Monday, December 19, 2011

Holiday Detox

It’s not unusual for patients to express how different it feels to be treated at The Coleman Institute.

Yesterday, a gentleman from Maryland who came to The Coleman Institute for a Rapid OpiateDetox remarked about his previous doctor who had treated him for pain, but did not have experience in treating the physical dependence which subsequently developed.

 He knew how to get the patient on pain meds…but didn’t know how to help him get off pain meds. In frustration his doctor cut him off, basically telling him he ‘didn’t need the meds anymore’, and implied it was a character flaw that he was still using them. 

He’d been chastised, lectured to, and judged for his inability to stop. At best, he felt like a second class citizen; on bad days—like a criminal.

 He told me it was a refreshing experience to come to a facility staffed by medical professionals who understood the disease of addiction.

Besides recognizing addiction as the medical condition that it is, another feature that distinguishes us is our commitment to working with our clients’ schedules.

We cared for several patients getting off methadone and other opiates throughout the Thanksgiving holiday, and we will be treating patients through the Christmas and New Year’s holidays as well.

If you or a loved one is ready to commit to starting 2012 drug-free, please give us a call. We’ll have the (virgin) eggnog ready. 

Joan R. Shepherd, NP


Thursday, December 15, 2011

Opiate Recovery (without Naltrexone Implants) is extremely difficult

Since doctors first started treating addiction, it has been clear that long term recovery rates for patients with opiate addiction are very low.  In 1989, I worked in a very good outpatient treatment program here in Richmond Va.  After a few years, we studied our success rates.  Our alcoholic patients did quite well - about 60% were still sober after six months.  But when we looked at our heroin addicts, it was a completely different story - not even one patient who had been hooked on opiates was still off drugs after six months.  Most of the patients didn’t even complete the 8 week program.  They dropped out of treatment because they had relapsed back onto their opiates – (This was before I started using Naltrexone implants).  I realized at that time, that without help, most patients are just not able to overcome the intense cravings to use again.

A recent study from a VA Hospital in Washington State affirmed my experience.  Their study showed terrible success rates, even with very good treatment.  They studied 112 patients who wanted to get clean, and were admitted to a hospital for detox.  22 % didn’t even complete the detoxification process!  What is worse, and very significant, is that after only 3 months there were only 3% who were still free of opiates!

Three percent success rates with regular treatment is awful.  And this was a good program - their detox methods were standard, they offered intensive therapy, either inpatient or outpatient, and they offered other long term support for all their patients.  And, even with all of this, they had only 3% of their patients who were drug free after three months.

There is a lot to learn from this study.  First, the withdrawal symptoms from opiates are so strong that many patients do not complete the acute phase of detox.  Second, most of the patients that do get through the acute detox period suffer from post acute withdrawal symptoms and quickly relapse, within the first three months. When you think about results like this, it is not surprising that many physicians and many treatment facilities give up on having their patients get completely off drugs. Instead, they recommend long-term opiates like Methadone or Suboxone. Fortunately, we have found a better way to help patients stay completely drug free! We use a non-addictive medicine that decreases cravings and helps patients avoid relapse – Naltrexone Implants.

I have to say I am very proud of the programs we have developed here at The Coleman Institute to help patients get through the critical time period of early recovery.  Our Accelerated Detox Program is comfortable for the patient and it has over a 99% success rate at completing the detox.  It is very rare that patients who start our program drop out and do not complete the detoxification.  

At the end of the detoxification process, we insert a small Naltrexone Implant.  It is an easy procedure that usually takes only 5 minutes.  The Naltrexone implants we use provide excellent protection during those first critical months when the brain is crying out so strongly for opiates.  

A number of research studies have shown that patients using Naltrexone Implants achieve a 60% success rate, even after 12 months.  We have similarly good success in our offices. 

It feels good to be providing programs that help patients get completely off drugs and start to reclaim their lives. 

The staff and I The Coleman Institute wish all of you a great Holiday Season and a Happy New Year!!!

 ~ Dr. Peter R. Coleman


“A man dies daily, only to be reborn in the morning, bigger, better and wiser.” – Emmett Fox
We are entering the final stretch of 2011.  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, M. Div. 

Wednesday, December 14, 2011

Special Delivery!!!

I saw a patient in follow-up today who just made me smile.  He came in for his 6th implant today; so although he’s had one relapse on his journey, he’s been clean for most of the year.  And he is one peaceful, happy, and grateful man!

