Opiates, Suboxone and Recovery

Opiates, Suboxone and Recovery

Recovery

The history of opiate addiction goes way, way back. Wars have been fought over opium. From the opium poppy plant to morphine to heroin to opioids like oxycodone, it’s been a long progression. Opium has been used for pleasure, enlightenment, escape from reality and to kill pain. Opiate/opioid addiction has been difficult to treat, but new medications, like Suboxone, have changed the game for addiction treatment.

Methadone was the preferred treatment for hard core addicts for a long time, but Methadone has it’s drawbacks — Methadone is a substitute, maintenance opiate that allows professionals to regulate a person’s opiate addiction. This explains the Methadone treatment method. Methadone treatment is better than active addiction in the streets, but better ways of treating opiate addiction have developed and are evolving. With Suboxone and other Buprenorphine based drugs the addict can get a prescription to take from home, and the medicine doesn’t create the same euphoric effect as the opioid medication or heroin. Here is how Suboxone works.

Suboxone takes take care of withdrawals, but opiate/opioid dependence is not resolved by simply taking medication. Addiction is a chronic brain disease that causes the addict to return to the drug over and over until they’ve received sufficient treatment to combat the addiction and to allow the brain to heal. Some people recover without counseling or group therapy, but they are a small minority. In the past, so many so many addicts returned to active addiction the idea developed that opiate addicts don’t really recover, they just manage their condition with another drug or go back and forth from Methadone to heroin, or they have to stay on Suboxone the rest of their lives.

Opiate addicts can recover and become drug free just like alcoholics, Benzo addicts, cocaine addicts, etc. It might be a little more difficult for opiate addicts who’ve used heroin heavily for years, but it’s possible and very likely if a treatment plan is followed. With the current opiate/opioid addiction epidemic, it’s important to know that opiate addiction is treatable, and that addicts can live drug free lives. The idea that opiate addicts must be relegated to Methadone clinics is an old idea that has to be smashed.

With medicine to ease the withdrawal, with outpatient group therapy and counseling, and with follow-up, long term recovery management, an opiate addict can become drug free and live a normal, healthy and happy life. The road to recovery might be difficult and it requires persistence and sticking to the plan, but the urge to use opiates will leave a person if they stay in and practice a long term recovery management plan. The use of Suboxone should be guided and managed by a physician with an understanding of addiction medicine. NA or AA are critical tools. Nutrition and exercise are important. It takes a holistic approach, but it’s very possible and very, very worth it. Opiate addicts can be free from drugs — they can.

Chemical Dependence and Psychology

chemical dependence and psychologyChemical Dependence and psychology are often intertwined, but they’re not as closely related as most people believe. Chemical Dependence and psychology are related, but it’s a mostly relationship of co-existence. There’s a common misperception that chemical dependence is a result of unresolved mental and emotional conflict. It this were true, the addict could go through psychotherapy and this would allow the person to drink alcohol normally or use some other drug without the problems of chemical dependence.

When someone suffers from alcoholism or some other drug addiction, and they return to their drug of choice after a period of time, the active addiction returns — we see this over and over. Because society has had this misperception about addiction and mental health, most people who stop  drug use and improve their mental health feel as if they can now use a drug without consequences. If mental demons from the past drove them to drink heavily or use cocaine or seek relief with opiates, then surely if the mental/emotional demons have been identified and dealt with through counseling, there’ll be nothing harmful driving them to use drugs addictively. Recreational use ought to be possible, right? No, not right.

Research shows that drug users, including use of the drug alcohol, who become chemically dependent (the more scientific term), addicted (as we commonly call it), have a combination of factors that leads to chemical dependence. Genetics plays a large role. Brain chemicals and how the brain processes a drug plays a large role. The addict responds differently to a potentially addictive drug than others who don’t become chemically dependent regardless of the addict’s mental/emotional health. It’s also a mistake to equate chemical dependence with everything that people now call “addiction”, like chocolate addiction, yoga addiction, internet addiction — science hasn’t found any evidence that all these “addictions” are some common obsessive disorder.

