Wednesday, November 25, 2009

Dog Therapy

OK, sometimes I admit I go for forgiveness rather than permission.

Last week the CEO of The Coleman Institute saw a large boxy head with dangling tongue sticking out from the door of one of our beautiful treatment rooms. He’s a smart guy and recognized instantly it was not a human, but a very large dog’s head.

A charming patient (I’ll refer to her as Melissa from Minnesota) was here to detox from oxycodone. She wasn’t taking as high a dose as we have seen many patients take. Nonetheless, she was unable to get free from the 40-60mg a day she’d escalated to after a fairly routine knee surgery two years prior to her contacting us.

Melissa-like all of the clients we serve at TCI-had several reasons for wanting to be opiate free. Most everyone who comes through is just sick of the lifestyle of being a slave to the addiction. Work, money, relationships, and general vitality all take a toll when a person is physically dependent on narcotics. But the other thing driving Melissa was a deadline looming two weeks from her detox: she had a book signing with Barnes and Noble as her first novel is being published.

She had traveled across the country with her husband and Butch, her well behaved canine to do a detox with us and get a naltrexone implant.

It is so fun to come into a room all day long and see a sweet dog! And even though our detox process makes things very tolerable, I think it really helps to have your beloved dog with you. In the two years I’ve been at TCI, I’ve seen a toy poodle, 2 mastiffs, a beagle, a bull terrier and a couple others I can’t identify. I wish someone would come in with a Bernese Mountain Dog.

I suspect Butch will be accompanying Melissa on her book signing tour; he’s that kind of dog.

If you or someone you love needs some help getting off narcotics, benzos or alcohol, please—just show up with your dog—don’t call ahead to get permission. There may be some sort of regulation if we have to ask.

Thursday, November 19, 2009

Happy birthday to me

This month I was very grateful and delighted to be picking up my 25 year medallion to celebrate my 25th sobriety birthday. On October 28, 1984 I had a near fatal overdose and was forced to enter treatment. Since that time I have been blessed to be able to stay clean and sober. As this birthday has come around it has got me thinking about why I have been so fortunate to be able to have 25 years of sobriety without any relapses. For me this is an especially interesting question, since I work with patients - many of whom have difficulty staying clean and sober.

It seems to me that I have been very lucky but I have also put in a lot of hard work. Some factors were out of my control and I was just plain lucky. At the time of my overdose I was a young medical family practice resident and in complete denial that I could have a problem. But fortunately I was forced to complete a 4 month treatment program so that I could continue to work as doctor. I didn’t want to go to treatment but it was the only way to save my career. During that time of very intense treatment, I learned a lot - about myself, the disease of addiction, and how to stay clean and sober. The treatment was long enough and intense enough for me to be able to totally believe that, if I stayed in recovery, my life would be very happy. After treatment, I was forced by the Board of Medicine to document my recovery. I had to go to 12 step meetings and have negative drug screens. I was forced to attend therapy and continue to grow and learn. This continued for about 3 more years, always with the reality that I could lose my license if I did not maintain my sobriety.

I didn’t try to short change my recovery. I followed advice and did what I was told. From the beginning I worked with a sponsor in my 12 step groups and also with a professional therapist. I sensed the importance of learning as much as I could about the beliefs and attitudes I had and how I could change them if they weren’t helpful. I was able to get feedback and advice on some of the decisions I needed to make.

I quickly came to believe in the disease concept that taught me that it wasn’t my fault that I had a drug problem but that it was my responsibility to take care of it. I also met a lot people who tried to give up one drug like opiates but keep drinking - they always failed and usually failed very quickly. I have not risked having even one sip of alcohol because I love my life now and I don’t want to take any chance of ruining it.

Early on, I decided that I would work with others who have addiction problems. It is very fulfilling when I see people get clean and sober and really turn their lives around. It also very quickly brings me back to reality when I see people suffer because they don’t take care of their disease.

Lastly, through my recovery I have been blessed to find a spiritual dimension to my life that I was always looking for. When I was using drugs I thought I had found happiness. What I found of course was just a short term pleasure experience in the brain that was never very fulfilling and always wore off. Now I have found a peace of mind, a sense of purpose and a road map for the future.

