Wednesday, October 26, 2011

A Priest, a Nun, and a Gobstopper?



 By 
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)

The Coleman Institute



By
Peter R. Coleman, M.D.
I have been working with substance abuse patients ever since I got clean and sober in 1984. In the late 1990s, there was a big increase in the number of people getting hooked on strong Heroin and a big increase in the number of people getting hooked on prescription painkillers like OxyContin, Hydrocodone and Methadone. Many of these people simply could not get off the drugs because the withdrawal was so difficult. And, what is perhaps even worse, if patients were able to get off the drugs, the relapse rates were astounding. In some studies, more than 95% of patients who went to treatment to get off opiates were back on opiates after only 3 months. It is no wonder that many patients turned to Methadone Maintenance as a solution.  I knew that there had to be a better way.
From my experience, I knew that most patients crave being completely clean. Most patients do not want to be on maintenance Methadone or Suboxone. They want to be free. I also knew that everyone who gets into a solid recovery lifestyle is able to lead a happy and productive life.
Once people get into a solid recovery they are able to overcome their addiction and become positive influences in their families, their workplace and their communities. They are able to be happy. Some are even able to look back on the struggles that they went through and see that there are positive things they have learned from their struggles.
For people who get into recovery, these positive changes seem to come about, no matter where people start from, no matter how much trouble they got into, or how much damage they did. It is all a question of turning their lives around, and making healthy positive choices on a consistent basis.
When I learned about rapid opiate detoxification and Naltrexone Implants, I realized there was a way to help patients both get clean and stay clean. An effective detoxification process can make it possible for everyone to safely get off the drugs, and long term implants can make it possible for everyone to stay off the drugs.
The early versions of rapid detox were effective, but not very sophisticated. They used general anesthesia and completed the detoxification too quickly so that the post-acute withdrawal was too painful. They required overnight stays in hospitals that increased costs.
I did over 300 of these “Ultra-Rapid Detoxification” procedures and we didn’t have any major complications, but I knew that I could improve on the technique. Over the years we have refined our technique dramatically. We don’t require anesthesia and we are able to do the detoxification completely as an outpatient procedure. We are still able to achieve over 98% success for our patients to complete the detoxification, but now it is considerably safer and much more comfortable. It is also much less expensive and more convenient. When I surveyed a number of our patients a while ago, every one of them said that this was the easiest detoxification they had ever done.
Our Naltrexone Implants have also continued to improve. Now the implants we use reliably deliver doses of Naltrexone for 8 weeks, so that we don’t have to replace them as often. This makes it easier and less expensive for our patients. Our infection rates have also improved so that now we have less than 2% of patients develop infections. We have also added other programs, so now we can help patients with alcohol problems and we can help patients with addictions to Benzodiazepines.
Once our clinical procedures improved, we decided it was time to start to work with other physicians around the country so that they could help their patients get clean and stay clean. For the last few years we have been working with other doctors and now we have a network of seven clinics providing services. We all work together, sharing ideas and experience and I think that our patients benefit from our collaboration.
Our mission statement at The Coleman Institute states that we are in business to “help patients and their loved ones achieve lifelong recovery from their substance abuse problems”. We are “committed to developing and implementing affordable programs to achieve this mission”. As we continue to grow, we are committed to improving what we do to achieve the best long term outcomes for our patients. We are currently working on a 12 month aftercare program which we think will further help our patients to avoid relapse after they complete their detoxification.
This month, Gene Wilson has joined us in the position of Chief Operating Officer. Over the last 25 years, he has provided executive leadership and top quality business management in a wide variety of industries. He is ideally suited to helping us maintain the very top quality in our business practices. Specifically, he brings substantial experience in multi-location business models, including franchising/licensing environments. This will help us to develop more physician practices across the country. He has a wealth of experience in marketing and business growth. Gene also has a personality that makes him easy to work with. He has a natural talent for being able to work with people and support them to get things done.
With Gene’s help, I feel confident we will be able to grow our business and provide top quality services to more people. We will also be able to continue to improve our programs and develop new services to help patients get clean and stay clean. The Coleman Institute will be able to offer patients better and more choices for how they can resolve their substance abuse problems.
Gene said to me when we first met that he was looking for his next big adventure. I think he's found it!


Tuesday, October 25, 2011

Cyber Review

CYBER REVIEW











I would like to review three websites that will be of interest to you the reader. There is a lot of junk on the internet, that’s for sure. However, for all the junk, there is a TON of treasure. It’s hard to ignore the impact of the internet on our lives when even the term “Google” is an official entry in the dictionary!


The first site is http://aa.org/lang/en/subpage.cfm?page=359. It is from the Alcoholics Anonymous main webpage. It features two seminal works on recovery that launched a worldwide phenomenon so many years ago: The Big Book and The Twelve and Twelve. These two books have literally helped to transform millions of lives from the clutches of alcohol and drug addiction to freedom and sobriety one day at a time. If you have a connection to the internet, you now have access to both of these books 24/7/365!

