Saturday, October 31, 2009

Creative Chris

It was so gratifying to see Chris today! He had detoxed from Oxycontin a couple months ago and came to The Coleman Institute for a naltrexone implant.

We have the expectation that when people return for their 2nd implant, many aspects of their lives will be better. If they were skinny and scrawny, they’ve probably gained back some of the weight they needed. If they were a little chunky, they’ve often lost a few pounds. Their eyes, skin and hair are “brighter”. Their energy is better, they are sleeping more, and their problems with anxiety and depression are slowing improving. Money is in the bank again, relationships-if not easier-are infused with more honesty.

So, I was not surprised when Chris reported all the above to me on this 2 month return trip. What is even vastly cooler (my English professors would roll in their graves at that turn of phrase; mea culpa) for Chris is his phenomenal re-connection to his creative self. It is like the opiates were bonds that shackled his artistic soul—once they were cut away—Oh My God—the Genie has catapulted out of the bottle.

His day job is web design, and I can only imagine how that has improved. His love is water coloring and he has started again.

He described a painting he did for a friend who wanted some kind of an angel image. Chris painted an angel hovering over a tree, loosening the noose on a guy attempting to hang himself.

He is also the creator of some of the most beautiful tattoo art I have seen. He is currently working on having the names of his four children tattooed on various parts of his body, each name drawn in a unique, original calligraphic style.

Creativity is a gift we all have access to, whether in the form of artwork, inspiring people with your preaching, masterfully operating heavy equipment, designing a birthday battle party for your children complete with homemade shields and swords or doing whatever it is that speaks to our hearts. Chris is convinced that this surge of creativity is directly related to his ability to FEEL again. Without the opiates on board, his heart is again receiving messages.

He has promised to bring a painting for us at his next visit, so ask to see it if you are coming to the office in the next couple months. And Chris, if you’re reading this, know how proud we will be to display it. In fact I think you should post some of the body parts bearing your children’s names on our website while you’re at it!

Wednesday, October 28, 2009

Addicts have hearts, too

Every month at TCI/Hamilton Family Practice we offer a free workshop, open to all our patients and their families. They are held on the 3rd Wednesday of each month from 7 to 8. I call this series The Chosen Twelve because they are scheduled each month for a year and topics are picked based on what my patients tell me they are interested in learning more about.

In September we discussed Sugar Blues and how our bodies respond to a constant barrage of refined products. In October the topic was Figuring Out The Fats, with an emphasis on how different types of fats we eat can impact our health, particularly our risk for heart disease.

Even though this blog is geared toward discussing topics pertinent to addiction, the majority of my detox patients have hearts and want to keep them just as healthy as my family practice patients do. Especially if they are going to the trouble of getting clean.

So, in case you weren’t able to be there, here are the take-home points:

Risk factors for heart disease include getting older (that’s the good news/bad news, huh?), a family history of heart disease (although every recent study I see says that lifestyle totally trumps genes), smoking, high blood pressure, obesity, diabetes, sedentary lifestyle and psychological stress.

We discussed the Lipid Panel that checks your cholesterol levels and what the HDL (good cholesterol) and LDL (bad cholesterol) levels should be.

The main message when it comes to keeping your heart healthy in regards to fats is to choose the right ones and use them in moderation. All fats are very calorie dense, whether they are the finest purest organic cold pressed extra extra virgin olive oil or whether it’s a can of Crisco. So using lots of any fats (or too much of any foods and not burning enough calories in a day) will cause weight gain. The body needs certain essential oils that it can’t produce on its own. These fats are found in soy, canola, olive and flaxseed oil; in fish and fish oils, in walnuts and other nuts and in avocados, to mention a few really excellent sources.

Fats that are solid at room temperature are saturated (like butter and beef or chicken fat); some solid fats are also partially hydrogenated and contain trans-fats. Stay away from any food that has partially hydrogenated on the label. Partially hydrogenated oils increase the shelf life of twinkies, but not of humans. The correlation between heart disease and intake of trans-fats is huge.

On the other hand, studies of people with high blood levels of Omega 3 fatty acids show a higher reduction in the risk for sudden cardiac death than any lipid lowering drug currently on the market.

