Friday, July 31, 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, July 27, 2009

Liquid Handcuffs

Two people started methadone detox’s today at The Coleman Institute. They are both in their mid 20’s and their lives have been on hold, in limbo as they have escalated their use over the past 4 and 6 years respectively.

Marion bought it off the streets, getting to a maximum of 85 mg/day. Jason methodically went to the clinic reaching a maximum of 115 mg of liquid methadone a day.

At first they both described feeling jubilant because they had stopped using other narcotics and heroin. The methadone gave them an entry into semi-normal life. Jason was no longer chasing down dealers, breaking and entering, stealing from his parents. Marion had helped her mother through chemo and radiation for colon and breast cancer, and was grateful she’d been able to be present.

After several months on methadone, both wanted off. Although staff at Jason’s clinic acknowledged his desire to reduce his dose, it was necessary to schedule that kind of discussion with the clinic doctor, which was nearly impossible. Marion tried several times to quit on her own. For both, it became the path of least resistance to stay on the methadone and their doses gradually increased.

When Jason started his detox today, he referred to his methadone as ‘liquid handcuffs’. What a great analogy.

Our clients are so motivated to make changes they are a pleasure to work with. They know the detox isn’t easy, but they also know they will be supported the entire way, and in 8 short days—compared to 30 to 50 days for a cold-turkey-methadone detox—they will be on their way to a new life.

Martha Beck, a well-known life coach, talks about the dissolution period people must go through in order to find their calling. Like the caterpillar in its chrysalis whose contents completely dissolve and re-assemble to form an amazing butterfly, so it is with a patient going through detox. One must make the decision to surrender their old self to become the person they are meant to be.

Easy to say; profound to do.

If you know what it’s like to be entrapped by Liquid Handcuffs, give us a call at The Coleman Institute. Find out if our methadone detox and naltrexone therapy are right for you.

Friday, July 24, 2009

The Importance of Aftercare

I first met Maureen last fall. She was 19,bright and beautiful. She came in with her mother and they shared a warm rapport. Plenty of laughing, inside jokes and warmth.

Maureen, with her mom’s help, had managed to detox off heroin. She had heard about The Coleman Institute and wanted a naltrexone implant to assure her continued sobriety. We talked at length about follow up counseling and options. We discussed how the brain takes at least a year to heal and restore neurotransmitters to their normal functioning, which is why we are so convinced of the importance of a year of naltrexone therapy. They were a bit dismissive, but took the information.

Several months went by and we didn’t hear from Maureen….until last week.

I went into the exam room to start our new patient’s heroin detox. It was Maureen, but I barely recognized her. The first thing I noticed were her huge green eyes-once sparkling—now dull and bloodshot. Then I saw the scars on her arms and a huge poorly healing abscess at her antecubital vein. Her face was blotchy. She was pale and very thin. She looked 10 years older. What she had to do to get enough money for her heroin had left her in a state of self-loathing.

Her detox proceeded smoothly and she is back on naltrexone. She and her mother had several discussions with our aftercare coordinator about residential treatment, outpatient counseling and other resources. They listened, but who knows if they will follow through?

We know we can do an effective, gentle detox from opiates, benzos and alcohol. We also know it is just the tip of the iceberg. The rest of life must continue to unfold from this chance to start over fresh. Be assured if you come to The Coleman Institute you will be well coached in resources for follow up. I hate to say it, but I have my doubts about Maureen’s quality of life if she doesn’t embrace some kind of aftercare.

Wednesday, July 22, 2009

The Coleman Institute - A Patients Perspective

People come from around the country to The Coleman Institute for help getting off of opiates, benzos and alcohol and getting a naltrexone implant to enhance their chances of staying clean. We know how important it is for our clients to pursue follow up counseling when they leave us, but many of them are from small towns and resources are limited.

One mother who brought her son to us for an opiate detox also came from a place where very little was available in terms of help for detox, and the drug problem is rampant. Instead of giving up, she has started a support network for other parents dealing with this issue. I asked her to write her story in her own words. Here it is.

