful and messy. At this point, the verse is pretty grim just like the lives of those stuck in active addiction to drugs and alcohol. But wait, the story’s not over yet.

Stone sings, “I begin to stop”. The protagonist stops running. He/she is tired of the bullets, tired of the pain, and tired of the suffering and decides to do something about it and stops. Do you remember the day you decided to stop? Do you remember how good it felt to make that decision? Do you remember what it felt like to turn around and look the “accuser” (i.e. heroin, pot, alcohol, etc.) straight in the eye as it called you names? It was the beginning of the struggle back to life. It became the wrestling match of your life.

The word “wrestle” means, “to combat an opposing tendency or force” and that’s exactly what happens in the song as Stone belts out the line, “we begin to wrestle.” Just like the song, the addict who stops, turns, and faces the accuser, begins that crucial wrestling match for sobriety and recovery. Wrestling is not for the weak of heart. It causes bumps and bruises. But, we see at the end of the verse that the devil is getting it handed back as Stone confidently sings, “I was on the top.”

Any addict who faces their addiction can be on top too. And when you’re on top, life begins to change. Your perspective shifts. Gratitude starts to sweep in and take over. And that’s what recovery is about: a process of changing into who we really are in the first place; ourselves, and adopting an attitude of gratitude for all the goodness in our lives! As this process continues, we become more and more thankful. We are filled with gratitude for the blessings of sobriety and recovery. We are thankful not to be a slave to the drug any longer one day at a time. Gratitude is a gift that feels very good. It’s crucial to staying sober. So, this Thanksgiving as you gather with family and friends to celebrate all the blessings in your life, I encourage you to be grateful for your progress in recovery. And when you do that, why not pause and say, “Thank You for Letting Me Be Myself Again”!

P.S. We never hear whether or not the protagonist wins the wrestling match but I have a feeling he did. So can you!

Monday, November 16, 2009

Big Rocks

I am in the luxurious position of spending most of my time doing exactly what I want to do. Of course, there are still toilets to clean, laundry, bills and taxes, but I love my day job and spend my free time riding my bike, cooking good stuff, doing yoga, learning new things, doing calligraphy and hanging with friends and family.

I’ve managed to pull this off in large part by taking to heart the advice I learned years ago from Steven Covey, a guru of many things, including time management. I saw him speak at a large seminar where he did the Big Rocks Demo. With two large empty jars in front of him, he filled the first one completely with small pebbles. Needless to say when he tried to then put a large rock in the jar, it didn’t fit. In the second jar he placed four or five of the large rocks. On top of these he poured in smaller pebbles, then added sand, and finally water so the jar truly was filled to capacity.

The point of the demo was an admonishment to create time in your life for the Big Rocks—the things that are most important. I don’t know what that means specifically for you, but for most people it means time for our family, our health, our spiritual growth, jobs, fun and friends.

Being in the grip of addiction, whether to pills, pot, booze or benzos—robs you of the best life has to offer. It causes you to ‘fill your jar’ with a thousand tiny pebbles, neglecting what’s most important.

Geneen Roth who has written and speaks extensively about her experiences with eating disorders eloquently states, “Until we examine what we really want, we mistake indulgence (in what we think we want) for freedom.”

I urge you to contact The Coleman Institute if you need some assistance in releasing yourself from your addiction to opiates, alcohol or benzodiazepines. Putting your Big Rocks in the jar first is what it’s all about.

Friday, November 13, 2009

Old Addicts

It’s pretty fun working at The Coleman Institute. Besides helping people to be released from their addictions and launching their new lives through our various Accelerated Detox programs, we have a pretty rockin’ family practice, too.

Many of our ‘local addicts’ become our family practice patients. It’s pretty convenient for your doctor to know your history and understand the medical problems that accompany alcohol and drug addiction.

I have to say, I am humbled when some of the ‘old addicts’ come for a check up. These are men and women who have many years of sobriety under their belt. You can almost tell whom they are when you walk into the room, even if you’ve never met them before.

There is an air of joy, acceptance, and perspective. In stark contrast to the many, many people who have stress and anxiety issues, these patients radiate a peacefulness about them-even if they have some pretty complex medical issues. The message they send is: I could have been dead so many times in the past because of things I’ve done, every extra day is a gift.

Most of these folks spend their time in selfless giving. They are quietly accessible to others who need help. They live in deep joy but not in deep drama.

Now that I think about it, I’m certain I feel better after a visit with these folks than anything I could possibly do for them. Maybe this is how it feels to be in the presence of the Dali Lama. How lucky am I?

Tuesday, November 10, 2009

Tricky Tramadol

If you think tramadol is a benign drug because it is not a controlled substance in the US, think again.

Yesterday we started an Accelerated Opiate Detox on Gus, a 30 year old man from Arizona. He was using an unbelievable amount of tramadol, averaging 100 50mg tablets daily which he purchased on-line. He denied any history of seizure, which is often in seen in people who take upwards of 30 tablets a day.

Tramadol causes typical opiate-like withdrawal symptoms, as well as the atypical symptom of seizure. Withdrawal from tramadol can be brutal, causing anxiety, depression, severe mood swings, brain “zaps”, electric-shock sensations throughout the body, pins and needles, sweating, palpitations, restless leg syndrome, sneezing, insomnia, tremors and more. Often withdrawal from tramadol doesn’t set in for 12 to 20 hours after the last dose, and the withdrawal often lasts longer than that of other opioids.

Dependence to tramadol can occur within 3 months of regular use, usually at doses of 400mg a day.

So far Gus is doing OK. He’s here with his wife and 3 week old son. They were resting comfortably in our coziest room eating a little Chinese take-out earlier today, watching Austin Powers. Because of the large amount of tramadol, his detox will last for 8 days. He is ready to be present for his wife and son.

If you have any questions about tramadol, or are struggling to stop using it on your own, please don’t hesitate to call.

Saturday, November 7, 2009

Suboxone Detox

Suboxone has flooded the country as a maintenance medication for opiate addiction. Undoubtedly it has its place, but from where I sit, it’s also creating a lot of problems.

Suboxone contains a combination of buprenorphine and naloxone. Buprenorphine is an opioid medication. Buprenorphine is similar to other opioids such as morphine, codeine, and heroin however, it produces less euphoric ("high") effects and therefore may be easier to stop taking.

Naloxone blocks the effects of opioids such as morphine, codeine, and heroin. If Suboxone is injected, naloxone will block the effects of buprenorphine and lead to withdrawal symptoms in a person with an opioid addiction.

We receive countless calls from people who cannot understand why they can’t get off their suboxone. In many cases the people we talk to can wean down from 24mg to 16mg, from 16mg to 8mg, and even pretty easily from 8mg to 4mg. the problem seems to be dropping lower than that if a person has been on suboxone for an extended period of time.

