Recovery From Opioid Addiction

Opioid recoveryOpioids once referred to synthetic opiates, such as Oxycontin. Opiates referred to drugs derived from opium, such as heroin. Now, most people in the medical field use the term opioids to refer to all opiate-like drugs, natural, synthetic or semi-synthetic. So, when I write opioids, I’m referring to all opiate-like drugs. Suboxone is an opioid, but it’s a different kind of opioid, and it’s a misunderstood opioid. There might be more misinformation disseminated about Suboxone than any other known drug at this point. I’m not familiar with all controversial drugs, so maybe I’ll limit the misinformation regarding Suboxone to within the field of addiction treatment.

Some in the treatment field have a financial incentive to oppose Suboxone, such as in-patient detox facilities, because now opioid addicts are detoxed on an out-patient basis with Suboxone from a doctor’s office. I’m not saying that the detox facilitity personnel consciously oppose Suboxone for purely financial reasons, but the resistance to Suboxone is better understood from this perspective. Otherwise, the resistance makes no sense at all.

For anyone unfamiliar with Suboxone, go here. When it’s said that Suboxone has a significantly lower euphoric effect, it’s an understatement. Ask an opioid addict who’s taking Suboxone if the euphoric effect of Suboxone is anything like heroin or Oxycontin — they’ll laugh. Any “euphoric” effect from Suboxone, after the first few days, is mostly the feeling of relief an addict experiences when they’re no long craving opioids. Suboxone is a partial agonist, which means it doesn’t produce the full opioid effect, but it blocks the receptors so that withdrawal is stopped. Recovering addicts using Suboxone can perform all their daily actions without impairment. Some people are a little tired on Suboxone, but once their dosage is adjusted properly, they are able to work, drive, and do anything else a non-addict would do. Some people, of course, react differently, but that’s true of practically all medicines.

The point is that Suboxone is a great tool when used to stop opioid withdrawal so that an opioid addict can get into treatment and make the necessary changes to recover and  live a drug free. The controversy comes in when some in the treatment field say you shouldn’t treat drug addiction with an addictive drug. First of all there’s a difference between reliance/physical dependence on a drug and addiction. Treatment of chronic pain can cause a person to become reliant or physically dependent on pain killers, but most do not become addicted with the mental obsession and crazed need to continue the drug despite negative consequences. Addiction is associated with compulsion to use a drug, obsession with the drug and the continued use of a drug despite negative consequences. I don’t know of anyone who takes Suboxone for a mood altering effect, or who would continue taking the drug if they were locked up for taking it, or if they lost their family from taking it, or if they were fired from their job for taking it.

Yes, Suboxone can be abused, but, because of the Naloxone, Suboxone is not an easy drug to abuse, nor is it a drug that can be abused long term because of the ceiling effect. If you have to go through a lot of trouble to get a minimal effect, it’s not usually worth it to an addict. Just because a certain treatment can be abused, though, doesn’t mean that the treatment shouldn’t be used — it just needs  monitoring by a competent, knowledgeable physician.

The reason most people take Suboxone long term is because it’s doing no harm and their lives are so much better — they simply don’t want to fix what’s not broken. At NewDay our Medical Director recommends that an opioid addict take Suboxone long enough to get into recovery, then taper off and become drug free. Let’s call it Planned Abstinence. We know a lot more today about the science of addiction, how brain chemistry changes. It’s malpractice to force an addict to suffer withdrawals, and probably relapse, when there’s medicine to relieve withdrawals long enough for the person to get into treatment and plan their path to a drug free recovery. Do doctors and counselors need to a better job helping recovering addicts manage their recovery to a drug-free state? Certainly, but that’s something we can all work on. In the meantime, let’s not allow old ideas to block progress in addiction treatment. And let’s not subconsciously treat recovering addicts who use Suboxone like they aren’t in recovery — they are in recovery.

Heroin, Dope Fiends and Mystics

Heroin, dope fiend and mysticsFor those who get the impression from the news that heroin addiction is a new problem, please understand that heroin has been around for a long, long time, and I mean long. The earliest written history of the opium poppy dates back to the Sumerians in 3300 B.C. The name for the opium poppy is Papaver Somniferum. Arab merchant traders spread the knowledge and use of opium as far as Greece. Of course, it eventually spread across the world — there were medicinal purposes, such as insomnia or pain relief, pleasure purposes and even spiritual purposes as some used it to enhance mystic and religious experiences and rituals.

Around the first century A.D. a leading physician, Dioscorides, wrote about opium crushed and mixed with liquids in an elixir that cured diarrhea, nausea, insomnia and that had an aphrodisiac effect. As Europe established means to travel around the world, the Portuguese discovered the value of opium and traded it along with other goods. The Portuguese introduced the smoking pipe and along with greater access opium became a problem across the far East. Opium’s addictive powers were enhanced by innovative means of using opium and greater access.

