Wednesday, September 29, 2010

Coleman Institute Sponsors Louisville Local Radio


The Coleman Institute is proud to announce it's sponsorhip of of Public Radio stations WFPK - 91.9 FM, WFPL - 89.3 FM, and WUOL - 90.5 FM in Louisville KY.
Tune to these great stations!

Sunday, September 26, 2010

“All the Lonely People”


An addict is a person who wants to be held while they are isolating” ~ Anonymous


As a kid, I used to think loneliness was a condition for wimps. Then, I got married. The first time my wife went out of town to visit her parents, I was a basket-case, crying like a little girl, feeling lonely and desperate for my wife to be back in my arms again. Needless to say, it was a very long week but I survived (as this article is evidence). By the way, she did come back!


This month I’d like to talk about two issues that plague every alcoholic and addict, which are, isolation and loneliness. First, it is important to recognize that both of these issues are common to all people. Isolation and loneliness is something we all experience from time to time. However, neither is meant to be our permanent state of being, our modus operandi, if you will. Unfortunately, for many alcoholics/addicts, that is just the case.


Isolation is a condition wherein a person chooses, for whatever reason, to temporarily, or sometimes permanently, cut themselves off from contact with the outside world. Regardless of the reason, and without judgment of the reason, isolation is not a healthy behavior. It leaves a person with a limited perspective about their life, the world around them, and other people. Recovery gurus call this being “stuck in your own head” and the results can be disastrous (see above picture on the right).


In John Cacioppo's 2008 book, Loneliness: Human Nature and the Need for Social Connection, the author states that, “loneliness impairs cognition and willpower, alters DNA transcription in immune cells, and leads, over time, to high blood pressure.” Science is providing unequivocal data pointing to the measurable, detrimental effects of loneliness on the human physiological and psychological condition. Our penal system has used solitary confinement (a.k.a. “enforced loneliness”) as a punishment for decades. Still in a world that has the means for over-connection, many remain alone whilst in the company of others.


Loneliness is a perfectly human emotion than can run amok. This is because most people do not know how to deal with this powerful and sometimes baffling emotion. In particular, alcoholics/addicts tend to struggle with any intense feeling(s) and loneliness can feel very intense. It seems like the logical step would be to gravitate toward other people to alleviate loneliness, but the addict/alcoholic mind doesn’t see it that way. Instead, they tend to move away from, rather than toward, community when loneliness strikes. They often rationalize their isolation with thoughts like, “no one wants me, no one cares, everyone thinks poorly of me, etc.” which is usually not the case at all.


So, is there a cure for these troublesome states of being? Yes. One day at a time, immerse yourself in a community. Community destroys isolation and helps soothe loneliness. It also has as a by-product, the added bonus of accountability, a must for recovering alcoholics/addicts. Create a “loneliness plan” that is for emergencies with phone numbers of people who have agreed to help you when a bout of loneliness strikes that is extra powerful. Remember that feelings are not facts and they change just like the weather. To answer the Beatles important question posed in their song “Eleanor Rigby”, “all the lonely people, where do they belong?”, they belong in healthy relationships with other people living in accountability, honesty, and commitment. These three slay isolation and its’ comrade loneliness dead.


Chris Newcoomb

Thursday, September 23, 2010

“Just Between You and Me”


It’s September! Summer is over and school is back in session. Life goes on, as they say, and recovery must continue! We’ve been going through the 12 Steps this year and we now arrive at one of the most difficult of the 12, Step 9 which states, “Made direct amends to such people wherever possible, except when to do so would injure them or others.” It is hard enough to be honest with yourself about your mistakes much less with the person that you have harmed. But, the Steps call for living in right relationship at least by cleaning up our side of the street with those we have harmed in order to stay clean and sober. To learn more about how this works, please see the A.A. Big Book, pgs. 76-84.


