Thursday, February 25, 2010

Boundaries: Drawing a Line in the Sand

The year was 1987. A curious event took place at a local Richmond, VA high school. I remember it as if it was yesterday. The high school I attended was a Catholic Military School. Part of the “fun” of military school is the experience of being hazed as a freshman to include things like excessive push-ups, cleaning the school bus with your nose, and eating in absolute silence during lunch. However, on this day, lunch did not remain silent for long. Allow me to explain…

As some of you may remember through your high school experience, people tend to sit in groups based on social status. For example, there are several diverse groups such as jocks, popular kids, geeks, emo kids, science nerds, stoners, and artsy kids, to name a few. True to the norm, I sat in my social group which, much to my dislike, was the “geek” section. I remember another “geek” section across the room that included a high ranking member of the “jock/popular group”. I never understood why he would denigrate himself to sit with those of less social status than himself. I came to find out that he lived near those kids so he could get away with sitting next to them. But, to save face, he had to verbally berate them daily to keep them in their places. But, on this particular day, the Geeks rose up in defiance and would have none of it!

Imagine a quiet lunch room and the only sound is forks against plates and the sounds of dishes being washed in the kitchen when all of a sudden you hear a loud CRASH that pierces the silence like a gunshot that echoes through the woods. I looked up from my otherwise dull lunch to see the popular kid’s head covered in spaghetti with a mixture of sauce, meatballs, and blood running down his face. Across from him, the nerd he berated for days on end was standing up defiantly and held the remnants of his lunch plate now snapped in two that he used to encourage the young man to leave him alone. The whole place broke out in applause! And, I, for once, breathed a sigh of relief and flashed a victory sign in my mind seeing that we just might be able to take back our social dignity and get through this thing called high school!

I tell this story because it is relevant to our topic of discussion this month which is the book Boundaries: Where You End and I Begin by Anne Katherine. Katherine makes the point that each of us deserves basic human dignity and respect. We maintain that dignity with the use of boundaries. There are 5 main boundaries that we all get to keep regardless of who we are or where we came from. They are physical, mental, emotional, spiritual, and sexual boundaries. Maintaining our boundaries is important because, as Katherine notes, it helps us realize our love and acceptance of ourselves. It teaches us that we have value and deserve the best for ourselves.

Properly setting boundaries can help addicts to stay sober. Boundaries keep them from going back to unsafe people, places, and things which can result in a relapse. They also help replace bad behaviors with good ones. For example, you can choose to set the boundary of a 10pm bedtime instead of pulling all-night drug binges!

The hard work of setting appropriate physical, emotional, mental, spiritual, and sexual boundaries can seem daunting and pointless at first. However, in time most addicts realize that a boundary kept is oftentimes a life saved!

Chris Newcomb - Aftercare Councelor / Coordinator

Tuesday, February 23, 2010

New Webinar for Doctors

In March we will be starting our series of internet seminars for primary care docs. We recognize that most primary care physicians see a lot of patients who are suffering with alcohol and other addictions, but they often don’t feel very comfortable bringing it up or talking about it. They often report that they don’t really know what to do.


There is quite a lot of evidence that physicians don’t often make a diagnosis of a disease, or even explore a problem, when they don’t have a readily available solution to that problem.


So we decided we could help close this gap. If we can help physicians know what to do with alcoholics and patients with other drug addictions then they will be more likely to look for these problems. Hopefully more patients will be able to get the help that they need.


The first seminar will be in March and will deal with the causes of addictive diseases and how to make the diagnosis in an office setting. In subsequent seminars we will discuss specific drugs including opiates, sedatives, alcohol, cocaine and other stimulants.


If anyone has any comments or questions please feel free to comment.

Monday, February 22, 2010

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.

Joan Shepherd - FNP

Friday, February 19, 2010

Cora's Story

I was going to write a little blurb about this patient who’s here for her 3rd naltrexone implant, but then thought she could say it even better in her own words:

“After years of using pain pills and brief periods of abstinence I looked at my life and felt so hopeless.

My only means to function at all was chasing drugs; it consumed my every thought. My marriage had crumbled. I was unemployed and I couldn’t properly take care of my kids. I was so desperate to live a “normal” life. I just didn’t know how to or how to get there.

