Friday, April 30, 2010

A Change of Perspective

Eddie came to The Coleman Institute last week after a couple mis-starts. He’d relapsed and found it extremely difficult to get the 7 clean days off opiates for us to safely place a naltrexone implant.

He was with his Mom, Eleanor who was calm, pleasant and self-possessed. She admitted that a month ago it was a different story for her. Eddie’s Mom had become so depressed and despondent for yet another relapse on his part, she felt suicidal. If her son couldn’t be off heroin, she felt that she no longer wanted to live. It was just too painful to watch him destroying his life.

Ironically, the following week Eleanor went to see her doctor and was told that her recent mammogram showed suspicious lesions and a biopsy was necessary. Eleanor’s world as she knew it spun around on it’s axis and suddenly she experienced a clarity she hadn’t known in several years. She came to the realization that she desperately wanted to live. She realized how much she loved life, loved her son and especially how much she loved herself. She was able to hold in both hands the grief and the joy that come with loving an addict. And she realized Eddie’s choice to use heroin is Eddie’s business. Eleanor’s business is to love herself first; that loving Eddie and anyone else in her life has to flow from this truth.

The biopsy results will be available early next week, but regardless of the outcome, Eleanor has found a peace inside herself that “passes understanding”. The prayer now is for Eddie to find his own.

Joan Shepherd - FNP

Tuesday, April 27, 2010

Ideal Clients

In a class I’m taking, one of the exercises recently given was for us to describe our ideal ‘clients’. As I listed the characteristics of the type of people I want to work with, it became even clearer to me why I love the work I do at The Coleman Institute.

These are the qualities my “ideal clients” have:

· Intelligence

· Creativity

· a sense of humor

· Motivation

· Willingness to make positive changes

Our clients have made the choice to deal with their substance abuse. This is a simple choice, but not always easy. It will take all the above listed qualities, and plenty more to maintain sobriety.

At the end of a 3 or 5 or 8 day Accelerated Opiate Detox, giving that client a big bear hug for accomplishing this first important step is exhilarating. I invite you to experience it if you are ready to make some important changes.

Joan Shepherd - FNP

Thursday, April 22, 2010


Here is an interesting article from an English Newspaper.



It turns out that for 5 years doctors and prison officials in England have been putting Heroin addicts on Methadone before their release from prison – a process some are calling “Retoxification”. The idea is that the prisoners won’t overdose and die when they get out of prison - I guess they usually relapse pretty quickly.


This is obviously a pretty contentious program and a somewhat desperate measure. The positive of course is that it may cut down on fatal overdoses after prisoners leave the jail. The negatives include the fact that some prisoners may be fully detoxed and may be able to do very well in a drug free treatment program and for these people, getting them hooked on methadone is a real disservice. This is especially true since getting off methadone is actually a lot harder that getting off heroin. And, by the time they leave jail, many of these prisoners are completely drug free – they have been through their detoxification. The hard part is over.


The other time I’ve heard of something like this is from some docs in Sydney, Australia. They were having a number of fatal overdoses actually inside the jails –the heroin addicts who were in jail had gone through their detox and so they would have lost their tolerance. When people lose their tolerance, even very small doses can be fatal. Enough of them were getting Heroin smuggled in and using it in the jail. This is dangerous enough on the street but even more dangerous in jail. In jail you have no idea of the purity of the Heroin, and the inmates would usually be under a lot of pressure to use quickly to avoid detection. Easy to make mistakes and take too much. So there were a lot of fatal overdoses in the jails. The Sydney doctors decided on a trial program where they put some of their opiate addicts on methadone while in jail – often even prisoners who had never been on methadone. In fact the program was successful in decreasing overdoses, but at the price of having all of those prisoners addicted to methadone when they left the jail.


The truth is that fatal overdoses following a period of jail time are quite high. One study I saw a while ago had fatality rates as high as 4-5% in the first year.


So what should be done? We believe that all patients (or prisoners) should be treated as individuals. We believe that being drug free is the best course, provided the patients are willing and able to make the necessary changes. So, jails should identify prisoners with substance abuse problems and start their treatment while they are a “captive audience”. Before the prisoner is released, they should have already received basic treatment and then a very comprehensive ongoing treatment plan should be in place. This treatment plan should include a suitable living arrangement, intensive therapy and support groups. It should also include job training, random drug screens and real consequences for lack of compliance. Here at the Coleman Institute we also recommend Naltrexone implants for at least 12 months to decrease cravings and prevent relapse.


If this much attention is paid to each prisoner then the need for methadone in jails would either be eliminated or greatly decreased.