So, in all, I have been lucky. But it has not been all luck. I have taken my recovery very seriously. I have truly made my recovery the most important thing in my life. I have been, and am still, willing to go to any lengths to stay clean and sober. I have gone to meetings, worked on the 12 steps, worked with a sponsor and done all the things that people do if they want to maintain sobriety. I believe the path of recovery is actually fairly clear. It is a bit like riding a bike. After a while it is really pretty easy - but it is also fairly easy to fall off a bike if you take your eyes off the road. We have to maintain vigilance on this path of recovery, especially when there are road bumps or tricky spots.

And when we travel this path with friends and companions it sure is a fun journey. I wouldn’t want to be anywhere else.

Peter C.

“THANK YOU FA-LETTIN-ME BE MICE ELF AGIN” - ~Sly & the Family Stone~

I love a good song. As a matter of fact, I am “thankful” for music. It expresses what words can’t say. But sometimes the lyrics to a song can move you too. Take, for example, Sly & the Family Stone’s 1970 funk hit “Thank You Fa-Lettin-Me Be Mice Elf Agin” (yes, the title is purposely misspelled). The song speaks of the social struggles of the 1960’s & 70’s which included a whole lot of drugs and alcohol. Check out the lyrics to the first verse:

"Lookin' at the devil, grinnin' at his gun; Fingers start shakin', I begin to run; Bullets start chasin’, I begin to stop; We begin to wrestle, I was on the top”

If we take these lyrics and apply them to addiction recovery, it is striking what they can tell us. When people are out using, the drug is like a “devil” which means “accuser”. The drugs accuse the addict of being worthless, needy, imperfect, unlovable, and powerless. They call the addict to use. “Fingers start shakin’” is akin to getting the rush or “jonsing” for the drug. The body starts shaking and the mind starts racing. And the struggle not to use begins much like a “bullet chasin’” you because you know if you use it’s like getting shot in the back with a shotgun, painful and messy. At this point, the verse is pretty grim just like the lives of those stuck in active addiction to drugs and alcohol. But wait, the story’s not over yet.

Stone sings, “I begin to stop”. The protagonist stops running. He/she is tired of the bullets, tired of the pain, and tired of the suffering and decides to do something about it and stops. Do you remember the day you decided to stop? Do you remember how good it felt to make that decision? Do you remember what it felt like to turn around and look the “accuser” (i.e. heroin, pot, alcohol, etc.) straight in the eye as it called you names? It was the beginning of the struggle back to life. It became the wrestling match of your life.

The word “wrestle” means, “to combat an opposing tendency or force” and that’s exactly what happens in the song as Stone belts out the line, “we begin to wrestle.” Just like the song, the addict who stops, turns, and faces the accuser, begins that crucial wrestling match for sobriety and recovery. Wrestling is not for the weak of heart. It causes bumps and bruises. But, we see at the end of the verse that the devil is getting it handed back as Stone confidently sings, “I was on the top.”

Any addict who faces their addiction can be on top too. And when you’re on top, life begins to change. Your perspective shifts. Gratitude starts to sweep in and take over. And that’s what recovery is about: a process of changing into who we really are in the first place; ourselves, and adopting an attitude of gratitude for all the goodness in our lives! As this process continues, we become more and more thankful. We are filled with gratitude for the blessings of sobriety and recovery. We are thankful not to be a slave to the drug any longer one day at a time. Gratitude is a gift that feels very good. It’s crucial to staying sober. So, this Thanksgiving as you gather with family and friends to celebrate all the blessings in your life, I encourage you to be grateful for your progress in recovery. And when you do that, why not pause and say, “Thank You for Letting Me Be Myself Again”!

P.S. We never hear whether or not the protagonist wins the wrestling match but I have a feeling he did. So can you!

Monday, November 16, 2009

Big Rocks

I am in the luxurious position of spending most of my time doing exactly what I want to do. Of course, there are still toilets to clean, laundry, bills and taxes, but I love my day job and spend my free time riding my bike, cooking good stuff, doing yoga, learning new things, doing calligraphy and hanging with friends and family.

I’ve managed to pull this off in large part by taking to heart the advice I learned years ago from Steven Covey, a guru of many things, including time management. I saw him speak at a large seminar where he did the Big Rocks Demo. With two large empty jars in front of him, he filled the first one completely with small pebbles. Needless to say when he tried to then put a large rock in the jar, it didn’t fit. In the second jar he placed four or five of the large rocks. On top of these he poured in smaller pebbles, then added sand, and finally water so the jar truly was filled to capacity.