After researching online I found The Coleman Institute with the Accelerated Opiate Detox and naltrexone implant. In June of 2009 I did undergo the detox and got my 1st implant. This was the first step to getting my life back. Now 5 months later with the help of God and a program I’m finally happy. My husband can trust me again, we are working on our marriage and so can my kids and my parents. With the years of lying and manipulating I never thought I could say that. My kids can depend on me again. I’m working now, teaching school. I’m a productive member of socity and I feel great about where I am. Not everyday is wonderful but my worst day today beats my best day out there using! “ CR.

Joan Shepherd -FNP

Thursday, February 18, 2010

The Coleman Institute Expands into Louisville, KY metro area

New, full-service branch of the nationally acclaimed addiction treatment center to open in Louisville metro area

February 9, 2010, Richmond, VA—The Coleman Institute, the nationally acclaimed addiction treatment center based in Richmond, Virginia, announced today that it will open up a new, full-service office in Jeffersonville, Indiana on February 15, 2010. The Coleman Institute has four other offices nationwide (in West Virginia, northern California, southern California and Illinois) and this new office in Indiana will be a branded branch, providing all of The Coleman Institute’s proven addiction treatment services to southern Indiana and the surrounding areas, including the Louisville, Kentucky metropolitan area.

“I am really excited to bring The Coleman Institute’s unique services to the people of southern Indiana and the surrounding states,” said The Coleman Institute’s founder, Dr. Peter Coleman. “Unfortunately, the illness of addiction is very prevalent in this area. I hope we can bring some help and relief to many individuals and families over the coming months and years.”

The Indiana branch of The Coleman Institute will be led by Joseph Koenigsmark, DO, MBA, or “Dr. K” as he is better known by his patients. Dr. Koenigsmark is a Board Certified Family Physician trained in Osteopathic Medicine from the Midwestern University of Medicine in Chicago. He has held a variety of medical positions over the last 25 years, including a solo medical practice as well as Medical Examiner for the Commonwealth of Kentucky. Dr. K also earned an MBA, allowing him a better understanding of insurance programs and government medical programs. More recently, Dr. Koenigsmark provided medical evaluations to the disabled veterans of Kentuckiana at the Louisville VA Medical Center. This experience, especially, gave him direct experience treating addictions induced by pyschological and physical pain.

“I am proud to partner with Dr. Coleman and his team. This is a wonderful opportunity to not only open and develop The Coleman Institute in Louisville and the surrounding cities, but offer innovative and, most importantly, effective addiction treatment services to the area,” Dr. Koenisgsmark said. “As a long time resident and physician in Kentucky, I understand the extent of the addiction problem in the area and I look forward to being able to bring these much needed services to the community.”

The Coleman Institute has successfully treated thousands of drug and alcohol abusers since its establishment in 1998, and is hoping to make a similar impact on the residents in the greater Louisville metropolitan area. The new branch of The Coleman Institute be located at 1035 Wall Street, Suite 204, Jeffersonville, IN and is scheduled to open its doors to patients on February 15, 2010.

For more information regarding this partnership between Dr. Joseph Koenigsmark and The Coleman Institute, please contact Mike Stevens at 877.77.DETOX (877.773.3869) or visit

About The Coleman Institute

Since 1998, The Coleman Institute has helped hundreds of patients detoxify and recover from the effects of heroin use and other narcotics such as Methadone, Oxycontin, Percocet, and Vicodin. The combination of The Coleman Institute’s Accelerated Detoxification Technique with Naltrexone therapy is what makes it unique among addiction treatment centers—and its success rate so high.

“By the Power of Grayskull…I have the Power!”

I was like any kid growing up in the 1980’s. I had my Swatch watch, my “Zips” tennis shoes, and my action figures. From G.I. Joe to Star Wars, I had every possible figurine up to and including the massive He-Man. A 6 inch mass of plastic muscle, long blond locks, and the ever embarrassing “Speedo” swimwear trunks, He-Man, the twin brother of She-Ra fought to defend Eternia and the secrets of Castle Grayskull from the evil army of Skeletor. We had many adventures together, He-Man and I, but he came to an unfortunate premature demise when a friend’s bic lighter sent him to the afterworld in a blaze of glory! So much for Grayskull!

