Tuesday, May 31, 2011

PERSPECTIVE



Chris Newcomb, M.Div.

As I write this article, it is the Tuesday following Memorial Day weekend.  Perhaps you joined family and friends in celebrating with gratitude the freedoms we have in America because of those who serve in our Armed Forces.  Memorial Day is a great opportunity to re-orient our perspective about how we live in light of where we live. 

Perspective is important in life for several reasons.  First, reality is not always what we think it is.  We have a way of seeing things in a skewed direction usually in our favor and against others.  Second, right perspective helps us to ascertain the best plan for moving ahead.  Last, perspective can be a game changer, especially in the life of an addict/alcoholic.

When a person begins using drugs and alcohol, they usually are uncomfortable with some sort of aspect of reality that does not fit their perspective.  For example, a girl breaks up with her boyfriend.  In the depths of despair, he decides to shoot heroin because the loneliness feels too overwhelming.  Reality is that the loneliness is not overwhelming and will pass given enough time.  

If, on the other hand, the heroin addicts’ girlfriend breaks up with him and he is aware of his gnawing loneliness, the right perspective would lead him to call a friend or sponsor to talk about it and not shoot up heroin.  The right perspective (I will get past this break-up and these lonely feelings) will lead to the best plan for moving ahead (I will call a friend so my sobriety is not endangered).

In the wake of the break-up, the heroin addict may realize that this is an opportunity for personal growth and exploration.  He might ask such questions as:  Why did this happen?  What was my part in this failed relationship?  What type of person do I want to date in the future?  What type of person do I want to be for my future significant other?   What do I do with these uncomfortable feelings?  

As we continue living our lives this week, let us take a hint from our Memorial Day weekend observances.  Life can be difficult.  Life can be tough.  The right perspective is important and can be a game changer.  After all, not getting hit by artillery would be a great birthday present for me, at least, from my perspective!

Older Addicts Will Stress the Health Care System



Peter R. Coleman, M.D.

My sister-in-law sent me an interesting article from England about how the authorities there are worried that all of the aging baby boomers who are still active addicts will be taxing on the health system.


This is an interesting article from a country and heath care system that often seems to treat addiction in a different way than we do here in the U.S. Doctors in England frequently put their opiate addicts on Methadone and sometimes this all the treatment they get. What struck me when I read the article was that if the addicts had gotten into a drug-free recovery,  their future heath care needs would have gone down - not up. The people I know who are clean and sober have a healthy lifestyle and they take good care of themselves. They are not a drain on other people or the health care system.  How will you live your life and recovery?  

Wednesday, May 18, 2011


WRONG!!!

Chris Newcomb, M.Div.

I am a child of the 1980’s.  This is great for many reasons one of which includes cheesy 80’s game shows.  Do you remember “Press Your Luck”?  How about “Remote Control”?  $25,000 Pyramid?  The Price is Right, anyone? 
One of my favorite shows was “The Family Feud” with host Richard Dawson.  As you may recall, two families would square off against one another to see who could rack up the most points based on surveys the show conducted about various topics such as “#1 item used in the bathroom?” (Answer:  toilet paper).  Each family had a total of 3 chances per turn to answer correctly.  However, if they got a question wrong, a big huge red X much like the one at the top of this article flashed across the TV screen to indict their failed intellect and lack of point acquisition in the game due to an erroneous answer.  I remember as a kid wincing whenever a contestant got an answer wrong and the big “X” of rejection showed up on the screen.  I almost took it personally as if I got the answer wrong! 
Wrong.  I don’t like the word.  It hurts to have it applied to you.  It can mow down your intellect and slay your self-esteem in one fell swoop!  However, we humans are anything but perfect.  Therefore, we have the ability and the eventuality of being wrong.  Sorry to burst your perfect bubble, pardon the pun!
That’s why the good people of Alcoholics Anonymous provided Step 5 which reads, ““Admitted to God, to ourselves, and to another human being the exact nature of our wrongs”.  They were up to something good back in the 1930’s.  They understood the course of human nature and our potential for screwing things up.  Furthermore, they had keen insight into the connection between wrong actions and the drive towards addiction.  They are like two peas in a pod.  In order to recover, it is up to the addict/alcoholic to admit and confess their wrongs to someone they trust. 
Personally, I hate admitting I’m wrong.  Ever felt that way?  There’s just something uncomfortable about it.  However, I have found when I am humble and admit I have “shot the proverbial pooch in the hindquarters” it usually ends up ok.  I tend to forget that fact.  How about you?  What’s your experience in admitting you’re wrong?  Are you willing to do it?  Do you run from the responsibility?               
The most important part of this process is honesty.  As the saying goes, “you’re only as sick as your secrets.”  Are you willing to try this type of honesty out?  After all, the most authentic kind of right you can be is when you admit you’re wrong.  And we all know right feels way better than wrong!
               




