Friday, August 26, 2011

 Chris Newcomb, M. Div. 

Lists.  “Type A people love them.  Type B people can’t stand them.  I am somewhere in the middle.  When I make them, they are very effective.  I remember to make them about .2% of the time! 
Do you make lists?  If so, why?  If not, why not?  I’m going to make the case that list-making is a very fruitful and productive use of your time in life and in recovery.  Step 8 instructs recovering individuals to make a list.  Let’s see why…

As recovering people move through the Twelve Steps, one thing becomes apparent to them:  most of their time has been spent living for just themselves via their drug and alcohol abuse.  The result has been selfish and self-destructive behavior that has also wreaked havoc on those most close to them and even random strangers. 

If you think back to when you were a kid, you probably grew up singing the words to this familiar holiday classic “Santa Claus is Coming to Town”: “He's making a list, and checking it twice; gonna find out who’s naughty and nice, Santa Claus is coming to town.”  I remember hearing those words and thinking I was a well-behaved boy that year.  I knew for certain that I would be given the ‘nice’ stamp of approval.  Of course, my young mind stopped remembering anything I did wrong before December so I was usually incorrect about my lack of bad deeds!  The one feeling I remember was a sense of guilt and shame wondering if I had, in fact, fallen into the “naughty” category!

Thankfully, there is hope!  Step 8 says, “we made a list of all persons we had harmed and became willing to make amends to them all.”  This type of list has a different purpose than the supposed list St. Nick keeps on boys and girls across the world.  This list is not about bad and good.  It is about right and wrong.  Where was I wrong to someone in my behavior?  When did I act selfishly at the expense of someone else?  How have my selfish actions hurt other people? 

These are tough questions to ask but they are necessary.  In order to free ourselves from the guilt and shame of our past, we must be brutally honest with ourselves.  Second, we must be willing to be brutally honest about how our behavior hurt other people.  In doing so, we remove the veil of secrecy, denial, rationalization, and justification that will keep us acting in similar destructive ways. 

So, get out your pen and paper.  Make a list.  Check it twice or more.  Go easy on yourself but also be honest and write it all down.  The door to freedom is swinging wide open…will you take the list and walk through…?

Accepting that Alcoholism and Drug Addiction are Diseases

Peter Coleman, M.D.
It is becoming hard to remember just how much society has looked down on alcoholics and people with drug addiction problems. Since the beginning of recorded history, there have been references to the fact that, while most people are able to enjoy their alcohol, some people drink too much, make fools of themselves and hurt themselves and the people around them. It sure looks like these people are weak and immoral. It is actually very hard to conceive that they may be suffering from a disease, and that these behaviors are not their fault. Betty Ford helped to change all of that.
Until recently, even the medical establishment did not view alcoholism as an illness. There were some pioneers like Benjamin Rush who, in the 1700s, believed that alcoholism was a disease, but this was very much in opposition to the usual thinking of the day. It is easy to understand this because alcoholism and drug addiction involve the willful taking of substances. It absolutely seems that alcoholics are making willful choices that end up hurting themselves and hurting everyone around them. It certainly appears that alcoholics and drug addicts have a “weakness of character, poor willpower, poor ethics, and a general disregard for themselves and for others”. Society, in general, has had problems seeing things any other way. And the people with these problems have their own difficulty accepting that they have a disease. Who wants to admit that they are not in control of themselves? It is not surprising that the main support group for alcoholics determined that they needed to be anonymous. Early people in recovery had to meet completely anonymously. The reality was that being found out could have devastating consequences. I recently saw a photograph that now looks pretty comical. It is from the very first days of AA and shows early AA members talking and giving testimony on a radio show. They were standing in front of a microphone wearing Lone Ranger type masks, obviously because they felt the need to guard their anonymity. It is a pretty ironic photograph considering the fact that no one who was listening to the radio would be able to see them! In fact this is a powerful reminder that these men and women felt it was so necessary to be anonymous that they had to guard their identity even to the staff of the radio studio.