Eventually, in the 19th century, scientists learned how to isolate morphine from opium, then later in the century the hypodermic needle was invented, then heroin was discovered by the chemist C.R. Alder Wright in 1874. The smoking pipe was what created the addiction epidemic in the Far East — America and the west were affected by the needle and heroin. Laws were created to deal with opium dens and overdoses and spreading addiction. Campaigns started to demonize heroin. Black market trade exploded. First the Chinese were used as demons who spread heroin, then African-Americans were the demons, then hippie junkies in alleys — now heroin is in middle class and upper class homes.

The efforts to demonize and punish heroin users have failed. Opioids prescribed by Pharmacists and used by people across the socio-economic realm are not much different from heroin — the make-up of the drug, and effects it has on the body and mind are almost identical. Heroin sold on the street can be laced with certain products, and opioids sold by Pharmacies are regulated, but the drugs, heroin, morphine, OxyContin, Percocet, are what they are and the body and mind don’t know the difference. Someone addicted to OxyContin is just as addicted as someone addicted to heroin.

When opioid addicts are cut off by doctors and Pharmacists, they often go to the street for heroin, because the body craves what originated in the opium poppy. Perhaps we should stop demonizing heroin because it’s sold on the streets and look at what creates the demand — addiction. If we can talk reasonably about heroin, and if we remove the old ideas of dope fiends, and remove the romance of the mystic seeking transcendence, and then look at the drug for what it is and what it does, then maybe with science, facts and reality we will make progress reducing the deaths caused by ignorance and fear more so than the drug itself.

 

Alcoholism and Relapse

Alcoholism and relapseAlcoholism is often called a disease of relapse. What pertains to alcoholism and relapse actually pertains to drug addiction and relapse in general, but for simplicity’s sake I’ll write about alcoholism and relapse. Relapse is when an alcoholic has had a period of recovery and then starts drinking again. If an alcoholic has had a period of sobriety and drinks for one or two nights then gets back on track and continues in sobriety, then that’s more of a lapse than a full blown relapse.

It’s not uncommon for alcoholics who are trying to stay sober to “fall off the wagon”, especially in the beginning. Even after months or years of sobriety, alcoholics will return to drinking for different reasons and for varying lengths of time and intensity. If an alcoholic gets into a long term recovery program like AA, the chances of the alcoholic staying sober permanently are much better, but it’s definitely not a sure thing. Some alcoholics return to drinking after many years of sobriety and steady AA attendance. The alcoholic who relapses might drink for a while then return to AA and recovery or they might drink for years before reentering recovery, or they might die drinking.

Alcoholism is a disease that’s difficult to overcome, and even more difficult to understand. Alcoholism is treatable, and relapse is not inevitable or, if it happens, is not the end of the world. Sometimes a person is shamed for returning to drinking – “how could you?” – but it’s a part of the disease. Shaming an alcoholic is never productive. The alcoholic will always have a special relationship to alcohol, even if it seems insane to someone looking from the outside. Science doesn’t have all the answers, but science learns more and more as time goes on. Sometimes it’s as simple as the alcoholic forgetting how bad it was, then after a period time deciding that it wasn’t that bad and that now they can handle it better since they know more about the condition. Sometimes there is no explanation — the alcoholic, when brutally honest, will admit they have no idea why they returned to alcohol.

The best way to deal with alcoholism is to not over-react if relapse happens — remember that most alcoholics die from their condition, so even if recovery is not perfect and relapse free, if an alcoholic is staying sober more than they’re drinking, and if their life has improved significantly, even with the relapses, then that’s better than uninterrupted alcoholism that progressively gets worse and ends in disaster.

Language of Addiction

Language of addictionThe language of addiction is important. When people use certain language to speak about addiction it can perpetuate old ideas that are counterproductive to dealing with addiction. Often you’ll hear someone say with disdain “all he does is get high everyday”. I’ve heard over and over that the addicted person just doesn’t want help so nothing can be done. Often a family member or friend will say that the addicted person is just selfish and doesn’t care about anyone else.

The truth is usually something different. When a person becomes addicted all the “fun” of using is gone and the person is using drugs so they don’t feel the pain of withdrawal. The brain chemistry actually changes so that a person feels as if the drug is a vital part of life. When the person thinks about stopping, the fear of not having the drug is often overwhelming. So, when we say the person is getting “high”, this is not a pleasant high — it’s just an attempt to feel normal because without the drug the physical pain and mental anguish are excruciating. The idea that the addict is getting high, partying, living it up, having a ball, doesn’t accurately describe the reality of the addict.

Once we realize that the addict is using because the pain of not using is too much to bear, then anger and condemnation toward the addict don’t make much sense. The addict is not consciously choosing to use drugs for selfish enjoyment — the addict uses drugs because to the addict it’s a matter of survival.

Not all addiction has reached this stage. Addiction becomes progressively worse. The signs and symptoms become more obvious over time. It could be that a person is selfish and lives a party life without thought of how it affects others, but all too often constant, obsessive drinking and other use is a sign of addiction. In order to deal with the problem this progression has to be understand, and the correct language of addiction must be used to describe the reality. If old ideas persist that the addict is simply choosing a selfish lifestyle of partying and getting high, then it’s difficult to reach the empathy necessary to effectively recognize and deal with the problem.

