Friday, August 27, 2010

HOW CAN I AVOID BAD PEOPLE AT NA MEETINGS?

Today we helped a guy by putting a naltrexone pellet in place. He’s come twice before in the last month and a half for naltrexone, but both times he used within a few days of his appointment, so when he had the narcan challenge, he went into pretty bad withdrawal. Both times he was sure he could handle the withdrawal symptoms, but he couldn’t.

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This guy is so cute and nice; he’s got parents that love him and he’s only 20. It would be great if this were the last time –for sure—that he

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I wonder why he doesn’t stop?

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One thing is, he has never completely embraced the idea of recovery. I know young people can get the 12 steps because I see it all the time. He really is worried that he’s gonna run into people who will steer him the wrong way if he goes to meetings.

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I’m not in recovery myself, so I can’t totally put myself in his shoes, but what I do know is that whatever limiting belief you are holding onto, if it doesn’t serve you and make your life better, you can discard it and create new thoughts that will work.

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So…let’s say you go to a meeting. Your Limiting Belief is: “I’m gonna see people that will get me to use.”

Because of the way our brains are wired, you’re going to gather evidence to prove your theory.

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You’ll walk into the meeting and see all those rascals who want you to fail, and your brain will go there.

What if you go into the meeting and think: “There are so many people here who really want me to succeed….I’m gonna find them.”

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Your brain will then seek evidence to support this thought.

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You really shouldn’t trust me on this; try it yourself and see.

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If you still have a problem, call us. We want to help you and we’re pretty darn good at it.

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Joan Shepherd, NP

Tuesday, August 24, 2010

Some patients actually cut out their own Naltrexone implant

At a recent Quality Assurance meeting, Dr Blaise Wolfrum from Chicago brought up the fact that one of his patients wanted to cut out the Naltrexone implant so he could get high again. When the patient was told that this was very dangerous, he wanted to know how long he had to wait before his implant would have worn off so he could get high.

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It is amazing to think that patients would go through a whole detox and finally be free of the withdrawal symptoms, and still be thinking seriously about taking a knife to their abdomen to cutout their implant. But the truth is that over the years we have had a number of patients who have actually done this.

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To me it shows just how powerful the disease really is. I always remember a study I saw that was done in Seattle. It showed that even with good detox and good treatment that was available, only 3% of their patients were still free of opiates after only three months.

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We need to remember that this is a serious illness that is very difficult to recover from without a lot of help. This is why we recommend the Naltrexone implants. Without this “crutch” very few people are able to remain free of their addiction. It shouldn’t surprise us that some people want to cut out their implants. Of course we always do what we can to help patients also get into counseling and support groups.

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Dr Peter Coleman

Thursday, August 19, 2010

Low Dose Naltrexone (LDN)



Naltrexone seems to be a pretty amazing drug. At regular strength it is able to completely block the opiate receptors which decreases the craving for a number of addictive drugs and prevents relapse back to opiates. At lower doses it seems to be able to help with a number of conditions ranging from helping with infections and immune disorders and even helping body builders recover from an intensive workout.

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Here at TCI, we have been using oral Naltrexone for over 20 years now. For over 12 years we have been using Naltrexone in our implants. The Naltrexone implants block all of the opiate receptors and this dramatically decreases cravings and prevents patients relapsing back to addictive opiate use. It helps both alcoholics and opiate addicts stay in recovery.

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But lately there has been a lot of interest in whether this medicine can also have beneficial effects at very low doses - beneficial effects in a whole variety of diseases. To understand why Naltrexone may help with other conditions, and why it may help at very low doses, it is necessary to understand a little about how Naltrexone works.

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The body has an endorphin system that is made up essentially of endorphin molecules and their receptors. The word endorphin is derived from endo (from within) and morphine. These endorphin molecules (natural morphine) exert their effect by attaching to receptors and turning on the switch like a key in a lock. Initially it was thought that the endorphin system was there to provide natural pain relief in case of accidents and acute pain – possibly to allow us to continue to function somewhat if we are injured and need to get out of danger. No question it does do this, but the more we learn about this intricate and elegant system, the more it is apparent that endorphins do much more than just provide pain relief. The endorphin system is very involved with our sleep cycle, our energy levels and our general sense of well being. Endorphin receptors have also been found in a variety of tissues including the immune system, the intestines, and cardiac and vascular tissues. The placenta even makes large amounts during pregnancy – which may explain some cases of post partum depression.