Suboxone can cause drug dependence. This means that withdrawal symptoms may occur if you stop using this medication. These are the people we are hearing from. Not everyone has a problem getting off suboxone, but for those who can’t kick It on their own, we provide a safe, convenient out-patient detox. Call Jennifer or any of our staff at TCI to find out more about it.

Thursday, November 5, 2009

Naltrexone Blood Level Study

Just a short and sweet message: we have started measuring the blood levels of naltrexone in patient’s receiving our new 1.4 gram implant. Although it is early in our study, the results are promising. At 8 weeks post-implant, the levels of opiate-blocking naltrexone are still stro ng. We are hoping this pellet will give coverage for longer than the previous 6-8 week implant.

Until we know for sure, please continue to keep your scheduled implant appointments. Remember, after 2 months of abstinence a person is a heightened risk for overdose.

It’s been a wonderful month of seeing our returning patients doing so well, reclaiming their lives without opiates.

Wednesday, November 4, 2009

Moving Toward a Plant Based Diet

Many of our patients come from around the country-and some from farther than that—for an Accelerated Detox, either from opiates, benzos or alcohol. For our local patients (or anyone traveling here in mid November) I invite you to attend our monthly wellness seminar. We’ll be talking about Moving Toward A Plant Based Diet on November 18th from 7-8, here at The Coleman Institute.

No meat bashing going on, I promise, but a discussion of evidence based research about: living longer, feeling better, having more energy, losing weight, lowering cholesterol, preventing (even reversing) heart disease, lowering your risk of prostate, breast and other cancers and more…Call 804 353 1230 ext 303 or rsvp to if you can attend. Hope to see you there.

Monday, November 2, 2009

Cycle of Change - Stage 1

Eight years ago at 230 pounds, Larry was a body builder. One day at the gym he was doing squats without a spotter and ruptured a disc.

When he came to see us in July of this year, he was 175 pounds and he’d been through eight years of escalating opiate use. . The opiates were decreasing his quality of life. With his doctor’s encouragement Larry decided it was time to try to stop; he wanted see how much pain was really present, and if it was tolerable without narcotics.

The detox went beautifully. He hasn’t touched an opiate, benzo or alcohol for two months. His cravings are gone. His back pain is manageable with anti-inflammatory medication.

The problem is: Larry feels extremely depressed. When he wakes in the morning sometimes he doesn’t want to even get up to go to work. Things that used to be fun for him no longer seem to interest him.

The depression is surely a multi-faceted problem. His doctor is working with him to find the right anti-depressant medications, and his brain is still trying to restore the neurotransmitters which have been depleted over the years of opiate use. But clearly, Larry is struggling with a more fundamental issue: who is he without his pain medication?

Martha Beck, a Life Coach with a PhD in Sociology from Harvard, would put Larry in Stage 1 of the Change Cycle. Any cataclysmic event which causes a person to ‘meltdown’ or have to drastically change the way they see themselves qualifies as a Stage One-r, also known as the Death and Rebirth phase.

Without opiates, Larry can no longer define himself as he has for the last 8 years. He also no longer has the identity of a body builder. The general cry of stage one is “I don’t know what the hell is going on…and that’s OK”. Larry needs to grieve the loss of the life he knew—as fraught with problems as it was—before he can move forward through the Change Cycle. How long this stage takes for anyone is variable, but knowing that there are predictable components and helpful tools can be most reassuring.

I think the first three steps in the AA recovery process speak to Stage I and are the perfect tools for dwelling peacefully in a chaotic transitional phase: admitting powerlessness, realizing there is a greater Power at work and turning one’s life over to the care of God.

At some point Larry will start to get little glimmers, glimpses, ideas and visions of things he wants to do again. They may be things he has never done before or even thought of doing before. Some of these ideas may first show up in his dreams. When this starts happening, Larry has moved into Stage II of the Change Cycle: Dream and Scheme. He’ll start plotting his New Life.

Stage III, The Hero’s Saga will come when he starts trying out his new ideas—some will inevitably fail, and he’ll briefly move back to Squares I and II. But some ideas will succeed—and his New Life will be underway as he moves into Stage IV: The Promised Land, having achieved the visions he saw for himself.

Needless to say, all of us are always dynamically moving between different stages of the Change Cycle in various aspects of our lives. But anytime a person chooses to become sober, he or she is re-inventing him or her self and must go through the Change Cycle. There are no short cuts beyond Acceptance. Our staff at The Coleman Institute is devoted to supporting our clients make this transition to the ‘Promised Land’ of Recovery.

Saturday, October 31, 2009

Creative Chris

It was so gratifying to see Chris 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’ve probably gained back some of the weight they needed. If they were a little chunky, they’ve 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 of 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—Oh My God—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.

He 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.

He has promised to bring a painting for us at his next visit, so ask to see it if you are coming to the office in the next couple months. And Chris, if you’re reading this, know how proud we will be to display it. In fact I think you should post some of the body parts bearing your children’s names on our website while you’re at it!

Wednesday, October 28, 2009

Addicts have hearts, too

Every month at TCI/Hamilton Family Practice we offer a free workshop, open to all our patients and their families. They are held on the 3rd Wednesday of each month from 7 to 8. I call this series The Chosen Twelve because they are scheduled each month for a year and topics are picked based on what my patients tell me they are interested in learning more about.

In September we discussed Sugar Blues and how our bodies respond to a constant barrage of refined products. In October the topic was Figuring Out The Fats, with an emphasis on how different types of fats we eat can impact our health, particularly our risk for heart disease.

Even though this blog is geared toward discussing topics pertinent to addiction, the majority of my detox patients have hearts and want to keep them just as healthy as my family practice patients do. Especially if they are going to the trouble of getting clean.

So, in case you weren’t able to be there, here are the take-home points:

Risk factors for heart disease include getting older (that’s the good news/bad news, huh?), a family history of heart disease (although every recent study I see says that lifestyle totally trumps genes), smoking, high blood pressure, obesity, diabetes, sedentary lifestyle and psychological stress.

We discussed the Lipid Panel that checks your cholesterol levels and what the HDL (good cholesterol) and LDL (bad cholesterol) levels should be.

The main message when it comes to keeping your heart healthy in regards to fats is to choose the right ones and use them in moderation. All fats are very calorie dense, whether they are the finest purest organic cold pressed extra extra virgin olive oil or whether it’s a can of Crisco. So using lots of any fats (or too much of any foods and not burning enough calories in a day) will cause weight gain. The body needs certain essential oils that it can’t produce on its own. These fats are found in soy, canola, olive and flaxseed oil; in fish and fish oils, in walnuts and other nuts and in avocados, to mention a few really excellent sources.

Fats that are solid at room temperature are saturated (like butter and beef or chicken fat); some solid fats are also partially hydrogenated and contain trans-fats. Stay away from any food that has partially hydrogenated on the label. Partially hydrogenated oils increase the shelf life of twinkies, but not of humans. The correlation between heart disease and intake of trans-fats is huge.