Maybe you can join us in person for a workshop. If you have any topics you’d like to hear about, please let me know. Here are the dates and topics of the next workshops:

November 18, 2009 Moving Toward a Plant Based Diet
December 16, 2009 Healthy Holiday Recipes and Tips
January 20, 2009 Post-menopausal Health
February 17, 2010 Men’s Health Concerns
March 17, 2010 Cancer Prevention
April 21, 2010 Supplements? Which ones?
May 19, 2010 Buffing up Your Physical Activity
June 16, 2010 Eating for Energy
July 21, 2010 Have Less of the Stress
August 18, 2010 Getting A Delicious Nights’ Sleep

Thursday, October 22, 2009

F.E.A.R. - Forgetting Everything is Alright

SPLASH! Diving to the bottom of pool, I grinned underwater as I enjoyed the rush from the high dive into the deep end of the pool. I surfaced and swam towards the ladder. And once again, it came back. What, you might ask? That old familiar tune, you know the one. Dun, Dun, Dun, Dun, Dun, Dun, Dun, Dun, Dun…JAWS! I had seen the movie earlier in the summer and it had ruined every subsequent waterway I encountered from the toilet to the sink to swimming pool to a rain puddle. I walked in perpetual fear that the Great White Shark of Death was going to consume me at any moment. And for that long moment, my definition of fear was not like the title of this article. It was more like…”Fear = My impending death!

I felt a lot like Dory and Marlon from the popular Pixar movie Finding Nemo.
The two stumble upon a Great White whilst looking for Marlon’s son Nemo. As they shake in their fins, they realize this is no ordinary shark. He hosts a 12 Step Shark’s Meeting, much like a 12 step meeting for addicts, only these addicts are addicted to fish. The meeting starts with the following pledge:

“I am a nice shark not a mindless eating machine. If I am to change this image, I must first change myself. Fish are friends NOT food!” Bruce, the Great White in question, who also happens to be Australian, then leads the sharing saying, “Hello, my name is Bruce, it’s been three weeks since my last fish, on my honor, or may I be chopped up and made into soup.” The other attending sharks yell out affirmations, “You’re an inspiration to all of us. I’m in!” Meanwhile, the two fish do not seem impressed nor do they look all that peaceful.

Fear is a big part of life. It is also a big part of recovery from drug and alcohol addiction. Fear of relapse, fear of feeling good, fear of feeling bad, fear of feeling at all, fear of having a good time, fear of having a bad time, fear of staying clean, fear of being normal…you get the point. So how does one deal with fear while trying to stay clean from their addictive behaviors? Let’s take a look at this important question.

First, redefine the fear. For example, if you make it an acronym (F.E.A.R.), it can stand for the following: F.E.A.R. - Forgetting Everything is Alright. You see, fear operates best when it keeps us from actually looking at the real problem. It knows that if we only speculate, anticipate, or worry about potentialities than it has us in its grip.

It can also mean F.E.A.R. - Face Everything and Recover. When we face our fears, we can overcome them. For example, once I realized it was absurd to be afraid that Jaws was going to eat me at my local swimming pool, I no longer feared going in the deep end. I realized that it was impossible because a) sharks can’t live in chlorine, b) the pool wouldn’t allow kids into the deep end if a shark resided there, c) how can a shark get to this pool when the nearest ocean shore is over 100 miles away and they can’t survive outside of water for very long? See my point?

Second, after redefining the fear, you can create helping statements to combat the lingering effects of the fear. For example, you can say things like, “I am not made of fear but of courage.” or “There is nothing I can’t do as long as I apply myself.” Helping statements help you to actively control the thoughts in your mind versus becoming a victim of your own thoughts

Third, fear thrives in the dark…so turn on the light. For example, you never hear of a kid lying in bed with the lights on complaining about a potential monster under the bed. But turn the lights off and the child’s imagination suddenly goes berserk. In order to stay sober, it is important to leave the dark thoughts, attitudes and actions of active using. Going to meetings, journaling your feelings every day, seeing a counselor, talking to your sponsor and reading recovery literature are just a couple of ways you can expel the darkness, turn on the light, and transform your mind with helpful, sobriety-focused information.

Unfortunately, Bruce relapses after a fish gets cut and Bruce smells the blood declaring, “I’m having fish TONIGHT!” as he bears his teeth in a mean growl. The good news is you don’t have to be a victim of Bruce (in your case, the drugs or alcohol). You can turn away from fear and embrace courage in order to get clean and stay clean!

Outpatient Alcohol Detoxification

A lot of patients are coming to us because they are having a very hard time getting off alcohol. Detoxifying off alcohol is very uncomfortable, both physically and psychologically. It can also be very dangerous medically. For over two years now we have been providing an outpatient detoxification for alcohol that is comfortable, safe, and avoids the hassle and expense of an inpatient hospital stay. The program has been working very well.

Without our outpatient detoxification program almost all of the patients we have treated would have required an extensive inpatient detoxification in a hospital. We were able to quickly and successfully detox all the patients, usually in three days. We have not had any complications and have not had to transfer any patients into a hospital.

