Friday, May 29, 2009

Cracked Pots

You’ve likely heard the story about an elderly Chinese woman who has two large pots, which she carries with a pole balanced across her neck. One of the pots had a crack in it while the other pot was perfect and always delivered a full portion of water. At the end of the long walk from the stream to the house, the cracked pot arrived only half full. Precious water always dripped onto the ground.
For a full two years this went on daily, with the woman bringing home only one and a half pots of water. Of course, the perfect pot was proud of its accomplishments. But the poor cracked pot was ashamed of its own imperfection, and miserable that it could only do half of what it had been made to do. After 2 years of what it perceived to be bitter failure, it spoke to the woman one day by the stream. 'I am ashamed of myself, because this crack in my side causes water to leak out all the way back to your house.' The old woman smiled, 'Did you notice that there are flowers on your side of the path, but not on the other pot's side?

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

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

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

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

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

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

Monday, May 25, 2009

SAARA

The Substance Abuse and Addiction Recovery Alliance (SAARA) have a lot of very happy people in their organization lately. And so they should. SAARA is a non-profit organization whose mission is to advocate for treatment and recovery. One of their biggest missions was to get legislation passed in Washington for parity for treatment of addiction and mental health. This finally passed in 2008 and was signed into law on October 3rd. What this means is that now all health insurance plans must cover addiction and mental health in the same way they cover other medical illnesses. Equal access to treatment and equal coverage. This is exciting and the folks at SAARA should be proud – a lot of hard work went into convincing people that this was the right thing to do. If you want to support SAARA they can be contacted at saara.org

Sunday, May 17, 2009

Homeless Chronic alcoholics do better if you house them first

An article in this month’s JAMA looked at homeless alcoholics. Traditional treatment holds out the promise of help sometimes including free housing for those who decide to get detoxed and stop drinking. Traditional thinking goes something like this - “If you show us you are serious we will help you, but we don’t want to waste our resources on people who don’t want to help themselves”. These researchers did the opposite. They housed the alcoholics first and then provided services irrespective of whether the alcoholics stopped drinking or not.

They found that, in their program, total costs went down by about 50% and the benefits kept improving the longer the alcoholics stayed in the program. This is very interesting and is the opposite of what we usually do, but it makes a lot of sense. People need hope and they need to see the benefits of their new decisions – which for these guys was initially as simple as agreeing to stay in a free house. Once there the alcoholics got the opportunity to continue to change and improve their lives. Many got detoxed and started to change their lives. Without the free housing hardly any of them made any improvements. It is hard for those of us in the field of addiction to know when to use tough love and say that “we won’t help you until you do these things”. Sometime it is best to be flexible at the start and keep our eye on the final goal.

Friday, May 15, 2009

Teen Drug Use Shows No Sign of Slowing Down

Every year the National Institute of Drug Abuse (NIDA) conducts a survey of high school students. They have been surveying 12th graders since 1975, and 8th and 10th graders since 1991. In 2008, a total of 46,348 students were surveyed.

The results of the 2008 survey show that adolescent drug abuse remains high, and is not decreasing. Some of the results are as follows:

  • 14.6% of all the teens reported illicit drug use just in the previous month

  • 15.4% of the 12th graders reported abusing prescription drugs

  • 9.7% of the 12th graders abused Vicodin (hydrocodone)

  • 4.7% of the 12th graders abused OxyContin

  • 32.4% of the 12th graders had used marijuana in the past year

  • Fewer 8th graders reported thinking that either marijuana or inhalants were harmful

  • All of these results are essentially unchanged from the previous year

This survey shows that illicit drug use remains high in our high schools. Over one-third of the students were willing to break the law and use illegal drugs. The perception of many students is that drugs are not harmful, which is particularly naive when it comes to inhalants that cause significant brain damage, and opiates that lead to physical dependence, often after only a few uses.

The results of the survey are not really surprising to those of us here at TCI. When we ask our patients when they first tried opiates, the answer is often "before I was 18 years old." Most of them became physically dependent on their opiates after only a few weeks of "experimentation." After that, they could not stop without a withdrawal reaction that is so painful that most people simply cannot tolerate it on their own. It is tragic.

I am not sure how attitudes and beliefs can be changed with our adolescents, but it is important that we continue to try to get the word out.

Wednesday, May 13, 2009

Freedom Plan

Rita, a 24 year old from Kentucky, came for her 2nd implant earlier this week. She had her first one 2 months ago after detoxing in jail from 240mg oxycontin a day.

She has been clean for 2 months, which she considers nothing short of a miracle.

“I feel like a teenager” was the response to how she was feeling. “I don’t wake up sick, looking for dope. I have energy again. I actually read to my 3 year old son and play with him.”

I continue to be amazed when I see people on the Freedom Plan returning to The Coleman Institute for their follow up naltrexone implants…They look so GOOD! Glowing, actually. It shows up especially in their skin, hair and eyes. Opiates have a real aging effect –not only on the psyche, but also on the body.

Research has informed us that the brain can take a year or more to heal from drug use before it is able to manufacture dopamine again. This is why we encourage people to continue with the naltrexone for a year. We believe in this approach so strongly, we developed The Freedom Plan, which allows a person to have a significant discount when he/she commits to a year of naltrexone therapy.


If you or a loved one is ready to move into the light of recovery and start reversing the aging process, please call us with all your questions.