“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 our of 5 kids in his class were using is some form even the “good”kids. I did not know about the problem until his pay check (one 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 WV was very limited. Someone could receive “treatment” for 3 to 28 days and then you are turned back out into the wild. Most drug rehabs 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 four our first 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.”

Saturday, July 18, 2009

National Recovery Month - Win A Free Detox

September is National Recovery Month! During this month, thousands of treatment providers celebrate the success of those in recovery as well as educate the community on substance abuse. 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, LaMirada 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 of 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 stevens@TheColemanInstitute.com 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.

For any further questions, please contact Jennifer at 877-77-DETOX.

Friday, July 17, 2009

The Coleman Institute Rebuilds

It’s been over a year since our building burnt down, but we are now in the final stages of rebuilding our new state-of-the-art facility here in Richmond. Designed and built from the perspective of our patients and how they interact with the facility, this new space should provide a real step forward in terms of patient comfort and experience. We expect to move into the new facility in late August, but you can follow the building progress on Flickr!

Thursday, July 16, 2009

Michael Jackson - Could it Have Ended Differently?

Recently, people all over the world mourned the loss of the infamous King of Pop, Michael Jackson. The media continues to speculate if the cause of his death was related to an overdose of pain medications he received from his doctor. Like many chronic pain patients who are prescribed narcotics, most family and friends do not believe that the person has an addiction because they appear to act “normal” instead of “high”. The truth is that after a long period of time, the patient will continue taking the opiate just to curb the withdrawal symptoms and there is actually very little to no euphoric feeling. The reasoning for this is related to the opiate’s physiological resemblance to endorphins. Endorphins are a group of peptide hormones produced by the body which reduce pain. Over time, the body will perceive the opiates as endorphins and therefore stop the endorphin production. When the endorphin levels drop and the narcotic pain medication starts wearing off, the patient starts going through withdrawal, hence the need for more pain medication.

So if the rumors surrounding Michael Jackson’s death are found to be true, could there have been other options available to have prevented his untimely death? The answer is yes. Initially, most patients try a tapering method with their prescribing doctor in which the opiate is slowly weaned down over time. The downside to this method is that it can take several months to complete and can also be very uncomfortable for the patient. Another method is Accelerated Opiate Detox. This medical procedure is better suited for patients who wish to be detoxed more quickly and with very little discomfort. It is completed in an outpatient environment over three days and conscious sedation is used to minimize withdrawals. At the completion of the detox, the patient receives a Naltrexone implant. This implant is inserted under the skin and dissolves slowly over two months to help with opiate cravings and prevent possible relapse.

Great talent is hard to find in our world today. As we mourn the loss of a great musical icon, we also realize that even Michael Jackson felt pain and needed help. While our practice may not have the world-wide impact that Mr. Jackson’s music did, we do believe our talented medical staff, cutting edge technology, and compassion for the suffering makes the Coleman Institute the best place to, “Beat it” and to Get Clean and Stay Clean! For more information on The Coleman Institute, please contact Jennifer at 877-77-DETOX or Jennifer@thecolemaninstitute.com.

Are we all addicted to eating?

It is an undeniable fact that more and more Americans are getting fat. Obesity rates have skyrocketed over the last 30 years. Of major concern is the number of our children who have problems with their weight. And Type II Diabetes, (so-called Maturity Onset Diabetes), is now showing up in pediatric practices all over this country.

Dr David Kessler has just published a great book on why so many people overeat and how our culture and the food industry promote this. It ties in with our work in the addiction field very nicely because it turns out that the process is really the same. In his book Dr Kessler explains how the brain works, particularly the reward system which is responsible for giving us drives and desires for things necessary for our survival. He shows how what he calls “hyper-palatable’ foods hijack the brain and make us want more, even when we are not hungry. Eating these hyper-palatable foods leads to changes in our brains that make it very difficult to resist in the future.