The point of the demo was an admonishment to create time in your life for the Big Rocks—the things that are most important. I don’t know what that means specifically for you, but for most people it means time for our family, our health, our spiritual growth, jobs, fun and friends.

Being in the grip of addiction, whether to pills, pot, booze or benzos—robs you of the best life has to offer. It causes you to ‘fill your jar’ with a thousand tiny pebbles, neglecting what’s most important.

Geneen Roth who has written and speaks extensively about her experiences with eating disorders eloquently states, “Until we examine what we really want, we mistake indulgence (in what we think we want) for freedom.”

I urge you to contact The Coleman Institute if you need some assistance in releasing yourself from your addiction to opiates, alcohol or benzodiazepines. Putting your Big Rocks in the jar first is what it’s all about.

Friday, November 13, 2009

Old Addicts

It’s pretty fun working at The Coleman Institute. Besides helping people to be released from their addictions and launching their new lives through our various Accelerated Detox programs, we have a pretty rockin’ family practice, too.

Many of our ‘local addicts’ become our family practice patients. It’s pretty convenient for your doctor to know your history and understand the medical problems that accompany alcohol and drug addiction.

I have to say, I am humbled when some of the ‘old addicts’ come for a check up. These are men and women who have many years of sobriety under their belt. You can almost tell whom they are when you walk into the room, even if you’ve never met them before.

There is an air of joy, acceptance, and perspective. In stark contrast to the many, many people who have stress and anxiety issues, these patients radiate a peacefulness about them-even if they have some pretty complex medical issues. The message they send is: I could have been dead so many times in the past because of things I’ve done, every extra day is a gift.

Most of these folks spend their time in selfless giving. They are quietly accessible to others who need help. They live in deep joy but not in deep drama.

Now that I think about it, I’m certain I feel better after a visit with these folks than anything I could possibly do for them. Maybe this is how it feels to be in the presence of the Dali Lama. How lucky am I?

Tuesday, November 10, 2009

Tricky Tramadol

If you think tramadol is a benign drug because it is not a controlled substance in the US, think again.

Yesterday we started an Accelerated Opiate Detox on Gus, a 30 year old man from Arizona. He was using an unbelievable amount of tramadol, averaging 100 50mg tablets daily which he purchased on-line. He denied any history of seizure, which is often in seen in people who take upwards of 30 tablets a day.

Tramadol causes typical opiate-like withdrawal symptoms, as well as the atypical symptom of seizure. Withdrawal from tramadol can be brutal, causing anxiety, depression, severe mood swings, brain “zaps”, electric-shock sensations throughout the body, pins and needles, sweating, palpitations, restless leg syndrome, sneezing, insomnia, tremors and more. Often withdrawal from tramadol doesn’t set in for 12 to 20 hours after the last dose, and the withdrawal often lasts longer than that of other opioids.

Dependence to tramadol can occur within 3 months of regular use, usually at doses of 400mg a day.

So far Gus is doing OK. He’s here with his wife and 3 week old son. They were resting comfortably in our coziest room eating a little Chinese take-out earlier today, watching Austin Powers. Because of the large amount of tramadol, his detox will last for 8 days. He is ready to be present for his wife and son.

If you have any questions about tramadol, or are struggling to stop using it on your own, please don’t hesitate to call.

Saturday, November 7, 2009

Suboxone Detox

Suboxone has flooded the country as a maintenance medication for opiate addiction. Undoubtedly it has its place, but from where I sit, it’s also creating a lot of problems.

Suboxone contains a combination of buprenorphine and naloxone. Buprenorphine is an opioid medication. Buprenorphine is similar to other opioids such as morphine, codeine, and heroin however, it produces less euphoric ("high") effects and therefore may be easier to stop taking.

Naloxone blocks the effects of opioids such as morphine, codeine, and heroin. If Suboxone is injected, naloxone will block the effects of buprenorphine and lead to withdrawal symptoms in a person with an opioid addiction.

We receive countless calls from people who cannot understand why they can’t get off their suboxone. In many cases the people we talk to can wean down from 24mg to 16mg, from 16mg to 8mg, and even pretty easily from 8mg to 4mg. the problem seems to be dropping lower than that if a person has been on suboxone for an extended period of time.

Suboxone can cause drug dependence. This means that withdrawal symptoms may occur if you stop using this medication. These are the people we are hearing from. Not everyone has a problem getting off suboxone, but for those who can’t kick It on their own, we provide a safe, convenient out-patient detox. Call Jennifer or any of our staff at TCI to find out more about it.

