Wednesday, March 31, 2010

I was never the home coming queen

Tracey was at The Coleman Institute the other day for a follow up visit. She’s been clean from heroin for about 7 months. She is in her mid-20’s, doesn’t have a car --which wouldn’t do her any good anyway because she lost her license, and she doesn’t have a job. She’s living with her boyfriend, because he’s been clean for 5 years and he charges no money for rent. It’s not ideal, but for Tracey right now, she feels like it’s her best option.

We talked most recently about what was going well and what was most troubling. Her greatest concern de jour was the prospect of sending out resumes in search of employment. And no wonder. Her career history appears moth eaten with several gaps of un-employment (or ways of making money she wisely chooses not to reveal). Her stomach clenches at the prospect of exposing herself to a potential employer and having to be the ‘new kid on the block’ trying to prove herself worthy when she perceives herself mostly to be a loser and a failure.

Think again I tell Tracey. Or maybe, more accurately, Stop Thinking!

Every time she has these thoughts, driven by fear of failure based on her past story, she reinforces the feelings which drive the actions which manifest as Her Life Today.

There are a couple ways to approach a cover letter, I’ve been told. One is to focus on your past employment experiences. The other is to focus on your strengths: what is it you bring to the table.

It took a little prodding to help Tracey verbalize some of her God-given talents, but there are plenty.

Example: In jail, she was the one who could make everyone laugh and calm down. Application to resume: I’m a leader and work well with others.

Example: She only went through 8th grade and hasn’t procured her GED, but she’s quite street smart. Application to resume: I work three times harder than the degreed applicant because I have to.

Example: For all the years Tracey used heroin, she never once sold her body to get it. Application to resume: I am innovative, creative and solution oriented.

Now, I’m not advising Tracey to include on any cover letter her multiple trips to jail and her vast experience in the world of drugs. But this is a young woman who is going to meetings several times a week, because she has found a way to get rides, she’s got a safe place to live, and is showing up for every scheduled appointment with us for her naltrexone implant and follow up.

Clearly the actions she chooses for herself these days are the result of changing her thinking. The more she changes her thoughts about herself, her feelings then actions will follow in kind, and the result will be a continued movement toward the life she is meant to live.

If I were an employer receiving dozens of resumes by FAX every day and say a cover letter come across my desk with the opening line, “I was never the home-coming queen “, I would by God want to read further.

Joan Shepherd, FNP

Monday, March 29, 2010

Dave's Endorsement

A note from one of our patients:

“Dr. Coleman and The Coleman Institute wee the first to help me realize that I needed to treat not just the alcoholism, but also the underlying reasons for why I drank. I didn’t need someone to tell me to go to AA meetings and “just don’t drink”. Additionally, they helped me realize that I needed to do this for myself, whereas before I was doing it for everyone else. The outpatient treatment program meant I didn’t need to undergo the time and significant expense in a hospital.”

Dave P

Friday, March 26, 2010

“We Weren’t Born to Follow”

Someone once said, “music is what feelings sound like”. Just as music is the sound of feelings, I believe one can make the argument that, “lyrics are the speech of the heart.” Words have the power to change us just as a melody affects our emotions.

There are so many hit songs with immediately recognizable lyrics. For example, Simon and Garfunkel’s “Bridge Over Troubled Water” was just sung on the Grammy’s by Mary J. Blige giving the song a generational rebirth over 30 years after it’s original introduction to the public’s consciousness.

Likewise, Kool and the Gang wrote an international hit in the song “Celebration”. This song is played at every wedding, party, and funeral (just kidding) all over America. Yet, perhaps it most poignant moment was when it was blasted out loud in 1981 when the Iran hostages were successfully rescued and returned to America. Everyone identified with the powerful lyrics of the song and freedom was celebrated indeed!

x

Which brings us to the song I’d like to share this month by the rock band Bon Jovi called “We Weren’t Born to Follow”. Part of addiction recovery is having a positive attitude. One of the hardest parts of early recovery is resisting peer pressure to join the party crowd again. For most addicts, this social group was the source of their identity. This group often gave their life meaning and identity. Most people don’t join such a group with the intention of getting a “purpose” or “identity” but for many it seems to do the trick. And, as they fall victim to chemical peer pressure, they soon become nothing more than the blind being led by the blind.