Things have changed a lot since those days. Those of us who are either in recovery ourselves or who are working in the addiction field have Betty Ford to thank for a big piece of that change. In the 1970s, while she was First Lady of the United States, Betty Ford was abusing alcohol and was addicted to pain medicines. In 1978 the Ford family found it necessary to deal with Betty's alcohol and drug addiction. They staged an intervention in order to convince her that she needed to stop drinking and stop taking the opiate pain pills that she had been prescribed for a pinched nerve in the early 1960s. This was radical stuff. The president's wife was not supposed to be an alcoholic, and she was certainly not supposed to be a drug addict. But the truth is she was. Fortunately for her she had people around her who loved her and cared enough about her to help her get the help she needed. She went to treatment. She stopped using alcohol and drugs. She got into recovery, and like many people in recovery she decided that it was important to help other people who suffer with alcoholism and drug problems. She announced to the world that she had been suffering from these problems, and she did it in a non-judgmental and an unapologetic way. She took responsibility for her recovery. In 1982, she helped establish the Betty Ford Center in California. This excellent treatment program remains one of the preeminent inpatient treatment programs in the nation and has literally helped thousands of alcoholics and drug addicts and their families.

Our understanding of what causes alcoholism and drug addiction has changed a lot since the 1970s. It is now more clear that there is really no difference between alcoholism and drug addiction - it is really one illness that we can call chemical dependency. Patients who drink alcohol heavily do not have a different disease from those who are addicted to drugs. Dr. Bob, one of the founders of Alcoholics Anonymous, was simultaneously addicted to alcohol and drugs - just like Betty Ford. The medical evidence makes it more clear that patients with addictive problems are genetically vulnerable to the addiction process. It is not their fault that they have an addiction. It is their responsibility to deal with it. Since 1978, medical research has clearly outlined the parts of the brain that are corrupted in the addiction process. The brains pleasure center, which is there to ensure we survive as a species, becomes damaged and drives people to continue to take their alcohol or drugs even though all of the evidence says they should stop. There is now a large field of genetic research that is beginning to outline the exact genetic differences between those who can drink safely and those who lose control.
It is an exciting time to be working as a physician in the field of addiction medicine. It is becoming easier to work with patients and to help them understand that they do not have to feel guilty for having the drug or alcohol problems. For many patients knowledge of this fact is very liberating. It helps them to accept their illness, move on and reclaim their lives. It helps them repair the damage from the past and become the people they want to be.
Many of us have Betty Ford to thank. While she was only one piece in the puzzle of helping society to accept alcoholism as a disease, she was an important piece.

Wednesday, August 24, 2011

Fruity pebbles for twelve, please

Busy week working with people who are getting off methadone, suboxone and various combinations of oxycontin, percocet and vicodin.

Behind Door Number One, the patient’s mother, asked, “Is it normal that he’s eaten 2 boxes of Fruity Pebbles since he started this detox?

Behind Door Number Two, the puzzled wife of the detoxifying patient states with incredulity, “He ate the whole pan of banana pudding and an entire crumb cake in the last 12 hours….is that OK?”

And behind Door Number Three, an amused best friend and former patient, laughs and says his buddy has gone through three bags of pork rinds, 2 cheeseburgers and a gallon of ice cream, wondering if he’d done the same thing during his own detox.

According to Dr. David A. Kessler, author of The End of Overeating: Taking Control of the Insatiable American appetite, “The neurons in the brain that are stimulated by taste and other properties of highly palatable food are part of the opioid circuitry, which is the body’s primary pleasure system. The “opioids,” also known as endorphins, are chemicals produced in the brain that have rewarding effects similar to drugs such as morphine and heroin. Stimulating the opioid circuitry with food drives us to eat.”

So, it is not a bit surprising that the abrupt cessation of opiates would trigger this craving for whatever happens to be one’s own comfort food.

Not to worry. We can always talk about diet and exercise at the follow up visits. Just remember to brush your teeth.

Joan R. Shepherd, NP

Friday, August 12, 2011

Tattoo tells all

I heard a chilling story from a patient yesterday.

Jimmy (not his name, of course) came in for a re-fill on his Antabuse. Antabuse, for those who are unfamiliar, is a drug that can make you pretty ill if you ingest alcohol while taking. He had about 4 months sobriety from drinking when he fell off the wagon and went on a pretty huge bender for about a week. He woke up in his room, slumped at his desk to find a suicide note that he’d written. He had no memory of writing it. He implored whomever found the note to “take care of his daughter” and that “it was no one’s fault but my own”. On his computer screen—again something he had no memory of—was a page describing the easiest ways to kill oneself.