On the other hand, studies of people with high blood levels of Omega 3 fatty acids show a higher reduction in the risk for sudden cardiac death than any lipid lowering drug currently on the market.

Maybe you can join us in person for a workshop. If you have any topics you’d like to hear about, please let me know. Here are the dates and topics of the next workshops:

November 18, 2009 Moving Toward a Plant Based Diet
December 16, 2009 Healthy Holiday Recipes and Tips
January 20, 2009 Post-menopausal Health
February 17, 2010 Men’s Health Concerns
March 17, 2010 Cancer Prevention
April 21, 2010 Supplements? Which ones?
May 19, 2010 Buffing up Your Physical Activity
June 16, 2010 Eating for Energy
July 21, 2010 Have Less of the Stress
August 18, 2010 Getting A Delicious Nights’ Sleep

Thursday, October 22, 2009

F.E.A.R. - Forgetting Everything is Alright

SPLASH! Diving to the bottom of pool, I grinned underwater as I enjoyed the rush from the high dive into the deep end of the pool. I surfaced and swam towards the ladder. And once again, it came back. What, you might ask? That old familiar tune, you know the one. Dun, Dun, Dun, Dun, Dun, Dun, Dun, Dun, Dun…JAWS! I had seen the movie earlier in the summer and it had ruined every subsequent waterway I encountered from the toilet to the sink to swimming pool to a rain puddle. I walked in perpetual fear that the Great White Shark of Death was going to consume me at any moment. And for that long moment, my definition of fear was not like the title of this article. It was more like…”Fear = My impending death!

I felt a lot like Dory and Marlon from the popular Pixar movie Finding Nemo.
The two stumble upon a Great White whilst looking for Marlon’s son Nemo. As they shake in their fins, they realize this is no ordinary shark. He hosts a 12 Step Shark’s Meeting, much like a 12 step meeting for addicts, only these addicts are addicted to fish. The meeting starts with the following pledge:

“I am a nice shark not a mindless eating machine. If I am to change this image, I must first change myself. Fish are friends NOT food!” Bruce, the Great White in question, who also happens to be Australian, then leads the sharing saying, “Hello, my name is Bruce, it’s been three weeks since my last fish, on my honor, or may I be chopped up and made into soup.” The other attending sharks yell out affirmations, “You’re an inspiration to all of us. I’m in!” Meanwhile, the two fish do not seem impressed nor do they look all that peaceful.

Fear is a big part of life. It is also a big part of recovery from drug and alcohol addiction. Fear of relapse, fear of feeling good, fear of feeling bad, fear of feeling at all, fear of having a good time, fear of having a bad time, fear of staying clean, fear of being normal…you get the point. So how does one deal with fear while trying to stay clean from their addictive behaviors? Let’s take a look at this important question.

First, redefine the fear. For example, if you make it an acronym (F.E.A.R.), it can stand for the following: F.E.A.R. - Forgetting Everything is Alright. You see, fear operates best when it keeps us from actually looking at the real problem. It knows that if we only speculate, anticipate, or worry about potentialities than it has us in its grip.

It can also mean F.E.A.R. - Face Everything and Recover. When we face our fears, we can overcome them. For example, once I realized it was absurd to be afraid that Jaws was going to eat me at my local swimming pool, I no longer feared going in the deep end. I realized that it was impossible because a) sharks can’t live in chlorine, b) the pool wouldn’t allow kids into the deep end if a shark resided there, c) how can a shark get to this pool when the nearest ocean shore is over 100 miles away and they can’t survive outside of water for very long? See my point?

Second, after redefining the fear, you can create helping statements to combat the lingering effects of the fear. For example, you can say things like, “I am not made of fear but of courage.” or “There is nothing I can’t do as long as I apply myself.” Helping statements help you to actively control the thoughts in your mind versus becoming a victim of your own thoughts

Third, fear thrives in the dark…so turn on the light. For example, you never hear of a kid lying in bed with the lights on complaining about a potential monster under the bed. But turn the lights off and the child’s imagination suddenly goes berserk. In order to stay sober, it is important to leave the dark thoughts, attitudes and actions of active using. Going to meetings, journaling your feelings every day, seeing a counselor, talking to your sponsor and reading recovery literature are just a couple of ways you can expel the darkness, turn on the light, and transform your mind with helpful, sobriety-focused information.

Unfortunately, Bruce relapses after a fish gets cut and Bruce smells the blood declaring, “I’m having fish TONIGHT!” as he bears his teeth in a mean growl. The good news is you don’t have to be a victim of Bruce (in your case, the drugs or alcohol). You can turn away from fear and embrace courage in order to get clean and stay clean!

Outpatient Alcohol Detoxification

A lot of patients are coming to us because they are having a very hard time getting off alcohol. Detoxifying off alcohol is very uncomfortable, both physically and psychologically. It can also be very dangerous medically. For over two years now we have been providing an outpatient detoxification for alcohol that is comfortable, safe, and avoids the hassle and expense of an inpatient hospital stay. The program has been working very well.

Without our outpatient detoxification program almost all of the patients we have treated would have required an extensive inpatient detoxification in a hospital. We were able to quickly and successfully detox all the patients, usually in three days. We have not had any complications and have not had to transfer any patients into a hospital.

Alcohol detoxification can be very difficult and medically dangerous for a number of reasons. Firstly, alcohol is a very strong sedative. The body adjusts to regular use of alcohol by not producing its own calming down neurotransmitters – Gamma Amino Butyric Acid (GABA) and Glutamate. This means that when the alcohol is gone the body is in a very agitated state. The pulse and Blood Pressure are elevated and there can be lot of sweating. There are tremors and even violent shakes. The agitation can be so severe there are even seizures. There can also be confusion, memory loss, and even loss of touch with all reality (delirium). This condition of tremors, combined with the loss of reality, is called Delirium Tremens, or DTs. DTs are sometimes fatal.

Secondly, alcohol leaves the body very quickly, so that the withdrawal symptoms begin early and are very intense. The whole withdrawal process is concentrated in a short period of time, making it intense and dangerous.

Thirdly, alcohol is a very toxic substance that damages almost all parts of the body. This means that at the very point in time that the body is trying to recover from alcohol withdrawal it is in a much damaged state. Alcohol causes the stomach and the esophagus to develop ulcers. The pancreas can shut down, and the liver can get cirrhosis and frequently goes into liver failure. Alcohol poisons the blood cells, so it is harder to fight off infections. Alcohol damages the brain, causing confusion, memory problems and balance problems. The net effect of all this is that just as the patient needs a strong body to deal with the stress of withdrawal, the body is operating in a very weakened state. It is no wonder that without the right treatment complications can develop.