Recovery teaches a different principle. In the words of Bon Jovi, recovery teaches that, “we weren’t born to follow.” This song is the quintessential call to stand strong and face life on life’s term without joining the crowd. Jovi croons, “come on and get up off your knees, when life is a bitter pill to swallow, you gotta stand up for what you believe.” Standing up for what you believe is not always easy especially in early recovery. But part of getting better is learning to swallow the bitter pill of non-conformity and finding out it does the body good! x


The song continues, “believe that the sun will shine tomorrow, And that your saints and sinners bleed, We weren't born to follow, You gotta stand up for what you believe” An important part of recovery is the belief that life is going to get better. Much like the hope one has on a cloudy day that the sun will indeed come out again. The statement regarding saints and sinners bleeding is really saying, “hey, everyone has stuff that goes wrong in life.” In spite of that, stand up because recovery is about leading not following and changing the world one sober moment at a time. So, of course, just as the song ends, so shall this article end, “let me hear you say yeah, yeah, yeah, oh yeah!” [insert big guitar chords ringing out, drums crashing, and the ear splitting roar of the crowd!]


Chris Newcoomb - Aftercare Coordinator

Tuesday, March 23, 2010

Defined by the Struggle

We are working with five people at the Richmond office of The Coleman Institute this week that are getting off methadone.

I’ve never gone through withdrawal before so I can only imagine what it’s like to go cold turkey from a drug that can take 30 to 50 days to completely leave your body. Participating in an Accelerated Opiate Detox is generally an eight day processThere is a lot of fear associated with stopping opiates. Fears not only about the physical withdrawal but also: what happens next? The answer is: everything you want and some of what you don’t want. . Dr. Coleman likens the period after stopping opiates to being a burn victim; even after you are pulled out of the fire, your skin hurts until it heals.

Starting the Recovery process is the beginning of an Epic Journey. It will be rich with struggles, set-backs, monsters, villains, close escapes, magical help along the way when least expected, moving forward, slipping back, triumph, tears and laughter. As I tell our patients, no one reads a book or goes to a movie whose plot is: He was born, lived a calm and rewarding life, then died peacefully. It is in the struggle that your story defines and refines you, turning the Hero’s Saga into The Promised Land.

I read recently that if a butterfly is ‘helped’ out of its cocoon by a well-meaning soul witnessing the struggle, the butterfly’s life expectancy is drastically reduced.

So it is with a life free from addiction. There really aren’t any short cuts. The rewards come with walking through the fire.

Thursday, March 18, 2010

Teaching about Addiction in Primary Care

Earlier this month I had the pleasure of speaking at the Virginia Nurse Practitioners Annual conference up in Reston Va. It was a very well attended conference with over 450 participants. I chose to speak on “Addiction in the Primary Care Setting”.

x

There is a lot of evidence that primary care practitioners, whether Physicians or Nurse Practitioners, are not very skilled at detecting alcohol or other drug addictions when they see patients in a primary care setting. Not only do they not detect the illness, but they frequently don’t know what to do when they do come across it. This is especially a pity because alcohol and other addictions are major factors in a large percentage of primary care visits. Frequently patients come in with anxiety, depression, stress, accidents, hypertension, GERD, or other problems that are directly caused by their use of addictive substances. You can add to this all the problems that the family members suffer with –depression and anxiety in the spouses, school problems for the children, etc. It is also important to add in all the diseases that are made worse by the patients’ substance abuse – their diabetes that is not well managed, their lack of exercise and poor nutrition, forgetting to take their regular medicines, and so on. When you add it all up substance abuse has a huge impact on our national health.

x

And yet Primary Care Practitioners almost never look for the disease, unless the patient comes in and actually asks for help – which is a small minority. When patients come in and ask for help it is usually only in the later stages of the illness, when a lot of damage has already been done and success rates are lower. It is so important then, that doctors look for the disease and diagnose it in the early stages when treatment can be most helpful.

There are many reasons for this. Many docs don’t fully accept that alcoholism and other drug addictions are illnesses. They often feel that alcohol and drug problems are not any of their business. They may feel they are being judgmental. They may be afraid that the patient will get mad and may leave the practice. It has also been shown that doctors often hesitate to investigate a problem or make a diagnosis if they don’t feel comfortable dealing with it. So if a doctor doesn’t know what to do if the patient does admit to a problem then the doctor often won’t bring it up. Often times Doctors and Nurse Practitioners just don’t have the knowledge base about addiction – they don’t have the information about what substance abuse really is. They frequently don’t know how to screen for the disease or how to diagnose the disease if the screen is positive. They often don’t know where to get help if the patient does acknowledge there is a problem.