Pretty scary, huh?

So like a good alcoholic, he went to the bar. I’m guessing to celebrate the fact that he was still alive.

There he ran into a girl who he’d known for a long time. She knew of his struggles with alcohol. He joined her and her friend. He says he was carrying a drink in each hand when he sat down at the table and before the girl could introduce Jimmy to her friend, the guy says, “I like your tattoo.” It was the AA insignia with a date; the date was about a year earlier and it was meant to be the last relapse. Clearly it was time to revisit the tattoo studio and have things updated.

A bit confused and embarrassed, Jimmy noticed that the guy was drinking tea. He was in The Program.

Jimmy got really drunk that night. When he got home he says he just prayed for God’s help.

Be careful what you ask for. The next day there’s a knock on his door, and there stands Tea Drinker. “Let’s go to a meeting,” he says.

That was 30 days ago and Jimmy’s got the chip to show for it. He’s refilled his antabuse, he’s going to meetings, he’s signed up for classes to start school this fall. There’s every reason to believe that this relapse date can be at the bottom of the tattoo.

For people who just can’t stop drinking and have experienced dangerous DTs or seizures when they’ve tried in the past, call The Coleman Institute to find out about our Accelerated Alcohol Detox. It’s a safe and discrete way to stop. We’ll hook you up with some good treatment ideas and give you the option of a naltrexone implant which has been shown to cut cravings and relapse in chronic alcoholism.

Joan R. Shepherd NP

Choose your poison

Forgiveness is a recurring theme…I guess that’s consistent with the famous instructions by Jesus to Peter to forgive his brother “not seven times but seventy-seven times.”

Earlier this week one of our patients completed the Freedom Plan; he has faithfully returned every 8 weeks for a naltrexone pellet for a year.

His life is going pretty well. The money he isn’t spending on drugs anymore is now being spent on some pretty (loud sounding to me) high tech music equipment and (loud sounding) water toys. He is spending high quality time with his beloved 5 year old son (who, in my opinion, will probably some day need hearing aids).

As we were wrapping up the procedure, he let me know some things that had gone on with him. Some pretty tough things to deal with involving his wife’s sleeping with his friend and another family member in order to get narcotics. All this happened while my patient was away at a treatment center.

He and his wife split up a couple years ago, and in many ways he has moved on. But it was clear this was still a major wound that hadn’t been dealt with.

Even though anyone with half a brain and a quarter of a heart knows that no one thinks: Boy, I hope I can grow up one day, be a drug addict and sleep with my husband’s friends so I can get high” it’s still a lot to swallow when it’s happening to you.

We talked about the idea that forgiveness is so much more a gift we give ourselves than anything it can possibly do for the other person. It frees up an awful lot of emotional space to release thosE resentments. As I’ve heard many people say: Resentment is like taking poison and waiting for the other person to die.

I’d like to believe that the space he’s clearing out by choosing forgiveness is creating all kinds of room for more high quality (maybe loud, maybe quiet) relationships in his new life.

Joan R. Shepherd, NP

Thursday, August 11, 2011

Thanks for the Thanks

I was on call this weekend and it was rocking. I had people throwing up, stepping on nails and growing pesky fungus under pendulous breasts. Those were the daytime calls. Throughout the night and into the wee hours of the morning I heard from four different local emergency rooms. Our reputation is growing. They were all inquiry calls because there were people in the ER going through opiate withdrawal and needed some kind of help. I directed them all to our intake coordinator, so I hope she got a little sleep between calls.

When the phone rang on Sunday afternoon while I was hanging out at the lake with my family, I was a little exasperated. “Give me a break,” I’m thinking. Turns out this call was from a former patient. He was actually calling to tell me how well he was doing and to thank me and the rest of the staff for helping him get his life back together. He was recently released from prison, and he’s one of those guys who made the most out of his time there. He is going to meetings on a regular basis, and he has stopped using any kind of drug. He has enrolled in classes, he is hanging out with a whole different crowd than he’d hung with before. Next week he’ll come in for another implant.

It was so nice to hear from him. How cool is it to be part of helping a person get their life back?

Joan R. Shepherd, NP