Our outpatient detox deals with all of these issues and helps the patient get though the detox safely and comfortably. We ask our patients to stop their alcohol by about 11 pm the night before the detox begins and then come to the office at 8.30 am. We perform a comprehensive History and Physical, get lab work, an EKG, and then we check a breath alcohol level. Next we star an IV solution with vitamins and nutrients to replenish all of the nutrients the body may be lacking. Then we give doses of IV Phenobarbital, which is a great medicine for alcohol withdrawal. It calms the person down, helps them relax, and it prevents seizures. It has a long half life, so it lasts a long time. After about 8 hours the patient is calm and relaxed and can be discharged home under the care of a support person. The patient continues to receive some oral medicines and they come back to the clinic each day for two more days. They are often able to return to work by the 4th day.

The patients we have treated with this outpatient alcohol detoxification process have done very well and have really enjoyed the process. They have been able to detox in the comfort of their own home instead of in a hospital room. The withdrawal symptoms they have experienced have been very manageable. Of course, during the time patients are with us we plan for their ongoing recovery. We usually recommend a Naltrexone implant because it helps so much with cravings. We often prescribe Antabuse or other medicines to prevent relapse. We also have our aftercare counselor, Chris Newcomb, meet with everyone to plan for a counseling program as part of their ongoing recovery plan.

Detoxification is necessary, but it is not sufficient for long term recovery.

Peter Coleman MD

Monday, October 19, 2009

Prison Bars

I saw a cartoon recently that provides a powerful metaphor for how a person can be trapped by his or her own thinking-- and if you don’t know by now, your thoughts determine what your life is like. Period.

It is a picture of 2 guys facing each other wearing defeated expressions on their faces. They are standing in a wide open-almost desert-like environment and are both peering through prison bars they are clinging to. The thing is, the bars are free floating, unattached to any walls or structures. The two men have placed themselves behind these bars, oblivious to the freedom surrounding them.

If you become even a little mindful of this concept as you go through your day, you may be amazed at the thoughts you are telling yourself; the elaborate twists and turns and scenarios your mind will take. If these thoughts keep you rooted in fear, anxiety or pain, these are the prison bars you are holding up for yourself.

Some of the Prison Bar Talk I hear at my day job:
“I’m too busy to go to meetings—really!”
“I relapsed because I got so stressed out about my boy (or girl) friend.”
“I eat fast food because I don’t have time to cook.”
“I drank because it was my birthday—what’s wrong with that?”
“My husband doesn’t understand what it’s like to have a drinking problem.”

The thing is, there will always be circumstances we can’t change, but what’s important is to question your thoughts. Stand back and observe your thoughts as if they were projected on a screen. One way to question your thoughts is to use Byron Katie’s Inquiry Work:

Question 1: Is the thought true?
Question 2: Can you absolutely know it is 100% true?
Question 3: How do I react when I attach to this thought?
Question 4: Who would I be without this thought?

Intervening at the thought level allows you to drop the prison bars by creating alternative thoughts. Our emotions flow directly from our thoughts; our actions from our emotions, and our accumulated actions culminate in Our Life Story.

It is much like the serenity prayer: God grant me the serenity to accept the things I cannot change; courage to change the things I can;and wisdom to know the difference.

Some of the ‘things’ we can indeed change are our thoughts.

Friday, October 16, 2009

Choosing to Feel Again

Mark is here at The Coleman Institute with his wife, his son Mark Jr who is 5 years old and his father. Mark has been using 1000 mg of various oxycodone and hydrocodone pills for many years because of a back injury, and is going through an Accelerated Opiate Detox. He is part of a booming family construction business in Arkansas and he has access to lots of pain medications from his employees.

His detox is going beautifully. He has been relatively uncomfortable, partly because the week before he came he reduced the amount of pain meds he was taking.

Today he talked about some of the reasons he feared going off his narcotics: fear of anxiety, fear of boredom and fear of pain.

It’s true…choosing to stop using drugs or alcohol is to choose to feel again.

I recently had a conversation with a person who personifies Recovery. He has allowed himself to dwell in The Process for 25 years and he has a beautiful life to show for it. Recently he is going through some scary emotional risk taking, but he told me how incredibly good it is to feel every single emotion-regardless of the outcome. It is exhilarating for him.

The fact that Mark can name his fears will help him immensely. He says that giving up the pills is like losing a brother. It’s an amazingly accurate statement: these drugs have been there for him when things were going well and when things were going badly. They never judged him.

Mark needs to enter fully into grieving this very real loss. If he is able to stay present to himself as he feels the anger, the sadness, the anxiety, the frustration—he’ll have a much better shot at making it.

He is blessed to have an extremely supportive wife and parents. I can’t emphasize enough to him how much he also needs to be immersed in a group of people who know what he’s been through and can help replace the ‘brother’ he’s losing.

If you can offer any words of encouragement based on your own recovery, please respond to our blog.

Friday, October 9, 2009

Cognitive Behavioral Therapy (CBT) is useful for insomnia

A small study by Dr Morin and colleagues, reported in JAMA in May 2009, studied CBT with or without sleeping meds. We know that Ambien and other sleeping medicines do help people sleep, but only in the short term. As predicted, the brain gets used to the effects of the Ambien and then it loses its effectiveness. There is usually a rebound period of insomnia when it is stopped (withdrawal).

This study was interesting because they combined CBT with Ambien for the first 6 weeks. They found the combination quite effective. After 6 weeks everyone continued the CBT for a total of 6 months. Half the group stopped their Ambien completely and the other half could take Ambien if they felt like they needed it. At the end of 6 months the people using no Ambien had better sleep than the people who used Ambien when they wanted to.

Previous studies have shown that CBT is helpful for insomnia. Now we can say that combining it with Ambien is also helpful, but patients shouldn’t take the Ambien for more than 6 weeks.

Monday, October 5, 2009

Ben's Wild Night

I’d like to say that everyone who goes through an accelerated opiate detox at The Coleman Institute sails through it painlessly, or at least with minor discomfort. This describes the experience for about 98% of our clients, but that 2% can be a little tricky.

Ben and his parents came from a small town in a near by state. Several of his friends had detoxed with us in the past year and are doing beautifully in their respective recovery programs. Ben had been snorting and shooting 320mg of Oxycontin daily. He knew it was killing him and he wanted to stop.

He’d tried to stop. All tolled, his parents had paid out close to one grand in various treatments, medications, hospitalizations and bail. They were all tired of it. They knew that a naltrexone implant would provide Ben with the stability and freedom he needed to be abstinent from opiates.

His first day was uneventful. In the middle of the night on day 2 the police were called to their hotel because of his disruptive behavior. He got quiet and the police left him alone. That morning at the office Ben became quite aggressive with his parents, and again, the police were called. He quieted down and they returned back to their hotel, but I admit, I wasn’t surprised when I heard later from the police that Ben had been found in a bathroom of a local eatery trying to shoot up benzos.

A Temporary Detainment Order (TDO) was issued and Ben completed his detox in the hospital. He returned to our office the following day and received his two-month naltrexone implant.

