Wednesday, September 30, 2009

Resource Review: GET UP: A 12-STEP GUIDE FOR MISFITS, FREAKS, & WEIRDO’S BY Bucky Sinister

I spoke with a patient the other day. He was a younger guy in his mid-20’s. Struggling with addiction, he had come to the Coleman Institute for Naltrexone Implant Therapy hoping to gain back his life from heroin abuse. After his detox, I shared a book with him that I thought would help him greatly. He immediately took interest in it noting that he could relate to the author and his story. It is an unconventional book but then again addictive behavior is unconventional. The book is entitled Get Up: A 12-Step Guide to Recovery for Misfits, Freaks, and Weirdo’s by Bucky Sinister. Mr. Sinister, if I may call him that, is a recovering alcoholic who put the alcohol in alcoholic. He was a late night bar closing drinker and drug-user who almost lost his battle with these substances. However, he got into 12 Step Meetings and things started to change. He hasn’t taken a drug or a drink in 7 years!

Get Up is a no-holds barred look at the 12 Steps of Alcoholics Anonymous. The book is not for the faint of heart. Without giving really gory details, Sinister is honest, thought-provoking, and sometimes even profane. Yes, profane. He is a self-proclaimed cynic, freak, weirdo, and misfit. He uses salty language and he doesn’t pull any punches. But more than the language, he is real. That is what recovering addicts need from addiction professionals and other support people. They need people who are real that will walk with them through their storm of withdrawal, sobriety, and recovery.

The book speaks with authority, verve, and clarity on the 12 Steps using hipster lingo for the kids. If you are an addiction professional or a support person to an addict in their 20’s to 30’s, I highly recommend this book. Where it offends, it enlightens and where it ruffles feathers, it smoothes them down with the truth. You can learn more about the author at www.buckysinister.com

Friday, September 25, 2009

Prisoners of Poppy Seed Tea

Recently, within a week of each other, The Coleman Institute received two calls from people who were concerned about addictions to poppy tea.

Jane, a middle school teacher from Georgia was consuming 5 cups of tea daily, made from the ground pods of dried poppy flowers. She purchased these from an internet site that sold them for ornamental purposes. The addiction was ruling and ruining her life. She and her husband of five years were ready to start planning to have children. What seemed at first to be an innocent relaxing brew had turned into a full blown addiction. Within 8 hours of her last cup of tea, Jane started having classic intolerable withdrawal symptoms.

Cary, a young man from Boston who had been treated unsuccessfully for intractable migraine headaches consumed 2 liters a day of a poppy seed decoction, made by agitating large quantities of the seeds in a solution of slightly acidified water. He purchased the seeds in bulk from several local grocery stores, alternating his visits to average going to each store about once every three months.

As a parent, I often share stories with my own children of what I see in a days’ work, with the thought, of course, that they might learn lessons vicariously and make better choices. I could not bring myself to share these stories with my children—the idea that these substances are relatively easy--and certainly legal—to obtain, had me a little--well--freaked out.

We extended both of these from the usual three day accelerated opiate detox to five days, because it was new to us and we were not sure what to expect. It was a good idea. These were tough detoxes, made tolerable by our program.

Jane and Cary are due to return for their 2nd naltrexone implants within the next week or so. Since working with them, I have heard several more stories of people enslaved by this addiction. If you have any questions, need help for yourself or a loved one, please call us. We’re here for you.

Thursday, September 17, 2009

We are testing out two new implants

It is very exciting for us at The Coleman Institute because we have two new implants that are available for us to use for our patients. Both are looking like they will significantly extend how long the implants last and make it much more convenient for our patients to stay in recovery. One of the problems with implants has been that they deliver a lot more Naltrexone than is really needed in the early part of the implant treatment cycle, and then they lose their effectiveness too quickly. It turns out that patients don’t need very large amounts of Naltrexone to completely block the effects of Heroin, OxyContin or other opiates. All it requires is about 1 nano-gram (1 millionth of a gram), per milliliter of blood. Naltrexone is a very powerful blocker. By making an implant more tightly compressed we should be able to reduce the amount of Naltrexone delivered at the start of the implant cycle and extend the duration of the implant cycle.

The first new implant is a newer and improved version of our current 2 month implant. It is compounded in a bigger machine that can compress the Naltrexone more tightly. The end result is that the implant has 40% more Naltrexone but it is essentially the same size. It is just as easy for us to insert. But because the Naltrexone is more tightly compressed it will last a lot longer.

The second new implant has been under development and early use in Australia for the last couple of years. I have spoken with a physician over there that uses them. He and his colleagues have already begun a major study on these implants. The early results show that they seem to last at least 4 months and possibly 6 months. They are a double implant system - two implants put in at the same time. The implants are being compounded in the US by a large pharmacy in NY.