Fortunately here in Virginia, as in many parts of the country, there are now many drug courts that are helping people recover from their addiction instead of just locking them up. At the Coleman Institute we believe that everyone, including prisoners, should have the opportunity to receive treatment for their disease. It is surely better to give prisoners treatment than just hope they “learned their lesson”

Dr Peter Coleman

The Heart of the Matter


Ever feel broken? Used? Falling apart at the seams? Wandering? Useless? Imperfect? Flawed? Chances are you answered ‘yes’ to at least one of these questions. Unfortunately, the human condition is such that we are all imperfect people capable of making colossal mistakes and obtaining tremendous success. The problem becomes when our flaws, mistakes, and mishaps get the better of us and others. Left unchecked, these behavioral gaffs can lead us right down the not so primrose path of addiction.

This month we’re looking at Step 4: “Made a searching and fearless moral inventory of ourselves.” This step is where the rubber meets the road or, if you like, we get down to the, “heart of the matter.” Step 4 is a detailed inventory of our thoughts, behaviors, and speech over the course of our lives up to the present as it pertains both to us and others. It is not a moral reckoning of dirty deeds done dirt cheap, as the saying goes, rather just a detailed listing of such events so one can understand the full scope of one’s character before progressing further in recovery to who one will become.

I think one of the most relatable art forms to real life is music. Many artists are people who have made mistakes, broken hearts, and just generally screwed up their lives. What better way to purge such memories than to write a hit song about it! That’s exactly what solo artist Don Henley of The Eagles fame did in with his hit “Heart of the Matter”!

One of the key components of a Step 4 inventory is taking a look at your resentments. You may have heard the old saying that resentment is like taking poison and waiting for the other person to die. It doesn’t work. Henley expresses that fact when he penned these words,

There are people in your life
Who’ve come and gone
They let you down
You know they hurt your pride.”

Here Henley acknowledges both the pain and reality that people hurt people. They can embarrass, mock, cajole, and create all sorts of difficulties for you. We can choose to be resentful or as Henley put it…

xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxYou better put it all behind you, baby
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx‘Cause life goes on
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxYou keep carryin’ that anger
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxIt’ll eat you up inside, baby!”

Truer words have not been spoken. Life does go on and part of recovery is looking at where life has been in order to understand where it is going or where it could go in the future. Step 4 is not for the weak of heart. It will challenge you. It will hurt. It will cause pain. But on the other side of the pain, there is a new reality waiting to be experienced. After all, we are just trying to figure things out in our recovery much like Henley is trying to figure out his own life as he sings,

xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx“I’ve been trying to get down,
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx to the heart of the matter.”

Chris Newcomb - Afterare Coordinator

Wednesday, April 21, 2010

Detox in a Box

I’ve been trying to talk our CEO into a whole new marketing scheme. What do you think of Detox-In-A-Box?

See, Box 1 would be: Drop the Drug.

Box 2: Cut the Cravings

Box 3: Live Your Life

Drop the Drug is what happens when you come to TCI for an Accelerated Opiate Detox. We keep you pretty darn comfortable as the opiates leave your blood stream.

Step 2 is Cut the Cravings. The naltrexone implant provides a steady stream of blocker for about 8 weeks. When a person knows he or she cannot get an effect from an opiate, the brain begins to heal and the cravings subside.

Step 3, most importantly is Live Your Life. It’s the whole reason you consider coming for a detox. That means when you leave here, you have a plan for treatment.

If Detox In a Box seems a bit ‘flip’, that’s kind of my intention.

No one says detoxing is easy, but it’s not all that hard. Take a deep breath, take your meds, look at your thoughts; stop telling yourself how hard it’s gonna be. Start living your life.

Joan Shepherd - FNP

Monday, April 19, 2010

Exercise works like Antidepressants.

Here is a great article about how exercise works like antidepressants, It is something we have known and felt to be true for a while but it is nice to see evidence of it. It builds on research earlier this year that pointed out that for many patients with mild or moderate depression, antidepressants are no better than placebo – they just have more side effects!


Dr Peter Coleman

Saturday, April 17, 2010

Thank You to a Son

Randy is completing a detox today. He relapsed from heroin and his father is his support person. Last year they came to The Coleman Institute for an Accelerated Opiate Detox and followed up with a couple naltrexone pellets. For a while Randy went to meetings and worked conscientiously at his recovery. About a month ago he ran into some old ‘friends’ doing court ordered NA meetings and he slipped up. When his parents found out, they were heartbroken and Randy is struggling with guilt and shame.

I had to come into my office and shut the door briefly in the midst of this busy day, in between patients because I was so moved by the interaction between Randy and his father. Every time Randy says “I’m sorry” to his father, he simply responds by saying “Thank you” to his son.

He’s saying “Thank you” because he still has his son. “There’s nothing worse than wanting to help someone, knowing he needs the help, and him not being willing to accept it. So, thank you, son, for being here.”

The bar-b-q sandwich arrived for his lunch so I excused myself. It was a good chance to wipe a tear away.

