Wednesday, March 30, 2011

A Special Valentine's Gift


     
      Last week, we saw a patient who was getting his 3rd or 4th pellet.  He was there with his wife who was sporting a pretty nice bracelet, which she proudly showed me.  “Billy got me this for Valentine’s Day,” she told me. “I’ve got my husband back—and he’s a better man.”
     Seems that Billy’s wife had stuck with him through many years of drug use.  He is so grateful to be clean again, and he is so grateful that he’s got the love of his life still walking beside him.  He says he is always looking for ways to show his appreciation, and quite frankly, now that he’s not spending his money on roxycodone (called Roxy’s on the street), he’s got some to spare!
     He said his relationship with his kids has drastically improved as well.  It was so funny to hear him talk about how they rally ‘round him on payday.  They remind him of all the chores they’ve done over the week and put their hands out for a little reward.  His eyes actually got teary when he described how he felt to be the person they now come to for a hug, for support, and yes, for allowance.
     We are in the business of helping people get their lives back.  We are committed to sharing successful stories like Billy's with you from time to time.  It is our goal to have even more so we don't have enough space to tell them all!  Call if you or a loved one feels ready!

Joan R. Shepherd, NP

Thursday, March 24, 2011

I WORK WITH A GREAT GROUP OF DOCS!!!



Every month I coordinate a Quality Assurance meeting with the other physicians in our network. These physicians are in various locals in the United States such as San Francisco, Los Angeles, Seattle, Chicago, Jefferson, Indiana, and Barboursville, West Virginia.  We get together on a conference call on the last Friday of each month and discuss interesting or challenging patients – not that we have any of those!!! The idea is to learn from each other and improve our programs as much as we can so that each patient receives the highest quality care possible. 

This last Friday we had a very lively and interesting discussion about a couple of patients. I was struck by how lucky I am to be part of a group of caring physicians who are smart and knowledgeable, and care about their patients. It is really nice.  We love what we do!

Wednesday, March 16, 2011

U-TURN



            I love to drive!  Most people find driving an annoying but necessary function of modern life that is to be endured not enjoyed.  I have found the contrary to be true, while necessary to succeed in modern life, driving can be thoroughly enjoyable (minus the traffic, of course)!
            Of all the traffic signs available today, I find the ‘u-turn’ sign to be the most amusing.  Written as an upside down letter ‘u’ with arrow on one side, if you do not know what it means ahead of time, you might think it is a right-side up letter ‘n’ that starts with an arrow pointing down.  But, alas, the u-turn sign is important to safe driving.
            The u-turn sign lets a driver know that they can or can’t turn around at a particular intersection.  In this case, we will look at the ‘pro-u-turn’ sign, the one that says, “hey, if you want to turn around, it’s cool to do it here and the cops won’t get ya!”  Believe it or not, it has a direct correlation to Step 3. 
            Step 3 states, “Made a decision to turn our will and our lives over to the care of God as we understood God.”  Did you see that important word?  Turn.  See, I told u-turn signs connect to Step 3!  Let’s see how they fit together.
            People enter recovery because their lives have gotten out of control.  They come to a place that is too tough and too painful to continue without risking serious harm and/or death.  The reason people enter recovery is to try something different because the current path is fraught with pain.  So, initially, when an alcoholic/addict enters recovery, he or she turns away from their old lifestyle to embrace a new one.  After that initial step, the addict/alcoholic is faced with yet another opportunity to turn even further away from their old lifestyle by turning over their will and their life to a power greater than themselves.  This is good news!
            The choice to turn your life over to the power and direction of a power greater than yourself is awesome.  It comes with fear and trepidation for many people.  However, just talk to someone who has made that choice and 9 out of 10 people will give you a positive report.  You will find release, freedom, insight, wisdom, joy, peace, and purpose.  These were not the common gifts of self-destructive addictive behaviors!
            As you consider taking Step 3, consider the possibilities of being even freer than you are right now.  There is a u-turn sign right in front of you.  There aren’t any cops around.  It’s totally legal.  Go ahead.  Do it.  You know you want to.  Turn around and start driving with the sun to your back and the clear blue sky in view.  See where the road takes you.  You might be surprised at what or who you find.   