This month we tackle Step 2 from Alcoholics Anonymous which says that we, “came to believe in a power greater than ourselves could restore us to sanity.” Often times, people struggling with drug and alcohol addiction feel like they are locked in a cosmic battle between good and evil and right and wrong. They know they want to be good, strong, sober people but they lack the power to do so. So, they spend all their time obsessing over new ways to control or overpower the disease only to end up flat on their back for a 10 count. There is a better way!

The essence of Step 2 is that the addict needs help. DUH! The addict needs someone or something that has the edge over the addiction. This is the key to getting free from addiction. It does not have to be a religion or specific belief system as some believe. Rather, it is a higher power of your own understanding! This can be He-Man, She-Ra, Buddha, Jesus, or Santa Claus. It can be the 12 step group you regularly attend or the principles of the program in the 12 steps themselves that serve as your high power. The point is letting go of our own lack of power and embracing the power of our high power allows us a daily reprieve from addictive behaviors with drugs and alcohol. The Power of Grayskull indeed!

Relapsing with narcotic pain meds - Dr P Coleman

This last week I have had the pleasure of training Dr Joe Koernigsmark from Indiana. He is the Medical Director in our new office in Indiana. He is a fabulous doctor and I am very excited to be working with him.

During our training, I was amazed at how many patients we saw who had relapsed because they had to take opiates for legitimate medical pain. We saw at least four patients who had relapsed in this way. They had all taken the narcotics as prescribed but then found themselves physically dependent and quickly needing the medicines just to avoid withdrawal. Eventually their use developed to the point of causing problems and needing detox and more treatment. I have changed the details of these patients for confidentiality reasons.

We saw a health care professional who had over 5 years of clean time. She had been going to NA and really working a good program. Unfortunately she developed foot pain and required surgery. She warned her doctors that she was a recovering addict. The post-operative pain was quite severe and she needed strong narcotics for quite a long time and became physically dependent. Over time she felt guilty and made some bad choices, fearing what would happen if she told people what was happening. She started taking Suboxone to avoid using street drugs and has now become very dependent on that. We are trying to wean her down off the Suboxone but she is having a very difficult time. Now she has lost her license, feels terrible, trapped and very depressed.

We saw another health care professional who quit alcohol about 15 years ago and was doing beautifully. Unfortunately he injured his back on the job and has had chronic pain for over 5 years now. He has seen many doctors and had numerous surgeries but none of these have provided good pain relief. Through all of this he became very dependent on opiate painkillers and started having severe withdrawal whenever he didn’t take his medicines. He also was having a lot of side effects from the medicines. He had sleep problems, low energy, felt depressed, mental fogginess, and many other symptoms. In addition to this, he was still in a lot of pain. So we detoxed him over 5 days with our Accelerated Detoxification. The detoxification went beautifully and he has done well. He is now off all opiates for about 3 months. His side effects have all gone away, but he has still having considerable pain and may require more surgery.

Last week we finished a detox on a lovely young lady. We had detoxed her about 5 years ago and she used Naltrexone implants. She did beautifully but unfortunately developed some complications after her last baby. She had severe abdominal pain and needed narcotics. Fortunately she is now back on track again.

These patients, and others like them, have become dependent on opiates because of legitimate and real medical problems. It is not their fault. These patients teach us a number of very important things. They teach us just how powerful this disease is. Re-exposure to mood altering drugs can very quickly reactivate the disease. They reaffirm for us that people who have this disease of Chemical Dependency really are vulnerable to relapse when they take any mood altering substance, even when they take it as prescribed.

We believe that Chemical dependence is a disease characterized by a genetic vulnerability. The genetic vulnerability seems to have two components. There is an initial increase in pleasure effect when addictive substances are taken – a dopamine effect. This high pleasure that addicts feel seems to make them more likely to repeat the experience, and be more willing to keep doing it even when there are negative consequences. This is, of course, the hallmark of addiction – continuing to use even when there are negative consequences form the using. The second genetic component in people with a vulnerability to addiction seems to be that these people have a more difficult time stopping, and more painful withdrawal symptoms. This is what happens to someone who is in a healthy recovery but gets re- exposed to addictive medicines. Their withdrawal symptoms are worse and they have a very difficult time stopping. There are animal models of this phenomenon. Scientists are able to breed rats which have much more difficult withdrawal symptoms. These tendencies are passed down genetically.