Mental/emotional problems are often caused by addiction, and co-existing mental/emotional problems almost always become worse not better as a result of addiction, but the absence of mental/emotional problems doesn’t ensure an absence of addiction. It’s also evident from experience that addicts in recovery have to deal with mental and emotional problems if they want a strong and healthy recovery. Recovery from chemical dependence is at risk when a person suffers from unresolved mental and emotional problems, because if they’re in mental and emotional pain, they’re likely to try alleviating the pain with a drug, then the addiction takes over.

This is important for the person in recovery to understand, because once a person in recovery begins to feel better mentally and emotionally they might begin thinking they can handle a beer, or a glass of wine, or just one line of cocaine, or a joint every now and then. Once the recovering addict starts drinking or using again, they either become addicted to some substitute drug or return to their drug of choice and the vicious circle continues. So, in recovery, it’s a matter of dealing with addiction as a problem in and of itself, but also dealing with mental and emotional problems that exist to avoid relapse and have a healthy and happy recovery.

Alcohol and the Body

Alcohol and the bodyMost people don’t know how alcohol affects the body. With most moderate drinkers, although even in small amounts alcohol affects all parts of the body, the amount of alcohol consumed could create positive effects – but when drinkers consume alcohol on a regular basis in large amounts it can lead to physical problems.

This site at Healthline.com describes how alcohol acts on the entire body. Here’s an excerpt:

Alcohol consumption causes physical and emotional changes that can do great harm to your body. The long-term effects of alcohol abuse are many, putting your health in serious jeopardy and endangering your life.

When I was younger, I thought all such information was simply much ado about nothing. How could a few beers cause damage when so many people are drinking beer and appear to be in good condition? The harm comes in when a person drinks alcohol heavily over a period of time. Sometimes, though, alcohol can cause problems even if the person isn’t drinking heavily and hasn’t been drinking for a long time. It’s good to know the truth about what we put in our bodies. Humans consume lots of food and drinks that eventually have harmful effects.

I think the main thing is to not let marketing cloud the truth about alcohol. Alcohol is, after all, a powerful drug that if it were discovered today would require a prescription to purchase. Because alcohol has been society’s drug of choice, and society chose to make it legal, this obscures the fact that it is a drug and can do a lot of damage if misused, more damage than most other drugs that are illegal – however, it’s marketed as if it’s as harmless as a fruit drink.

The statistics related to alcohol are staggering – from National Institute of Alcohol Abuse and Alcoholism:

In 2012, 3.3 million deaths, or 5.9 percent of all global deaths (7.6 percent for men and 4.0 percent for women), were attributable to alcohol consumption.13

  • Alcohol contributes to over 200 diseases and injury-related health conditions, most notably alcohol dependence, liver cirrhosis, cancers, and injuries.14 In 2012, 5.1 percent of the burden of disease and injury worldwide (139 million disability-adjusted life-years) was attributable to alcohol consumption.13

  • Globally, alcohol misuse is the fifth leading risk factor for premature death and disability; among people between the ages of 15 and 49, it is the first.15 In the age group 20–39 years, approximately 25 percent of the total deaths are alcohol attributable.

The point is not scare anyone about alcohol and to start a prohibition movement. Moderate drinking is hardly ever a problem, but it’s crazy to ignore the facts and to start drinking alcohol without knowing what can happen.

 

Addiction Treatment: Change

Addiction Treatment: Change

Group therapy

Change is frightening to many people, not just to those going through addiction treatment. Most addicts, though, fear change, because it means experiencing life without their drug of choice. Addiction creates an obsession with a drug that goes to the part of the brain which deals with our basic needs, so it’s almost like someone is asking the addict to twiddle their thumbs when they’re hungry, or eat broccoli when they crave sex.

King Wiitney, Jr. wrote:

Change has considerable psychological impact on the human mind,
to the fearful it is threatening because it means things may get worse.
To the hopeful it is encouraging because things may get better.
And to the confident it is inspiring because the challenge exists to
make things better.

