Opioids and Insurance

The argument over healthcare that’s raging in D.C. reveals different philosophies and values. There’s legitimate debate between government control of healthcare and free market forces, but if government decides to control healthcare, one of the worst things they can do is limit coverage of mental health and addiction. Typically, when money is trimmed from healthcare costs, addiction services are hit hard. This makes no sense, especially when large parts of the nation are presently beset by an opioid addiction epidemic. Opioids and insurance are important topics. The cost to society caused by untreated addiction is astounding.

The new GOP healthcare plan would negatively affect addiction treatment. Below is an excerpt from U.S. News regarding to lack of national concern for our addiction problem:

Addiction is America’s most neglected disease. According to a Columbia University study, “40 million Americans age 12 and over meet the clinical criteria for addiction involving nicotine, alcohol or other drugs.” That’s more Americans than those with heart disease, diabetes or cancer. An estimated additional 80 million people in this country are “risky substance users,” meaning that while not addicted, they “use tobacco, alcohol and other drugs in ways that threaten public health and safety.” The costs to government coffers alone (not including family, out of pocket and private insurance costs) exceed $468 billion annually.

Over 38,000 peopled died of drug overdoses in the U.S. in 2010, greater than the deaths attributed to motor vehicle accidents, homicides and suicides. Overdose deaths from opioids (narcotic pills like Oxycontin, Percodan and Methadone as well as heroin) have become the fastest growing drug problem throughout the U.S., and not just in large urban settings.

The opioid epidemic’s getting worse and insurance coverage will likely get worse, yet news outlets and politicians are obsessed with Tweets. It’s going to take a serious, national effort to curb the costly and deadly consequences of addiction, but I don’t see any real urgency among those who possess the most leverage to create change. So government policy makers deal with symptoms as the fundamental problem grows worse by the day.

Sober on St. Patrick’s Day

sober on st. patrick's dayBeing sober on St. Patrick’s Day is no doubt odd to many revelers who come to Savannah to party and drink hard. Does the recovered alcoholic have to hide from the festivities? No, not if they’re firmly grounded in recovery. This is what a lot of people don’t understand. It’s not uncommon to think of recovering alcoholics as always on the verge of drinking again, ready to pounce on a bottle of liquor if the opportunity is presented. The idea that a person prefers to be sober is a strange concept to the dedicated drinker.

I don’t know of any recovered alcoholics who would enjoy bumping shoulders with thousands of stumbling drinkers on River Street, but, if they wanted to view the spectacle, it wouldn’t be a problem. There are some alcoholics in the early stage of recovery who should avoid River Street because they aren’t grounded in recovery — to their minds, the drunkenness would most likely look appealing. That’s the difference between being grounded in long term recovery and still being at risk in early recovery.

The recovered alcoholic can do anything anyone else does except drink alcohol. The recovered alcoholic loses the desire for alcohol — they don’t want to drink. Being sober on St. Patrick’s Day is perfectly normal. It’s a sad statement that human beings have to have an artificial stimulus in their system to “party” and have a good time. It’s an untrue statement, actually. Sobriety is a valid choice. Sobriety allows one to fully experience life, to remember what happened, and to not pay dearly (and painfully) for drunkenness the next day with a hangover.

The brain learns in sobriety how to have fun without alcohol — there are natural feel-good brain chemicals that the sober mind learns to activate. It takes time though. It takes practice. The recovered alcoholic who practices Recovery Management will develop alternative ways to capture the good feeling alcohol once gave them but stopped providing. To the recovered alcoholic, being sober on St. Patrick’s Day is infinitely preferable, thank you.

Addiction and Reality

addiction and realitySometimes, reality sucks. I haven’t written a blog post lately because reality, as it has a way of doing, dealt me a set-back. I’ve been doing work on my kitchen lately. I usually hire out this type of work, but I enjoy doing it myself sometimes. I’ve never been injured doing remodeling or construction work, but 9 days ago I cut my hand with a chop saw, severing two tendons. They operated on the hand four days later, and now it’s healing, and I can at least type a little, now. I was angry for awhile — how could I make such a stupid mistake? — but like addiction and reality, first there’s acceptance of reality (you didn’t think I was going to write a whole blog post about hand, did you).