The second site I’d like to share was suggested to me by one of our patients who is now clean and sober from her addiction to pills ( http://www.fancast.com/tv/Vanguard/105470/1285764318/The-Oxycontin-Express/videos). The title of this documentary is, “The Oxycontin Express”. The site says,
“In this Peabody award-winning piece, correspondent Mariana van Zeller reports from South Florida, the epicenter of the prescription drug abuse epidemic in America.” Oxycontin is a plague that is scourging the landscape of America, sold under cute names such as “Hillbilly heroin”, “OC”, and “Oxy”. There is nothing cute about this drug!

The last site I’d like to review is called ‘Everyday Tai Chi’ and is found at http://www.everyday-taichi.com/learn-tai-chi.html. Tai Chi Chuan is translated “Supreme Ultimate Fist” and is an ancient Chinese (secret? Joke, couldn’t resist!) martial art form that Western science has discovered offers great health benefits to the body, including lower blood pressure, increased sense of well-being, and a decrease in stress on the body and mind. So, check it out and pump your fist!



Chris Newcomb – Aftercare Coordinator

Worth the Time

Clearing space for quiet is important for those in recovery or for anyone who breathes and eats and occupies space on this planet. This was the blog article from Daily OM. I couldn’t say it better, so I won’t. I’ll send it to you intact. Check out his website sometime.

Ironically, when we get busy, the first thing that tends to get cut back is our meditation practice. We have less time and a lot on our plates, so it makes sense that this happens, but in the end it doesn't really help us. Most of us know from experience that we function much better when we give ourselves time each day to sit in silence. And the more we have to do, the more we need that solitary, quiet time for the day ahead. As a result, while it may sound counterintuitive, it is during busy times that we most need to spend more time in meditation rather than less. By being quiet and listening to the universe, we will be given what we need to get through our day.

Expanding our morning meditation by just 10 minutes can make a big difference, as can the addition of short meditations into our daily schedule. The truth is, no matter how busy we are, unless we are in the midst of a crisis we always have five or 10 minutes to spare. The key is convincing ourselves that spending that time in meditation is the most fruitful choice. We could be getting our dishes done or heading into work earlier instead, so it's important that we come to value the importance of meditation in the context of all the other things competing for attention in our lives. All we have to do to discover whether it works to meditate more when we are busy is to try it.

We can start by creating more time in the morning, either by getting up earlier or by preparing breakfast the night before and using the extra time for meditation. We can also add short meditation breaks into our schedule, from five minutes before or after lunch to a meditation at night before we go to sleep. When we come from a place of centered calm, we are more effective in handling our busy schedules and more able to keep it all in perspective. If more time in meditation means less time feeling anxious, panicky, and overwhelmed, then it's certainly worth the extra time.

Joan Shepherd - FNP

Saturday, October 15, 2011

Grocery Fantacies

I was really struck yesterday by some of the things Evie, our most recent Accelerated Methadone Detox patient was saying.

While she was still actively using methadone she would wake up daily, feeling sick, then take her meds to feel normal again. That is, what had become normal for her. She never had any energy. She rarely laughed with her kids, and she needed frequent naps.

She said she would go the grocery store and fantasize about the other shoppers. Get your mind out of the gutter—not that kind of fantasizing. She would look at this person and that person and think, “I wonder what it’s like for them to just get up every morning and not need a pill to get moving? How wonderful to just be able to go to the grocery store or the bank or put gas In the car…”

I am tickled to think that Evie is back at her neighborhood grocery store, with a shit-eating grin on her face, rolling a cart around and filling it up with milk and eggs and pasta. I can just imagine her looking around and smiling and nodding at the other shoppers, going,”yeah—here we all are, just buying groceries….how sweet it is!”

Life’s simple pleasures are mighty sweet when you haven’t tasted them in far too long…

From Maggot to Chameleon

Every time I think I can’t like a patient more than the one I just detoxed at The Coleman Institute, I meet another one I’m saying the same thing about.

Yesterday Evie (not her real name) completed an Accelerated Methadone Detox. She is such a hero!

After years of heroin use she was started on methadone 3 years ago. Miserable almost immediately on methadone because of the life style and the way it made her feel, and because she was so ready to start a life of recovery, she determined to stop using. Then she discovered she was pregnant. Thus, the three years on methadone.

It was an elegant detox. When we were getting ready to place her naltrexone pellet I noticed

the tattoo of a beautifully detailed chameleon wrapped around her left ankle. She told me it was a cover up tattoo.

When she’d been using lots of heroin a friend talked her into allowing him to tattoo his specialty on her: maggots coming out of a wound. She said it had been pretty realistic.

Evie shakes her head and laughs that she would ever let anyone put a tattoo of maggots anywhere on her body! The chameleon was drawn in when she decided to seriously start recovery. She said she could change with her environment, and indeed, the quality of her life—her work, her relationships with her child, finance, and friends, and her health—are all vastly better since she stopped the heroin and changed her environment.

I can only imagine how her life will continue to change as she experiences the freedom that naltrexone brings. Wonder how that chameleon would look with wings?

Oil in the Motor of Life

Most of the psychotropic medications used for depression and anxiety in some way manipulate the serotonin, norepinephrine or dopamine receptors. It’s not unusual for patients to feel out of sorts as their brains return to homeostasis after years of being ravaged by opiates, benzos, or alcohol.

