Tuesday, April 28, 2009

Getting High on Helping Others

An amazing article recently published in the Proceedings of the National Academy of Sciences, by Doctors Jorge Moll and Jordan Grafman, shows what happens in the brain when we help others. Incredibly, when we help others, a primitive area of the brain gets activated--the same area that is activated by food, sex or drugs.

We have known for a long time now that the pleasure center of the brain (The Ventral Tegmental/Nucleus Accumbens region) is full of dopamine and when we satisfy our basic needs (food, fluids and fornication), we release extra dopamine in that region and we feel a strong pleasurable sensation. Addictive drugs, of course, all release extra dopamine, which is why we like using them.

Now, Doctors Moll and Grafman have put patients into a special MRI scanner and asked them to imagine either donating money to charity or keeping it for themselves. To their surprise, when the patients were asked to think of others more than themselves, their pleasure centers were strongly activated.

So, what does this mean for us? Well, maybe your mother was right when she said, "Always think of others." A long time ago, St. Francis of Assisi said, "For it is in giving that we receive." It seems that he was on to something. This research really does show that when we give to others we also benefit.

The 12-step programs have a long tradition of helping others. Bill W., who founded AA, said that it was only when he reached out to another suffering alcoholic that he was able to forget about his problems and stay sober himself.

Active 12-step participants are encouraged to sponsor newcomers, and most sponsors will report that they feel that they also get a lot out of the relationship. One of the slogans of AA is that "we only get to keep it, if we give it away!" The 12th step of AA and NA teaches us to "...carry the message to the alcoholic or addict who still suffers."

Giving back and helping others is a huge part of what recovery is all about. It is so exciting to me that we now have brain research that shines a little light on how and why this works.

So, do yourself a favor--get out there and help someone else!

Sunday, April 26, 2009

New Black Box warning for Methadone

Recently a black box warning was added for Methadone but most prescribers are unaware of this. The warning concerns the fact that Methadone can prolong the QT interval and lead to Torsades de Pointe and sudden death. The effect seems to happen more often at higher doses (over 100mg daily) but can also happen at lower doses. This effect seems to stop when the methadone is stopped but recurs if the Methadone is restarted. An expert panel was recently convened and they recommended the following for all patients being prescribed Methadone:
  • Inform the patient of the risk

  • Ask patients about previous heart problems

  • Measure Qt interval before treatment, after 30 days, and yearly

  • Inform patients and consider changing meds if QTc is above 450

  • Be aware of other meds that can prolong the Qt interval

These new guidelines will present quite a challenge for clinicians. Most frequently Methadone is prescribed in a methadone clinic, a setting that often has limited medical oversight. However, patient safety is paramount and so this new information should be incorporated into all medical practices.

Friday, April 24, 2009

Richmond area sheriffs support recovery efforts in their jails.

What a treat to see the sheriffs of Richmond city, Chesterfield county and Henrico county, all at the McShin fundraiser. The McShin foundation is putting a lot of effort into bringing the message of recovery into Richmond City jails. They organize recovering addicts to volunteer and go into the jails and teach the inmates about addiction and recovery. They organize support services and help for the inmates when they get out. What a great job they are doing for a population who really need a lot of help and who traditionally have not received much help.

That appears to be changing. At the recent fundraiser, the three sheriffs were there supporting these efforts. When this level of support comes from the top down, you know real change is on the way.

Wednesday, April 22, 2009

Naltrexone Implants

Several months ago a husband and wife traveled eight hours to Richmond from West Virginia so Richard, the husband, could get a naltrexone implant.

Richard’s wife, Margaret is a smart, no nonsense emergency room nurse, and Richard is a big strapping guy who works as a night shift supervisor in the coal mines. His job is fraught with potential for injury at every turn. They both work hard and they both bring home a healthy paycheck.
When I first met them, Margaret was still in shock and despair after learning that her husband had a severe drug addiction problem to Oxycontin. Being an ER nurse, she had plenty of experience working with drug seeking patients. I can’t even remember now how she learned that Richard was taking 4-5 Oxycontin 80s most days, but it just about killed her.