Alcohol detoxification can be very difficult and medically dangerous for a number of reasons. Firstly, alcohol is a very strong sedative. The body adjusts to regular use of alcohol by not producing its own calming down neurotransmitters – Gamma Amino Butyric Acid (GABA) and Glutamate. This means that when the alcohol is gone the body is in a very agitated state. The pulse and Blood Pressure are elevated and there can be lot of sweating. There are tremors and even violent shakes. The agitation can be so severe there are even seizures. There can also be confusion, memory loss, and even loss of touch with all reality (delirium). This condition of tremors, combined with the loss of reality, is called Delirium Tremens, or DTs. DTs are sometimes fatal.

Secondly, alcohol leaves the body very quickly, so that the withdrawal symptoms begin early and are very intense. The whole withdrawal process is concentrated in a short period of time, making it intense and dangerous.

Thirdly, alcohol is a very toxic substance that damages almost all parts of the body. This means that at the very point in time that the body is trying to recover from alcohol withdrawal it is in a much damaged state. Alcohol causes the stomach and the esophagus to develop ulcers. The pancreas can shut down, and the liver can get cirrhosis and frequently goes into liver failure. Alcohol poisons the blood cells, so it is harder to fight off infections. Alcohol damages the brain, causing confusion, memory problems and balance problems. The net effect of all this is that just as the patient needs a strong body to deal with the stress of withdrawal, the body is operating in a very weakened state. It is no wonder that without the right treatment complications can develop.

Our outpatient detox deals with all of these issues and helps the patient get though the detox safely and comfortably. We ask our patients to stop their alcohol by about 11 pm the night before the detox begins and then come to the office at 8.30 am. We perform a comprehensive History and Physical, get lab work, an EKG, and then we check a breath alcohol level. Next we star an IV solution with vitamins and nutrients to replenish all of the nutrients the body may be lacking. Then we give doses of IV Phenobarbital, which is a great medicine for alcohol withdrawal. It calms the person down, helps them relax, and it prevents seizures. It has a long half life, so it lasts a long time. After about 8 hours the patient is calm and relaxed and can be discharged home under the care of a support person. The patient continues to receive some oral medicines and they come back to the clinic each day for two more days. They are often able to return to work by the 4th day.

The patients we have treated with this outpatient alcohol detoxification process have done very well and have really enjoyed the process. They have been able to detox in the comfort of their own home instead of in a hospital room. The withdrawal symptoms they have experienced have been very manageable. Of course, during the time patients are with us we plan for their ongoing recovery. We usually recommend a Naltrexone implant because it helps so much with cravings. We often prescribe Antabuse or other medicines to prevent relapse. We also have our aftercare counselor, Chris Newcomb, meet with everyone to plan for a counseling program as part of their ongoing recovery plan.

Detoxification is necessary, but it is not sufficient for long term recovery.



Peter Coleman MD

Monday, October 19, 2009

Prison Bars

I saw a cartoon recently that provides a powerful metaphor for how a person can be trapped by his or her own thinking-- and if you don’t know by now, your thoughts determine what your life is like. Period.

It is a picture of 2 guys facing each other wearing defeated expressions on their faces. They are standing in a wide open-almost desert-like environment and are both peering through prison bars they are clinging to. The thing is, the bars are free floating, unattached to any walls or structures. The two men have placed themselves behind these bars, oblivious to the freedom surrounding them.

If you become even a little mindful of this concept as you go through your day, you may be amazed at the thoughts you are telling yourself; the elaborate twists and turns and scenarios your mind will take. If these thoughts keep you rooted in fear, anxiety or pain, these are the prison bars you are holding up for yourself.

Some of the Prison Bar Talk I hear at my day job:
“I’m too busy to go to meetings—really!”
“I relapsed because I got so stressed out about my boy (or girl) friend.”
“I eat fast food because I don’t have time to cook.”
“I drank because it was my birthday—what’s wrong with that?”
“My husband doesn’t understand what it’s like to have a drinking problem.”

The thing is, there will always be circumstances we can’t change, but what’s important is to question your thoughts. Stand back and observe your thoughts as if they were projected on a screen. One way to question your thoughts is to use Byron Katie’s Inquiry Work:

Question 1: Is the thought true?
Question 2: Can you absolutely know it is 100% true?
Question 3: How do I react when I attach to this thought?
Question 4: Who would I be without this thought?

Intervening at the thought level allows you to drop the prison bars by creating alternative thoughts. Our emotions flow directly from our thoughts; our actions from our emotions, and our accumulated actions culminate in Our Life Story.

It is much like the serenity prayer: God grant me the serenity to accept the things I cannot change; courage to change the things I can;and wisdom to know the difference.