In addiction treatment we strive to lead the client from fearful to hopeful to confident (not over-confidence, but realistic confidence based on receiving help from others when needed). Years of chemical dependence does a lot of damage to self-esteem, and most research shows that years of addiction  actually rewires the brain, so it takes a good while to change, to re-wire the brain. If the client can’t get past the fear of change, then recovery never really happens, and the person is stuck in old patterns and behaviors and ways of thinking that lead back to drug use.

When the client is presented with facts and new ideas and agrees to try recovery, the process of change begins — this process is helped along greatly by group therapy as each client in the group draws strength, hope and confidence from the others who are also wrestling with fear of change. It’s easier to change when you have support from others who’re going the same process. Also, in groups, clients can see what happens when a person is stuck and refuses to change — the group can see the conflict and consequences of fighting change and it helps them make even greater progress.

Many might say it’s no big deal, that the addict is just doing what they should’ve been doing all along, but, to those who understand addiction, making changes in recovery is a pretty big deal that takes a lot of courage.

 

EAP and ROI

EAP and ROI

Employee Assistance Program

Do Employment Assistance Programs (EAP) create a return on investment (ROI)? EAP and ROI has been a controversial issue in the business world for a long time. Studies have shown that EAP creates a ROI, but a lot depends on the EAP program and the company’s commitment to support EAP. Also, some EAP programs are more effective than others.

If a company signs a contract with an EAP company yet doesn’t train supervisors and employees on what EAP is and how it should be used, then it won’t likely be effective. Yet, if company leadership buys into EAP and assures employees and supervisors that the program has backing from the CEO down, then EAP can help the company deal with costs related to behavioral/mental health. Billions of dollars are wasted among companies yearly due to absenteeism, accidents, low productivity, and other costs that arise when employees are negatively affected at work from marital problems, substance abuse, stress/burn out, financial problems, retirement concerns, depression, etc. For a company to simply ignore these problems is asking for trouble.

It’s common sense that if employees can access help through an EAP, they can improve their work performance and lower costs to the company. Several Large companies, like Dupont, GM and Ford, did follow up studies in the 80s and 90s covering over a decade of EAP and they found that for every dollar spent on EAP there was a 2 to 3 dollar return on investment. EAP has been around in some or another since the 1940s, although in the beginning it was mainly a program helping companies with their alcohol problem — they were called Occupational Alcoholism Programs (OAP).

EAP really took off in the 70s when they expanded the area of concern to all types of personal difficulties that employees experience, such as a anxiety over company downsize or merger. EAP can help with financial planning, elder care, and other such concerns, although the EAP professional might not handle these problems alone — EAP professionals usually see an employee, assess the problem, deal with the problem if it’s easily resolved in a few sessions, but refer the problem to the appropriate resource if outside the EAP professional’s ability to address. EAP maintains a database of local resources for referral so that an employee can find the needed help if the problem is more complicated and needs long term, specialized care.

A good EAP that’s supported by upper management creates trust between employees and the company, thus the company avoids excessive turn-over and increases productivity through a more healthy and happy workforce. The troubled employees have an opportunity to improve their mental/emotional health, avoid job problems, thus enhance their chances for advancement and long term job security. EAP and ROI makes for a win-win situation.

Addiction and Relapse

Addiction and Relapse

This excerpt is from EverydayHealth.com regarding addiction and relapse:

Addiction relapse is generally considered to be the return to substance use after a period of abstinence. However, according to James Garbutt, MD, professor of psychiatry at the University of North Carolina in Chapel Hill and a researcher at the Bowles Center for Alcohol Studies, “Relapse has different definitions. Some would say that it is a return to any amount of substance use, while others would say it is a return to heavy use. The medical profession states that a relapse is a return to destructive or heavier use.”