He has a girlfriend who chose to stay with him because he committed to getting and staying clean.  He has proven this to her by coming to The Coleman Institute for regular appointments and going to AA meetings several days a week. His consistent choices are helping him stay clean one day at a time. 

Today, he told me that he and his – now fiancé- planned a pregnancy and she is about 8 weeks pregnant!  They will wrap up a ‘onesie’ (you know, one of those little baby long-john outfits with the built-in feet) and present it to his parents on Christmas Day.  They will be first-time Grandparents…and yes, they will be thrilled!

He told me that the most interesting thing for him since he has become sober is realizing how he used to view the world.  He says he used to blame others for all his problems.  Now, he says he can see how his behavior affected others.  He is starting to give back in little ways, like coaching his niece’s basketball team.  He promised me he’ll bring a picture of the baby’s ultra-sound in two months.  I can’t wait for that chapter!  

- Joan Shepherd, FNP

Thursday, December 8, 2011


A couple of weeks ago, we did an Accelerated Alcohol Detox on a lovely young man who is happily still among the living.  He was involved in a pretty bad motor vehicle accident and ended up in the hospital after blowing a breath alcohol level of 2.8.  Yikes!!!   Amazingly, he didn't get hurt too badly. 

At The Coleman Institute, we steer people into the most appropriate level of aftercare which may also include therapy.  He didn't talk much during the detox because he's a pretty quiet guy.  After he completed his detox, he started going to his I.O.P. (Intensive Out-Patient) classes.  I think the experience was kind of like a drowning, thirsty guy getting water.  He realized for maybe the first time in his life that he was surrounded by people who KNEW him! 

This not in any way discounting his very supportive family.  They talked about feelings and what happens when we don't know how to express them.  They discussed the A.A. 9th step promise: "We are going to know a new freedom and a new happiness."

He said good things were already starting to happen.  He owed over $10,000 for his emergency room visit, and he has no health insurance.  He received a call a couple of hours before his follow up appointment with me from the patient advocate at the hospital: the entire debt has been dissolved!  He is looking for more good things to continue.  I have no doubt they will!

- Joan Shepherd, FNP   

Thursday, December 1, 2011

Affirmations of a Warrior

Chris Newcomb, M.Div.  

I love action movies.  In particular, I like movies with action heroes who are the epitome of muscle bound, gun-toting, tough guys who obliterate the enemy.  Why?  Because every guy wants to be THAT guy!  Whether they admit or not, there is not a guy out there who hasn’t wished, at one time or another that they had the body of Arnold Schwarzenegger, the fighting skills of Chuck Norris, and the suave of George Clooney combined with the black tie good looks of any James Bond actor (or if you’re a child of the 80’s who wanted to be the Ultimate Warrior…see picture above).* 
There’s good news:  even if you are none of the above, you can still be a mental warrior.  Below you will find the 5 mantra’s of Warrior Affirmations for Recovery**.  I challenge you to speak these out loud first thing in the morning and last thing before you go to bed for the next 5 days.  Keep a written record of how you feel each day and if you notice any changes in your thoughts and/or behavior as it pertains to your sobriety.  You never know what you will gain if you do not try!
Warrior Affirmations:

Ø  I am a warrior.  I live in a no excuse world.
Ø  I am a warrior.  I play at 100%.
Ø  I am a warrior.  I do whatever it takes.
Ø  I am a warrior.  I keep my commitments no matter what.
Ø  I am a warrior.  I never give up.

* Ultimate Warrior and Warrior Affirmations are separate, unrelated entities
**Warrior Affirmations are from an anonymous author

Monday, November 28, 2011

“Hopelessness is the negation of possibility”

The title of this blog is actually a phrase from The Tao of Sobriety David Gregson and Jay S. Efranleapt. On Thanksgiving morning, I read the quote and it jumped off the page at me after two incredibly busy weeks at The Coleman Institute working with people who are choosing to get off methadone and other opiates.

The authors go on to say, “Hopelessness trades on the past, which it depicts inaccurately. Possibility is about the future, which remains virgin and uncharted. No matter how badly Acts I and II have gone, Act III has not yet been fully scripted.” I could share so many stories of possibility—from this week alone!

There was the beautiful mother of two boys whose fiancé overdosed a week after she’d accepted his proposal. She went on methadone herself then, feeling it was the best choice to keep her alive—and sane. After four years of daily visits to the methadone clinic, she came to us for our rapid detox program. In eight days, she came off methadone, enrolled in an excellent counseling program, and is very grateful to be more present for her sons.