In the best of situations, there are two parts to Step 9. The first component is confession. The second is forgiveness. It is the addict’s responsibility to confess unequivocally their wrong doing. It is the option of the victim to forgive. Whether or not forgiveness takes place, confession is still important to help the addict/alcoholic stay clean and sober. Lingering mistakes and foibles left undone only serve to sear the conscience with guilt and shame which leads to using. Resolution is the order of the day. It is the only thing that brings peace.


In 1995, rock band D.C. Talk released a very powerful song about confession and forgiveness. The song is called “Just Between You and Me”. I have reprinted some of the lyrics to the song because they say so much in so little a space. I will let their words close out my column this month. Read them. Meditate on them. Share them. Most importantly, live them. Just between you and me…you’ll be glad you did!




“Just Between You and Me”

D.C. Talk


(Verse 1)
Sorrow is a lonely feeling
Unsettled is a painful place
I’ve lived with both for far too long now
Since we’ve parted ways
I’ve been wrestling with my conscience
And I found myself to blame
If there's to be any resolution
I’ve got to peel my pride away

(Chorus)
Just between you and me
I’ve got something to say
Wanna get it straight
Before the sun goes down
Just between you and me
Confession needs to be made
Recompense is my way to freedom now
Just between you and me
I’ve got something to say


(Verse 2)
If confession is the road to healing
Forgiveness is the Promised Land
I’m reaching out in my conviction
I’m longing to make amends

So, I’m sorry for the words I’ve spoken
For I’ve betrayed a friend
We’ve got a love that's worth preserving
And a bond I will defend


(Chorus)
Just between you and me
I’ve got something to say
Wanna get it straight
Before the sun goes down
Just between you and me
Confession needs to be made
Recompense is my way to freedom now
Just between you and me
I’ve got something to say

How Naltrexone cuts down on cravings

A patient I saw 2 weeks ago had an implant put in and he kept raving to me about how well it was working. He said that as soon as he had it put in his cravings went away. What he said next was fascinating to me. He said that what had changed was that he couldn’t bring up the memories of getting high any more.

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He was a patient at Williamsville Wellness, an inpatient program where I am the Medical Director. He was in early recovery. Often patients in early recovery like to bring up memories of getting high. They get a bit of a rush from the memories and this temporarily can feel pretty good – until they realize they aren’t actually going to get high! It is hard to stop our brains thinking about and romanticizing those euphoric feelings. I think it is a bit like thinking about a girl we just started dating or if we are remembering those fabulous brownies we love so much. So, my patient said that if he would try to conjure up those euphoric memories he just couldn’t do it. He said it was like the connection just wasn’t there anymore. He felt so good to be free of the obsession.

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When I asked my next patient, an alcoholic, about his experience with the implant he said the same kind of thing. From the moment he got his implant he said he had completely lost his cravings. He particularly noticed it when he went to the grocery store. Normally he would look at bottles of wine and remember how good it used to be. With the implant in he went to look at the wine bottles and realized he just had no interest in them. He had lost the memories of how the wine might make him feel. Like my earlier patient, he felt so great to be free of the obsession.

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I got to wondering if there was anything in the literature that would help me understand this. The prevailing wisdom is that Naltrexone works because it partially blocks the endorphin receptors. The endorphin system (our natural morphine) helps us feel energetic and euphoric. Alcohol and other drugs work by stimulating this system and releasing endorphins so blocking parts of the endorphin system reduces cravings because our brains know that they can’t get high anymore. Naltrexone shouldn’t be doing anything to patient’s memory systems. But does it?

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We have known for a while now that alcoholics and patients with drug addiction get cravings when they are exposed to triggers – small amounts of their drug, or pictures or other memories associated with their drug and alcohol use. When patients get these cravings their pleasure center (Ventral Striatum or Nucleus Accumbens) is activated – just like when they use the actual drug. So could Naltrexone be actually blocking the way these memories activate the pleasure center?