Monday, May 11, 2009

Moments of Clarity

A great book I have been reading lately is called Moments of Clarity, written by Chris Kennedy Lawford. Chris had written a previous book outlining his own recovery from a heroin addiction about 20 years ago. Since that time he has had many people come up and ask him, “How did you do it?” He realized that for him there was a moment of clarity – a moment of surrender, a moment when he knew he was beaten, that he had to stop fighting and accept that he had a problem and needed help. As he talked with other recovering addicts he realized that many other people had had those same experiences. So he decided to interview other people and compile their experiences into a book. It is a great read. Very inspirational. Real stories of real people whose lives have dramatically turned around and they feel so good about it. I find myself recommending it to a lot of my patients and their families. Many of our patients are right at that turning point. They know their lives are miserable and they know they need help, but so often they haven’t fully given up and surrendered. They are still holding on to that fantasy that they can use a little something, or that one day they will be able to control it. It is one of those recovery paradoxes - surrender actually brings total freedom!

Thursday, May 7, 2009

Over 5 million people go to a 12 step group each year

The Substance Abuse and Mental Health Services Administration (SAMHSA) conducts a nationwide survey each year. In 2006 they surveyed over 67,000 people and found that 5 million people over the age of 12 had attended at least one 12 step meeting in the last year. It is amazing to me that 2 alcoholics back in 1935, were able to start an organization that now has this kind of reach. Of course not all those people stayed clean and sober for the whole year. In fact the survey found that 45.1% of those surveyed reported they had not used in the previous month. That is still pretty good – 2.3 million alcoholic and drug addict Americans who are not using alcohol or drugs, at least partly thanks to their participation in a self support group.

Tuesday, May 5, 2009

Relapse

It is difficult to keep truly accurate statistics with the kind of work we do. A satisfied customer who has eaten a great meal at a restaurant will gladly share the information with family and friends. Having a successful detox situation is not always something one wants to share. Upon completion of a detox at The Coleman Institute, we encourage our patients to return for naltrexone implants for a year while immersing themselves in an intensive counseling program. This combination helps to ensure successful recovery. Unlike many other businesses, a true success story for The Coleman Institute means after a few naltrexone pellets, we may never hear from a patient again.

We do however, see patients who have relapsed. I was very impressed with a particular mother and son team who came in last week, and their perspective on the relapse.

Jason, age 23, had gone through a detox from heroin with us in the early fall of last year. He had been working his program and had returned to school and a part-time job. He came for a 2nd three month pellet and continued to feel strong. He started gradually going to fewer and fewer meetings as his life became busier with school and work, and his confidence in his recovery grew with each day clean.

When the second pellet wore off, he felt he was doing very well—and he was. He opted to forgo a 3rd implant. Whatever his particular ‘perfect storm’, when this opportunity to use came along, Jason succumbed. He didn’t use for long; he had had enough of feeling good to know he didn’t want to slide into that life-style again.

Jason’s mother-like many of the mothers who accompany their children through the maze of drug treatment and detox, has done lots of research. She could easily give a lecture to a group of new medical school grads. She knows that addiction is a life-long condition that needs daily treatment. She also knows-because of her research and because of living through the agonies and triumphs of her son’s story—that it is all a process…and for Jason, getting a naltrexone pellet would ensure his return along the right path. Jason may have backslid a couple steps, but in the big picture he is so far ahead of where he was three years ago when he was going through 20 bags a day.

While working on the light bulb, Thomas Edison is charged with commenting that he never failed. It (the light bulb) just didn’t work the first 10,000 times.

There was not one iota of discouragement or self pity as Jason’s mom stationed herself next to his bed on the final day of his 2nd detox, armed with coffee, laptop and the daily rag.

“I know Jason is on his way to being one of your success stories. This relapse made him smarter; helped him fine tune his recovery,” she told me.

What that means is we may not ever hear from or see him again after he gets a few more naltrexone pellets under his belt. With all due respect, good riddance and God speed, Jason!

Sunday, May 3, 2009

The Language of Recovery

A lot of our patients and their families wonder why we recommend that all of our patients get help from professional therapists and attend "12-step" meetings.

Learning to get into recovery and stay in recovery is just like learning a whole new language. Those who actively use drugs and alcohol are accustomed to their old ways; they know where to go, how to use, who to hang out with, etc. Using is a way of life--a dysfunctional culture--that no longer fits with a life of recovery. It calls for a complete change.

Recovery is a new world. There are new people to meet, new places to visit and a whole new language of different words and expressions. There are even new ways to view the world. Recovering addicts begin to think about living "one day at a time," honesty, open-mindedness and willingness. They think about "accepting the things that we can't change, and changing the things that we can."

If you want to learn Spanish, it will not be very helpful to sit at home or to go about your usual activities and hope that you just might pick it up. You could read some books on your own, but that wouldn't be very effective either. The smartest thing to do is to hire a teacher who knows the language and knows how to teach it. Even better: join a group class, where there are other students learning at the same time.

Just like a language teacher, an addiction therapist has already mastered the language of recovery and how to teach it. The therapist knows how and why it all works. S/He can teach you the material in proper succession and how to build on the knowledge you already have. A therapist can even see some of the bad habits (like denial or rationalization) that you may be developing and can't see in yourself. Of course, the therapist also motivates and offers encouragement for progress with the new language.

Alcoholics Anonymous and Narcotics Anonymous are free, 12-step support groups for people practicing the recovery language. Like a mixed-level language course, there are some who have been practicing for many years and are very proficient. There are also others who are new and just starting. As you listen to the others in the group, you pick up on new ideas and new ways to stay in recovery. You will also have fun as the recovery process becomes more real and natural for you. Just like a language group, recovering people get together and practice their recovery in 12-step support groups. Some find it helpful to get together for an hour every day (especially in the beginning) while others only go a couple of times per week.

So, if you are just starting out on your recovery, take advantage of two things. One, get a teacher (therapist) who can dramatically speed up your learning/recovery. Two, join a 12-step support group and have some fun being around other people who love their new way of life. Remember that this new language is very much like any other language--it becomes second nature--and any chance of going back to that old, using life becomes very unlikely.