Tuesday, December 22, 2015

After 5 Years of Recovery Are Patients Cured?

by Peter R. Coleman, MD

Recently, we have been hearing more and more about the idea that if people can sustain recovery for 5 years, they are (almost) cured. The concept is, just like a cancer diagnosis, if people can be free of their disease for five years, then the chance of the disease coming back is very unlikely - we can almost say they are cured. It is very unlikely that relapse will occur.

This idea appears to go beyond traditional thinking. We all know the saying - "once an alcoholic, always an alcoholic". We also refer to people in recovery as being "in recovery" and not "recovered", because we don't want to forget the fact that relapse is always possible, and recovering people need to protect their recovery. So, this new thinking is very bold, but maybe it is not so different after all.

I attended the American Society of Addiction Medicine (ASAM) annual conference earlier this year and some preliminary research was published that sheds some light on this situation.

A large study is looking at what happens to people if they are able to maintain 5 years of drug and alcohol free recovery. The results of the study so far indicate that if the patients were able to maintain 5 years of drug free recovery, then the relapse rate over the next five years was an amazingly low rate of only 3%. Fully 97% of people did not fall off the wagon. 

These are amazing results and very encouraging. When you think about it, the results are not as surprising as they first seem. If we think of nicotine dependence, another chemical addiction, then we would probably see very similar results. If people are able to stay off cigarettes for five years, they are very unlikely to pick up smoking again. Of course, they can relapse back to cigarette use if they make silly mistakes, but they are unlikely to do so. After 5 years of abstinence, people see themselves as non-smokers. They are no longer affected by triggers and they have learned how to deal with their emotions rather than just smoking cigarettes when they are bored, lonely, or frustrated. 

So, it makes sense that if people can achieve 5 years of abstinence from drugs and alcohol, they will also be unlikely to return to their former addictions.

Is five years the magic number? We do know that it takes a long time for the brain to heal after the drug use stops. I used to say that 12 months was a reasonable amount of time to assume the brain had returned to normal, but when it comes to opiates like prescription painkillers or heroin, I believe it takes a lot longer for all of the brain to heal. 

There is no other explanation for the fact that relapse is so common, even after very long periods of abstinence. The truth is most people who go to jail and are then released, will relapse virtually as soon as they get out. This seems to be true even when people are incarcerated for long periods of time. Clearly, the memory circuits in the brain and the systems responsible for cravings and impulse control have not fully healed.

We are now recommending treatment and follow up for five years. Using Naltrexone implants and injections for this first part of recovery is crucial. Transitioning to lesser levels of support can then be done when clinically indicated. If we treat this disease just like other medical conditions, we are much more likely to have favorable outcomes.

Tuesday, December 8, 2015


by Gabriella Pinto-Coelho

For some, the holiday season can be a time of year filled with love, family, and joy. And for others, it can be a total you-know-what-show. A lot of it depends on your family, and that’s no surprise. Family is the one place where you can regress 10, 20, 30 years without even realizing it. Family is the one place where you can feel simultaneously loved, loathed, hurt, rejected, and accepted. Everything that comes with reuniting with your family - from memories of bad haircuts to reminders that yes, your aunt is still crazy - can create a perfect storm to exacerbate both mental illness and the risks for substance abuse. Sometimes we get so caught up in the dread of returning home and the pressure of buying the best holiday gifts that we forget what the season is really about - love, gratitude, and peace.

Gratitude isn’t just something that’s good for Thanksgiving, Christmas, or New Year’s. Gratitude should be an everyday kind of thing. And if you don’t buy into that because it sounds too kumbaya, then consider the fact that science has proven gratitude might just be really effective medicine (and it just might help protect you from your crazy aunt and your desire to pick up the bottle). Here are seven reasons why gratitude is the best medicine:

1.   Gratitude creates more opportunities for new relationships. Showing your appreciation for someone isn’t just a pleasantry, it can actually lead to new friendships, according to a 2014 study published in Emotion. And it makes sense: if you are kind to someone and they thank you for your generosity, you’re a lot more likely to want to interact with them again. Especially if you have had to prune your group of friends after starting on the road to recovery, making new friends can be a really good thing.
2.   Gratitude improves your physical health. A 2012 study published in Personality and Individual Differences revealed that grateful people report feeling healthier than their less-grateful counterparts. Grateful people are also more likely to take care of their health, exercise more often, and have regular physicals with their doctor.
3.   Gratitude improves your psychological health. Do you want to be happier and less depressed? Practice gratitude! Gratitude is proven to reduce a number of negative emotions like envy, frustration, regret, and resentment.
4.   Gratitude heightens empathy and decreases aggression. A 2012 study out of the University of Kentucky proves that grateful people are more likely to exhibit pro social behavior even when others are unkind. I’m pretty sure that all of us could use a dose of that when it comes to dealing with family members that drive us up the wall.
5.   Grateful people sleep better. Most people know and appreciate the fact that getting adequate, deep sleep is an essential part of being healthy. A 2011 study published in Applied Psychology demonstrated that writing in a gratitude journal before bed can lead to better quality (and longer) sleep.
6.   Gratitude improves self-esteem. A 2014 study in the Journal of Applied Sports Psychology found that gratitude increased the self-esteem of athletes, which is an essential factor in their performance. Although this study focused specifically on athletes, I would argue that most of us do better at whatever we do when are confident in our abilities and have a healthy self-esteem. Gratitude is also shown to reduce social comparisons, like becoming resentful of others for having a bigger house or better job. That sounds like a pretty valuable skill during the gift-buying and gift-receiving of the holidays.
7.   Gratitude enhances mental strength & resilience. Research has demonstrated the power of gratitude in overcoming trauma. A 2006 study in Behavior Research and Therapy found that Vietnam War veterans with higher levels of gratitude were less likely to develop Post Traumatic Stress Disorder. A 2003 study in the Journal of Personality and Social Psychology found that gratitude contributed heavily to resilience after the September 11th terrorist attacks. Practicing gratitude even in the face of grave circumstances can help promote resilience. Those are some really encouraging results given the all that it takes to be in recovery.

The moral of the story? Gratitude is good for everyone, but it might be even more beneficial for those of you on the road to or already in recovery. So when you’re sitting next to your crazy aunt at the Christmas table, do your best to think about all you have to be grateful for (even if it’s just good food at the table).