Some of the ‘things’ we can indeed change are our thoughts.

Friday, October 16, 2009

Choosing to Feel Again

Mark is here at The Coleman Institute with his wife, his son Mark Jr who is 5 years old and his father. Mark has been using 1000 mg of various oxycodone and hydrocodone pills for many years because of a back injury, and is going through an Accelerated Opiate Detox. He is part of a booming family construction business in Arkansas and he has access to lots of pain medications from his employees.

His detox is going beautifully. He has been relatively uncomfortable, partly because the week before he came he reduced the amount of pain meds he was taking.

Today he talked about some of the reasons he feared going off his narcotics: fear of anxiety, fear of boredom and fear of pain.

It’s true…choosing to stop using drugs or alcohol is to choose to feel again.

I recently had a conversation with a person who personifies Recovery. He has allowed himself to dwell in The Process for 25 years and he has a beautiful life to show for it. Recently he is going through some scary emotional risk taking, but he told me how incredibly good it is to feel every single emotion-regardless of the outcome. It is exhilarating for him.

The fact that Mark can name his fears will help him immensely. He says that giving up the pills is like losing a brother. It’s an amazingly accurate statement: these drugs have been there for him when things were going well and when things were going badly. They never judged him.

Mark needs to enter fully into grieving this very real loss. If he is able to stay present to himself as he feels the anger, the sadness, the anxiety, the frustration—he’ll have a much better shot at making it.

He is blessed to have an extremely supportive wife and parents. I can’t emphasize enough to him how much he also needs to be immersed in a group of people who know what he’s been through and can help replace the ‘brother’ he’s losing.

If you can offer any words of encouragement based on your own recovery, please respond to our blog.

Friday, October 9, 2009

Cognitive Behavioral Therapy (CBT) is useful for insomnia

A small study by Dr Morin and colleagues, reported in JAMA in May 2009, studied CBT with or without sleeping meds. We know that Ambien and other sleeping medicines do help people sleep, but only in the short term. As predicted, the brain gets used to the effects of the Ambien and then it loses its effectiveness. There is usually a rebound period of insomnia when it is stopped (withdrawal).

This study was interesting because they combined CBT with Ambien for the first 6 weeks. They found the combination quite effective. After 6 weeks everyone continued the CBT for a total of 6 months. Half the group stopped their Ambien completely and the other half could take Ambien if they felt like they needed it. At the end of 6 months the people using no Ambien had better sleep than the people who used Ambien when they wanted to.

Previous studies have shown that CBT is helpful for insomnia. Now we can say that combining it with Ambien is also helpful, but patients shouldn’t take the Ambien for more than 6 weeks.

Monday, October 5, 2009

Ben's Wild Night

I’d like to say that everyone who goes through an accelerated opiate detox at The Coleman Institute sails through it painlessly, or at least with minor discomfort. This describes the experience for about 98% of our clients, but that 2% can be a little tricky.

Ben and his parents came from a small town in a near by state. Several of his friends had detoxed with us in the past year and are doing beautifully in their respective recovery programs. Ben had been snorting and shooting 320mg of Oxycontin daily. He knew it was killing him and he wanted to stop.

He’d tried to stop. All tolled, his parents had paid out close to one grand in various treatments, medications, hospitalizations and bail. They were all tired of it. They knew that a naltrexone implant would provide Ben with the stability and freedom he needed to be abstinent from opiates.

His first day was uneventful. In the middle of the night on day 2 the police were called to their hotel because of his disruptive behavior. He got quiet and the police left him alone. That morning at the office Ben became quite aggressive with his parents, and again, the police were called. He quieted down and they returned back to their hotel, but I admit, I wasn’t surprised when I heard later from the police that Ben had been found in a bathroom of a local eatery trying to shoot up benzos.

A Temporary Detainment Order (TDO) was issued and Ben completed his detox in the hospital. He returned to our office the following day and received his two-month naltrexone implant.

The whole process of Recovery is fraught with pitfalls. Whatever the addiction, it is waiting to snare its victim time and time again.

Ben was surrounded by angels; some dressed in blue uniforms, some in the form of loving parents, a devoted uncle, and our staff—all of whom truly care about Ben’s Recovery.

My hope for Ben is that one day in the future he will have a life of joy and peace, in a great relationship with a great job. I hope he will be telling his story to a young kid who’s trying to get straight, describing the hard work he did to get clean, how people did not give up on him, that he didn’t give up on himself. That he continues to work daily on his Recovery.

Although we are always gratified to see any of our patients come back with success stories, I admit, I will be very very happy to see Ben come back in 2 months for his next implant…without the drama.