In addiction recovery, one of the first things a person has to do is accept reality. Addiction becomes a constant retreat from, or battle with, reality, and, thus, the active addict is always at odds with the way things are. The problem is that reality always wins. We can change some things, many things, and that’s where responsibility plays a big part in recovery — change the things we can. But there are certain immutable aspects of reality we can’t change — they’re accepted, if we’re going to make progress. We might change our perception of reality, but, contrary to the saying “perception is reality”, immutable reality isn’t changed through drug use, positive thinking, will-power, magic, stomping our feet, or fighting — if we don’t accept these unchangeable aspects of reality, then there’s constant turmoil, consequences, frustration, resentment and a general state of tension. Again, like the Serenity Prayer says, grant me the serenity to accept the things I cannot change; courage to change the things I can; and wisdom to know the difference.

In addiction recovery, the tension that’s felt when a person is at odds with reality is dealt with positively or negatively. Goals are set in recovery, and hopefully expectations are realistic. It takes time to change ourselves, to repair the past the best we can, and to move forward creating a new life. There are set-backs, obstacles, and there are times it doesn’t seem possible or worth the effort. Impatience can cause us to try shortcuts, to skip the hard parts, to deny that certain things about ourselves are holding us back. This all creates tension, and we can either escape the tension by giving up and going back to drinking/drug use, or we can use the tension as creative energy.

Creative tension is when a person accepts where they are in life, accepts the gap between where they are and where they want to be, uses the tension to generate creative energy to achieve the set goals, making adjustments along the way. Tension can be painful and unwelcomed, or tension can generate creative energy and the desire to change and grow — it’s up to us. Addiction and reality can find peace in recovery.

Neuroplasticity and Addiction Treatment – Part Three

Neuroplasticity and addictionThis is the last in the Neuroplasticity and Addiction Treatment series. Recovery from addiction is a long term process. Recovery calls for intent, focus and repetition. The recovering person claims their intent — to stay sober and clean. In order to do this, the person has to accept that alcohol or the drug of choice will cause the same problems over and over if the person continues to drink or use. The recovering brain only half-believes this in the beginning. The old neural pathways told the brain alcohol/other drug is good and necessary, and these neural pathways are strong. These messages to the brain don’t disappear just because the drug has been removed.

The neural pathways of addiction weaken over time as the recovering person focuses on recovery, telling the brain that recovery is good and necessary, creating new neural pathways. One of the great benefits of attending AA or NA is that the recovering person receives positive recovery feedback over and over. The rewards in recovery aren’t as immediate, strong and reliable as the original rewards of alcohol/ other drugs once were, but they’re real and become increasingly more substantial. The drugs only worked for awhile, then they became more and more unreliable and less potent.

The recovering person is continuously working on a new life, a new way of thinking. Recovery is about positive change and growth. Although there are ups and downs in recovery, they’re nothing compared to the violent ups and downs of addiction.

In early recovery, the recovering person tries to stay away from alcohol/ other drugs, but as recovery progresses there’s a generative effect in which the person’s pulled forward to something good and fulfilling. Rather than expending negative energy to stay away from the drug, recovery creates more energy to move forward. If a person is just white-knuckling it in sobriety, they’ll wear down and likely give in to the desire to return to their drug of choice, but when the person is actively participating in recovery with the goal to improve and grow as a human being, then the energy spent in recovery is regenerated over and over, creating ever more energy and desire to recover. The addictive mind slowly changes — the addicted person now becomes a new person with a new life full of possibilities.

Neuroplasticity and Addiction: Part Two

neuroplasticity and addiction recoveryJust as neuroplasticity and addiction are strongly associated, so are neuroplasticity and addiction recovery. The neural pathways and networks continuously strengthened in active addiction gradually weaken in recovery as pathways and networks in recovery strengthen. In recovery, a person establishes purpose and meaning, then begins to actively pursue recovery goals on a regular basis. I’ve written here about Recovery Management, and this is what that’s about — managing the recovery process with purpose and focus. We are what we think, in a sense.

Tasha had always told herself that she didn’t fit into groups. In high school, even when she had a chance to improve her social connections, her negative thoughts sabotaged potential relationships. After a lonely and mostly frustrating college term, she began a career. Tasha eventually became depressed and told herself over and over that this was her fate, to be lonely and unloved. It became so bad that Tasha couldn’t leave home except when absolutely necessary. Tasha sought help and began a program of changing her brain. Sasha was asked to look fearlessly at reality. Sasha accepted that she could change her brain, that she could become a different person. Sasha was intelligent — Sasha was empathetic — Sasha was funny when she let herself loosen up — Sasha began sending different messages to herself, taking note when she was negative, then changing that message to something more realistic.