This is very exciting for us. Longer lasting implants make so much sense. With a 4 month implant, patients can realistically get detoxed with us and then only have to come back 2 more times to stay off all opiates for a year. A 6 month implant would of course mean that, with only one repeat implant, patients and their families can have security and confidence that there will be no opiate use for at least a year. We believe that a 4 – 6 month implant would be ideal for patients and their families. We believe that many more patients will come back if it is more convenient for them. Especially patients who have to make a long trip. Many more patients can get clean and stay clean.

We are excited to be able to use these new implants and we are also very excited to start some research studies on them. I have already begun discussions with researchers at the Medical College of Virginia (MCV). We will study blood levels and look at other measures of how well the implants work. Hopefully the research will get underway in the next couple of months.

For the last 10 years we have seen firsthand just how happy patients are when they get implants. Most patients completely lose their cravings and they start to be able to get their lives back. Now we will have improved implants and we will be able to document this in a research study. Our findings will let other doctors and patients know that Heroin addicts and other people with Opiate dependence really do have choices.


Peter Coleman MD

“Just What I Needed?” - The Cars

That’s exactly what many addicts think as soon as a craving thought hits their mind! Cravings, a consuming desire, as dictionary.com puts it, are a part of life for any recovering addict regardless of how long they have been sober. You can count on them happening but you can’t always count on how you will deal with them. Let’s talk about some ways to survive the inevitable!

American author E.L. Doctorow once said, ““Writing is a socially acceptable form of schizophrenia.” While a funny quote, it is true that cravings can make a recovering addict feel like a schizophrenic because of the war in their mind. So, I say, write it down! Write out a list of your cravings. This achieves two things. First, it helps you clear your mind. Second, it gives you an objective view of what you are thinking about. You can share this with a counselor, sponsor, or trusted friend in recovery to gain insight about your addiction and most importantly your real needs, not wants.

Essentially, a craving is much like a Sprite campaign advert. You remember the line, “Obey Your Thirst”?! That’s exactly what cravings tell you to do. They tell you to indulge, to give in, and to “obey your thirst”. The problem is that the craving doesn’t tell you the consequences of that indulgence. It’s kind of like a used car salesman with really bad hair who shows you the contract for your new car but “neglects” to show you all the fine print that will leave you broke relying on your two legs to get you to work every morning.

What is important to understand with craving is that they lie. They do not tell the whole truth. They tell you shades of truth such as “it’ll feel so good” (but not when you wake up), “everyone is doing it” (my 5 month old cousin?), “you gotta have it now” (the only thing I have to have is food, water, and air). You get the point. Next time you start to experience strong cravings for drugs and/or alcohol, try this. Think about the exact opposite of the craving and you will most likely find the truth every time. Speaking of truth, go ahead and disobey your thirst!

William Booth, founder of the Salvation Army, made a very astute observation when he said that, “the greatness of a man's power is the measure of his surrender.” The way to defeat the cravings train is to surrender to it. Get off the tracks. Step away from the platform. Walk away. It is more powerful than you. You know the whole, “more powerful than a locomotive” thing. You’re not Superman/Superwoman. Cravings are your kryptonite. But, they have no power over you that you don’t give them. Therefore, you can just surrender because they can’t force you to do anything. You can be the weakest person and the strongest person at the very same time when you surrender. The truth is that no one gets struck drunk or high, it is a participatory event. Therefore, choose to surrender your participation and remember that, “craving is the mother of a reckless giving of oneself!” Eric Hoffer

Chris Newcomb - Aftercare Coordinator

Monday, September 14, 2009

Mom's Letter

When patients go through a detox at The Coleman Institute, one of the most important components of a successful experience is the care given by the support person.

Not infrequently our patients and their families live in small towns with few resources and limited access to recovery services. One mother who was devastated to find out that her son was heavily addicted to Oxycontin did something about the lack of support services available for her son. Here is how she responded, in her own words:

“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 out of 5 kids in his class were using in some form –even the “good” kids. I did not know about the problem until his pay check (1 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 West Virginia was very limited. Someone could receive “treatment” for 3 to 28 days and then you are turned back out into the world. Most drug rehab’s 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 for our first naltrexsone 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.”

Both her son and several of his friends have been drug free for several months. If you would like information on Parents Against Addictions or our detox programs at The Coleman Institute, please call.

Thursday, September 10, 2009

The final day of an accelerated opiate detox at The Coleman Institute is the longest. Our patients come in early with their support person and may stay until 4 or 5 o’clock. The support person has been instructed to bring whatever the patient may need for the day: a change of clothes, a blanket, pillow; as well as snacks for him/herself (although we always offer to provide a lunch for the support person from one of a number of nearby eateries).

