Wednesday, June 24, 2009

Alcohol and Women

How does a girl know when she is drinking too much? The National Institutes of Health have determined that women who drink more than 3 drinks on any day, or more than 7 drinks per week fall into the “heavy” or “at-risk” drinking category. Why is this a particular problem for women?

Research tells us that women start to have more alcohol-related issues at lower levels than men. Partly this is due to women’s relatively lower weight compared to men. Further, alcohol disperses in body water, and pound for pound women have less water in their bodies than men do. If a man and a woman of equal weight drink the same amount of alcohol, the woman’s blood alcohol concentration will tend to be higher. This can put her at risk for harm.

Although many of the health risks associated with alcohol are not restricted to women, women are more vulnerable because of the reasons sited earlier. The damage from too much alcohol can affect many systems:
· Alcohol is a neurotoxin and destroys brain tissue in men and women.
· Heavy drinking causes heartburn, pancreatitis, liver disease and gastritis. Just about
everywhere that alcohol touches in the gastrointestinal system, from the mouth to the
rectum, rates of cancer are increased in heavy drinkers.
· Alcohol weakens the immune system making one more susceptible to pneumonia,
septicemia and tuberculosis.
· The heart becomes enlarged after years of heavy drinking, compromising its ability to
contract.
· Breast cancer has been linked to heavy drinking in women.
· Pregnant women may cause potentially serious effects on their unborn child by consuming
alcohol.

The Coleman Institute offers a screening consultation for those who are concerned about their own or a loved one’s drinking habits. Our out-patient detox for alcohol allows the client a safe, friendly and discrete environment to get help. Call today if we can answer any questions.

Sunday, June 21, 2009

Dr. Peter Coleman Certified by New Addiction Medicine Board

Dr Peter Coleman is among the first physicians in the United States certified by the American Board of Addiction Medicine, a new independent medical specialty board. The American Board of Addiction Medicine (ABAM) has begun to certify addiction medicine physicians. ABAM sets standards for physician education, assesses physicians' knowledge, and requires and tracks life-long continuing education.

"We want addiction prevention, screening, intervention and treatment to become routine aspects of medical care, available virtually any place health care is provided," said Kevin B. Kunz, MD, President of the American Board of Addiction Medicine.

Although one in five Americans entering the health care system has a substance abuse problem, there has never been a medical specialty, drawn from all areas of medicine, dedicated to treating addiction. Now, patients have somewhere to turn for specialized medical care for substance use disorders related to alcohol, tobacco and other addicting drugs, including some prescription medications.

"Physicians are often at a loss for what to do about substance use and addiction issues, and may even misdiagnose the problem," said Kevin B. Kunz, MD, President of the American Board of Addiction Medicine. "We hope to change this by creating a cadre of thousands of specialized physicians across medical specialties.

"Studies show that fewer than one in five physicians consider themselves adequately prepared to diagnose alcoholism or other drug use disorders. Physician training is sorely lacking. Separate courses in Addiction Medicine are rarely taught in medical school, and there are no Addiction Medicine residencies among the 8,200 ACGME-accredited residency programs in the nation's hospitals.

"The American Board of Addiction Medicine will provide assurance to the American public that Addiction Medicine physicians have the knowledge and skills to prevent, recognize and treat addiction," said Dr. Kunz. "ABAM-certified physicians will also be able to address common medical or psychiatric conditions related to the use of addictive substances."

Created in 2007, with the assistance and encouragement of the American Society of Addiction Medicine (ASAM), ABAM offers a rigorous certifying examination that was developed by an expert panel and the National Board of Medical Examiners, as well as a maintenance of certification examination to ensure that ABAM-certified physicians maintain life-long competence in Addiction Medicine. ABAM has formed a governing body of 15 distinguished physicians from across a range of medical specialties, each of whom is certified by a member board of the American Board of Medical Specialties (ABMS).

The new medical specialty board is being launched at a time of increasing promise for addiction treatment. Recent discoveries have added to the preponderance of evidence that addiction is a chronic disease of the brain, with unique vulnerabilities and pathology, and a predictable course if not interrupted by effective treatment. An increasing number of medically based addiction treatments have become available, and more are on the horizon.

"Years of scientific research have proven drug addiction is a brain disease caused by biological, environmental and developmental factors--a disease which can have far reaching medical consequences. Given the proper training, tools and resources, physicians can be the first line of defense against substance abuse and addiction--identifying drug use early, preventing its escalation to abuse and addiction, and referring patients in need to treatment," said Nora D. Volkow, MD, Director of the National Institute on Drug Abuse. For more information, please visit http://rs6.net/tn.jsp?t=4my6g7cab.0.0.ifwxhscab.0&p=http%3A%2F%2Fwww.asam.org%2FABAM.html&id=preview

Friday, June 19, 2009

The Coleman Institute Expands to San Francisco

As part of our goal to make our unique Products and Services available to a broader population we are pleased to be able to announce our newest partnership. Dr. Travis Svensson joins our network of skilled and dedicated professionals, bringing our services to San Francisco and the Bay Area.