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Naltrexone is an opiate antagonist, a blocker at the endorphin system. There are two ways that Low Dose Naltrexone (LDN) may be beneficial. It could block the endorphin system for short periods in order to block unwanted effects. Or it could block the endorphin system for a short period of time so that the endorphin system will build itself back up in response and be “supercharged” after the LDN wears off. This could even increase the amount of endorphin in the body. The endorphin system is very intricate and it may be that LDN both blocks some parts of the endorphin system and supercharges other parts. It may help to regulate itself.

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Low dose Naltrexone (LDN) is being used and studied in a number of conditions involving the immune system. We know that opiates can cause immune-suppression in conditions such as cancer and HIV/AIDS. So could blocking the opiate system with Low Dose Naltrexone (LDN) actually lead to an improvement in the immune system and help patients? Some HIV infected patients are using it. Some patients with Multiple Sclerosis are using it. There are lots of case reports and patients who swear that it has been helpful, but not a lot of controlled research studies have been done. That is changing, and just this year a well controlled study was reported on patients with Crohn’s disease – an immune disorder effecting the GI system. Dr Jill Smith from Pennsylvania State University studied 40 patients with Crohn’s disease and showed quite dramatic results. In her study, 82% of the patients receiving LDN achieved a large drop in their symptoms scores and 45% achieved clinical remission. This was much higher than the placebo (sugar pill) group.

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Fibromyalgia and Chronic Fatigue Syndrome are conditions that are frequently characterized by chronic pain. A number of patients are using LDN for these conditions and reporting good results. This could easily make sense because often chronic pain affects the body’s ability to deal with pain so modulating the endorphin system could have very beneficial effects.

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I have personally used LDN for patients with irritable bowel syndrome (IBS) and have had good results. IBS is a condition where the bowel seems to be alternating between over stimulation and under stimulation. The bowel has more opiate receptors than the brain, and so it is not hard to imagine that blocking these receptors could help the GI system regulate itself.

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Another condition that could be related to over production of endorphins is autism. Some researchers believe that some cases of autism are caused by an over stimulation of the body’s endorphin system. These children could be almost high on their own natural morphine and so have problems interacting socially and functioning in the world. Some physicians are using LDN to tone down the endorphin system and help it to re-regulate.

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Recently a patient came to ask if I would prescribe LDN to help him in his body building regimen. It seems there is evidence that LDN helps the body recover more quickly from vigorous workouts.

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I have also recently used Naltrexone combined with Wellbutrin in a couple of patients who have weight problems. So far the response has been very powerful. They have lost a lot of their cravings for food and have also lost quite a lot of weight. We will see if the changes continue.

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So what do we make of all of this? There is a popular website at Lowdosenaltrexone.org with lots of personal testimonials and case reports. There are books written about patient’s personal experience with LDN. The truth is that we just don’t know how effective LDN is for these conditions. It makes sense, given how extensive and how powerful the endorphin system is, that it could have dramatic effects in a number of conditions. The good news is that there are a number of well qualified researchers who are beginning to conduct the kind of research that will give us more answers.

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Peter Coleman MD

SORRY vs. WRONG

Step 8, “Made a list of all persons we had harmed, and became willing to make amends to them all”

In the Alcoholics Anonymous “Big Book”, Bill W. writes, “At some of these we balked. We thought we could find an easier, softer way but we could not “(p.58). Step 8 would be the step most addicts/alcoholics balk at upon learning about it. This where so many of them have to face a laundry lists of harsh words spoken, evil actions taken, and self-humiliating situations that must be accounted for and explained. And this is no easy or pain-free task!