Lately I have been struck by the blankets and quilts our patients bring on that last day. I have seen some of the most beautiful homemade quilts and afghans, and the coziest, snuggliest, softest blankets.

Last week it was Alex, an electrician by trade and a potter by God-given talent. He detoxed from methadone under the cover of a warm, thickly woven afghan, the colors of early fall on the Blue Ridge Parkway. His Mom had made it for him, though admittedly, it was also her ‘therapy’.

Rita and her husband came from Ohio earlier in the week. Rita had been on fentanyl patches with multiple opiate breakthrough pain meds for nearly seven years. She brought with her a kaleidoscope of comfort --squares of soft heavy flannel quilted together into a thick warm cover. I wanted to take a nap every time I walked in her room.

Leah’s blanket was a quilt she’d made for her own daughter many years earlier. Her daughter had detoxed from Oxycontin several months earlier, snuggled under the same blanket. Her daughter is now pregnant with Leah’s first grandchild. When Leah saw how beautifully her daughter was doing, and wanting to be fully present as a Grandmother, she was determined to stop using Oxycontin herself.

I remember the “blankie” my youngest daughter carried with her everywhere. I recall the incredible amount of time spent, searching when that blanket went missing. When she started Kindergarten I stitched a scrap from that blanket to the sleeping mat she’d be using for naptime. Her blanket would instantly calm and comfort her.

Someone who is a better writer than I could give this metaphor the elegance it deserves. These blankets, quilts and comforters are a symbol of the love our support people want to wrap their loved ones in. They have been through so much. They have lived through terrifying moments that turn into years of resignation, spiked with hope. So much is tied into being willing to go through a detox with a person who has been enslaved by drugs.

Please call us if you are ready to support your loved one through a detox, to a new beginning. We’ll be glad to answer any questions.

Sunday, September 6, 2009

Chantix may be effective for Alcoholism

Chantix (Varenicline) is the new drug for Nicotine dependence. It is a pretty amazing drug. It was designed in the lab to specifically attach to the Nicotine receptors and block them. The idea is that patients would be unable to get any benefit from smoking and hopefully they would lose their cravings. Indeed this is what happens. I have seen people quit smoking when they really weren’t particularly motivated to quit. The Chantix took away their cravings so much that the patients figured they might as well quit.

Soon after Chantix began to be prescribed, some case reports started coming in that some alcoholics, who were using Chantix to quit smoking, were losing their cravings for alcohol. It doesn’t quite make sense, since we don’t think alcohol works through the nicotine receptors. But the brain is complex and inter-related system.

So, Dr McKee at Yale University studied some heavy drinkers half of whom who had been put on Chantix, and the other half on placebo. They were all given one drink and then given unrestricted access to alcohol. The group on the placebo drank quite a lot more than the group on the Chantix and they had much higher cravings for alcohol.


This is very preliminary data but very interesting that there could be another medication we can use to reduce cravings and help alcoholics stay in recovery. It will be interesting to see what further research shows.

Wednesday, September 2, 2009

Support People ROCK!

If I’m repeating myself….sue me….but I wish I could write a ‘script for every support person assisting their loved one(s) through an opiate detox for a 2 week all expenses paid vacation to the tropical paradise of their choice.

Support people: YOU ROCK!

To be a support person, you have wrestled with questions like “Am I helping my daughter (son, wife, lover, husband….) or am I enabling her (him…) by going through all that’s involved in a detox? And, you don’t really know what is involved until you go through it.

Committing to be a support person for a loved one going through a detox will push every button you have. The patient is scared but determined, rude but contrite, ashamed but hopeful.

As a support person you may not get much sleep-or you may sleep peacefully for the first time in years… you may not recognize the loved one who is emerging from the “ashes” of the hazy drug induced cloud that opiates create. One Mom said to me, “I don’t even know who the real Sam is…” as she saw him smile and laugh for the first time in years.

This extraordinary week we are detoxing 4 people from methadone. Since The Coleman Institute is a busy mix of family practice patients and addiction medicine, the detox patients’ paths may not cross during the week. But on the weekends when we meet only with our detox patients some beautiful chemistry can happen.

This past weekend these 4 families sat together in the waiting room. They shared stories, laughed, cried and loved their ‘patients’ to the end. One family commuted from Northern Virginia, another family went to Kings Dominion, while another family hit the mall daily, and the fourth family quietly went home and started the slow healing process of caring for a long-lost daughter who has suffered years of sexual abuse.

Please call us if you want to talk about helping your loved one move forward to uncovering who they are meant to be; it will undoubtedly be a vehicle that uncovers truths and strengths about yourself- and who knows? There may be a surprise trip to Hawaii at the end of it all.