Max* came for a follow up visit and to get his naltrexone refilled. In December, it will be a year since he completed a rapid opiate detox and has been free from oxycodone. He had all our staff in tears when he proudly showed us the picture of his exquisite ten-month old daughter. His testimony about how sweet his life is was so moving, I asked him to make the rounds with me to visit other patients who were completing rapid detoxes. There are no words—even from our staff who see daily success stories—that can compare to seeing a person in the flesh that’s a year away from the powerful grip of opiates.

Lisa* lost her sister and nephew in a tragic car accident several years ago. She had access to opiate pain medication and began to use it to blunt the pain of her loss. It was not long before she turned to heroin. She too, completed our three-day rapid detox. Her beautiful spirit matches her outer beauty. We teased her about being the Detox-Queen—she was feeling good enough to indulge in a manicure, pedicure and facial while she was in Richmond, so she was looking pretty good! Her plan: reclaim her health in all realms: physical, spiritual, emotional and intellectual. Besides participating in our Recovery-U program, she will work with a grief counselor and has re-joined her gym. She has flanked herself with friends who will go to AA and NA meetings with her.

I could go on and on with the stories of possibility I hear and am blessed to participate in daily. After Max told his story, my colleague, Courtney Harden, FNP said, “That’s why I love my job.” Amen.

If you, or a loved one, are ready to embrace possibility and quiet the intrusive voice of hopelessness, please call and speak to Jennifer . We would love to help you get to Act III!

- Joan R. Shepherd, NP

*Names changed and stories altered in minor ways to maintain patient’s confidentiality.

Five year outcomes for physicians treated for substance abuse

Here is the abstract of a great article showing what great success we can have treating substance abuse.

Five year outcomes in a cohort study of physicians treated
for substance use disorders in the United States

A Thomas McLellan, chief executive officer,1 Gregory S Skipper, medical director,2 Michael Campbell,
research scientist,3 Robert L DuPont, president3

Objective To evaluate the effectiveness of US state
physician health programmes in treating physicians with
substance use disorders.

Design Five year, longitudinal, cohort study.
Setting Purposive sample of 16 state physician health
programmes in the United States.

Participants 904 physicians consecutively admitted to
one of the 16 programmes from September 1995 to
September 2001.

Main outcome measures Completion of the programme,
continued alcohol and drug misuse (regular urine tests),
and occupational status at five years.
Results 155 of 802 physicians (19.3%) with known
outcomes failed the programme, usually early during
treatment. Of the 647 (80.7%) who completed treatment
and resumed practice under supervision and monitoring,
alcohol or drug misuse was detected by urine testing in
126 (19%) over five years; 33 (26%) of these had a repeat
positive test result. At five year follow-up, 631 (78.7%)
physicians were licensed and working, 87 (10.8%) had
their licences revoked, 28 (3.5%) had retired, 30 (3.7%)
had died, and 26 (3.2%) had unknown status.
Conclusion About three quarters of US physicians with
substance use disorders managed in this subset of
physician health programmes had favourable outcomes
at five years. Such programmes seem to provide an
appropriate combination of treatment, support, and
sanctions to manage addiction among physicians

Tuesday, November 22, 2011

Substance Abuse Treatment Programs for Physicians: Are These Programs the Best Possible Treatment for Everyone?

Last week, I was asked to speak to a group of Physicians, Nurse Practitioners, and Nurses on the subject of Substance Abuse in Health Care Professionals. It is a subject near and dear to my heart, and it was a pleasure sharing my knowledge and experience with this group. They were bright and eager to learn and share their experiences.

As I researched the topic, I came across some recent research that is very illuminating. The research reviewed, not just how we treat physicians, but the research also gives us information on some of the principles that we can use to treat anyone who has a substance abuse problem.

The research was reported in The Journal of Substance Abuse Treatment, and was written by Robert DuPont MD and his colleagues. Dr DuPont decided to study how we identify, and treat, addicted physicians. Most states in the US have programs called Physician Health Programs (PHP’s), to help physicians with substance abuse problems. The programs are usually set up under the authority of the State Licensing Board with the intention of both protecting the public from impaired physicians, and helping those doctors heal from their addiction.