It’s an important distinction: If you drink one beer on one occasion, you have had a lapse. But if you are abusing regularly or your alcohol or drug abuse is causing negative consequences in any area of your life, you are having a relapse and need professional help.

Addiction Relapse: Why Does It Happen?

“Relapse can occur because an addictive disorder is a chronic disorder. As there is no cure, there is always the potential for relapse,” notes Stephen Gilman, MD, an addiction specialist in New York City. “Anyone can relapse.”

Dr. Garbutt agrees, “Addiction is a chronic illness, and like any other chronic illness, it must be managed over time.”

Yes, “it must be managed over time.” This is the downfall of those who’re chemically dependent and don’t understand or accept the importance of long term management and abstinence — the addict hits a bad spot and proclaims they’ll stop and get straight, then when things are better the person gradually slips back into old mindsets and behaviors, starts using again and the addiction gets worse.  Just because someone gets drugs out of their system for a period of time doesn’t mean they’re cured — there’s no known cure for chemical dependence. This is the serious nature of addiction that the recovering person accepts in order to maintain motivation to manage the addiction. It would be malpractice to implant in the addict’s mind that relapse is almost inevitable and all they have to do is get back on track. The problem with relapse is that the person has no guarantee that they can get back in recovery. Many recovering addicts relapse and don’t return, they die from their addiction. It’s very hard to get back into recovery after relapse, and there’s no value in pretending it’s easy, especially multiple relapses. Yes, if an alcoholic slips and gives into the temptation to drink a beer, then calls someone who can help and give support, than gets back to his/her support group and talks about the lapse, it’s not that hard to start over. Relapses are different, and lapses often turn into long term relapses and active, destructive addiction.

Professionals working with addiction and relapse have to be careful that they don’t give the impression that relapse is inevitable. Relapse is not inevitable. A major part of addiction treatment is learning coping skills to avoid and prevent relapse. Everyone leaving treatment should follow a recovery plan. When relapse happens, though, it does no good to shame a person for not trying hard enough, because recovery from addiction is difficult, but the recovering addict also needs to know that if certain steps are taken and recovery is managed according to a long term plan that includes medical management, then the chances are good they can achieve long term recovery.

Chemical Dependency and Stigma

Chemical dependence and stigmaChemical dependency and stigma in 2016 shouldn’t be an issue – however, there’s still stigma attached to chemical dependence, addiction, drug use disorder, or whatever one calls it. Most professionals are using the term chemical dependence because “addiction” is so loaded with negative connotations, but to be honest there’s nothing wrong with the word addiction — it’s old mindsets that have to change – the terms “drunks”, “junkies”, “pill heads”, etc., haven’t disappeared despite efforts to educate the public.

The online dictionary defines stigma as:

a mark of disgrace associated with a particular circumstance, quality, or person.

“the stigma of mental disorder”

synonyms:

shame, disgrace, dishonor, ignominy, opprobrium, humiliation, (bad) reputation

“the stigma of bankruptcy”

A major reason many people don’t ask for help with addiction is the stigma that’s attached to the disease. They’re afraid they’ll be ostracized, seen as weak or stupid, rejected, fired, divorced, cut-off, laughed at, judged, condemned, etc. Addiction is still perceived by way too many as a moral failing, an association with criminal elements, a lack of will power, a lack of intelligence, poverty, as irresponsible, self-centered, and a host of other negative perceptions that are applied one way or another to someone who’s chemically dependent. The stigma is often different for alcohol than for heroin, a professional than for a blue collar worker, one race as opposed to another, on and on. If a person is addicted to opiates, the stigma might relate to ghettoes, needles and back alleys. If a person is an alcoholic, the stigma might relate to a lack of will power, or just plain old sinfulness of gluttony. If it’s pot, the stigma might relate to youth, laziness, dullness and irresponsibility. If it’s cocaine, the stigma might relate to criminality, wild parties or the profligate nature of too much money.