Through tears she told me she couldn’t believe it was happening to her family. They have 2 daughters who adore their father. Richard was strong, hardworking, and honest, she’d thought. She was humiliated to think that she had missed all the clues that now seemed so obvious to her…She knew he had been prescribed narcotic pain medicines years earlier when a beam hit the back of his neck, but she thought he only now used them occasionally. For months now he had been coming home after work and never interacting with her or the girls, but it was easy to attribute to the hard work he did all night. And somehow, there was never money in the bank at the end of the month, despite the sizeable salaries and overtime both of them made…Margaret chose not to look too hard at this, always making excuses for their being overdrawn frequently. A little extra overtime more than made up for the deficits.

They heard about a guy who also worked in the mines and had come to The Coleman Institute for a naltrexone implant . He never had to go on methadone or suboxone and he was staying away from opiates. It was convincing enough for Margaret to start doing some on-line research. Not only that, she was pretty clear with Richard: unless he stopped using, she and the kids were leaving.
He received an implant and was told to return to the office in 8 weeks for the next one.
Earlier this week, they returned for Richard’s 2nd implant. When you see someone for the 2nd time after 8 weeks, it’s hard to remember their exact story. But I did remember Margaret’s eyes-they are huge and green and heavy lidded with thick eyelashes—and had been full of tears at our first meeting.

One of the questions on our Repeat Implant Form asks if there are any changes in relationships since the last visit. Now her eyes were beaming. She said for the first time in at least 2 years, there is extra money in their bank account. She told me last week they reserved and paid in full for a beach house for their summer vacation.
Richard said his friends are still skeptical. They can’t believe that some kind of little pellet under the skin can have this kind of effect, blocking cravings in someone who’s been using oxycontin for years

I guess when you’re Richard’s size, you don’t have to prove anything. He just smiled while Margaret made a list of beach items they were going to pick up at Target while they were in the city.

Naltrexone and Alcoholism

CNNhealth.com had a very interesting article outlining the benefits of Naltrexone treatment for Alcoholism. The article tells the story of Walter Kent and his fight with the disease of Alcoholism over a 30 year period, and how he has finally managed to achieve Sobriety with the help of Naltrexone.

The article can be found at http://tr.im/jr5I

Monday, April 20, 2009

Recovery Coaching – a concept coming into its own

More and more people are talking about recovery coaching and it is not hard to see why. There are even some professional organizations offering training. One of the biggest is the Connecticut Community for Addiction Recovery. Recovery Coaching is somewhat of an old idea that has come back in vogue, but in an updated and more helpful form. At its essence, recovery coaching is like a sophisticated sponsorship relationship. Sponsorship has always been an integral part of 12 step programs. Now some people are taking the concept to a new level. They are learning the newest and best techniques to help support, motivate, and facilitate change. Some recovery coaches are charging for their services and others are doing it as a volunteer service. Many people in early recovery can really benefit from this level of help, so this is an exciting development.

Sunday, April 19, 2009

Alcohol Detox Program

Our outpatient Alcohol detoxification procedure is a big success. Patients love being able to safely and comfortably detoxify in their own home, instead of going into an expensive hospital. The procedure is really very simple and easy for patients to use.

First, we meet with the patient for an initial History and Physical. We perform a blood test, an EKG, and check the blood alcohol level with a breathalyzer. Then, we insert an IV to start an infusion of fluids and a combination of vitamins, minerals and other medications. Alcoholic patients going through withdrawal are usually depleted of Thiamine and other nutrients, which need to be replaced in order to prevent brain damage and other complications. We rapidly replenish these nutrients and stabilize the alcoholic's condition. Additionally, we immediately start the patient on powerful anti-seizure medications that provide a calming effect and help prevent any withdrawal reaction. We monitor the patient for at least four hours and provide additional doses of medication as needed. The patient stays in the office under close observation until they are stable and ready for discharge. They go home with a support person and additional medicines, and return for short office visits from then on. The whole detoxification process is usually complete in only three days. Most patients then get a Naltrexone Implant which powerfully reduces cravings and helps them stay clean and sober.