Joan Shepherd - FNP

Thursday, April 15, 2010

A new Opiate designed to decrease drug abuse

King pharmaceuticals have just released a new painkiller called Embeda. It is a schedule 2 drug containing morphine that is designed to slowly release in the body, similar to OxyContin. The morphine is in tiny little beads with a slow release coating.


The difference with Embeda is that each little bead of Embeda also has Naltrexone inside a special coating that can’t dissolve in the body. So if a patient takes it as prescribed, they will get the Morphine and no Naltrexone. But if they crush it and inject it they will get the morphine and they will also get the Naltrexone. This could certainly spoil your high!


It is a bit scary actually, because the Naltrexone will not only block the Morphine high, but it may be a high enough dose to also push them into complete withdrawal. The severe withdrawal may be dangerous and may last for over 24 hours. We have certainly seen a lot of patients who have taken Naltrexone before they are fully detoxified and it is not a pretty sight.


So, will this cut down on drug abuse? It may be some help but there are a couple of points to remember. Firstly, patients can simply take the medicine orally and get the full morphine effect. They don’t have to inject it to get a buzz – especially if they take double or triple doses. Secondly, most addicts are pretty resourceful. It may be possible to break down the first barrier to release the Morphine and leave the other barrier intact – keeping the Naltrexone locked away.


One thing is sure, we will know in a few months how it fits into teh picture both in clinical medicine and on the street.


Dr Peter Coleman

Monday, April 12, 2010

Home Grown Potatoes

Yesterday I had the distinct pleasure of meeting with a client who did an accelerated opiate detox at TCI a few months ago. The last time I saw him he was really struggling with lots of feelings and emotions that had cropped up. Not an unusual scenario: emotions are blocked pretty well when you spend your day stoned.

Part of his deep grief at the time was the realization of how profoundly he had separated himself from living his own values. Part of the reason he’s doing so beautifully now is that his actions and values are much more aligned because of the daily choices he is making.

ACT (Action and Commitment Therapy) uses the image of a garden when they work with clients on values. Imagine choosing a plot of land for your garden. You work the soil, plant the seeds, and take care of the weeds, etc. While this is in progress you notice another piece of land that looks a little better to you. You pull up your vegetables and go work that plot of land….until you look around and find another plot that seems ever better. As the authors of this exercise so aptly state: values are like a spot where you plant a garden. You can grow some things very quickly, but others require time and dedication. The question is, “Do you want to live on lettuce, or do you want to live on something more substantial—potatoes, beets, and the like?”

You can’t really know how things work in this garden unless you stick around for awhile. Of course, that means you will also notice the imperfections. From time to time thoughts will arise about the poor quality of the soil during this drought, the stones that have come to the surface and the like. The choice to garden here will help you stay in this garden even when your thoughts are making you doubt your decisions.

I think my above mentioned client is gonna be eating a big serving of home-grown hash browns one of these fine days!

Joan Shepherd - FNP

Sunday, April 11, 2010

A though on relapse

A thought on relapse…

Sometimes when a person relapses, he is full of shame, doubt and despair. He believes that he has let his family down yet again and he may not even feel that he is worthy of picking up the pieces and starting all over. The implication is that losing focus of a commitment means the person has defective values.

The question that may be asked is: have your values changed? Do you still want to be the best father to your children? The best spouse to your partner? The best son to your parents?

For most people the answer is “no, my values have not changed; yes, I still want to be ____________ “. (Fill in the blank with your values.)

Dr. Stephen Hayes, a practitioner of Action and Commitment Therapy uses the metaphor of a person driving west. If you get sidetracked, you can still turn the car around. Any time. If you were planning to drive from the east to the west coast and your mind was telling you that the car will break down, the road will be closed ahead, or that you will fall asleep at the wheel and get in a wreck, could you continue to drive west? If west is where you want to go, get in the car and start driving.

At The Coleman Institute we’re all about driving west.

Joan Shepherd - FNP

Friday, April 9, 2010

The Ultimate Pollyanna

I am the ultimate Pollyanna. (If you’re too young to know what I’m referring to, go to Hulu and look it up.) I truly believe if you are here taking up space on this planet at this time, there’s a damn good reason for you to be here. And—it’s up to you to figure out what it is.

That’s why this job suits me so well. When a client comes to The Coleman Institute for An Accelerated Opiate Detox, it’s kind of like we’re helping to peel an onion: removing some outer layers to help him/her get closer to the true core.

The thing is, a client has to want it more than we or his parents or his girlfriend want it for him.

Yesterday a 25 year old guy came in for a pellet. We’d detoxed Alex a year ago and when he completed the detox he lived at the Salvation Army for a while, then went to a group home. This is a guy who was raised with every physical comfort, who lacked nothing material. He thrived in these conditions. He started to really get honest with himself and make some progress. And then he relapsed. Again and again. He stopped going to meetings.