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To my surprise I did find that there is some information about how Naltrexone can interrupt and block memories of getting high. I found some fascinating research and a very informative article written by Dr Hugh Myrick and his colleagues who are affiliated with the Medical University of South Carolina (Archives of General Psychiatry, volume 65, April 2008).

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It turns out there was already some animal research that does indicate that Naltrexone may exert a lot of its effect by reducing what is called “cue-induced reinforcement” – a fancy term meaning that if alcoholics have triggers – pictures or other memories - they will have cravings. The area that is affected by these “cue-induced reinforcements” is our old friend the Dopamine rich Pleasure Center (also called the Ventral Striatum, Nucleus Accumbens or Ventral Tegmental area).

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Myrick and his group wanted to see if Naltrexone would work the same way in humans. Whether Naltrexone would reduce the amount these memories of getting high would activate the pleasure center. They studied about 90 alcoholics and 17 social drinkers. They put some of them on a placebo sugar pill and others on oral Naltrexone. After 7 days they gave them all a taste of alcohol and showed them some alcohol related pictures. The results were exactly as they predicted. The social drinkers had no activation of their pleasure center with the small taste of alcohol or with the pictures. When the alcoholics had either a small drink or saw a picture of a drink they had an increase in cravings and they had an increase in activity of their Ventral Striatum. The social drinkers didn’t get either the cravings or the increased activity in the Ventral Striatum.

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But after the test subjects were on put on Naltrexone they had significantly less craving and significantly less activation of their Ventral Striatum following a drink of alcohol or after they were shown a triggering picture. The results were dramatic.

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In conclusion, it seems pretty clear that one of the major ways Naltrexone works is to interrupt the memory pathways that cause triggers or memories to induce cravings and relapse. This completely fits in with what my patients were telling me. Of course patients don’t really care exactly how Naltrexone Implants work – they just love the fact that the implants work so well. With cravings greatly reduced it makes it so much easier for them to stay clean and sober and start building up a new lifestyle.

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Dr Peter Coleman

Tuesday, September 21, 2010

Enjoying Disequilibrium

Just went to a pretty challenging yoga class. Ellie, my amazing instructor (check out www.yokid.org), told the class we’d be working on equilibrium.

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What she really meant was, we’d be watching what our minds do when we are in a state of disequilibrium. Most of the poses we did were balancing postures. Picture this, then try it (if you’re not currently using mind altering substances). Get in down dog position, then reach your left hand back toward the outside of your left calf or ankle. The idea is to pull all of your energy toward the midline and try to ignore the chattering of the mind: I’m gonna fall! I can’t do this…this teacher is ridiculous….etc. Repeat on your right.

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I always draw parallels between my yoga classes and real life, and often between yoga classes and my clients’ struggles.

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‘Enjoying the Disequilibrium’ certainly can apply to our patients going through Accelerated Opiate and Accelerated Benzo Detoxes.

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Beginning a detox can surely make one feel off balance. Between the opiates or benzos being released from the body and the sedating medications we use to ease people through, many people feel a bit floaty. It’s not unusual for a patient to ask a question on one day, then ask the same question the next day, and again the following day (you know who you are). Don’t get paranoid; we’re always laughing with you, not at you.

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The Coleman Institute is a great place to enjoy disequilibrium; we, along with your support person, are devoted to calmly getting you through. We are completely grounded in our confidence and ability to help you.

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And just like my yoga class, we work hard, but we have a lot of fun.

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Joan Shepherd, FNP

Friday, September 17, 2010

Geographic Expansion – Seattle


As part of our goal to make our unique Products and Services available to a broader population we are pleased to be able to announce our newest partnership. Dr. Michael Rosenfield joins our network of skilled and dedicated professionals, bringing our services to Seattle and the Pacific Northwest. Dr Rosenfield’s office is located at 16 Roy Street, Seattle. We expect to begin accepting patients in early November. Please call Jennifer at 877-77-DETOX if you have questions or would like to learn more about this facility.

Monday, September 13, 2010

Portals to Peace

There are so many portals to peace.