So what can recovering people do if they need narcotics?

Here at the Coleman Institute we frequently help patients get through these situations. When patients call us asking for assistance, we almost never have problems with them becoming re-addicted. There are a number of key things patients can do when they have to take addictive medicines:

1. Plan ahead – if you know you will need surgery or need narcotics then enlist help from people who can help you. This includes your physician, your spouse or family member, or someone from your support network. (I personally already have an AA member who has agreed to monitor medicines for me if I ever need to take them.) If it is an emergency situation like an accident or kidney stone, then enlist help as soon as possible.

2. Have your doctor use non- addictive medicines whenever possible – it is amazing how much Ibuprofen helps pain when people are not looking for a narcotic effect. There are now many other non-addictive medicines to help with pain.

3. Use non-drug techniques to help with pain as much as possible – ice, splints , rest, TENS, epidural steroids, acupuncture, etc

4. If you do need narcotics, use the lowest dose for the shortest time.

5. Be honest and open – with your doctor, your family and support people. Tell them how much pain you are in and how many pain meds you are actually taking.

6. Have a family member or a friend hold the medicines so you have to ask someone to get them – not to be cruel, just to have another check and balance.

7. Follow up with our office or your doctor within 1 -2 days after surgery. The specific goal for this follow up visit is to evaluate how much pain there really is and how many narcotics really need to be taken.

8. Continue close follow up visits, usually once or twice weekly, until the narcotics are no longer needed.

In our experience, when patients have followed these guidelines they have never gotten re-addicted unless the pain condition went on a very long time. And in these situations they can be detoxed again fairly easily.

Remember, we are available any time to help with these situations. We do it all the time, and we are delighted when people reach out to us for help.

Peter Coleman MD

Monday, February 15, 2010

Family Program

We are planning a weekend program in April for family members of our patients, or anyone who has been affected by active addiction or alcoholism.

The program will cover:

· What is addiction?

· Why do some people become addicts?

· Why can’t they just stop even when it is killing them?

· What can I do to help them?

· How can I stop being pulled down by someone who won’t get help?

If you are at all interested in this program please call our office at 804.353.1230 or leave a comment at the end of this blog. Space is limited so please call soon.

Friday, February 12, 2010

Digging Your Hole Deeper

Consider a man digging a hole. It starts as a shallow curve then becomes deeper, deeper. Imagine him standing inside the hole he is digging. The faster, harder, longer he digs, the deeper he is in. At some point, he looks around his hole and realizes he wants out. The only tool he knows is his trusty shovel. He clutches this shovel furiously and digs sideways, upwards, harder, deeper, longer still. Clearly, the shovel’s not working.

This is the pattern so many of our patients fall into when they try to stop using opiates. Attempt after attempt to stop on their own has put them deeper into their own personal hole: financially, spiritually, emotionally, and professionally. If you or a loved one is ready to ‘drop your shovel’ and explore a more workable solution, please call us at The Coleman Institute. Ask about our Accelerated Opiate or Benzo detox. It may be time to use a new tool.

Joan Shepherd - FNP

Wednesday, February 10, 2010

Yoga in treatment programs for anorexia

I just read a very interesting article about a program that started adding daily yoga for their patients suffering from Anorexia Nervosa. This was an inpatient program with girls who were very unwell. Many of them were very underweight and had failed a number of other programs and were too unwell to be treated on an outpatient basis. As soon as they added the Yoga, the girls started getting better. They felt better, they had better self esteem and they started to gain weight. Interestingly when the girls were asked why it helped them so much they gave comments like, “You know this is the only time during our day that we are able to not think about our weight, or food, or all the other negative things going around and around in our heads.” It seems that the concentration that is needed during the poses was enough to lift them out of their minds. It is a type of meditation. It is so powerful. I am sure that the yoga also helps with developing a healthy relationship between the mind and body. Let’s hope other programs start to add things like this.

Dr Coleman

Monday, February 8, 2010

Junk food turns rats into addicts

A fascinating study gives us some insights into how drugs and food affect the brain. This study shows that after the brain gets used to getting hyper (extra) stimulated it continues to require extra stimulation just to feel normal. This study looked at how junk food – high fat, and high calorie - hijacks the brain just like Heroin and other addictive drugs. This study was from Paul Johnson at Scripps Research in Florida. He gave rats unlimited junk food. Sure enough the rats developed compulsive eating habits, ate twice the number of calories and became obese.