x

So there was a lot to cover in my talk up in Reston. Fortunately the group of Nurse Practitioners who came to the talk were very eager to learn and participate. They asked very insightful questions and had very helpful feedback. We were all able to share our experiences and learn from each other. Hopefully they will have a little better idea of when to suspect there may be a substance abuse problem and they will be a little more willing to ask those difficult questions.

x

Now it is on to Physicians. Later this month we are starting a Webinar series for Primary Care Doctors to help teach them the same kind of material. If you know a physician who may like to participate please call Mike at our office to get more information.

x

Peter Coleman MD

Step 3 - “We became willing to turn our will and our lives over to the care of God as we understood Him”

Step 1 is the beginning of the journey to sobriety with the admission of personal powerlessness. This admission paves the way for help from the outside…outside of the addict. In Step 2, the addict embraces the belief that a power greater than himself/herself can restore them to sanity. Finally, we come to Step 3…the ultimate decision. In this step, the addict makes the purposeful decision to turn their will and their life over to their High Power. It is at this point the addict can breathe a sigh of relief knowing that their life is now under the control of Power with more wisdom, insight, and power than they ever had!

x

If Step 3 sounds so good, why do so many addicts hesitate at this step to move forward? Simply put, Step 3 is not easy to take! In doing so, it is a confession that life under the addicts direction has failed. It is a confession that the addict’s best thinking kept him/her from successfully enjoying the addiction without devastating consequences. In short, Step 3 is an ego deflating step. And that is very good news!

x

There are several reasons to take Step 3. First, it releases the pressure of trying to make things happen without the power to succeed. Second, it helps the addict become right-sized understanding his/her right place in the world. Last, it is freeing allowing to give up the control they never actually had in the first place!

Through the history of addiction recovery, the stories remain the same. Although the details differ, one truth is a common thread that ties their success together, namely, allowing God to do for them what they could not do for themselves. In taking Step 3, the addict understands the truth of the Big Book when it says, “his defense [against alcohol/drugs] must come from a Higher Power” (p. 43).

X

Chris Newcoomb - Aftercare Coordinator

Substance Abuse Among Adolescents 12 – 17 Years of Age

A recent clinical review presented the significance of substance abuse among adolescents, 12 to 17 years of age. According to the 2008 National Survey on Drug Use and Health, 9.3% of 12 to 17 year olds are current illicit drug users. Of those users, 6.7% used marijuana, 2.9% used psychotherapeutics, 1.1% used inhalants, 1.0% used hallucinogens, and 0.4% used cocaine. In addition to illicit drug use, more than one-half of Americans, aged 12 or older, reported being current consumers of alcohol. In 2008 alcohol consumption rates were 3.4% (12 to 13 year olds), 13.1% (14 to 15 year olds), and 26.2% (16 to 17 year olds).

With this in mind, the implications of substance abuse in the adolescent population are huge. According to the National Institute on Drug Abuse, one in every four deaths is attributed to alcohol, tobacco, or illicit drug use. Substance abuse also places a huge burden on the United States economy and healthcare system. It is estimated that substance abuse costs the U.S. economy four- hundred and fourteen billion dollars every year. Furthermore, five-hundred twenty-seven thousand dollars are spent every year on Emergency Department visits for illicit drug use.


Managing substance abuse amongst adolescents requires awareness about the issue, prevention efforts, adequate treatment interventions, and access to care. Issues facing primary care practitioners managing substance abuse include patient acknowledgement of the problem, patient motivation to receive treatment and adhere to the treatment plan, and insurance restraints surrounding coverage and funding for substance abuse services. Resources needed to effectively manage substance abuse include individual counseling, family therapy, centers offering detoxification, inpatient and outpatient treatment facilities, and self-help groups such as Alcoholics Anonymous, Narcotics Anonymous, Alateen, and Al-Anon. Such resources are imperative for both the primary care practitioner as well as the patient, in aiding the recovery process.


Practice implications for primary care practitioners include awareness about substance abuse in the adolescent population, maintaining current knowledge about guidelines and recommendations for managing patients presenting with substance abuse, recognizing which substances are most prevalent in the geographical area they are serving, screening all adolescent patients for substance abuse at each visit, and providing appropriate referrals and follow-up.


Stacy Baldwin, RN, CRC

Virginia Commonwealth University

Monday, March 15, 2010

Visvamitrasana

Today in yoga class Ellie, my incredible instructor, had us working on a pose called visvamitrasana. If you think it’s hard to say and to spell, you should try doing the dang thing!