Dr DuPont and his colleagues were able to survey all 49 of the state PHP’s and then get outcome data on many of the physicians who were followed by these PHP’s. The features of the PHP programs usually included: (a) intensive and prolonged initial treatment – either inpatient, residential, or outpatient treatment (typically 30 to 90 days), (b) treatment that was almost always abstinence based and usually included strong 12 step support, (c) 5 years of extended support and monitoring with significant consequences for any relapses, (d) involvement of family, colleagues, and employers.
The treatment outcomes for these physicians were remarkable. The researchers were able to review the records of 904 physicians and remarkably 78% of these doctors had no positive drug screens for alcohol or drugs over a 5 year period. In other words, 78% of these physicians were able to get detoxed off their drugs, complete their treatment program and not have a single relapse on alcohol or any drug for at least five years. Many of these physicians were highly addicted to very potent drugs and many went back into practice where they had access to the drugs, but they still did not relapse. The results are actually even more impressive - of the physicians who had one positive test, 74% had only one positive test – they were able to get back on track and then maintain their sobriety.

I find this research very interesting and very informative because it supports what I was taught back in 1984 when I went to my own treatment. I had a serious problem with drugs and alcohol and was forced to go to a program for impaired professionals. The treatment program I went to was supported by the Virginia Impaired Physicians Program. It had all of the features that were described in the research article. The initial treatment lasted 4 months. It was definitely abstinence based. It was followed up by aftercare and 12 step involvement. It included drug screening and I knew that there were serious consequences for any relapses. In 1984, while I was in treatment, I was told that if I surrender to the program and do what I was told, that lifelong recovery was virtually guaranteed. I remember feeling very reassured that the path out of my problems was clear. I have now been clean and sober for over 27 years and I am so grateful that I was able to get the treatment that I did. It is also nice for me to see that the other people I was in treatment with are also doing well.

The success rates that are described in this research are very impressive. When I was in treatment, I was very aware that most patients who came to treatment only stayed for one month. I was told that their long term success rate was about 60% - good, but not as good as the success rates that can be achieved if patients stay for 3 – 4 months of initial treatment. The main reason why the physicians were able to achieve such high recovery rates seems to be the length and intensity of their initial treatment.

Since that time I have done what I can to design programs that help all of our patients achieve the best recovery rates. Our treatment protocols at the Coleman Institute recommend a rapid detox, to quickly get the drugs out of their systems. We then do what we can to have the patients to opt for 12 months of Naltrexone implants, and intensive counseling for at least 3 months. We know that it takes time for patients to physically recover, and it takes time for them to fully accept their illness, and learn the skills needed for lifelong recovery.

- Peter R. Coleman, M.D.


I love a good song. As a matter of fact, I am “thankful” for music. It expresses what words can’t say. But sometimes the lyrics to a song can move you too. Take, for example, Sly & the Family Stone’s 1970 funk hit “Thank You Fa-Lettin-Me Be Mice Elf Agin” (yes, the title is purposely misspelled). The song speaks of the social struggles of the 1960’s & 70’s which included a whole lot of drugs and alcohol. Check out the lyrics to the first verse:

Lookin' at the devil, grinnin' at his gun; Fingers start shakin', I begin to run; Bullets start chasin’, I begin to stop; We begin to wrestle, I was on the top”

If we take these lyrics and apply them to addiction recovery, it is striking what they can tell us. When people are out using, the drug is like a “devil” which means “accuser”. The drugs accuse the addict of being worthless, needy, imperfect, unlovable, and powerless. They call the addict to use. “Fingers start shakin’” is akin to getting the rush or “jonsing” for the drug. The body starts shaking and the mind starts racing. And the struggle not to use begins much like a “bullet chasin’” you because you know if you use it’s like getting shot in the back with a shotgun, painful and messy. At this point, the verse is pretty grim just like the lives of those stuck in active addiction to drugs and alcohol. But wait, the story’s not over yet.

Stone sings, “I begin to stop”. The protagonist stops running. He/she is tired of the bullets, tired of the pain, and tired of the suffering and decides to do something about it and stops. Do you remember the day you decided to stop? Do you remember how good it felt to make that decision? Do you remember what it felt like to turn around and look the “accuser” (i.e. heroin, pot, alcohol, etc.) straight in the eye as it called you names? It was the beginning of the struggle back to life. It became the wrestling match of your life.

The word “wrestle” means, “to combat an opposing tendency or force” and that’s exactly what happens in the song as Stone belts out the line, “we begin to wrestle.” Just like the song, the addict who stops, turns, and faces the accuser, begins that crucial wrestling match for sobriety and recovery. Wrestling is not for the weak of heart. It causes bumps and bruises. But, we see at the end of the verse that the devil is getting it handed back as Stone confidently sings, “I was on the top.”