But he wanted to study how this junk food had effected their brains. So, next he inserted electrical wires into their pleasure centers. They could feel pleasure from an electrical signal going through these wires, but the experiment was that they had to run on a little wheel to give themselves the pleasurable signals. He was able to measure how much work they had to do on the wheel to feel good. What he found was that the rats who ate the junk food had to run on the wheel a lot longer to be satisfied with the stimulation to their brain’s pleasure center. Within only five days the junk food had caused their brains to become accustomed to high levels of pleasurable stimulation and now they needed extra electrical stimulation just to be satisfied. Sadly the effects of the junk food lasted for weeks after the junk food was stopped – just like our patients with drug addiction. This study is very important and illustrates what our patients are going through in early recovery. Their brains are so used to being stimulated at high levels that “normal” activities seem to be boring. If they aren’t very careful they can easily relapse because to them using drugs may seem like the only way to feel normal.

Dr Coleman

Friday, February 5, 2010

Son’s of obese mice are fatter and have increased anxiety

In an interesting experiment, Dr Bilbo at Duke University gave some regular mice a diet high in saturated fats. These were not genetically obese mice, they were just fed a heavier diet and they became obese during the pregnancy. Their offspring were more anxious and also considerably fatter. The obesity in the offspring continued into adulthood even though the offspring were switched to a low fat diet. So it seems that when a pregnant mother eats an unhealthy diet it causes long lasting effects in the offspring. Some of the decisions we make and the actions we take can have very profound and long lasting effects.

Dr Coleman

Thursday, February 4, 2010

The Coleman Institute Expands to Indiana

The Coleman Institute is please to be able to announce the opening of our latest facility, to be located in Southern Indiana and a stone’s throw from downtown Louisville Kentucky.

Located at 1035 Wall Street, Suite 204, Jeffersonville, IN 47130, this facility will officially open February 15th 2010, and will offer all our Detoxification and Addiction Treatments, including Detoxification for Opiates (Heroin, Oxycontin, Methadone, Suboxone), Benzodiazepines, Alcohol and Naltrexone Treatment.

The facility will be managed by Dr Joseph Koenigsmark, Regional Medical Director – Indiana.

Please call Jennifer at 1-877-773-3869 to schedule appointments with Dr Koenigsmark.

Wednesday, February 3, 2010

Dr Koenigsmark joins The Coleman Institute

Dr Joseph Koenigsmark - Dr Peter Coleman

The Coleman Institute is pleased to announce that Dr Joseph Koenigsmark has joined the company to become the Regional Medical Director, Indiana.

Dr. Koenigsmark, or Dr. K as he likes to be called, is a Board Certified Family Physician trained in Osteopathic Medicine at the Midwestern University of Medicine in Chicago. For the last 25 years he has had a wide range of medical positions, ranging from a solo medical practice to being a Medical Examiner for the Commonwealth of Kentucky. He also earned an MBA so he could work with hospitals and physician, helping them understand the intricacies of insurance programs, and government medical programs, and how to get appropriate reimbursement. Most recently his training brought him to work with the veterans of Kentuckiana working at the VA Medical Center in Louisville. There he provided medical evaluations so disabled veterans would receive the compensation they deserved for defending our country. It also helped him to understand the extreme psychological and physical pain these individuals can be under, and how this can lead to many forms of addiction.

Monday, February 1, 2010

Customer Service

I’m telling you guys, if you are thinking about coming for an accelerated alcohol, opiate or benzo detox, don’t worry about accessibility to our staff. I am sitting at home enjoying this magnificent snowfall and needed to contact a patient. I called Jennifer, our intake coordinator to see if she could get the phone number for me as I don’t have a snow worthy vehicle to get in to the office. She answered my call en-route to a cheerleading competition out of state with her daughter and what sounded like 12 other cheerleaders-- and maybe a live band. I figured she would be unable to help me with the phone number but instead she laughed and told me she was tricked out and could run a mobile office from ANYWHERE. True to her word, in 5 minutes she was calling me with the information I needed. Just a small taste of the customer service you can expect from The Coleman Institute!