Thursday, November 5, 2009

Naltrexone Blood Level Study

Just a short and sweet message: we have started measuring the blood levels of naltrexone in patient’s receiving our new 1.4 gram implant. Although it is early in our study, the results are promising. At 8 weeks post-implant, the levels of opiate-blocking naltrexone are still stro ng. We are hoping this pellet will give coverage for longer than the previous 6-8 week implant.

Until we know for sure, please continue to keep your scheduled implant appointments. Remember, after 2 months of abstinence a person is a heightened risk for overdose.

It’s been a wonderful month of seeing our returning patients doing so well, reclaiming their lives without opiates.

Wednesday, November 4, 2009

Moving Toward a Plant Based Diet

Many of our patients come from around the country-and some from farther than that—for an Accelerated Detox, either from opiates, benzos or alcohol. For our local patients (or anyone traveling here in mid November) I invite you to attend our monthly wellness seminar. We’ll be talking about Moving Toward A Plant Based Diet on November 18th from 7-8, here at The Coleman Institute.

No meat bashing going on, I promise, but a discussion of evidence based research about: living longer, feeling better, having more energy, losing weight, lowering cholesterol, preventing (even reversing) heart disease, lowering your risk of prostate, breast and other cancers and more…Call 804 353 1230 ext 303 or rsvp to if you can attend. Hope to see you there.

Monday, November 2, 2009

Cycle of Change - Stage 1

Eight years ago at 230 pounds, Larry was a body builder. One day at the gym he was doing squats without a spotter and ruptured a disc.

When he came to see us in July of this year, he was 175 pounds and he’d been through eight years of escalating opiate use. . The opiates were decreasing his quality of life. With his doctor’s encouragement Larry decided it was time to try to stop; he wanted see how much pain was really present, and if it was tolerable without narcotics.

The detox went beautifully. He hasn’t touched an opiate, benzo or alcohol for two months. His cravings are gone. His back pain is manageable with anti-inflammatory medication.

The problem is: Larry feels extremely depressed. When he wakes in the morning sometimes he doesn’t want to even get up to go to work. Things that used to be fun for him no longer seem to interest him.

The depression is surely a multi-faceted problem. His doctor is working with him to find the right anti-depressant medications, and his brain is still trying to restore the neurotransmitters which have been depleted over the years of opiate use. But clearly, Larry is struggling with a more fundamental issue: who is he without his pain medication?

Martha Beck, a Life Coach with a PhD in Sociology from Harvard, would put Larry in Stage 1 of the Change Cycle. Any cataclysmic event which causes a person to ‘meltdown’ or have to drastically change the way they see themselves qualifies as a Stage One-r, also known as the Death and Rebirth phase.

Without opiates, Larry can no longer define himself as he has for the last 8 years. He also no longer has the identity of a body builder. The general cry of stage one is “I don’t know what the hell is going on…and that’s OK”. Larry needs to grieve the loss of the life he knew—as fraught with problems as it was—before he can move forward through the Change Cycle. How long this stage takes for anyone is variable, but knowing that there are predictable components and helpful tools can be most reassuring.

I think the first three steps in the AA recovery process speak to Stage I and are the perfect tools for dwelling peacefully in a chaotic transitional phase: admitting powerlessness, realizing there is a greater Power at work and turning one’s life over to the care of God.

At some point Larry will start to get little glimmers, glimpses, ideas and visions of things he wants to do again. They may be things he has never done before or even thought of doing before. Some of these ideas may first show up in his dreams. When this starts happening, Larry has moved into Stage II of the Change Cycle: Dream and Scheme. He’ll start plotting his New Life.

Stage III, The Hero’s Saga will come when he starts trying out his new ideas—some will inevitably fail, and he’ll briefly move back to Squares I and II. But some ideas will succeed—and his New Life will be underway as he moves into Stage IV: The Promised Land, having achieved the visions he saw for himself.

Needless to say, all of us are always dynamically moving between different stages of the Change Cycle in various aspects of our lives. But anytime a person chooses to become sober, he or she is re-inventing him or her self and must go through the Change Cycle. There are no short cuts beyond Acceptance. Our staff at The Coleman Institute is devoted to supporting our clients make this transition to the ‘Promised Land’ of Recovery.