Often times when people hurt someone else they will say, “I’m sorry for doing x, y, and z.” At face value, there is nothing wrong with that statement. It is important to let the person you have hurt know of your sorrow regarding your poor behavior choices. However, this can often be used as a cop-out. It can reek of insincerity. For many people, hearing “I’m sorry” from people repeatedly is the equivalent of hearing, “Have a great day!” from a department store clerk as you exit the building with your new purchase…a nice thought but not personal nor life-changing! This is where Step 8 comes in to play.

The essence of Step 8 is the admission of doing wrong. That is, the addict/alcoholic admits, without excuse, their behavior that had a detrimental impact on another human being. That is not to say one cannot also tell the victim you are sorry. However, sorry must come after an admission of guilt and the exact nature of the crime. After all it is hard to admit being sorry about something if you don’t first admit what it is that you are sorry for! This is the hardest thing to do because, through this process, the addict/alcoholic comes face to face with himself or herself.

Many addicts/alcoholics shy away from this step because they are really focused on the following step, Step 9. They get trapped in their heads wondering how they can make amends, if they can go through with it and make amends, and will they be successful. However, Step 8 only invites the addict/alcoholic to make a list of all persons they had harmed and become willing to make amends to them all. There are two actions in this step: 1.) Make a list. 2.) Become willing. Nowhere in the step does it talk about the mechanics of actually making the amends. So, it is wise for addicts/alcoholics to remember this as they write out their 8th step list. It is broken into two steps for a reason, namely, both can be overwhelming!

The list of persons that have been harmed due to the addict/alcoholics behavior usually comes from the 4th step inventory. It is here where the names are drawn and prepared for the future task of making amends. But for now, the only task is to make a list. So, get to it. It’s not hard. It’s worth it. What does humility require? A willingness to write down a list of people you hurt and not making any excuses for your actions!

Chris Newcomb - Aftercare Coordinator

Tuesday, August 17, 2010

Pesto and Opiate Addicition

I’d like to make a suggestion to anyone out there with an opiate addiction.

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Grow basil and make pesto.

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Combine about 3 cups of packed basil leaves in a food processor or blender with about 1/3 to ½ cup of olive oil (good olive oil), a few cloves of garlic, a little salt, 3 tablespoons of roasted pine nuts, and about ¼ to 1/3 cup really good parmesan or other hard cheese. Blend it and put it on pasta or brown rice. Add some lightly steamed broccoli and sun-dried tomatoes. (I keep a big jar from Costco forever handy.)

It is so freakin’ delicious.

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Mmmmmmm. just had a bowl with my daughter made from basil I picked from my garden this a.m.

If you are addicted to opiates and you are already making homemade pesto, please bring some to the office.

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Call to learn more about Accelerated Opiate Detox at The Coleman Institute.

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We’re good at what we do and we have fun doing it.

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Joan Shepherd, NP

Saturday, August 14, 2010

More Suboxone Problems

A few days ago we started another person at The Coleman Institute for a Suboxone Detox, one of our Accelerated Opiate Detox programs.

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Like many people who come to us for help, Steve (not his real name) was put on suboxone to get him off high doses of percocet and oxycontin for a previous sports injury and surgery.

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At the time, about three years ago, it seemed like a life saver; he was able to take a long acting opiate blocker and function. He wasn’t constantly watching the clock, wasn’t constantly worried about the next dose, and could even get a refill. His doctor was full of concern and confidence.

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Although it was pricey, because his doctor only worked on a cash basis, that was ok because he was off his pain meds and his pain was more than manageable using over the counter ibuprofen and such.

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The problem came when he wanted to stop the Suboxone.

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His doctor told him to drop back from 32mg a day to 16mg. No problem. It was a little tougher to go from 16mg to 8mg, but the real problem came when Steven tried to drop below 8mg/day.

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He developed severe withdrawal symptoms.

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Steve is a lawyer. He was unable to do his work while experiencing the withdrawal. His doctor suggested a medication in the benzodiazepene family: xanax. This really worried Steve because he learned how addictive this class of meds is as well. He really didn’t want to get on a drug to get off another drug.