The whole process of Recovery is fraught with pitfalls. Whatever the addiction, it is waiting to snare its victim time and time again.

Ben was surrounded by angels; some dressed in blue uniforms, some in the form of loving parents, a devoted uncle, and our staff—all of whom truly care about Ben’s Recovery.

My hope for Ben is that one day in the future he will have a life of joy and peace, in a great relationship with a great job. I hope he will be telling his story to a young kid who’s trying to get straight, describing the hard work he did to get clean, how people did not give up on him, that he didn’t give up on himself. That he continues to work daily on his Recovery.

Although we are always gratified to see any of our patients come back with success stories, I admit, I will be very very happy to see Ben come back in 2 months for his next implant…without the drama.

Wednesday, September 30, 2009

Resource Review: GET UP: A 12-STEP GUIDE FOR MISFITS, FREAKS, & WEIRDO’S BY Bucky Sinister

I spoke with a patient the other day. He was a younger guy in his mid-20’s. Struggling with addiction, he had come to the Coleman Institute for Naltrexone Implant Therapy hoping to gain back his life from heroin abuse. After his detox, I shared a book with him that I thought would help him greatly. He immediately took interest in it noting that he could relate to the author and his story. It is an unconventional book but then again addictive behavior is unconventional. The book is entitled Get Up: A 12-Step Guide to Recovery for Misfits, Freaks, and Weirdo’s by Bucky Sinister. Mr. Sinister, if I may call him that, is a recovering alcoholic who put the alcohol in alcoholic. He was a late night bar closing drinker and drug-user who almost lost his battle with these substances. However, he got into 12 Step Meetings and things started to change. He hasn’t taken a drug or a drink in 7 years!

Get Up is a no-holds barred look at the 12 Steps of Alcoholics Anonymous. The book is not for the faint of heart. Without giving really gory details, Sinister is honest, thought-provoking, and sometimes even profane. Yes, profane. He is a self-proclaimed cynic, freak, weirdo, and misfit. He uses salty language and he doesn’t pull any punches. But more than the language, he is real. That is what recovering addicts need from addiction professionals and other support people. They need people who are real that will walk with them through their storm of withdrawal, sobriety, and recovery.

The book speaks with authority, verve, and clarity on the 12 Steps using hipster lingo for the kids. If you are an addiction professional or a support person to an addict in their 20’s to 30’s, I highly recommend this book. Where it offends, it enlightens and where it ruffles feathers, it smoothes them down with the truth. You can learn more about the author at

Friday, September 25, 2009

Prisoners of Poppy Seed Tea

Recently, within a week of each other, The Coleman Institute received two calls from people who were concerned about addictions to poppy tea.

Jane, a middle school teacher from Georgia was consuming 5 cups of tea daily, made from the ground pods of dried poppy flowers. She purchased these from an internet site that sold them for ornamental purposes. The addiction was ruling and ruining her life. She and her husband of five years were ready to start planning to have children. What seemed at first to be an innocent relaxing brew had turned into a full blown addiction. Within 8 hours of her last cup of tea, Jane started having classic intolerable withdrawal symptoms.

Cary, a young man from Boston who had been treated unsuccessfully for intractable migraine headaches consumed 2 liters a day of a poppy seed decoction, made by agitating large quantities of the seeds in a solution of slightly acidified water. He purchased the seeds in bulk from several local grocery stores, alternating his visits to average going to each store about once every three months.

As a parent, I often share stories with my own children of what I see in a days’ work, with the thought, of course, that they might learn lessons vicariously and make better choices. I could not bring myself to share these stories with my children—the idea that these substances are relatively easy--and certainly legal—to obtain, had me a little--well--freaked out.

We extended both of these from the usual three day accelerated opiate detox to five days, because it was new to us and we were not sure what to expect. It was a good idea. These were tough detoxes, made tolerable by our program.

Jane and Cary are due to return for their 2nd naltrexone implants within the next week or so. Since working with them, I have heard several more stories of people enslaved by this addiction. If you have any questions, need help for yourself or a loved one, please call us. We’re here for you.

Thursday, September 17, 2009

We are testing out two new implants

It is very exciting for us at The Coleman Institute because we have two new implants that are available for us to use for our patients. Both are looking like they will significantly extend how long the implants last and make it much more convenient for our patients to stay in recovery. One of the problems with implants has been that they deliver a lot more Naltrexone than is really needed in the early part of the implant treatment cycle, and then they lose their effectiveness too quickly. It turns out that patients don’t need very large amounts of Naltrexone to completely block the effects of Heroin, OxyContin or other opiates. All it requires is about 1 nano-gram (1 millionth of a gram), per milliliter of blood. Naltrexone is a very powerful blocker. By making an implant more tightly compressed we should be able to reduce the amount of Naltrexone delivered at the start of the implant cycle and extend the duration of the implant cycle.

The first new implant is a newer and improved version of our current 2 month implant. It is compounded in a bigger machine that can compress the Naltrexone more tightly. The end result is that the implant has 40% more Naltrexone but it is essentially the same size. It is just as easy for us to insert. But because the Naltrexone is more tightly compressed it will last a lot longer.

The second new implant has been under development and early use in Australia for the last couple of years. I have spoken with a physician over there that uses them. He and his colleagues have already begun a major study on these implants. The early results show that they seem to last at least 4 months and possibly 6 months. They are a double implant system - two implants put in at the same time. The implants are being compounded in the US by a large pharmacy in NY.

This is very exciting for us. Longer lasting implants make so much sense. With a 4 month implant, patients can realistically get detoxed with us and then only have to come back 2 more times to stay off all opiates for a year. A 6 month implant would of course mean that, with only one repeat implant, patients and their families can have security and confidence that there will be no opiate use for at least a year. We believe that a 4 – 6 month implant would be ideal for patients and their families. We believe that many more patients will come back if it is more convenient for them. Especially patients who have to make a long trip. Many more patients can get clean and stay clean.

We are excited to be able to use these new implants and we are also very excited to start some research studies on them. I have already begun discussions with researchers at the Medical College of Virginia (MCV). We will study blood levels and look at other measures of how well the implants work. Hopefully the research will get underway in the next couple of months.

For the last 10 years we have seen firsthand just how happy patients are when they get implants. Most patients completely lose their cravings and they start to be able to get their lives back. Now we will have improved implants and we will be able to document this in a research study. Our findings will let other doctors and patients know that Heroin addicts and other people with Opiate dependence really do have choices.

Peter Coleman MD

“Just What I Needed?” - The Cars

That’s exactly what many addicts think as soon as a craving thought hits their mind! Cravings, a consuming desire, as puts it, are a part of life for any recovering addict regardless of how long they have been sober. You can count on them happening but you can’t always count on how you will deal with them. Let’s talk about some ways to survive the inevitable!