Enjoying the very fulfilling life of laying in front of his mom’s big screen TV all day getting high, hiding the fact from his hard-working infatuated girlfriend, Alex was finally told if he didn’t get another implant and get straight he had to leave.

So he shows up here for a pellet and guess what? That’s right, he’d used again so he couldn’t get a pellet.

His stepfather was furious. He ranted about the miles and miles he’d driven to get there, the time taken off work, the tens of thousands of dollars they’d spent on this kid etc etc. Yawn. I ‘ve heard it all too often.

Let him be. The reality is what it is. When and if Alex is ready to access the source of peace for himself he’ll do it.

In the meantime I told step-daddy, change the locks, take Alex’s mom to Al-anon and then on a well-deserved cruise. They need to find their own Core of Peace too.

Joan Shepherd, FNP

Tuesday, April 6, 2010

Rolling Around in Shit!

I get a lot out of my yoga classes. I expect my body, mind and soul to receive great benefit, but sometimes I can even hear a good story and get some inspiration for a blog entry. Like today.

After class a couple of us were sitting around and talking. Courtney was describing how wisdom appears everywhere, if you’re open to it…

She is going through a rough divorce and she was talking on the phone to her Mom about all the stuff she was dealing with…how hard things are (wah wah wah) and what her raggedy-ass almost-ex-husband was doing this week to make her life miserable (wah wah wah), etc.

While she was talking, her dog walked into the room. It was immediately evident that her black lab, Cody, had rolled in her own excrement in her own backyard.

“Oh my God!” exclaimed Courtney to her Mom, “Cody is rolling around in her own shit!”

No sooner than the words were out of her mouth did my funny friend, Courtney realize what a metaphor for her own life this was! She started laughing like crazy and between gasps said to her (probably mildly confused mother), “I’m doing the same thing! I’m rolling around in my own shit!”

How I savor self-awareness…especially when someone else is experiencing it.

Start peeking at yourself. Observe your drug use. Are you rolling around in your own shit? Call The Coleman Institute if we can help. It can really be pretty simple. Take your recovery seriously, not your self.

Monday, April 5, 2010

Losing Sarah

Our collective hearts at The Coleman Institute were broken last week when we received the news that one of our beloved patients had died. Sarah was 25 and had detoxed in January from heroin. At her last visit for her 3rd naltrexone implant, she reported that she’d been going to 3 meetings a week, was seeing a counselor, and felt better than she’d felt in a long time.

She was one week overdue for her 4th naltrexone implant; she’d cancelled her appointment. Although we haven’t heard conclusively, her death was likely due to an overdose.

One of the messages we reinforce with our patients is the healing process of the brain. Using narcotics depletes the brain of natural dopamine, which is the neurotransmitter responsible for pleasure. It can take over a year for the brain’s natural dopamine to be restored and this is why we are so adamant about patient’s returning to TCI for an implant every two months for a year. During this time it is vital to be in a good recovery program.

When a person has not used heroin for a couple months, whether or not they have a naltrexone implant, he/she is extremely vulnerable to overdose.

Sarah was the first patient we’ve lost since I started working with Dr. Coleman two years ago. She will always have a place in my heart and her story inspires me to reach out to others who are desperately trying to live a rich life of recovery.

Saturday, April 3, 2010

Stop Whining

Hey you young heroin addicts who have decided to stop this foolishness and get on with your lives…hurray, good for you, that’s great! Now let’s move on.

Stopping drugs isn’t your reason for being on the planet. It’s so you can get back to figuring out why you’re on the planet. Why here, why now, why with these challenges in this body with these parents in this country with this education-or lack thereof.

You did an Accelerated Opiate Detox with TCI or you detoxed yourself. You are on naltrexone therapy. Now what?

Too many of you are coming in for visits telling me what you don’t like about NA meetings. You are hearing war stories and it makes you want to go out and use. You don’t want to have to speak up and tell your story. The guys selling drugs are lurking around there waiting to grab your vulnerable self and get you high.

Just stop it with the excuses already. It is time for you to get on with the business of your business. The guys who are telling their war stories are not worried that they’re going to offend someone at a meeting. They are there for support from people they know have accepted the addiction condition. It’s not a pity party; it’s a support group. Go in there, bring something to the table, and know that your own gifts, talents, desires, and truth are trying to emerge from the drug fog you created.

Listen up: you are not a tragic figure. You have the disease of addiction. Embrace it with compassion then let it go. Become the first step—we admitted we were powerless over drugs—that our lives had become unmanageable…

Then get ready for the fun to start. For a bunch of dope addicts, I can say that I’ve never worked with a more talented, clever, hilarious, insightful bunch of people than you guys.