If you substitute the words alcohol or drugs for the word food you have the identical problem with chemical dependency. A chemical substance causes hyper-stimulation of the reward pathways of the brain. We really enjoy it. Our brain develops memory and emotional attachments to the experience, so that our brain is now hard wired to want to repeat the experience. If the substance is readily available, we continue to use it to the detriment of our well-being.

To explain the process of overeating, Dr Kessler has coined the term “hyper-palatable foods”. By their nature, and they are not ever found in nature, these foods cause the brain to want more and more. He points out that rats and other lab animals will keep eating and eating if they are exposed to foods that are unnaturally sweet. It turns out that if food has a sugar content of about 5%, animals, including us humans, will eat an appropriate amount of food and stop when we are full. But if the sugar content is artificially raised we will eat more, even past the point where we are no longer hungry. As the sugar content is raised even higher, animals will eat more and more and gain a lot of weight, and become obese. At some point the food does become too sweet and animals will reject it. The same process happens with fat content and salt content. There is an optimal percentage of fat and salt that induces animals, including us, to keep eating way past the point where we are full. It turns out that the food industry has specialized in providing us with foods with this exact perfect content of sugar, fat and salt. Think Doritos, chicken nuggets, French fries loaded with cheese and bacon, ice-cream with peanut butter cups added, oversized blueberry muffins. These foods have all been optimized to contain high levels of sugar, fat and salt – they are hyper-palatable foods.

And we love this stuff. It releases so many pleasure molecules in our brains – more than we were ever meant to get from natural foods. As mentioned, our brains are designed to attach memories and emotions to foods that provide this level of stimulation, so that we will want to, and be able to find them again. Our brains do this very well. And our culture specializes in making these hyper-palatable foods very available. We subsidize the farmers who produce cheap corn syrup. Fast food restaurants tempt us with huge portions of these foods that are often cheaper to buy than healthy foods we could prepare ourselves at home. Even grocery stores lay out their stores so that cakes and candy and other tempting foods are staring us in the face as we do our shopping. And in many neighborhoods, healthy choices for food are simply not readily available. Try to walk into a 7-11 when you are really hungry and buy something healthy! We can’t really blame the food companies or the fast food restaurants. They are just trying to compete and survive in our fast paced society.

So, it seems true that we are all being addicted to eating. What is scary to me is that the process seems to be starting very early in our children. As a parent of 11 year old twins, I am very aware of how easy it is to feed them these hyper-palatable foods. If we go out to a restaurant, there are almost no choices on the children’s menu that don’t involve hyper-palatable foods. I have started to cook a lot more at home.

So what does this teach us about chemical dependency? For me, it confirms a lot of what we know about how the brain works and how easy it is for hyper-stimulating substances to rewire our brain circuits. It helps us to understand that easy access to these drugs makes it very difficult to avoid temptation. It teaches us that triggers that remind us of the pleasurable drug experience are very powerful to induce cravings. It also teaches us that our recovery, whether from drugs or overeating, is ultimately our responsibility. For us to fully take responsibility for this, we need to accept it, understand it, and structure our lives to avoid temptations and, on a regular basis, make healthy choices.

“An ounce of prevention is worth a pound of cure” – Benjamin Franklin

As a kid, I used to love playgrounds. I loved the fresh air blowing in my face as I swung high in the air pumping my legs hoping to get as much height as possible before my huge, perfect 10 dismount (which usually ended up with me landing on my backside). Even better than the swing set was the sliding board! Whew…what a ride!

The swing set was great for several reasons. First, I climbed up the steps and the higher I went the more powerful I felt, a sort of superman-esque feelings. Second, I could see so much more when I got to the top step. I could survey my playground kingdom. Third, there was pre-slide rush. What I loved most was the anticipation, the adrenaline, and the fantasy of a fast descent and a big jump onto my feet with cute girls calling my name. Who wouldn’t want to do that over and over? The problem is; there were hardly ever any cute girls calling my name…it was just usually me and my imagination.