Serotonin is considered by some to be the “oil in the motor of life”. It is important for mood, sleep, digestion, evacuation and ejaculation.

Norepinephrine is the “go” neurotransmitter in the brain. It’s associated with focus and memory. It’s the one that gets us moving during a crisis…and maybe the one that’s keeping us awake if we’re on overdrive.

Dopamine is the pleasure drug. People who are low or poor dopamine makers have a ‘joy-deficit’.

One of the nice things about having an accelerated detox-opiate, benzo or alcohol—at The Coleman Institute is the patients’ option to follow up with us. We have a busy family practice-Hamilton Family Practice—and many of our patients were once addicted to one substance or another. Together we work with our patients to help their brains return to a Place of Peace, whether by manipulating the neurotransmitters, helping with Thought Work, or referring to counseling.

Friday, October 14, 2011

Cocaine Vaccine shows some positive results

For a few years, researchers have been trying to develop a vaccine that could block the effects of cocaine. The idea is that if we could get the immune system to make antibodies that bind to the cocaine the antibodies would bind to the cocaine and prevent the cocaine from getting into the brain. This of course would prevent the patient from getting high. Until now researchers have not been very successful. It turns out it is not that easy to have the immune system make antibodies against cocaine, and you need very high levels to attach to all of the cocaine that someone could use.

Things may be about to change. A recent study lead by Tom Kosten at Baylor College of Medicine in Texas showed some impressive results. They had 115 patients who received either a series of 5 vaccinations over 12 weeks or placebo. They were followed for an additional 12 weeks. They all received some counseling. The results showed that 38% had a significant reduction in their cocaine use. Most interesting was the fact that the patients who produced the most antibodies were also the ones who had the biggest reduction in cocaine use. It seems that it was the antibodies that were causing the positive results. There were no adverse reactions to the vaccines.

This was just a short term pilot study so we will need to wait as the company that produced the vaccine continues to improve the product and study it in larger trials and longer term trials. For now though, the results look very promising.

Vitamin D deficiency in patients taking Methadone.

In the 2009 Journal of Addiction Medicine, there was a recent study of patients taking Methadone. The study showed that 36% of these Methadone patients had Vitamin D deficiency and another 16% had Vitamin D insufficiency. For a long time now I have heard patients who are taking Methadone complain that “Methadone gets into your bones” and “Methadone rots out your teeth”. I didn’t quite know what to make of these comments although I have seen a number of patients who have developed very advanced dental decay soon after they went onto Methadone. Lately I have been checking Vitamin D levels in patients who are taking Methadone and it does seem that almost all of them have low levels.

It is interesting that this study found such a high percentage of patients have low levels. It is the kind of thing that we wouldn’t know about unless we actually test for it. We need to test these patients and keep on the lookout for Vitamin D deficiency and other deficiencies. One other question I have is whether patients taking other opiates such as OxyContin get depletion of their Vitamin D as well. I will be looking to see if this is happening as well.

New Warnings on Tramadol (Ultram)

The manufacturer and the FDA are requiring new warnings in the prescribing information for Tramadol (Ultram) - - “avoid in patients prone to addiction.”

Ultram came out as a new non-addictive medicine for pain control. The FDA even allowed it to be released as an uncontrolled drug for pain. Since then it has become very widely prescribed. Many physicians and patients believe that it is quite safe and non- addictive. I still hear physicians tell their patients it is not addictive.

But it works in the same part of the brain as Heroin, so most of us in the Chemical Dependency field were pretty suspicious. And sure enough, over the years, we have seen a lot of patients who have become addicted to it. In fact I find it is usually harder to get patients off Ultram than it is to get them off Heroin. The withdrawal seems to be more intense and often patients get quite confused and don’t know what is happening to them.

Our Accelerated Detox method works well for Ultram. We slow the process down a little and take a little more time so the patients are comfortable. But we should never underestimate just how addictive Ultram can be.

Stapleford Conference Scheduled for March 2011

The next Stapleford conference is going to be held in March 2011 in Athens, Greece. This will be the 9th Stapleford conference. It is a conference that is held for physicians and researchers who are interested in new approaches to treating addictive diseases. The first Stapleford conference was organized by Dr Colin Brewer back around 1995. The idea was to bring together physicians and researchers to share their experience and ideas using Ultra-Rapid Detoxification techniques (URD) and the use of Naltrexone implants. The Stapleford conferences have been held about every 18 months since then. They have been instrumental in helping these physicians advance the science by learning from each other. Physicians attend this conference from all over the world, particularly Europe and Australia.

This year there will be upcoming talks on:

New Naltrexone implants in Russia, Cocaine vaccines, new methods to detox patients off Heroin and new treatments in Alcoholism.

At this conference I will be presenting two papers: The first will be the results of our study on our latest Naltrexone implants and the second will be the results of a small study we have conducted on our new detoxification for Benzodiazepine Dependence.

One of the highlights for me of the Stapleford Conferences has always been being around other physicians who care so much about their patients and are trying to improve the results of how we treat patients with this terrible illness.