Saturday, April 18, 2009

Alcohol Treatment Pioneer Father Martin passes away

Anyone who went to an inpatient treatment program after 1975 probably saw “Chalk Talk”. It was a grainy old black and white film shot of Father Martin teaching how alcohol worked in the brain. He was one of the first to take the mystery out of alcoholism and establish it as a disease rather than a moral weakness.

Father Martin was a bright student, and a great teacher. Soon after he became a priest he developed his own problem with alcohol and was sent to a treatment program in 1959. He began to attend AA and devoted himself to helping other alcoholics. He started teaching and lecturing and developed his blackboard talks. They were so popular that the Navy filmed them and very quickly they became staples at treatment centers all over the country. Thousands of alcoholics saw those “Chalk Talks” and thousands of recovering alcoholics credit Father Martin for being an important part of their recovery. In the late 1970s a number of people encouraged Father Martin to help open a treatment center. After a lot of generous donations and lot of help, Father Martins Ashley opened in 1983. To date they have treated over 40,000 people and it is one of the most respected programs in the country. Here at the Coleman Institute we often refer people to Father Martin’s Ashley.

I found this great tribute to Father Martin on the Ashley website.

“In the words of the late Mike Deaver, former White House Chief of Staff under President Ronald Reagan, “Father Martin changed my life and changed me. When I came to Ashley, I had been with presidents and kings and popes and Prime ministers, but Father was the most powerful person I had ever met, and he still is today. You see, Father has the power to change people, to make them
better, to make them whole again.”

Thursday, April 16, 2009

McShin Foundation Fund raiser

We had a fantastic time the other night enjoying a comedian named Mark Lundholm. He was the headliner for a fund raiser event organized by the McShin foundation. Mark is a nationally known comedian who has appeared on HBO and other top ranked shows. He was hilarious and had us cracking up for over an hour and a half.

Mark is happy to share his own recovery. He has been clean and sober for over 20 years. A lot of his comedy was laughing at some of the crazy things people with addiction do and some of the crazy ways we look at the world. What was especially great for me was that he was able to laugh at this shared pain, but also acknowledge the pain and suffering that addiction is all about.

He was there to raise funds for addicts in jail. The McShin foundation is doing a wonderful job taking the recovery message into Richmond area jails. They organize recovering volunteers to go to jails to share their experience, strength and hope with the inmates, so that when the inmates get out they will know that recovery works.

Wednesday, April 15, 2009

Accelerated vs Ultra Rapid Detox?

As the only provider of the innovative Accelerated Detox Process, it is no wonder that many people are unaware of the distinctions between this and Ultra Rapid Detox. We want to ensure that these distinctions are clear.

During an Ultra Rapid Detox (URD), patients are placed under general anesthesia and the opiates are chemically flushed from the brain receptors over a period of about 10 minutes. The patient is effectively detoxed, but the body is often unable to keep pace with the speed of the detox and complications often arise. In fact, a recent medical study showed that the stress to the body was huge--equivalent to a major car accident.

Accelerated Detox was pioneered to address the issues with URD. By extending the detox period to a minimum* of three days, patients move more slowly through the process. This eliminates the "shock" to their system and allows their body to adjust more easily, significantly reducing the risk of complications and making the overall experience more comfortable. General anesthesia is not required, again reducing the risks and complications associated with this procedure.

We have completed over 1,500 Accelerated Detox procedures. A recent study of our patients showed that all of our patients reported it was the easiest detox they had ever had. Despite this, we still continually try to improve the procedure.

Please visit our website to learn more about our pioneering Accelerated Detox methodology.

*Subject to patient history; Detox duration may be extended to ensure a safe, comfortable experience.