Suboxone has an incredibly long half-life, meaning it stays in your system for a long time, and it has a very strong capacity to bind to opiate receptors. This is why it can be an excellent choice for people who choose maintenance therapy to get off opiates, but not so great for people who choose abstinence. This is also why it is so hard to detox on your own.

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Steve is doing great. He is on his 4th day, and in a few more days we will have the majority of the suboxone flushed out of his system.

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We have a good time with our patients. We like our work. This isn’t an easy thing for them to do, and we are really good at it. Give us a call if we can help.

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Joan R. Shepherd, NP

Thursday, August 12, 2010

Patients are on Methadone and their doctors don’t even know about it.

There was a recent survey of patients from a methadone clinic which revealed that 30% of the time, their regular doctors had no knowledge of their methadone use. This is a serious problem because a lot of medicines can interact with methadone and cause significant problems. Just the other day a colleague of mine had a patient who was on methadone and was given Narcan (Naloxone) in an emergency room because they were sleepy. I don’t think the ER Doctors knew about the methadone because the patient promptly went into severe withdrawal and has now ended up on a ventilator in the ICU. I have seen this happen on more than one occasion.

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It is understandable that doctors often don’t know that their patient is on methadone because methadone is given in separate clinics, and often patients are embarrassed to tell their regular doctors about their drug problem.

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The most logical solution would be for methadone clinics to insist that all patients sign a release and records be automatically shared between doctors. Then it may be possible to avert some severe problems.

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Dr Peter Coleman

Friday, August 6, 2010

Hypnosis for addictions

I heard a nice talk this morning from Dr John Boyd, a well respected hypnotherapist and addiction therapist from Charlottesville. He works with me and other therapists out at Williamsville Wellness, an inpatient rehab facility just outside of Richmond. John explained how hypnotism works and why it is helpful for patients with addiction problems.

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He explained that in actual fact we are quite often in a trance state. We are often in a trance state when we are driving a car and we suddenly realize that 10 minutes have gone by and we can’t remember driving during that time. Also we are often in a trance state when we are doodling or exercising. During the trance state our conscious brain is relatively inactive, but our subconscious and unconscious brains are active and processing information and integrating information.

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Addictions are found in the subconscious and unconscious (primitive or automatic) parts of the brain. That is where the dopamine systems are and where the cravings come from. One of the problems with addictions is that we remember the good parts of the using but we have not integrated the negative things that our addiction caused. So hypnosis can help patients pay attention to the part of the subconscious brain that is aware of all of the negatives and integrate that information, often in an unconscious way. If we can become automatically more attuned to the horrors and consequences of our addiction, it becomes a lot easier to not use, even when it may seem attractive at the time.

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Dr Peter Coleman

Tuesday, August 3, 2010

Klonopin Addiction

Using alcohol or drugs as a crutch to avoid painful feelings can lead to addiction.

Dora (not her real name) was 25 when her husband and child were killed in an automobile accident. Naturally, she was overwhelmed with sadness, despair, fear, and loneliness. Her doctor prescribed klonopin to help Dora cope with her anxious feelings and to help her sleep. She also started drinking to numb the painful feelings as they surfaced.

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No matter how far we try to push grief away, it is still there. It’s like trying to hold a beach ball under the water. At some point your arms are going to get pretty tired and the ball is going to shoot to the surface.

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After several months, with the help of counseling, Dora realized that the only way she could begin the healing process was to move through grieving. This was being thwarted by the use of benzos and alcohol.

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She found she couldn’t stop taking the klonopin without severe withdrawal symptoms. Even cutting back in small increments a few days at a time produced bizarre side effects.

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The Accelerated Benzo Detox at The Coleman Institute can make this process tolerable and safe. By using low dose flumazenil, we begin the process of gently restoring homeostasis in the brain, allowing our natural relaxation chemicals to return. How soon the GABA receptors in the brain are completely restored depends on the quantity of medications and the length of time a person has been using benzodiazepines, as well as other pre-existing medical conditions.

If your arms are tired from holding that beach ball under water, the staff at The Coleman Institute would welcome the opportunity to be part of your Healing Team. Give us a call.

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Joan Shepherd, FNP