American author E.L. Doctorow once said, ““Writing is a socially acceptable form of schizophrenia.” While a funny quote, it is true that cravings can make a recovering addict feel like a schizophrenic because of the war in their mind. So, I say, write it down! Write out a list of your cravings. This achieves two things. First, it helps you clear your mind. Second, it gives you an objective view of what you are thinking about. You can share this with a counselor, sponsor, or trusted friend in recovery to gain insight about your addiction and most importantly your real needs, not wants.

Essentially, a craving is much like a Sprite campaign advert. You remember the line, “Obey Your Thirst”?! That’s exactly what cravings tell you to do. They tell you to indulge, to give in, and to “obey your thirst”. The problem is that the craving doesn’t tell you the consequences of that indulgence. It’s kind of like a used car salesman with really bad hair who shows you the contract for your new car but “neglects” to show you all the fine print that will leave you broke relying on your two legs to get you to work every morning.

What is important to understand with craving is that they lie. They do not tell the whole truth. They tell you shades of truth such as “it’ll feel so good” (but not when you wake up), “everyone is doing it” (my 5 month old cousin?), “you gotta have it now” (the only thing I have to have is food, water, and air). You get the point. Next time you start to experience strong cravings for drugs and/or alcohol, try this. Think about the exact opposite of the craving and you will most likely find the truth every time. Speaking of truth, go ahead and disobey your thirst!

William Booth, founder of the Salvation Army, made a very astute observation when he said that, “the greatness of a man's power is the measure of his surrender.” The way to defeat the cravings train is to surrender to it. Get off the tracks. Step away from the platform. Walk away. It is more powerful than you. You know the whole, “more powerful than a locomotive” thing. You’re not Superman/Superwoman. Cravings are your kryptonite. But, they have no power over you that you don’t give them. Therefore, you can just surrender because they can’t force you to do anything. You can be the weakest person and the strongest person at the very same time when you surrender. The truth is that no one gets struck drunk or high, it is a participatory event. Therefore, choose to surrender your participation and remember that, “craving is the mother of a reckless giving of oneself!” Eric Hoffer

Chris Newcomb - Aftercare Coordinator

Monday, September 14, 2009

Mom's Letter

When patients go through a detox at The Coleman Institute, one of the most important components of a successful experience is the care given by the support person.

Not infrequently our patients and their families live in small towns with few resources and limited access to recovery services. One mother who was devastated to find out that her son was heavily addicted to Oxycontin did something about the lack of support services available for her son. Here is how she responded, in her own words:

“My son was injured during his senior year of high school. Due to the injury and the long period of time he was forced to take pain medication he developed a drug problem. Once the doctors stopped the prescriptions he looked to the streets for the “feel good feeling”. At first he thought that he was alone but soon found out that 3 out of 5 kids in his class were using in some form –even the “good” kids. I did not know about the problem until his pay check (1 year later) began to disappear. At this time he had a $800 to $900 a week habit. Drug dealers were telling him to get help. He had a green color to his skin and weighed approximately 130 pounds at 6’1”. Of course I was in shock. We began having everyone pray for him and we began looking for help. To our surprise the help in West Virginia was very limited. Someone could receive “treatment” for 3 to 28 days and then you are turned back out into the world. Most drug rehab’s have drugs being sold during treatment. A few friends and myself started a program Parents Against Addictions. This was the only way we found to help ourselves and our kids. Through the program I met a lady who had a brother that is –or was—an addict. She had brought him to The Coleman Institute. My son detoxed at home (by this time he was hooked on suboxone). We came for our first naltrexsone implant in March of 2009. It has been wonderful. We are now starting a 12 step program for 25 and under. We cannot save the world but already my goal has been accomplished and prayers answered. My son is on his road or journey to recovery. We ask for your prayers.”

Both her son and several of his friends have been drug free for several months. If you would like information on Parents Against Addictions or our detox programs at The Coleman Institute, please call.

Thursday, September 10, 2009

The final day of an accelerated opiate detox at The Coleman Institute is the longest. Our patients come in early with their support person and may stay until 4 or 5 o’clock. The support person has been instructed to bring whatever the patient may need for the day: a change of clothes, a blanket, pillow; as well as snacks for him/herself (although we always offer to provide a lunch for the support person from one of a number of nearby eateries).

Lately I have been struck by the blankets and quilts our patients bring on that last day. I have seen some of the most beautiful homemade quilts and afghans, and the coziest, snuggliest, softest blankets.

Last week it was Alex, an electrician by trade and a potter by God-given talent. He detoxed from methadone under the cover of a warm, thickly woven afghan, the colors of early fall on the Blue Ridge Parkway. His Mom had made it for him, though admittedly, it was also her ‘therapy’.

Rita and her husband came from Ohio earlier in the week. Rita had been on fentanyl patches with multiple opiate breakthrough pain meds for nearly seven years. She brought with her a kaleidoscope of comfort --squares of soft heavy flannel quilted together into a thick warm cover. I wanted to take a nap every time I walked in her room.

Leah’s blanket was a quilt she’d made for her own daughter many years earlier. Her daughter had detoxed from Oxycontin several months earlier, snuggled under the same blanket. Her daughter is now pregnant with Leah’s first grandchild. When Leah saw how beautifully her daughter was doing, and wanting to be fully present as a Grandmother, she was determined to stop using Oxycontin herself.

I remember the “blankie” my youngest daughter carried with her everywhere. I recall the incredible amount of time spent, searching when that blanket went missing. When she started Kindergarten I stitched a scrap from that blanket to the sleeping mat she’d be using for naptime. Her blanket would instantly calm and comfort her.

Someone who is a better writer than I could give this metaphor the elegance it deserves. These blankets, quilts and comforters are a symbol of the love our support people want to wrap their loved ones in. They have been through so much. They have lived through terrifying moments that turn into years of resignation, spiked with hope. So much is tied into being willing to go through a detox with a person who has been enslaved by drugs.

Please call us if you are ready to support your loved one through a detox, to a new beginning. We’ll be glad to answer any questions.

Sunday, September 6, 2009

Chantix may be effective for Alcoholism

Chantix (Varenicline) is the new drug for Nicotine dependence. It is a pretty amazing drug. It was designed in the lab to specifically attach to the Nicotine receptors and block them. The idea is that patients would be unable to get any benefit from smoking and hopefully they would lose their cravings. Indeed this is what happens. I have seen people quit smoking when they really weren’t particularly motivated to quit. The Chantix took away their cravings so much that the patients figured they might as well quit.

Soon after Chantix began to be prescribed, some case reports started coming in that some alcoholics, who were using Chantix to quit smoking, were losing their cravings for alcohol. It doesn’t quite make sense, since we don’t think alcohol works through the nicotine receptors. But the brain is complex and inter-related system.

So, Dr McKee at Yale University studied some heavy drinkers half of whom who had been put on Chantix, and the other half on placebo. They were all given one drink and then given unrestricted access to alcohol. The group on the placebo drank quite a lot more than the group on the Chantix and they had much higher cravings for alcohol.

