Thursday, December 16, 2010


Step 12
“Having had a spiritual awakening as the result of these steps, we tried to carry this message to other addicts and to practice these principles in all our affairs”

                I love art!  It moves me, excites me, angers me, gives me joy, brings up sadness, and a host of other emotions.  So, I found a picture I’d like to share with you this month at the top of this article.  It’s a very simple shot of a cathedral/sanctuary somewhere in the world.  I don’t know anything about what building it is a part of or how long it has been there.  I only know what I see….a small entry in the distance and wide row of columns that expand as the picture gets closer to the viewer. 
                If you look near the center of the picture, you’ll see a small doorway.  This is a great image for the small bit of hope many addicts see when someone invites them on the journey of the 12 steps.  It’s a hope that is full of light but a very small, narrow, even square, light that quietly whispers, ‘this is the way’.  Just as the steps expand our hope and the possibilities of sobriety and recovery, so too as we travel from the small doorway in the picture and out into the cavernous, stony, Gothic structure our vision expands until we reach the widest point closest to the viewer.  This is the perfect segue for the step of the month: 
Step 12.  
                When we started down the “12 Step Road” this past January, we began with a sliver of hope offered by an admission of powerlessness in Step 1.  We continued to expand our hope in Steps 2 and 3 through the exploration, discovery of, belief in, and surrender to a higher power of our own choosing.  Our journey took a look back at our past in Step 4 so we could be thorough as we sought to clean our spiritual/moral house.  We experienced acceptance and community as we shared these things with a sponsor and our higher power.  Steps 6 and 7 widened our hopes by help us face our character defects and releasing them to our higher power for spiritual surgical removal.  Once surrendered, we continued down the path of hope by listing all the people we had harmed because of our addiction and got ready to make amends through Step 9.  Once this work was complete, we learned a new, hopeful way of daily living through Step 10 (daily amends) and Step 11 (daily spiritual reflection).  And now, we stand at the widest part of our path and our last step of the year, Step 12.  Let’s do it!
                Step 12 is so important in recovery for several reasons.  First, it helps the sober addict to get outside of his/her own head.  Often times, we get stuck in our own obsessive thoughts and not outside of our heads into actual reality.  Getting outside of our minds helps keep relapse away by dealing with reality as it is.  The reality is that there are many people still lost in addiction who need to hear the message of hope.  They need someone to open that small door of hope and invite them in to a different journey and lifestyle. That someone just may be you!
                Second, Step 12 helps the sober addict to stay sober by reminding him/her of where they came from: a dark, windowless space that was lonely, scary, and pitiful.  By speaking with another addict who is currently active in their addiction, the sober addict should get a sober reminder (pardon the pun) of what active addiction looks like, sounds like, thinks like, and even smells like (unfortunately lol). 
                Last, Step 12 helps the sober addict remain sober because it instills a vision for life that is greater than him/her, namely, helping others.  It is in helping others that we help ourselves.  Compassion towards others can also help us practice compassion towards ourselves as well. 
                As we close down 2010, let me invite you to take a look at your perspective towards sobriety and recovery at this point in the year.  Is it hopeful or hopeless?  How has it changed?  How has it stayed the same?  Where could you go from here to have a fuller, more vibrant sobriety?  What things about yourself would you like to change in the coming year?  What kind of perspective would you like to have regarding sobriety this time in 2011? 
                Finally, remember that life is about perspective and I invite you to embrace 2011 with a ‘hopeful perspective’!  Enjoy this season of the year and all that it means to you and yours!

Chris Newcomb, Aftercare Coach/Coordinator

A New Combination Medicine for Weight Loss: Naltrexone + Wellbutrin

     I have already treated a couple of patients with a combination of Naltrexone and Bupropion (Wellbutrin) for weight loss, and the results have been quite impressive.  Now an FDA panel has given its recommendation for the approval of a new combination pill containing Naltrexone with Bupropion (Wellbutrin).  It is becoming more apparent that combination's of drugs can be more powerful when they are given together rather than just using each of them alone.  There is good reason to think that combining Naltrexone with Wellbutrin would be useful to help patients with weight loss.
     Naltrexone is, of course, quite a powerful drug used to treat addictive disorders.  We use Naltrexone Implants as part of our routine treatment for opiate and alcohol dependencies.  Our experience with Naltrexone Implants in opiate addicts is that over 50% of these patients report virtually no cravings.  In a similar way our alcoholic patients treated with Naltrexone implants usually report much reduced cravings.  A recent newsletter article of mine reviewed studies that showed that Naltrexone can greatly reduce the memories of getting pleasure from using drugs and alcohol.  But when it comes to food addiction or obesity, the evidence shows that Naltrexone, either pills or implants, is a lot less powerful.
     Bupropion (Wellbutrin ) is an antidepressant that has been in use for many years.  It is not in the SSRI family like most antidepressants such as Prozac and Zoloft.  It acts more on the dopamine system, which is also the neurotransmitter that is related to addiction (although in a different part of the brain).  Because it acts on dopamine, a number of physicians have tried using it for addictive diseases.  It has been approved by the FDA for tobacco dependence and it has showed some benefit.  Unfortunately, it has been tried for cocaine and other addictions but has not shown a lot of usefulness.  So, Bupropion clearly has some effect in some addictive diseases, just not a very strong effect.
     Combining these two medicines makes sense.  By targeting two separate pieces of the addiction puzzle, it makes sense that there could be an additive effect.  The results of the clinical trials are positive but not overwhelming.  The studies show that patients taking the combination for 12 months achieved about a 5% weight loss. This is better than placebo and better than many other treatments for obesity.  There is some concern about side effects but both of these drugs have been used for many years and have been found to be very safe.
     As mentioned earlier, I have treated a couple of patients with this combination.  One patient reported her cravings for food were virtually gone and she had never had such a powerful effect from any other weight loss treatment.  She lost over 10 pounds in a couple of months!  We are open to trying these medicines if patients want to try to see if this combination will work for them.  Similar to our experience with alcoholics and opiate addicts, it may be that the Naltrexone Implant will be more powerful than the oral tablets.  Like all other addictions, we believe that medicines alone are not enough.  We believe that the best recovery from addiction requires a holistic approach including other treatments such as the 12 steps, individual/group counseling, as well as inpatient/outpatient aftercare.  
Dr. Peter Coleman