Ellie gently reminded class as we stretched to capacity and tried not to tip over to:

Keep Our Hearts Open,
Our Minds Accepting,
and have
Contentment with Wherever We Are.

It is the Process, not the Outcome that is important in the practice of yoga.
One of the things I love about yoga is that what one practices on the mat is meant to be applied to real life ‘off the mat’.

People can try to avoid difficult situations in life, but those who have faced the reality that drinking alcohol, using opiates or using benzos have the potential to ruin their lives, know it is time to stop.

At The Coleman Institute we combine state of the art addiction medicine with open hearts and acceptance for our clients who begin the Process of Recovery. We can help you stretch and keep you from completely tipping over through our Accelerated Detox programs.

Saturday, March 13, 2010

Eric Clapton’s Autobiography is an inspiring book to read

I just finished reading this inspiring book. Eric Clapton has been at the top of his field in the music world for many years but what many people don’t know is just how much his life was affected by his addiction.

.

The book starts with Eric’s earliest years. It describes his upbringing and the early influences on his music. His passion and his dedication to music come through very clearly. Of course he was good friends with George Harrison and many other top musicians, so it is interesting to read about that world.

.

But then his life starts to become consumed with his use of drugs and alcohol. It starts subtly, as it does for most people, but then gradually gets worse and worse. Initially it was alcohol, but then he developed a severe Heroin problem. He was able to get off Heroin but he just switched to alcohol, as many of our patients do. As his addiction progressed there were more and more negative consequences, especially his profound unhappiness. It reached a point where suicide seemed like a good option.

.

Fortunately he had friends who cared for him and helped him get into treatment and begin his recovery. It did take two trips to a treatment program but eventually he got the message and started to live the program.

.

The book nicely follows his recovery and what a profound change that has been for him. He has been in recovery for over 20 years now and the personal and spiritual growth have continued. The book shows clearly that he has worked hard for it. One of the nice things in the book are the pictures at the start of each chapter. The pictures show what an amazing transformation has happened - gone are the gaunt pictures of active addiction and by the end there are pictures and stories of a happy family man who has truly come to terms with himself and his place in the world.

.

He is still making fantastic music, but now his music is coming from a different - a deeper place. He is an inspiration to us all.

.

Dr Coleman

Wednesday, March 10, 2010

Honor Your Choices

If you folks who are doing an accelerated detox with us weren’t mildly sedated, I’d probably try to get you to do some yoga. Not so much for the physical stuff, although it wouldn’t hurt to get a little good natural juice to your brains and limbs, but mostly for the philosophy. Today at class while we were all balancing precariously in half-moon pose, Ellie reminded us not to judge where we were. If we fell, that’s what we needed in our practice today; if the pose was strong and steady, own that without judgment as well. It is always the journey, the process that is important in yoga.

My friend Amy who’s an amazing person, being a school nurse these days sent me the following story. Although it was written by a guy in 1980 who probably never practiced yoga, the messages are strikingly similar:

THE STATION

By Robert J. Hastings

TUCKED AWAY in our subconscious minds is an idyllic vision in which we see ourselves
on a long journey that spans an entire continent. We're traveling by train and, from the
windows, we drink in the passing scenes of cars on nearby highways, of children waving at
crossings, of cattle grazing in distant pastures, of smoke pouring from power plants, of row
upon row upon row of cotton and corn and wheat, of flatlands and valleys, of city skylines and
village halls.

But uppermost in our conscious minds is our final destination--for at a certain hour and on a
given day, our train will finally pull into the Station with bells ringing, flags waving, and bands
playing. And once that day comes, so many wonderful dreams will come true. So restlessly, we
pace the aisles and count the miles, peering ahead, waiting, waiting, waiting for the Station.

"Yes, when we reach the Station, that will be it!" we promise ourselves. "When we're
eighteen. . . win that promotion. . . put the last kid through college. . . buy that 450SL
Mercedes-Benz. . . have a nest egg for retirement!"

From that day on we will all live happily ever after.

Sooner or later, however, we must realize there is no Station in this life, no one earthly
place to arrive at once and for all. The journey is the joy. The Station is an illusion--it
constantly outdistances us. Yesterday's a memory, tomorrow's a dream. Yesterday belongs to a
history, tomorrow belongs to God. Yesterday's a fading sunset, tomorrow's a faint sunrise. Only
today is there light enough to love and live.

So, gently close the door on yesterday and throw the key away. It isn't the burdens of today
that drive men mad, but rather regret over yesterday and the fear of tomorrow. Regret and
fear are twin thieves who would rob us of today.