Supervised Antabuse Program (S.A.P.)      

Peter Coleman, M.D.

Over the last few years we have been having very good success with our Naltrexone implants for alcoholics.  Many of our patients report that their alcohol cravings simply go away.  I wrote in this newsletter a couple of months ago that there is medical evidence that one of the ways Naltrexone implants work is by interrupting some of the brain pathways.  The Naltrexone seems to actually break some of the circuits that connect seeing an alcohol trigger and having a strong impulse to use the alcohol.
But, we are always doing what we can to improve all of our patient’s success.  So, this month we have introduced a new program to help alcoholics achieve long lasting sobriety.
Antabuse (Disulfiram) is a medicine that patients take on a daily basis and it makes them feel absolutely awful if they drink any alcohol.  It has been available as a prescription for over 40 years and has been found to be helpful in some situations.  Over the years, I have prescribed Antabuse for patients and have found it quite useful, especially for patients who have been relapsing frequently or who have very high alcohol cravings.  However, I have found that Antabuse has usually not been helpful for more than a few months.  Once patients are feeling better they often decide they no longer need the Antabuse and so they stop taking it.  They usually relapse shortly after that.

 That is why we are very excited to be introducing our Supervised Antabuse program (SAP).  The basic idea is that patients will agree to have someone watch them take their Antabuse for 12 months or longer.  They can choose to come to our office every day and our staff will watch them take the Antabuse or, more usually, we can enroll a reliable person they know as our medical assistant – a Temporary Medical Assistant.  The Temporary Medical Assistant will confirm that the patient has taken their Antabuse every day and report back to our office for our medical records.  We will provide some coaching and medical follow up during the program.

Over the last few years, there has been more and more evidence that Supervised Antabuse is the most powerful medical intervention that can be used to help patients.  At a recent conference, I attended in Greece there were a number of presentations on just how powerful the results can be.  Henning Krampe reported results of their work in Germany.  Over a 10 year period, their group had abstinence rates of around 50%.  These are very impressive results considering they were working with the most severe alcoholics.  Many of their subjects had suffered with D.T.'s and other complications of end-stage alcoholism.  Many were homeless, had very few resources and had failed multiple previous treatments.  The German program provided care to the patients for 10 years.  Considering this is over a ten year period, these are amazing results!  In India, Dr Avinash de Souza has achieved results that are even more impressive.  He has studied Supervised Antabuse Treatment and consistently had 12 month abstinence rates of around ninety percent.

The bottom line is that if patients are taking their Antabuse they will not drink, so the key to achieving sobriety using Antabuse is to make sure the patient does take it.  We can make this much more likely by working together as a team - with the patient, a Temporary Medical Assistant, and our office.

We are not thinking that this program takes anything away from the rest of a patient’s recovery program.  Patients need to be fully responsible for their own recovery.  Supervised Antabuse, like Naltrexone Implants, only provides a crutch to help the patient stay sober long enough to make the changes necessary for long-term sobriety.  We still recommend 12 step or other support groups, regular therapy or coaching and comprehensive medical care.  Some patients will benefit from Naltrexone Implants or Vivitrol.  Some patients will benefit from antidepressants or other medicines to help with insomnia, anxiety, Bipolar illness, etc.

I am excited that this program may be able to help a number of patients who are currently not doing well.  If you would like more information, please email me or call me at anytime!