The Cost of Addiction Treatment

The Cost of Addiction TreatmentWhen considering the cost of addiction treatment, people usually have two perceptions — one is of very expensive inpatient treatment in beautiful facilities that the rich and famous utilize, and the other perception is of a state funded facility that subsidizes the cost of addiction treatment. This two tiered view of addiction treatment, one for the poor and one for the rich, is not accurate.

Many state addiction treatment facilities utilize private companies to provide treatment, and many other private treatment facilities, like ours, NewDay Counseling, don’t, as of today, receive any state funds. Just because a private addiction treatment facility is funded through private pay and insurance doesn’t mean that the services they offer are too expensive for the average person. With new laws regarding insurance, all insurance companies have to provide coverage for addiction treatment, even though deductibles might be high. Even if a person hasn’t bought insurance, or the deductibles are high with the insurance they buy, the cost of addiction treatment is still not too high for the average person.

Let’s break it down.  First, let’s establish the fact that addiction treatment has value. Some might think treatment doesn’t work, but they obviously haven’t done any research — addiction can and does work for a good percentage of people who go into treatment. Success in treatment depends on many factors — quality, knowledge, experience, best practices, etc. But, because there’s the pervasive idea that addiction treatment should be free or mostly subsidized, addiction treatment is de-valued. It’s odd that a middle class couple will spend around $5000 on a big screen TV, a gaming computer and a nice sound-system setup for their favorite music, yet when faced with spending $5000 on addiction treatment, the cost is too high.

For around $5000 a person can pay for quality treatment, and the full amount is usually not demanded upfront — like the entertainment equipment, addiction treatment can be paid over time. I don’t know why the idea exists that addiction treatment should be an act of charity, but the idea is common. I told a relative about NewDay Counseling, and he wanted to know how we were funded — through a church? Through the state? No, I told him — we are private — people pay for treatment as they would other medical/treatment services. His idea of a drug addict was the skid row bum variety, the junkie in the alley, so he couldn’t fathom how an addict could afford treatment.

State funds are available for those who’ve lost it all and have nothing, but addicts exist at every socio-economic level. $5000 can pay for quality treatment, and if the person is serious about recovery, they can receive once a week aftercare group therapy, post-treatment, for as long as they need it at no extra cost – plus, they can start attending AA or NA at no cost for long term recovery support. $5000 is not much when you consider the quality of life in recovery compared to the quality of life in active addiction. Surely our lives, our family, our friendships, our mental health, our work performance and our physical condition, all negatively affected by addiction, are worth at least as much as our electronic gadgets. The cost of addiction treatment is not high at all, especially when contrasted to the cost of addiction.

Addiction Recovery and Exercise

Addiction recovery and exerciseAlthough medicine and counseling are important aspects of recovery from addiction, plain old physical exercise is also very helpful. Addiction recovery and exercise are not often associated with one another, but studies show that addiction treatment facilities should place more importance on exercise in recovery. Exercise releases brain chemicals called endorphins that help alleviate stress, anxiety and depression. This natural release of “feel good” brain chemicals is not meant to be a replacement for the drug high, but rather a natural enhancement of recovery — who says recovery has to be painful, gray and uncomfortable?

There’s also a social aspect to working out, if a person goes to a gym, that can also help in recovery. Being around others who’re working toward a common goal gives a person a sense of personal and shared accomplishment, much like AA or NA. Working out produces tangible results that inspire a person to strive for more progress. Often in early recovery the pay off is some intangible “awakening” in the future. With exercise there can be an immediate reward.

Also, addicts in early recovery have sleep problems. Exercise is usually an effective sleep aid. Years of alcohol or other drug use causes much damage to the body and brain. Talk with a physician before starting a major exercise program in recovery if there are health problems, but I’m sure there’s some level of exercise that’s possible to enhance recovery. Whenever someone’s taking action in recovery to make improvements it’s good for recovery. Just the discipline of following through with an exercise program is positive and helpful in recovery.

Perhaps a combination of good nutrition and exercise is what’s needed for anyone in recovery to reach a higher level of well-being. Those in long term addiction recovery sometimes get stuck in a rut, and this puts the person at risk for relapse — maybe a good exercise program is the change that’s needed to add another dimension to recovery. I don’t think eating well and exercising are going to hurt.

Heroin Epidemic: Solutions

Across the nation, cities are dealing with an heroin epidemic. The above video shows that not all authorities are doubling down on failed strategies to deal with the incredible rise in heroin use — some are actually looking for fundamental solutions. When authorities continuously apply symptomatic solutions to symptomatic problems, they go in circles and consequences continue to worsen.

It’s like a car that leaks oil — continuously adding oil only deals with a symptom. The fundamental problem, why the oil leaks, isn’t addressed and it gets worse. If professionals in healthcare and authorities in law enforcement begin dealing with addiction as a fundamental problem, then fundamental solutions will develop.

If heroin is viewed as strictly an issue of illegal drug use, and if heroin addicts are dismissed as low-lifes, losers, criminals, etc., fundamental solutions will not be found. Now that heroin overdose is killing middle class and upper class kids and adults, more people are paying attention. If this is what it takes to get more people to understand addiction, then so be it.

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.