"Relish the moment" is a good motto, especially when coupled with Psalm 118:24, "This is
the day which the Lord hath made; we will rejoice and be glad in it."

So stop pacing the aisles and counting the miles. Instead, swim more rivers, climb more
mountains, kiss more babies, count more stars. Laugh more and cry less. Go barefoot oftener.
Eat more ice cream. Ride more merry-go-rounds. Watch more sunsets. Life must be lived as we
go along. The Station will come soon enough.

Ellie finished the class with this thought: Honor the choices you make. Minute by minute, day by day. Call if we can help or if you have any questions.

Joan Shepherd

Sunday, March 7, 2010

Comparison of oral and implant Naltrexone - Colquhoun – 2005

Dr Colquhoun recently published a nice paper on the effectiveness of Naltrexone implants. The study was performed in Australia and it was in a very real world setting similar to the clinics and physician’s offices in this country.

.

The study involved 83 patients who had all been recently detoxified off Heroin and other opiates. The patients wanted to use Naltrexone to help them stay off Heroin and other opiates. Half of them took oral Naltrexone daily with the help of a support person who agreed to witness the medication everyday. This group of patients agreed to take the oral Naltrexone for 6 months. The other half had Naltrexone implants made by George O’Neil’s group. The O’Neil Implants are a bit larger than the ones we use here in the US. Some patients got a single implant which has been shown to last 3 months and some got a double implant that delivers adequate Naltrexone levels for 5 months.

.

The patients were followed and outcomes were determined by self report with corroboration from their support persons. Relapse was defined as when patients used more than 1 or 2 times (they determined that some patients used one or two times to test out the implant). Patients who couldn’t be contacted were assumed to have relapsed.

.

The results were very impressive:

.

Contacted and had not relapsed

.

At 6 months -

Naltrexone Implant 81%

Supervised Oral Naltrexone 45%

At 12 months -

Naltrexone Implant 61%

Supervised Oral Naltrexone 40%

.

These are very impressive results – actually in both groups. Compared with traditional treatment without any Naltrexone the results are very good. The strong results held up even after the Naltrexone was stopped after 6 months. A large number of patients were still able to maintain their abstinence.

.

Some of the other data from the study is quite interesting. The patients who relapsed in the group taking oral Naltrexone usually stopped their oral Naltrexone within 2 weeks. It could be that they were unable to deal with their Post acute withdrawal symptoms or perhaps they weren’t very motivated in the first place.

The patients who relapsed in the implant group were more likely to have had a history of selling Heroin, and were more likely to have a history of previous physical or sexual abuse. They often tried to use with the implant in place and reported that they would try to get over the blockage or if they couldn’t feel anything they liked to try anyway.

Dr Coleman

Friday, March 5, 2010

Chad's Story

Chad came in today for his 5th naltrexone implant. He’s been clean since his Accelerated Opiate Detox in February. He is a big burly bear of a guy. Here’s how he’s doing in his own words:
Day in day out we think about using. When we get clean we see things differently. But yet we have to go on about our life and now deal with it. I used to use whatever it may be to escape reality for just awhile; maybe a day or a weekend. Smart enough knowing that my problems and whatnot would still be there when I came around..but just wanting that release and free time. Now I deal with in constructively making use of my time, improving my home, time with kids, working etc. Yet, daily stress, anger, aggravation of normal life makes me want that release and escape. I find myself now dealing with it in what works for me as before mentioned. Not craving it-is so much freedom! But if I was to go back that is only existing and not living. I like living life. It’s not fair and it can be hard, but living life is wonderful.

Monday, March 1, 2010

Phase 2 Naltrexone Implant Study is Underway

Last year we began studying some Naltrexone Implants that were compounded for us by a pharmacy in New Jersey. These were 1.4 gram implants. The results were quite encouraging because 80% of the implants lasted at least 2 months. However we realized that the ideal implant lasts at least 3 months or even longer. So, in consultation with the pharmacy, we have helped them to modify the implants to make them have a longer duration. We have now begun the phase 2 study on these new improved implants.

.

The study is to draw blood levels in 5 patients with the new and improved implants. The patients will come in every 2 weeks and have blood drawn. We have already enrolled 3 patients and should have final results in the next few months. This is very exciting for us because as we get better and better implants it becomes a lot easier for patients to stay in recovery. Our goal of course is to help patients get clean and stay clean. We want to make sure that patients have an alternative that works - so they don’t have to use Methadone or Suboxone.

.

Dr Coleman