Most people who don’t understand chemical dependency have some form of stigma they apply, unless they’re unusually open minded and curious people who seek to find answers to those things they confront and don’t understand. It’s hard for people to understand addiction as a condition that can develop in their grandmother, their daughter, their best friend. There’s a lot of good information out now about chemical dependency. More and more people realize that addiction is not caused by lack of will power, or because a person is sinful or just plain irresponsible. A strong willed nurse can go to a doctor for a painful medical condition and the doctor can prescribe opiates to which the nurse can develop an addiction. It happens in about 15% of those who use opiates for any reason. An intelligent plumber who’s always been responsible and caring and conscientious can develop an addiction to alcohol over a period of time, even if he’s not going out to bars every night, cheating on his wife, getting in fights, avoiding his bills, or whatever other old mindset about alcoholism is applied.

Addiction can happen to anyone who uses a potentially addictive substance for whatever reason. There can be discussion about whether someone should start using a particular drug, especially for recreational use, but this is another topic. Addiction is not caused by personality disorders, lack of religion/faith, irresponsibility, too much money, stupidity, poverty, etc, – all these things can complicate addiction, but they are not causes. A drug addict can be a perfectly normal person before developing chemical dependence. Through the years I’ve counseled, or had in one of my groups at an inpatient facility,  the head of the Psychiatry Department at a large university hospital, priests/preachers/nuns, millionaire business people, housewives, middle class workers of all trades, professors, teachers, politicians, smart people, criminals, principled law-abiding people, old people, young people, irresponsible people, responsible people, wise people, ignorant people, rednecks, artists, liberals, conservatives — you get the picture. Chemical dependency and stigma shouldn’t be a problem — not if you learn just a little bit about addiction.

Mindfulness in Recovery

Mindfulness in recoveryAlcoholics Anonymous’s Step Ten is “Continued to take personal inventory, and when we were wrong promptly admitted it”. This step is intended to prevent the recovering alcoholic from drifting back into the alcoholic mindset and old behaviors that lead to drinking — it’s also for those in long term recovery to continue to grow. Another word for this practice of self reflection is mindfulness. Mindfulness is used in meditation, and, understandably, AA’s 11th step has to do with meditation. Psychology, as well as AA, has recognized the healing power of taking a “time out” and experiencing the present moment with full awareness.

In addiction recovery, those who practice mindfulness have a better chance of establishing long term recovery and personal growth. In day to day life there are so many distractions, so many demands on us to do this and do that, so many technological toys to keep us zoned out and dumbed down, it’s very difficult for most people to take time out and think deeply about what’s going on in the present. But most recovery actions that are difficult to perform are also rewarding. The challenge of getting to know our own minds pays off as we are better able to understand ourselves, our thoughts, our emotions, and to do those things that lead to human flourishing.

Anxiety can either lead us to do destructive things, or we can listen to the tension, understand it and discover something new about ourselves. Depression can push us into isolation and a lonely, negative place, or it can instruct us on what we need in order to move beyond the depression. Often, if we share our thoughts and feelings with friends or counselors or family members, we hear ourselves talk about what we’ve discovered about internally and it makes even more real.

Mindfulness in recovery helps the person adjust to a new way of life and a new way of thinking — recovery becomes deep and personal — recovery becomes real.

 

AA in the 21st Century

AA in the 21st CenturyAlcoholics Anonymous has changed through the years, but AA might be facing bigger challenges in the 21st century than it did in the latter part of the 20 century. AA in the 21st century faces secularism and a general trend of suspicion of all institutions that appear traditional. AA has become an American institution and tradition is important to AA. Through the years AA has been attacked for being too religious, too much like a cult, too unwilling to change with the times, too insistent on the need for total abstinent from all drugs, even prescribed drugs, etc.

AA in the 21st century, in many ways, looks like AA in the 1930s when it was created. AA is still based on a set of principles, traditions and concepts that have not changed. The make up of AA has changed, though, and how members talk about alcoholism and recovery has changed. In most cities with any size, AA members are usually poly0drug users, with alcohol as only one of the drugs with which they had a problem. Most groups don’t talk much, if any, about the Christian concept of God, but rather a generalized “higher power”. There are even meetings that cater to free thinkers, agnostics and atheists.