For more details visit our webiste at The Coleman Institute.


Dr Travis Svensson / Dr Peter Coleman

Thursday, June 18, 2009

Ball and Chain

Todd is a big guy from the southern part of Virginia. He and his wife had been married for about a year when he decided to come to The Coleman Institute for a detox off methadone. He described how he had started using oxycontin, then heroin until he finally started going to the methadone clinic. At the time he knew it saved his life and gave him the chance to work and have a relationship. After four years though, he was feeling desperate. The doctor at the methadone clinic was only there two times a week and when he was lucky enough to catch five minutes with him, he found the doctor was more in favor of increasing his dose rather than working to wean him down.

Todd told me about trying to go to Florida to help his brother move from an apartment to a new home. He had to register with a methadone clinic in Florida as a guest. When the plane was delayed, not only was Todd going into withdrawal, the methadone clinic was convinced something fishy was going on as he tried to explain about his flight problems. They refused to work with him, and Todd was forced to change his flight schedule and return home-never having even seen his brother.

Further, Todd was driving an hour each way to the clinic. He eventually lost his job because of the reduced hours he was working due to the commute.

Needless to say, he was ready to stop.

Todd was taking 260mg of methadone, a very large amount (although not the largest amount we’ve done in an 8 day detox). On the first day I met him, he rolled up his left sleeve to show me a skillfully rendered tattoo of a ball and chain on his forearm. This he told me, represents his life on methadone. He got it about a year after starting at the clinic.

He went through the 8 day detox . I won’t say it was easy, but between his wife being an excellent support person, and our being able to work individually with Todd’s specific symptoms, he got through it. On his last day he told me his plan in the very near future was to return to the tattoo studio. He had already sketched out the drawing of a broken chain for the artist to adapt from the original.

Friday, June 12, 2009

“The Truth Will Set You Free But It Will Make You Mad First!”

ChrisThe first time I heard these words I laughed out loud. Then I immediately thought, “Wow, someone has a bad attitude about Truth!” Yet, as I have thought more about it, there is a level of “truth” in the above statement. More on that later, but now time for an introduction…

Hi, my name is Chris Newcomb. I am the Aftercare Counselor/Coordinator at The Coleman Institute. I came on board in mid-March 2009. Since my arrival, I am having a wonderful time learning the ropes of the detoxification process as well as extending a hand of service to those who are suffering from the disease of addiction.

When a new patient arrives on our campus, my job is to sit down and have a conversation with the patient about their drug and/or alcohol history. We talk about things like money spent using, time spent using, possible reasons why the patient uses (i.e., pain management, recreation, both) and why they have come to the Coleman Institute. That last part may seem obvious but, believe it or not, many patients who come to us really just want to feel better. We want them to feel better; however, many of our patients do not immediately make the connection that healing from addiction is a life-long journey. In other words, it is a marathon, not a sprint!

This brings us back to our initial discussion about the truth making us mad before setting us free. A key component of addiction is the tricky little problem known as “denial.” Denial keeps so many people from the drug- and/or alcohol-free lifestyle they deserve. Denial is an inability to accept reality as it is. My job is to offer the truth to patients: that ongoing, self-care is of the utmost importance in order to experience long-term sobriety.

It is important to note that The Coleman Institute is a total abstinence-based program, that is, we encourage our patients to live a totally drug- and/or alcohol-free life. In order for patients to achieve such a lifestyle, I present them with an individualized treatment plan that gives them both short-term and long-term goals. This plan includes key components such as In-Patient Treatment (30-90 days), I.O.P. (Intensive Out-Patient), Individual and/or Group Therapy, 12-Step Meetings, Psychiatric Services (i.e., for depression and anxiety) and a few others. The plan helps the patient learn how to care for themselves one day at a time for the rest of their lives, if they chose to work the plan. Many of our patients do take the challenge and we see amazing results. For the ones that do not initially choose to embrace the plan, we keep in contact with them and keep encouraging them to embrace life and health.

Addiction is no joke, as they say. We have seen the destruction it causes for the addict and many of their relationships. That is I why I am personally committed to providing the best Aftercare Program to help our patients successfully “trudge the road to Happy Destiny.”

For Recovery,
Chris Newcomb – Aftercare Counselor / Coordinator

Which Comes First - Alcoholism or Depression?

A great research article by Dr. Fergusson from my Medical School in Christchurch, New Zealand came out this year which helps us answer the question of whether depression leads to alcoholism—or whether it is the other way around. It is an important question because often depression and addiction co-exist.