Alcohol and Drugs are kind of like a playground…fun in the beginning but deadly if you don’t respect it; which brings us to our topic this month: Relapse Prevention. The big obsession of every addict is trying to control his/her addiction. Upon an admission of powerlessness, recovery begins and sobriety is achieved.

Then for many addicts, unfortunately, relapse occurs. Dreams are shattered. Guilt is piled high like a skyscraper. Anxiety returns with a vengeance. The playground is no longer any fun. And before you know it, the relapse process starts and it begins with your imagination. Common thoughts include: I wonder what it would feel like if I took just one sip/one pill/one shot, etc.?, Why can’t I use like “normal” people? Why do I have to be boring and sober when everyone else is having fun? What’s wrong with doing something that feels good once in a while?

If you want to stay clean and sober, then you must wrestle with the issue of relapse prevention. Without this column becoming a vocabulary test, let’s take a look at the key terms to gain an understanding and plan to stay clean. First, let’s look at the word ‘relapse’ to understand what it really is: Relapse (verb): To fall or slide back into a former state; to slip back into bad ways. Second, let’s take a look at the root word of ‘prevention’: Prevent (verb): To keep from happening; to anticipate or counter in advance. The first word connotes a descent backwards into self-destructive behavior while the second word implies anticipation, planning, and action. Put together, then relapse prevention is all about anticipating, planning, and acting when the urge to reenter the self-destructive zone arises, as we know it will. How, is the question?

First, understand your triggers (bad feelings, physical fatigue, relationship issues, work, stress, etc.). Second, plan to do something about them when they arise. For example, call someone you trust who is sober, can listen without judgment, and encourage you to continue walking in sobriety. Consider doing a hobby, physical exercise or other stimulating, healthy behaviors. Third, help another addict. Helping someone else always gets you out of your own head and changes your perspective. Fourth, read recovery literature that can challenge your thinking. Fifth, journal your feelings on a daily basis. It is crucial to understand your feelings because many times addicts use because they don’t want to feel a bad feeling. Finally, have fun! The A.A. Big Book says, “we are not a glum lot” for a reason. And remember, you never regret being sober the night before!

Tuesday, July 14, 2009

Addicted to Cheese!

Addiction is addiction is addiction….

There is an ever growing body of research to suggest that certain foods are addictive-but who needs evidence based research? We don’t usually have to look far beyond the mirror to find someone we know and love with a chocolate, sugar or carb addiction. But, since I am trained to use research to guide my care of patients, I am fascinated by a recent article published by Dr. Neal Barnard, President of Physicians Committee for Responsible Medicine.

Dr. Barnard has found that people who are trying to move toward a more vegetarian lifestyle, or even vegan lifestyle-using no animal products or food that comes from animals—have a harder time giving up cheese than most other foods.

His research has found that when cheese is being digested, some of the components break down to form actual opiate like compounds. In fact, when a person is given naloxone, it appears to block the cravings for chocolate, cheese and meat.

The Coleman Institute has no plans at this point for a cheese detox….but keeping checking our website—you never know!

Saturday, July 11, 2009

Long Term Bupenorphine

A study done by Dr. George Woody, a professor at the University of Pennsylvania’s Department of Psychiatry has shown that teens treated for addiction to heroin or prescription painkillers are less likely to continue using these drugs if they receive extended treatment using the combination of bupenorphine and naloxone.

The study shows that by week 12, patients who received extended therapy compared to those who received short term therapy had fewer positive opioid urine tests. Still, at week 12, 43% of those on extended buprenorphine/naloxone had positive urine tests.

The researchers conclude that keeping the patients on long term buprenorphine/naloxone therapy will keep them opiate free for longer.

This may be true, however at The Coleman Institute we are meeting more and more people struggling to get off their bupenorphine. Many were initially started with the intention of getting off narcotics, and have been taking bupenorphine for over a year. Most people who use this medication have no idea of its addictive potential, and in fact, it does not affect everyone in the same way.

