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 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.

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 chris@thecolemaninstitute.com 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

Tuesday, August 18, 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.

Saturday, August 15, 2009

Acamprosate really can help alcoholics stay sober

There has been some concern about whether Acamprosate can really help patients stay sober off alcohol. Many of us who work in the field of substance abuse have been using this medicine for quite a few years and have been quite impressed with the results. Acamprosate has been used in Europe for over 20 years and results of studies over there are quite impressive – in a meta-analysis of 20 randomized studies ( a meta-analysis is a process where results from multiple studies are all combined together so we can gain more understanding and confidence in the results), 36% of patients on Acamprosate achieved complete abstinence at 6 months versus only 23% on placebo. It was surprising then that the 2 initial US studies, including a very large study called COMBINE did not show any efficacy.

Now a recent review and meta-analysis of all the Acamprosate trials, published in the Journal of Addiction Medicine, has found that indeed Acamprosate is helpful.

Why should there be such a discrepancy between trials, particularly between European and US studies?

The answer may lie in 2 factors. Firstly the European trials usually had patients start on Acamprosate after about 5 weeks of abstinence and inpatient treatment, whereas the US trials usually had patients start Acamprosate after only a few days – meaning more drop outs form the study. Also the European trials often went on for close to a year while the US trials were often much shorter.

So how do Clinicians make sense of all this? I think the evidence suggests that Acamprosate does have some usefulness. It seems to have its best effects if it is continued for a long period of time. It may be that because of its mechanism of action, which is to help restore the brains chemistry and reduce post acute withdrawal symptoms, it works best after acute withdrawal is over. It may be that if patients relapse and drink, it is best to advise them to continue with the medicine and eventually they will benefit from it.

Sunday, August 9, 2009

Suboxone can reduce Testosterone levels?

Some case reports are starting to come in that Suboxone can reduce Testosterone levels in some patients and lead to symptomatic difficulties. A recent paper in the Journal of Addiction Medicine reported on 10 such cases. The patients usually had symptoms of fatigue, weight gain and sexual difficulties that had begun after their Suboxone was started. The patients all had low blood levels of Testosterone. Some patients were in their 20s and in some cases the patients developed the problem less than 6 months after their treatment began.

This is not too surprising because other long acting opiates are known to cause this problem. In the 1970s, reports first came out about low Testosterone levels in some patients on Methadone maintenance. Since then other long acting opiates have been shown to cause this problem. At this point it is not clear how common this problem is, and how best to deal with it.

Wednesday, August 5, 2009

The Coleman Institute Expands to Chicago

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. Blaise Wolfrum joins our network of skilled and dedicated professionals, bringing our services to Chicago and the surrounding states. For more details visit our website at The Coleman Institute.

Monday, August 3, 2009

Dr Travis Svensson has started to treat patients in San Francisco.

It is a real pleasure to have Dr Svensson working with us. He has a busy psychiatric and addiction medicine practice in San Francisco and began a partnership with the Coleman Institute in May. He came out to Virginia in June to spend some time with us, seeing how we use implants and learning about our Accelerated Opiate Detox. It was a real pleasure to have him here. He is very experienced in the addiction field and has a great reputation in the Bay Area.Now he is back home and has already completed a detox and put in Naltrexone Implants. It is very nice having someone of his caliber working with us.