Many patients who come to us for their drug and alcohol problems also suffer from depression. As clinicians, we have to recognize and treat both problems if we want to have the best possible outcomes for our patients.

Some physicians talk about alcoholics and drug addicts “self medicating.” They believe that addicts are “self medicating” themselves with their drugs or alcohol. This seems to make sense since alcohol and drugs are mood-altering substances—that is, they alter moods or feelings. They relieve (or, in actual fact, “mask and cover up”) feelings that we don’t want. Feelings like anxiety or fear or sadness or anger or guilt. So, of course, people with addiction use their chemicals when they want to cover up unwanted feelings. They are in fact “self medicating.”

The problem that I have with the idea of “self medicating” is not that it happens. The problem I have is that the concept of “self medicating” can lead some people down a false path. It is important to see that addiction is a primary disease and not just a problem of “self medicating.” The natural extension of the concept of “self medicating” can be, for some clinicians, the idea that if patients just got a better control of their feelings—if they resolved their anxiety and depression—then they wouldn’t have to use addictive chemicals; their addiction would just go away. This seems to make sense in theory, but it does not bear fruit in practice. In practice, if an alcoholic or a drug addict goes to therapy but keeps using their mood altering chemicals, they are almost never successful. Firstly, they usually don’t make much progress on resolving their feelings because they are continuing to use mood-altering chemicals:

“You can’t heal what you can’t feel,
and you can’t feel what you medicate.”

Secondly, the disease hasn’t actually gone away. So, with therapy but no abstinence, there may be a temporary lull in the amount of using and a temporary decrease in the negative consequences of using, but there is usually a rapid return to using and more negative consequences.

So, working on the depression, the anxiety, and the other painful feelings doesn’t resolve the chemical dependence. But treating the chemical dependence first usually does relieve the depression and the other painful feelings. One study showed that 80% of alcoholics entering a 28-day alcohol rehab had a diagnosis of depression. But after only 28 days of treatment and no medications, only 20% were still depressed. So, over 75% of depressed alcoholics resolve their depression just by being sober and working a recovery program. We see the dame thing in clinical practice every day. As people get abstinent, go to therapy, go to their 12-step meetings and work their program, their psychiatric problems often go away. It makes total sense, of course.

The study by Dr. Fergusson, published in the Archives of General Psychiatry (2009; 66:260-6) backs this up. When I was in medical school Dr. Fergusson and others started up a fantastic long term study, The Christchurch Health and Development Study. They recruited over 1300 boys and girls born in 1977, and they have been studying these boys and girls every year since then. They have a unique perspective on being able to watch them grow up. Of course some of the boys and girls have developed different diseases. They found that, at age 24/25, about 14% were abusing or dependent on alcohol, and 14% were depressed. The interesting thing is that they found that the depression did not seem to lead to alcohol problems, but the alcohol abuse and alcohol dependence clearly did cause an increase in depression.

At the Coleman Institute, we believe that Alcoholism and Drug Addiction are actually one disease, Chemical Dependence. The disease is caused by an abnormality of the reward system in the brain (the pleasure center) and is strongly linked to genetics. It is a primary disease and not caused by depression or other psychiatric diseases. It is best treated as the primary disease, because when patients recover from their addiction, their other psychiatric problems often go away--often their high blood pressure and liver disease do, as well! Of course, some patients have two primary diseases: addiction and depression. As clinicians we need to recognize this and treat both diagnoses.

-Peter Coleman M.D.

Monday, June 8, 2009

Addicted to Suboxone

I remember three or four years ago when the drug, Suboxone was being heavily marketed to those of us who worked in Primary Care or Family Practice. Truly it seemed to be a Godsend-the answer for the patient who couldn’t get off prescribed narcotics or heroin.

Suboxone acts as a narcotic, occupying the opioid receptors eliminating cravings for drugs such as heroin, percocet, oxycontin and other opiates-but does not produce euphoria. It also contains a small amount of naloxone, so theoretically if a person misuses it, they will experience withdrawal symptoms.

We saw many patients who were able to successfully get off their opiates by using Suboxone. The problem seems to arise when a person is ready to be drug free and wants to stop the Suboxone.

At The Coleman Institute, we are seeing more and more clients who were prescribed Suboxone two or three years ago, or even for several months and are unable to stop it, even with appropriate weaning down, because of the protracted withdrawal symptoms they experience.

Last week we worked with a 47 year old man who became dependent on oxycontin 5 years ago following a shoulder surgery. He was eventually put on methadone and finally suboxone for the last two years. He wanted to be off all medications and started reducing his suboxone levels from 16mg a day, to 8mg a day, to 4mg a day to 2mg a day—all under his prescribing physician’s care.


