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 fiancĂ© 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