This is very preliminary data but very interesting that there could be another medication we can use to reduce cravings and help alcoholics stay in recovery. It will be interesting to see what further research shows.

Wednesday, September 2, 2009

Support People ROCK!

If I’m repeating myself….sue me….but I wish I could write a ‘script for every support person assisting their loved one(s) through an opiate detox for a 2 week all expenses paid vacation to the tropical paradise of their choice.

Support people: YOU ROCK!

To be a support person, you have wrestled with questions like “Am I helping my daughter (son, wife, lover, husband….) or am I enabling her (him…) by going through all that’s involved in a detox? And, you don’t really know what is involved until you go through it.

Committing to be a support person for a loved one going through a detox will push every button you have. The patient is scared but determined, rude but contrite, ashamed but hopeful.

As a support person you may not get much sleep-or you may sleep peacefully for the first time in years… you may not recognize the loved one who is emerging from the “ashes” of the hazy drug induced cloud that opiates create. One Mom said to me, “I don’t even know who the real Sam is…” as she saw him smile and laugh for the first time in years.

This extraordinary week we are detoxing 4 people from methadone. Since The Coleman Institute is a busy mix of family practice patients and addiction medicine, the detox patients’ paths may not cross during the week. But on the weekends when we meet only with our detox patients some beautiful chemistry can happen.

This past weekend these 4 families sat together in the waiting room. They shared stories, laughed, cried and loved their ‘patients’ to the end. One family commuted from Northern Virginia, another family went to Kings Dominion, while another family hit the mall daily, and the fourth family quietly went home and started the slow healing process of caring for a long-lost daughter who has suffered years of sexual abuse.

Please call us if you want to talk about helping your loved one move forward to uncovering who they are meant to be; it will undoubtedly be a vehicle that uncovers truths and strengths about yourself- and who knows? There may be a surprise trip to Hawaii at the end of it all.

Monday, August 31, 2009

Starting Again

Two weeks ago we worked with a kid who we were pretty sure wasn’t gonna make it.

In fact, in the middle of the last day of his accelerated opiate detox from heroin at The Coleman Institute, Barry called his dealer and arranged for a delivery.

After we dealt with that pesky little problem, the detox resumed without drama.

Two days later Barry called to tell me he bought some dope and tried to get high and was furious that he couldn’t. He took a razor, cut through his stitches, widening the incision and tried to dig out his naltrexone implant.

He was supposed to have stayed with his parents for 48 hours following his detox, but instead he called ‘friends’ to pick him up take him back to his apartment.

I wasn’t sure why he was even bothering to call me, but he was worried about the gaping incision and possibility of infection. I told him to come into the office.

Barry looked a little sheepish. I cleaned up and re-stitched his incision site. He spent about an hour talking to our counselor.

Barry has been to 3 different rehabs; he says his parents have probably spent over $60,000 treating him. He said when he realized he couldn’t get high, an incredible feeling of relief surged though him. For the first time in many years, he knew that it would do no good to buy or use heroin or other opiates. It was a freedom he hadn’t tasted in a long time.

I told him to come back to the office the next day. When he didn’t show up I was sorry but not too surprised. Our program works, but if a person is determined to fail, he will.

I was pleasantly surprised to have a phone call from Barry later in the afternoon. He wanted me to know that he didn’t make the appointment because he had returned to his parent’s home. He knew if he stayed in his apartment the only people he knew to call were his dealers or other users.

So far Barry has made it back for two follow up appointments. He has been clean for about 12 days now. He is a good looking guy, he’s smart, he’s got parents who support him, and he’s got a certificate in heating and air-conditioning. He has contacted a former employer who is in The Program to go to meetings with him.

Everyone at The Coleman Institute is pulling for Barry. He’s got a long way to go, but like everyone on the planet, can only do it a day at a time. He has started the journey. Call us if you’re ready to start yours.

Thursday, August 27, 2009

Back Pain and Detoxing from Fentanyl Patches

John came to The Coleman Institute with his wife, Sara this week for a consultation to get off fentanyl patches. He was referred by his physiatrist, a doctor of physical and rehabilitative medicine that John has been working with for the last couple years.

Fentanyl is a powerful opiate that is usually prescribed after patients have gone through the hydrocodones, oxycodones and other strong narcotic pain medicines. It comes in a transdermal form as a patch, emitting medication steadily for 2 to 3 days. Sometimes the medicines are escalated because a person does not have adequate pain relief, sometimes because a person has developed a physical tolerance to an opiate and experiences withdrawal symptoms without an increase in the dose or frequency of medication.

John is a successful businessman; he owns his own company and it’s doing quite well. He and Sara have been married for nine years and he is a devoted stepfather to her two daughters. When he was younger, John was an active athlete and played baseball and football in high school and college. He continued to stay in shape by lifting weights. During a grueling weight lifting session six years ago, John ruptured a disc in his lower back. He ended up having surgery, and his pain saga began.

He has been treated by several physicians and other specialists. He has had physical therapy, injections in his spine and even acupuncture. These modalities help his pain somewhat, but never quite relieve it.

Using strong narcotic medicines seemed to be the only answer. The problem is that although his pain is briefly relieved, the intervals between needing the medicine are shorter and shorter and the doses are higher and higher. Not only that, John’s quality of life is spiraling downward. His wife got tears in her eyes when she talked about how John “used to be” before taking all the narcotics. He now lives in a world with muted responses to all life’s pleasures. He is chronically constipated. His sleep quality is poor.

He chose to go through an accelerated opiate detox and stop using the fentanyl patches.
The reason patients decide to go to such extreme measures is to achieve a better quality of life than what they have, being chronically dependent on narcotic medication.

When the brain has a chance to manufacture its own pain-fighting neurotransmitters, many patients find they can tolerate their discomfort utilizing other types of pain medications that do not produce physical dependence. In fact, by stopping the narcotics, these other treatments are often significantly more effective.

Back pain is an extremely difficult problem to live with, but compounding it with physical dependence on narcotics can severely reduce one’s quality of life. If you or a loved one is struggling with a similar situation, please call us at The Coleman Institute and let us tell you more about how we can help you get your life back.

Monday, August 24, 2009

Q - How can we be happy?

  1. A - Be around other happy people

    That is right. Dr Nicholas Christakis from Harvard University has used data studying over 5,000 people for over 20 years. He has found that when someone close to us – friends or relatives – become happy then we do too. For example, if someone who lives within 1 mile of us becomes happier, then we are 15% more likely to be happier. What is more amazing, is that this effect seems to happen even at a 3rd degree of separation – in other words we are more likely to be happier if we know someone who knows someone else who is happy. Amazing, and yet not too surprising when you think about it. We see it all the time in Alcoholics anonymous and Narcotics anonymous, or in church or other social settings. We are social creatures and we benefit from feeling connected. And who we connect with makes a big difference to how we see ourselves. It is one of the reasons we are not big fans of Methadone clinics, and we are big fans of support groups.