AA groups have changed in many ways — there are gay groups, women’s groups, Hispanic groups, etc. There has been controversy about specialized groups, because many AA members believe that alcoholics of any race, gender, religion, etc., have a common bond in recovery. If specialty groups help individuals find sobriety and recovery, though, most AA members take a live and let live attitude.

AA in general doesn’t react in a knee-jerk style to criticisms, public controversy or demands to change. The AA central office basically stays clear of public controversy, avoiding politics or public displays of defense. AA simply says, this is what we do, and alcoholics are free to try it if they think it will help. There’s actually a libertarian streak in AA that’s attractive to most people. AA sticks with certain principles that are considered timeless and certain traditions that have worked to keep groups together, but AA leaves it up each group to be autonomous in its own affairs unless it harms AA as a whole — even, then, a renegade group that violates all traditions will simply not be recognized by the central office as an AA group — AA has no power to force the groups to conform. There’s enough latitude and flexibility in AA groups for AA to be wide enough and deep enough for any individual seeking help. If an individual doesn’t like one group, they can find another, or start one. I think AA in the 21st century will do just fine.

Motivation in Addiction Treatment

Motivation in addiction recoveryThere are basically three types of motivation in addiction treatment. One is to avoid unpleasant consequences through compliance. These clients are usually pushed hard to get into treatment, and they’re the most likely to return to their drug of choice. Another form of motivation is calculation — a person has calculated the costs and benefits of drinking and using drugs and has concluded that stopping will be a better choice. The third form of motivation is existential — the person has committed to addiction treatment because life in addiction has become miserable, hopeless and precarious. These last two forms of motivation are stronger than the first with the last being the strongest.

Although addicts who’re forced into treatment by the courts, family, spouse, etc., can and do recover, they usually have to go through more trouble before the desire to change is deep and meaningful. I’ve seen clients who’re forced kicking and screaming into treatment turn around and realize they have a problem. Most of us working in the field for a lengthy period of time have come to realize that it’s almost impossible to tell who’ll recover and who won’t, but the odds are not favorable for the person who’s in treatment just because someone holds leverage over the person. You’ll often hear people say about addiction treatment and recovery that the person has to want to stop drinking or using some other drug in order to recover. A desire to stop is not necessary in the beginning. I’ve seen people forced into treatment with no intentions of stopping have an epiphany and recover long term, and I’ve seen people who desperately wanted to recover never stop for any long length of time and eventually die from their addiction. Nothing has hurt the addict more than for people to tell him/her that they aren’t trying hard enough, and that if they just put their mind to it, they could stop drinking alcohol or using cocaine or shooting up heroin.

The person who rationally looks at their addiction and decides the costs of using drugs outweigh any benefits are at least motivated, but if addiction recovery were as simple as calculation, most people would stop long before the late stages of addiction. Calculation can be strong enough to get a person into recovery, but there usually has to be something stronger keeping a person in recovery or they go back to the drug of choice after the bad memories fade and the calculation changes. Perhaps the person has bad fortune in recovery and loses their job in a bad economy — the person who’s only calculating the costs and benefits might say that recovery is not “paying off”.

The point is that a desire to stop is a good motivator, but not necessary to start the treatment process. Having a desire to stop, though, doesn’t guarantee recovery, especially if the person is quitting with the expectations that life will be trouble free without addiction. Addicts forced into treatment can and do recover, and addicts who initially decide to deal with addiction and recover can and do die from their addiction. What usually determines if a person recovers or not is their level of ongoing commitment to the long term process of recovery. The main form of motivation in addiction treatment that enhances long term recovery is internal commitment. When a person has truthfully admitted that addiction is a life-threatening problem and has committed to taking steps to achieve and maintain recovery, regardless of external circumstances or obstacles, then the motivation is real enough to sustain long term change and growth.