Thursday, December 9, 2010

"Ask Alice"

     If you are getting pills from your doctor, don’t assume he’s got your best interest at heart. Just ask “Alice” (Not real name) …
     Last week one of our Accelerated Opiate Detox patients told me she was able to keep herself in denial for a long time because her doctors continued to prescribe pain medication for her. She justified this beautifully, telling herself, “Well, they clearly think I need it, so it must not be a problem.”  Little did she know how much her complicity with the doctor's orders would empower her addiction to opiates!
     Of course, she’d known for a long time it was a problem. The opiates were serving their purpose however. Alice had divorced three husbands, and her thirteen-year old daughter was driving her crazy.  To make matters worse, an uncle abused her when she was a child. The opiates were doing their job of keeping her safely not feeling or dealing.  To be fair to 'Alice', she had a lot of trauma to deal with but drugs only made that trauma worse!
     Recently, Alice met someone who seemed to really like her. She liked him but was ashamed of her pill use. She hid it from him as long as she could, but then totaled a car, and the truth came out. This guy was healthy and concerned enough to tell her that unless she got help, he couldn’t stay in a relationship with her. They split up for 3 months.
     Alice started going to NA meetings, got a temporary sponsor and contacted The Coleman Institute. Her friend returned and was a great support person during her 3-day detox, giving her a little slack when she needed it and a compassionate roll of the eyes when she needed that too!
     Alice’s chances of having a good relationship with a good guy are stellar. She is making choices to support her values. Some baby steps, some giant leaps.
      If you are getting pills from your doctor but want to talk about it, give us a call. Twice a month, Dr. Coleman has an open phone line to answer any questions you might have.  The next call in will be on Wednesday, December 15th - 1:00-2:00pm (EST)

Joan R. Shepherd, NP

“A man dies daily, only to be reborn in the morning, bigger, better and wiser.” – Emmett Fox

     We are entering the final stretch of 2010. The temperatures are dropping. The turkey has been digested. Christmas lights are starting to light up the avenues, byways, and highways of our nation. And yet at this time of year, people tend to be so stressed out. Whether they are celebrating Christmas, Hanukkah, Kwanzaa, or just being with family and friends, this time of year lends itself to stress, frustration, and sickness more than most of the rest of the year. Why? I wish I knew the answer.
     However, one thing remains constant regardless of what day of the year the current one is, we always restart who we are and where we’re going at the start of each new day. Psychologists say that one of the best times to figure out what is really important to you is by paying attention to your first thoughts when you wake up in the morning. It is during the first moments that we wake up that we are most vulnerable.
     Think about it: You’ve been asleep, usually all night, and now you have woken up to a new day. Your body begins to charge up. Your mind starts to wander and race about the day ahead. And you receive what might be termed a ‘daily rebirth’. That is, seeing that you are 6 feet above ground, you get another chance to go through life. This is GREAT news! Unfortunately, most of us never choose to see our lives this way. Instead, most of us get stuck thinking about bills to paid, deadlines to be met, kids to get to school, significant others to please, and rest and relaxation that seems unattainable. I think there is a better way to begin our new days ahead.
     Mr. Fox rightly asserts that each of us die daily. Biology proves that fact. All you have to do is look at our culture’s obsession with youth and beauty (read: cosmetic industry in the U.S. makes over 1 billion dollars annually) in spite of the fact that aging is an unalterable fact of life! However, what he says after that fact is pretty astounding. First, his perspective is positive. He doesn’t say that we wake up smaller, worse, and more stupid although that may happen to a few select individuals (see the Darwin Awards). His vision is that we awake to a new day bigger than the last because we got through it. We survived the soaring highs and low lows. That is something to be happy about it!
     Fox also makes note that we wake up better than we did a day earlier. Of course, many days we don’t feel that way but it’s true. If I face the challenges of the day and fail, I am still better for having faced them. It’s when we run from the challenges of life that we get ‘worse’, so to speak, in our personal growth.
Finally, Fox adds that we get wiser with each new day. Nothing could be more true! I’ve learned so much throughout my short life. And the more I learn, the more I grow. And the more I learn, the more I want to learn. And, the more I grow, the more I want to grow. It is addictive, pardon the pun.
     So, as you face the stress of this time of year, I encourage you to take those first few twilight moments as you wake-up and remind yourself of how much bigger, better and wiser you are on this day than you were just 24 hours ago. Believe it or not, you’ll be surprised at what you find. Submit yourself to a rebirth each morning. Embrace the re-calibration of the new day. Finally, embrace the rebirth of a new calendar year and all that it can bring to you and yours!

- Chris Newcomb, Aftercare Coach/Coordinator