This worked pretty well until he tried to reduce below 1mg a day. He was actually cutting a 2mg tablet into quarters, taking 0.5mg once or twice a day. He found that he could sometimes go as long as 32 hours, but then he got stomach cramps, “creeping skin” sensations and back and leg aches.

He came to The Coleman Institute for a suboxone detox with great trepidation, nervous about experiencing withdrawal. It was an incredibly successful detox. Our patient experienced minimal discomfort and used minimal sedation the entire time. He was so delighted with his experience, he offered to speak to anyone who is considering this program.

Please call Jennifer, our Intake Coordinator at 1-877-77-DETOX if you or a loved one is struggling with stopping Suboxone. We can help.

Thursday, June 4, 2009

Dr Peter Coleman CERTIFIED BY NEW ADDICTION MEDICINE BOARD

Dr Peter Coleman is among the first physicians in the United States certified by the American Board of Addiction Medicine, a new independent medical specialty board. The American Board of Addiction Medicine (ABAM) has begun to certify addiction medicine physicians. ABAM sets standards for physician education, assesses physicians’ knowledge, and requires and tracks life-long continuing education.

“We want addiction prevention, screening, intervention and treatment to become routine aspects of medical care, available virtually any place health care is provided,” said Kevin B. Kunz, MD, President of the American Board of Addiction Medicine.

Although one in five Americans entering the health care system has a substance abuse problem, there has never been a medical specialty, drawn from all areas of medicine, dedicated to treating addiction. Now, patients have somewhere to turn for specialized medical care for substance use disorders related to alcohol, tobacco and other addicting drugs, including some prescription medications.

“Physicians are often at a loss for what to do about substance use and addiction issues, and may even misdiagnose the problem,” said Kevin B. Kunz, MD, President of the American Board of Addiction Medicine. “We hope to change this by creating a cadre of thousands of specialized physicians across medical specialties.”

Studies show that fewer than one in five physicians consider themselves adequately prepared to diagnose alcoholism or other drug use disorders. Physician training is sorely lacking. Separate courses in Addiction Medicine are rarely taught in medical school, and there are no Addiction Medicine residencies among the 8,200 ACGME-accredited residency programs in the nation’s hospitals.

“The American Board of Addiction Medicine will provide assurance to the American public that Addiction Medicine physicians have the knowledge and skills to prevent, recognize and treat addiction,” said Dr. Kunz. “ABAM-certified physicians will also be able to address common medical or psychiatric conditions related to the use of addictive substances.”

Created in 2007, with the assistance and encouragement of the American Society of Addiction Medicine (ASAM), ABAM offers a rigorous certifying examination that was developed by an expert panel and the National Board of Medical Examiners, as well as a maintenance of certification examination to ensure that ABAM-certified physicians maintain life-long competence in Addiction Medicine. ABAM has formed a governing body of 15 distinguished physicians from across a range of medical specialties, each of whom is certified by a member board of the American Board of Medical Specialties (ABMS).

The new medical specialty board is being launched at a time of increasing promise for addiction treatment. Recent discoveries have added to the preponderance of evidence that addiction is a chronic disease of the brain, with unique vulnerabilities and pathology, and a predictable course if not interrupted by effective treatment. An increasing number of medically based addiction treatments have become available, and more are on the horizon.

“Years of scientific research have proven drug addiction is a brain disease caused by biological, environmental and developmental factors—a disease which can have far reaching medical consequences. Given the proper training, tools, and resources, physicians can be the first line of defense against substance abuse and addiction--identifying drug use early, preventing its escalation to abuse and addiction, and referring patients in need to treatment,” said Nora D. Volkow, MD, Director of the National Institute on Drug Abuse. For more information, please visit http://www.abam.net/

Monday, June 1, 2009

It Can be Expensive to Have a Drug Problem!

Drug users are affected in many non-financial ways. Emotional pain, health problems and work troubles are common side effects of a drug habit. But drug problems are also a literal cost to the user, affecting his or her pocketbook. Lost wages, high medical bills and, of course, the costs of the drugs add up very quickly. And, though treatment is highly recommended, one should remember that it costs time and money to deal with a drug problem. Consider the following costs.Using costs:

  • $100 Heroin per day sums to $36,500 per year

  • 2, OxyContin 80mg tabs per day equals $58,000 per year

  • Legal fees after possession charges cost $5-10,000

  • 12 months jail-time forfeits at least $20,000 in wages

  • Medical bills after contracting Hepatitis C or HIV surpass $20,000

Typical Treatment costs:

  • 28 days of inpatient rehab costs $5-30,000

  • Intensive outpatient program rack up $1-3,000 bills

  • Methadone clinics can exceed $4,380 per yearOne way or another, this disease costs you money

Our treatment programs not only help you get clean and stay clean, but are a lot cheaper than the alternative.