ISTAAV



The new society is called, The International Society for the Treatment of Addictions with Antagonists and Vaccines (ISTAAV).  It is quite a mouthful to pronounce, but this new organization will be an important ally in the fight to help patients recover from the devastation of addictive diseases. At the Stapleford Conference in Athens there were a number of very impressive papers and presentations using a variety of antagonists. There were presentations focusing on Flumazenil, Naltrexone Implants, Naltrexone tablets, Naltrexone Monthly Injections, Antabuse and a fascinating new Nicotine vaccine that may be able to permanently prevent people from getting any benefit from smoking cigarettes.

The presentations in Athens showed some impressive results including:

  • In a US study, Flumazenil helped 83% of patients detoxify off Benzodiazepines in 5 to 14 days.
  • In a study from Greece, oral supervised Naltrexone helped about 58% of opiate addicts stay off opiates for 12 months.
  • A study from Amsterdam, using Naltrexone Implants, showed an impressive 98% opiate abstinence while the implants were active, and a 58% opiate abstinence rate after 12 months of treatment.
  • A series of studies from India showed that between 88% and 92% of patients were able to stay off alcohol for 12 months by using oral supervised Antabuse. These results were better than a comparison group who were either given oral Campral (Acamprosate), Topamax (topiramate), or oral Naltrexone.
  •  A Russian study of Vivitrol (a monthly Naltrexone injection) used for opiate addicts showed very impressive results including a dramatic reduction in cravings.
  • An Australian study, using placebos, compared oral Naltrexone to long lasting Naltrexone implants and found that the Naltrexone implants were significantly more effective.
  • In a Russian study, Naltrexone Implants helped over 50% of patients stay in treatment.
  • A nicotine vaccine (Nicvax) being developed in the US has been studied in animal models and humans. In rats it was able to decrease the amount of nicotine getting into the brain by 60%. In human trials, the patients with the highest levels of antibodies had a 70% quitting rate.
  • A long term study from Germany using supervised oral Antabuse has a 50% success rate over 10 years.
 These are very impressive results, and I think it is fantastic that there are medicines being developed and studied to help us treat our patients and improve our results. The idea of helping patients get into recovery and stay in recovery by using antagonists is not new. Antabuse has been available to help patients with alcoholism since the 1950s. Oral Naltrexone was approved in the US to help patients with opiate dependence in the 1980s.  

In the past these medicines have not been found to be very effective because patients wouldn’t take them. What is new is the realization that these medicines can be extremely helpful – but only if they are used in an effective way. Oral Naltrexone is of course completely effective for opiate addicts if it is taken. It is a true statement to say that Naltrexone is 100% effective - if it is taken. But the truth is that most patients will not take the medicine over a long period of time. So implants and long lasting injections have been developed and studies from this conference show that these are very effective. Studies at this conference also clearly show that oral Naltrexone can be effective if its administration is supervised.

Similarly, Antabuse is extremely effective if it is taken.  Dr De Souza, from India, has shown in his research that if Antabuse is taken under supervision, as part of a program that involves family members, the success rates are astonishingly high – over 90% after 12 months.

The new Nicotine vaccine also has very impressive results so far. To think that 70% of patients with high antibody levels are able to quit smoking is astonishing. Most other medicines for smoking cessation are only able to achieve 10 – 20% success and these rates decrease after the treatment stops.  Some of the information on this new vaccine indicates that the success rates actually increase over time.  This makes sense because if patients have antibodies preventing the nicotine from getting into the brain, more and more patients will quit over time, as they realize they are not getting any effect.  It is even possible that one day we may be able to offer a vaccine to people who have never even started smoking!

New agents are being developed all the time and it is important to study these to see which new treatments work, in what setting, and how these treatments fit in with the current treatment options. ISTAAV will be an organization that will promote this important research, foster collaboration among researchers and clinicians, and help to disseminate the information. If medical practitioners and therapists have more knowledge about what works then more patients can be helped to restore their lives.

Of course these antagonist therapies are actually forcing patients to be drug free. So the question arises whether forced abstinence is helpful in the long term. What happens after the family member stops giving the Antabuse? What happens after the patient stops getting Naltrexone Implants? If patients have relied on medicines to keep them drug free, have they really learned any new skills? Have they learned why they wanted to use drugs in the first place? Have they really learned how to be happy without looking for a chemical to do it for them?

Here at The Coleman Institute, we believe that stopping drugs is only the first step in a full recovery. Antagonists can help many people achieve some clean time.  Antagonists can help many patients who would not have been able to have this clean time without help.  But long lasting recovery goes much deeper than just being drug free.  It involves changing how we act, how we see the world, and how we see ourselves.  It ultimately involves learning where our happiness really comes from.  These are things that will never come from a pill.



Peter R. Coleman, M.D.