Monday, May 16, 2011

Does Suboxone Have Even Worse Withdrawal Symptoms Than Heroin or Methadone?




We recently had a patient come to us to detox off Suboxone. He was a professional and had been told that he needed to come off the Suboxone in order to get a new job. He was on an average dose and had been on this dose for about 5 years. He went through our standard detox, getting off Suboxone over about 10 days.  During the detox we prepare his brain for being cleaned by giving tiny doses of Naltrexone. He did ok during the detox but once he was fully detoxed he became quite confused and this continued for over a week. Even a month later he was still very weak and not able to function well at all. 

We have had other patients have protracted withdrawal symptoms when they come off Suboxone but this was the most dramatic case so far. Suboxone is a new drug and does not have a long track record. It is now being prescribed very frequently. I hope that we don’t find that doctors prescribing Suboxone are causing more harm than good.

- Peter R. Coleman, M.D.

Friday, May 13, 2011





We all know the truth.  Deep down, whether we want to admit it or not, in the quiet moments before we get out of bed in the morning or as we lay ourselves down to sleep at night, the truth beckons us.  It screams out loud, “You’re not perfect”.  It reminds us of our faults, foibles, weaknesses, sins, mistakes, and mishaps of the day, week, month or years gone past.  Come on, admit it.  At least once, you’ve heard that unwanted voice 
talking to you.  Stop denying it dude, you know it’s there!

Ok, so there was a little melodramatic wording in my previous paragraph!  The point is this:  we are all imperfect whether we admit it to ourselves (others) or not.  The important questions I’d like to raise are: what happens when we try to be perfect and how do we stop trying to be perfect? 

I’d like to start with a quote from Melody Beattie who writes, “Much pain comes from trying to be perfect.”  Truer words have not been spoken!  Beattie hits the nail on the head.  Substance abuse.  Emotional upheaval.  Suicide.  Murder.  War.  Rape.  These are just a few of the awful things that our obsession perfection can illicit.  It sounds over the top but think about it.  At its extreme, Hitler decided to annihilate the Jews in order to preserve the ‘perfect race’ of Germany.  Many distraught women who have been dumped for someone else due to dissatisfaction over their body have killed themselves over that rejection of imperfection by their boyfriend.  

The reality is since none of us are perfect and we can’t be perfect.  Even more obvious, if we are not perfect then we must be imperfect.  Even more obvious than that, if we are not perfect and are therefore imperfect why do we insist on trying to be perfect?!?  I don’t have a clue to be honest.  But, I have a couple of guesses.

Our culture is my first guess.  We live in a culture that tells us to succeed at all costs and never let them see you sweat.  Culture tells us that weak is not acceptable.  It screams out the importance of vanity, strength, vitality, fiscal success, and material possessions.  It tells us that we will be perfect if do A.B.C. etc.  It lies to us. 

Peer pressure is my second guess.  When we see other people doing “well” or experiencing “success”, we often pour the pressure on ourselves to up our “game”.  We compare and contrast ourselves with celebrities, sports stars, and other famous people.  Then we feel let down when we don’t end up being Michael Jordan, Lady Gaga, or Prince William and Kate Middleton!  Interestingly the percentage of human beings who have lived in obscurity versus living famously is massive.  Fame is not the norm.  Obscurity is.  And that’s ok.  You can still have success and excellence within so called ‘obscurity.’

Last my guess is it comes from within each of us.  Deep down we all want to be loved.  We all want to be respected.  We all want to be ok.  Some of us are more aware of it then others but I think by and large that is true across races, colors, genders, sexual orientation, and religious/nonreligious practice.  It is a human thing. 

So, what is the solution to our dilemma?  Start admitting our imperfection.  Look to find freedom in not being perfect.  Tell yourself the truth that you are not perfect and that is ok.  Also, tell yourself to adopt the ideal of excellence as your standard.  Excellence is achievable.  Perfection is not.  After all, if you don’t expect to be perfect, you won’t be let down when reality proves you are not!  

- Chris Newcomb, Aftercare Coach/Coordinator