Friday, August 21, 2009

National Recovery Month - Win A Free Detox

“Together We Learn, Together We Heal” will be the theme for National Recovery Month this September. This annual observance is held to celebrate those in recovery and honor the professionals who serve them. As a part of our commitment to help those in need, we are offering the opportunity for professionals to win a FREE detox to be used by any patient they nominate. The detoxes included in this offer are as follows:

· Accelerated Opiate Detox and one year of Naltrexone implants

· Rapid Benzodiazepine Detox

· Alcohol Detox and one year of Naltrexone implants

Rapid Benzodiazepine Detox can only be completed in our Richmond, VA office. Other detoxes can be completed at any one of our locations: La Mirada CA, San Francisco CA, Chicago IL, Las Vegas NV or Richmond VA.

The requirements for those patients being considered for treatment include:

· 90 meetings in 90 days and

· Abstinence from alcohol and all other mood altering drugs.

· All of our detoxes are completed on an outpatient basis, therefore the patient must have a support person (sober family member or friend) for the full duration on the detox.

Not included with the detox is food, transportation and lodging.

To enter the patient into the drawing, please email your contact information to or call 877-77-DETOX. The deadline for all entries is September 12, 2009. The drawing will take place on September 19th at our Open House and all winners not present will be notified by phone or email.

Membership has its privileges!

American comedian and film star Julius Henry Marx (a.k.a. Groucho Marx) once quipped, “I would never belong to a group that would accept someone like me as a member!” While he was clearly poking fun at himself, his statement points to a deeper truth: people want to belong but are often afraid to be known for who they really are.

Many addicts, in particular, struggle on a daily basis to feel accepted and understood. This is crucial to the recovery process and long-term sobriety. That is why active participation in a recovering community is the best way to learn how to, “live life on life’s terms.”

We now have an online AfterCare Forum setup for all of our TCI Alumni and their Support Person(s). This is a place where you can connect with other TCI Alumni online from anywhere in the world! Our goal is to build an online community where those struggling with the day-to-day grind of addiction can connect with each other for support and encouragement. Some features of the AfterCare Forum include:
- Preventing Relapse: helpful strategies to stay on the path to health
- 12-Steps of Recovery: a primer on the 12 steps
- Recovery Journal: A place for you to blog about your recovery experience with others who share your struggle
- Mental Health: Anxious? Depressed? We can help!
- Men in Recovery: A place for men to share struggles with other men in recovery
- Women in Recovery: A place for women to share struggles with other women in recovery
- Support Persons: Pulling your hair out over the addict you care about…find help here!
- Much, Much, MORE!

The point is that we want to help you recover using as many different avenues as possible. Our AfterCare Forum is just one way we at TCI are trying to be on the cutting edge of the recovery movement. If you are an Alumni Patient or Support Person(s), we would like to invite you to email our AfterCare Counselor/Coordinator Chris Newcomb at to receive your login and password to access all the great features of this site. If you do not have email, you may contact him directly at 804.353.1230 EXT. 311.

In addition, we also have an area in this aftercare forum for professionals to connect, network, and “talk shop” with each other. We know that we are only one cog in the wheel of recovery. Our goal is to bring other professionals together so they can share, learn, grow, and partner with one another and the Coleman Institute to better serve those who suffer from addition.

Even though you may have misgivings about how an online forum could enhance your sobriety, please give it a try. Remember these words from M. Scott Peck, “There can be no vulnerability without risk; there can be no community without vulnerability; there can be no peace, and ultimately no life, without community.”

Can we get our recovery online?

The world is changing - rapidly. Our use of electronic devices and media are increasing at a dizzying pace. People all over the world are connecting with each other via regular email, Facebook, Skype, and now Twitter. There are literally millions of videos to find on YouTube. Students are studying and completing degrees at on-line universities. Physicians are routinely providing care to their patients via emails.

And recently a study in this year’s Journal of Substance Abuse Treatment explores the effectiveness of providing intensified substance abuse counseling using an Internet based videoconferencing platform. Dr Van King and his colleagues at Johns Hopkins University studied patients at a local Methadone Treatment program who had been failing at treatment and were having positive urine drug screens. The patients were being moved up to a more intense treatment, consisting of their usual weekly individual therapy session, plus two additional relapse prevention therapy sessions. Half of them received their extra therapy via “on-site’ counseling and the other half received their more intense counseling via a video link. In the video counseling, the participants could see the therapist but not the other participants. The therapist could see all the participants.

The results were impressive. The outcomes were the same in each group – marked reductions in drug use, and good attendance rates at the therapy sessions. The video therapy group reported a greater satisfaction with their therapy, because of the extra convenience.

However, this was the first study of this type and it was a small study consisting of only 37 patients. It was also a study of patients on methadone maintenance who had regular face to face time with their treatment providers. They had to show up to the clinic every day to receive their medication. They were also still having face to face sessions with a therapist every week. So it is hard to know how these results would generalize to other substance abuse situations. Could video counseling work with a regular Intensive Outpatient Program (IOP)?

These new ways of doing things challenge us to grow and learn more. Sometimes the road less travelled really does work better. Sometimes of course it leads to a dead end. More often, the road less travelled works well for some people but not for others.

As I see it, new electronic and internet systems can be quite helpful in a number of situations, but in most situations these systems shouldn’t replace face to face medicine or counseling. For me, practicing medicine is almost always best done face to face and in real time. The personal interaction with a patient is very important to me and I think this interaction is invaluable in terms of fully assessing a situation, making a diagnosis, communicating that to a patient, and getting agreement and commitment from the patient. This is even more important when it comes to substance abuse medicine, and especially important in an individual or group therapy situation.

I know that some alcoholics are getting their recovery at Alcoholics Anonymous chat rooms, but I just can’t believe that this works as well as a live meeting. There is something about going to the effort to get out of your house, meeting up with other recovering people, hearing a live discussion, and feeling real emotions. At a live meeting there is also the opportunity to help out and chat with other people after the meeting.

On the other hand, we have patients who live in very remote parts of the country or have such overwhelming commitments to family that they really can’t get to live therapy or meetings. For these people chat rooms or video therapy can be a useful adjunct. There are other people who really enjoy interacting over the internet, and get a lot out of this interaction. I think that for these people, internet chat rooms can be quite helpful, but I still think they need to complement this with live interactions.

We believe that these online, internet base interactions can be a useful adjunct to our patient’s recoveries. We are even in the process of setting up some chat rooms for our patients and their families. We believe that while this can be a useful aid to recovery, it should not replace actual therapy or live support groups.

I would love to hear your opinions on this timely issue. Please visit our chat room and let me know your opinion.—insert address and ? password here.

Peter Coleman MD