A detox off bupenorphine is an eight day program at The Coleman Institute because of the strong binding affinity it has to the opiate receptors. If you or someone you love has withdrawal symptoms when trying to stop bupenorphine, feel free to give us a call or set up a consult visit.

Wednesday, July 8, 2009

Neurotransmitter Precursors

When people come to The Coleman Institute for a detox, they are given specific instructions from Jennifer, our Intake Coordinator about what to bring. We may have to add nuts and seeds to the list.

We know that using narcotics, speed, benzos and other drugs essentially shut down the brain’s production of important neurotransmitters, notably serotonin, dopamine and GABA (gamma aminobutyric acid).A group of researchers from Food for the Brain, an educational foundation exploring how food affects our mental functioning, reports a growing body of evidence that providing food rich in the precursors of lost neurotransmitters will boost the levels of those chemicals, thus reducing cravings.

Anxiety and sleeplessness are common withdrawal symptoms, caused mostly by a reduction in the brain’s supply of glutamine, which is a precursor to GABA. GABA is our body’s own anti-anxiety chemical. Glutamine levels can be restored, thereby increasing the production of GABA by consuming an amino acid called N-acetylcysteine (NAC) which is found in seeds and nuts. Studies being done at the Medical University of South Carolina by Dr. Steven LaRowe showed that giving NAC to cocaine addicts caused a significant reduction in the cravings.

Serotonin is another neurotransmitter often deficient in people with drug problems. Insufficient amounts of serotonin in the brain are associated with depression. Serotonin is made from an amino acid called tryptophan, found in meats, brown rice, nuts and fish. Increasing levels of tryptophan has been found to induce a more optimistic outlook.

A diet high in Omega 3 fatty acids appears to help conduct nerve impulses. Many psychological problems have been associated with its deficiency, and trials are ongoing. Because it is not likely that successful results can be patented, most drug companies are not interested in pursuing this kind of research.

When you consider that we become everything we ingest—our skin, muscles, hair, organs, brain cells…it isn’t such a stretch to think that eating nutrient rich foods can contribute to stabilizing addictions. So when you arrive at The Coleman Institute for your detox, don’t forget to pack some almonds, walnuts, cashews and peanuts with your favorite pillow and comforter!

Monday, July 6, 2009

Talk to Someone Who’s Gone Through a Methadone Detox

Billy will complete his methadone detox tomorrow, but he almost didn’t come.

After using percocet, oxycontin and methadone for years and being able to hold down a job, he finally was fired. He kept getting sick until he could get his next fix. He had become close to his boss and his boss hated to let him go, but he was missing more and more time, and when he was there, he couldn’t do the work. Without a job Billy started stealing to get his drugs. Finally he stole from his parents. His father kicked him out. His mother pleaded with him to let them help him through a methadone detox program.

The thought was terrifying. He had tried to detox on his own before and the sickness it brings was the worst thing he’d ever experienced.

A patient who had successfully detoxed from methadone at The Coleman Institute was willing to talk to him. It’s one thing to hear about a detox from the company who’s trying to sell it; it’s an entirely different thing to hear it from someone who’s gone through it.

At The Coleman Institute, we can get people off significant doses of methadone in about 8 days. Obviously, the more a patient can wean down before they come, the better. Billy had slowly worked himself down from 200mg to 110mg a day, with the help of his methadone clinic.

After his conversation with Mark, who’d recently completed his own methadone detox, Billy was ready to commit. He has done incredibly well. Each day he came in with his mother, the change in him was noticeable: it’s always the eyes, the skin and hair that clear up first. He is amazed at how tolerable the week has been.

About a week after he leaves us, he will be heading to a half-way house in California—the state where he’s always dreamed about living. He has already told me he is willing to be a contact person for anyone else who wants to break the shackles of methadone maintenance and go through a detox.

If you are interested in learning more about our accelerated methadone, suboxone or other opiate detox, please call. Not only will our knowledgeable staff answer all your questions, we will be happy to give you Billy’s number. If he’s surfing, he’ll get back to you.