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A deeply practiced spiritual life, immersion in a 12 step program, consistent practice of yoga, meditation, regularly placing oneself in nature…

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And there are so many ways to block entrance to one’s core of peace: over-indulgence in food, chemicals, TV, video games, gambling, working…another endless list.

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The commonality of the portals to peace is wordlessness; creating and inviting space.

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How can you ever really know what gifts you have to bring to the world and what amazing gifts await you if you are constantly filling up every possible moment with mind numbing garbage?

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When you listen to music, be aware that the space between the notes is as important in creating a beautiful melody as the notes. In calligraphy, the white spaces on which the ink is laid allow exquisite expression of the written word.

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Working with people who abuse substances, I recognize there is quite a lot of fear about not using mind -altering substances. It’s fascinating to hear that people think they can’t get along without their pot or their alcohol—even when they are coming in for an Accelerated Opiate or Benzo Detox. I think some are afraid that there would be no one or nothing left to them if they didn’t have the crutch of a drug. For others it is more about the physical fear of stopping.

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If you recognize that you are never giving yourself the opportunity to look inward because you are tormenting yourself with opiate or benzo addiction, you should give us a call. At The Coleman Institute we specialize in helping you take a step toward finding the uniqueness that only you can express.

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Joan Shepherd, FNP

Friday, September 10, 2010

Endorphins Rock

Researchers have found that animals get much more social when they take naltrexone. Dogs wag their tails more and monkeys groomed each other more.

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Naltrexone is what we use at The Coleman Institute after our patients have gone through an Accelerated Opiate or Alcohol Detox.

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Naltrexone blocks the effect of opioids in the brain, which feels bad. No one wants low opioids—why else would people become drug addicts?

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But it’s not just drugs that raise the opiods in the brain, so does social contact.

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Think about this when you’re considering Life After Detox. The success rate for our clients skyrockets when they complete a detox and immediately immerse themselves into intensive therapy, be it intensive outpatient or a month long in patient program or committing to 90 meetings in 90 days.

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Not only are people about the whole process of addiction, they are also surrounded by caring people, which raises the endorphin levels in their brains.

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Endorphins Rock.

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It takes a while to build them back up after artificially slamming the brain with heroin or oxycontin or other drugs.

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Get started now.

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Call us with your questions. We love what we do and we’re good at it.

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Joan Shepherd, NP

Monday, September 6, 2010

Dwell in Possibility

There is some beautiful commaradrie out in the lobby. It’s a 3 day holiday weekend and several patients have taken advantage of scheduling Accelerated Opiate Detoxes with us.

I have people here who have been on methadone for years. One gentleman started with it as an inexpensive chronic pain medication for multiple back surgeries several years ago. Three have been on methadone maintenance after getting off heroin or oxycodone.

They have been on it for anywhere from 2 to 7 years. The amounts vary from 90mg a day to 300mg a day, plus one young fellow tells me on the days he wanted to get high, he used 1000mg a day. How he has survived is a miracle…but then, this whole business is full of miracle stories.

They all have different stories to tell, but the unifying thread, of course, is that each of these people have made the huge decision to change the course of their lives. As Oprah Winfrey says, “Understand that the right to choose your own path is a sacred privilege. Use it. Dwell in possiblity.”

Joan Shepherd NP

Wednesday, September 1, 2010

Five Components to Good Communication

We work with families all the time as part of our addiction treatment, and I’ve witnessed some pretty poor communication skills. It’s kind of exciting that after a person goes through an Accelerated Opiate Detox, the patient and his family can start to work on communication skills. Here are five components that I’ve found to be essential:

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1. Get clear about what you want to say.

2. Consider the other person’s needs before you get started.

3. Speak from your Own Skin, stay in your own business.

4. Be willing to ask for what you want.

5. Don’t have any expectations about the outcome.

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Write these on a bookmark or get a tattoo. Hire me to calligraphy them on your wall. They are most helpful and effective.

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Joan Shepherd, NP