Any addict who faces their addiction can be on top too. And when you’re on top, life begins to change. Your perspective shifts. Gratitude starts to sweep in and take over. And that’s what recovery is about: a process of changing into who we really are in the first place; ourselves, and adopting an attitude of gratitude for all the goodness in our lives! As this process continues, we become more and more thankful. We are filled with gratitude for the blessings of sobriety and recovery. We are thankful not to be a slave to the drug any longer one day at a time.

Gratitude is a gift that feels very good. It’s crucial to staying sober. So, this Thanksgiving as you gather with family and friends to celebrate all the blessings in your life, I encourage you to be grateful for your progress in recovery. And when you do that, why not pause and say, “Thank You for Letting Me Be Myself Again”!

P.S. We never hear whether or not the protagonist wins the wrestling match but I have a feeling he did. So can you!

- Chris Newcomb, M.Div.

The Couple that Detoxes Together...

One of the most gratifying scenarios we see at The Coleman Institute is when a couple—married, engaged or significant other—come together to do an Accelerated Opiate Detox. I know that doesn’t sound particularly romantic, but you can imagine the challenges that a couple face when they both have an opiate addiction.

Frequently, the plan is for one person to get clean, then the other. You can see why this is a tough problem. The newly detoxed patient, struggling with early sobriety, goes back home to an environment
where opiates are still being used. The guilt and shame of the still-using partner is compounded because they know their partner is desperate to stay clean.

When a couple is able to do this together, they are on the same page. They can start counseling together and move forward more steadily. They have each other to lean on, as well as the support of their families and/or sponsors. And, of course, with the naltrexone implant, a person will have opiate blocking for about two months: time enough to get a real start on their long-term recovery plan.

If you have specific questions about coming as a couple for an Accelerated Opiate Detox, please call our office…you can always go to the Bahamas next year. Trust me, it’s much better when you are sober!!!

- Joan Shepherd, FNP

Wednesday, October 26, 2011

A Priest, a Nun, and a Gobstopper?

Chris Newcomb

Happy October!  This is the month of ghouls, ghosts, goblins, and even gobstoppers!  That’s right, Halloween is just around the corner.   Kids will be trick or treating so they can visit the dentist in November!  And, of course, it follows, that many will be attending costume parties.  

One of the most popular costumes people wear is the cassock of a priest or the habit that is worn by nuns.  The joke is usually that the wearer of said costume is either non-religious or purposely blasphemous to religion in general.  Be that as it may, people find great joy in seeing someone play a role that is not normally them.  In spite of this obvious discrepancy, people will often playfully go up to a ‘nun’ or ‘priest’ at a party and ‘confess’ their sins or mistakes much to the delight of those around them.  These black marks of the soul may be actually committed by the confessing party or just made up off the top of their head.  Either way, people pay attention.  We should too. 

Step 10 of the 12 steps of Alcoholics Anonymous instructs addicts and alcoholics to continually pay attention to their words and actions because of the negative effect they can have on others around them.  In fact, not only does it encourage constant vigilance over personal conduct, it goes one step farther:  it instructs those who are out of line to make an amends as soon as possible after the offense is committed.  Brilliant idea.  Hard to live out!

So what does all this mean?  Well you don’t have to go to a priest or nun at a party for starters!  Of course, if you are of some religious persuasion, you can go to your spiritual advisor to discuss your misdeeds.  This is good for cleansing of the soul as well as an outsider’s perspective.  The most challenging part is confessing your wrongs to the person(s) you actually hurt. 

The important thing to remember is that you are only responsible for your side of the street, so to speak.  That is, you only acknowledge and confess your wrong doing to the injured party.  Their reaction, positively or negatively, should be their concern not yours.  They may thank you and forgive you on the spot.  On the other hand, they may chew you out and never speak to you again.  The point is not their reaction but rather your honesty and timeliness in making right your wrong. 

You may be asking the question why at this point.  Why is it important to do this in the first place?  Why does timing matter and why does it need to be as soon as possible?  These are all good questions.  The main reason for “clearing the slate” is if they do not deal with issues very soon after they happen, they tend to relapse.  Broken relationships, mistakes, faults, and sins cause many people to run right back to their addiction.  Then they continue to embrace the spiritual malady instead of running to the cure of confession.  What will you do? 

I’ll leave you with these words by the music group D.C. Talk.  The song is called “Between You and Me”.  They sing the following words which when digested can only leave us with one impression:  the need to take action.  Will you take action?

“Between You and Me”
 "Just between you and me,
Confession needs to be made
Recompense is my way to freedom
It’s my way to freedom”  (D.C. Talk)