Sasha found that she didn’t have to be less than she is or pretend to be more than she is, she only had to accept what and who she is and begin a program of gradual improvement as she reached her personal goals. Gradually, Sasha began seeing herself in a different way. First she was able to establish a clinical relationship with her therapist, which transferred to social relationships with co-workers and then to social connections she made outside work. The old neural pathways that once sent out-of-touch-with-reality messages to her brain weakened, as in-touch-with-reality messages strengthened new neural pathways and networks. It’s simpler to say Sasha discarded old ideas that were destroying her self-esteem, as Sasha empowered new ideas that lead to human flourishing. we are not stuck with the brain (thoughts and feeling) we have — we can change. The brain is plastic, not hard-wired.

In neuroplasticity and addiction recovery, the same thing happens. For the recovering addict, all they have to do is stop drinking alcohol or using whatever is their drug of choice and begin the recovery process. The problem is that it’s more than just changing ideas from negative to positive then living a beautiful life from that point on — it’s a long and sometimes arduous process. There are many people with life problems who have a tent and sawdust revival experience, only to fall back into the old way of thinking and acting once the dust clears and the revival show has left town. When a person goes through treatment, they’ll usually develop insights that create the revival experience — they are gung-ho for a short period, but then it gets difficult and they stop managing their recovery. The old neural pathways that told the brain drugs are good and necessary are still strong, so the person usually returns to alcohol or their drug of choice, thus, strengthening the idea they can’t change — they tell themselves they can’t stay sober and clean — it becomes a self-fulfilling prophecy.

In the next couple of days I’ll finish this with more about how people are successful in recovery, how they change over time. I’ll also write about mindfulness and meditation, which have proven to be powerful tools for neuroplasticity and addiction recovery.

Neuroplasticity and Addiction Treatment: Part One

Neuroplasticity and addiction treatmentI firmly believe that the relationship discovered going forward between neuroplasticity and addiction treatment will greatly improve recovery outcomes. With addiction, although it might seem strange to someone who doesn’t understand addiction, the particular drug used is not so important as what happens to the brain when an addictive drug is taken by someone with a predisposition to addiction. The particular drug of choice will be important to the person in recovery because of environmental, social and emotional triggers that remind the recovering addict of a place, a smell, a friend or a feeling associated with their main drug of choice – understanding these triggers is vital to relapse prevention, but, otherwise, the brain reacts pretty much the same, in relation to addiction, to all addictive drugs. The neuro-chemical actions in the brain are different from one drug to another – however, the neural-pathways created by repetitive drug use are what make recovery so difficult. Because this is not a simple subject, I’ll write this in several parts.

Let’s start from when neural pathways are strengthened and make drugs seem necessary and good to the addict. The addict consumes a drug, dopamine flows, the midbrain remembers the quick sense of euphoria or well-being, and neural pathways are strengthened, repeat and repeat and so on. In most people who’re social drinkers, their brains never change to the point that craving a drug overwhelms reason and judgment. For the addict, brain chemicals make changes that create tolerance and the irrational craving for more and more of the drug. This vicious cycle continues until there’s treatment and a reversal of the process.

People on the outside who witness an addict go into treatment and come out with the drug completely out of his/her system are mystified when the person returns to the drug shortly after treatment. It’s usually because he/she stops doing anything further to promote recovery. After years of strengthening neural pathways that tell the brain a drug is good and necessary, these pathways are too strong to overcome with just a few weeks of treatment. In treatment an addict should learn that recovery is a long-term process. It takes a while to strengthen the neural pathways that tell the brain the drug is deadly, and that recovery is healthy and life enhancing.

If you’ve ever had to change your ideas about something that’s deeply ingrained in your brain, that you’ve reinforced for years, like eating fried food, or a long-term love relationship that you discover, after decades, has gone terribly awry,  you understand how hard it is to change the brain to see something you enjoyed immensely, loved or craved as harmful and something that you must resist. Now, take that understanding and multiply it and you’ll get an inkling of an understanding how hard it is to stay away from a drug that captured the body and mind for years. For years the addict could take the drug and, quickly, the strong feeling of euphoria or well-being was there on demand — the addict’s brain stored the powerful memory of immediate satisfaction deep in the midbrain and associated this memory with people, places and things that trigger the desire to use the drug — now the drug has turned on the person, but the brain still wants the relief, quickly, with power and consistency. It takes awhile to change this in the brain. The good news is that the brain can change and recovery is possible.

In the next few days, I’ll write more in detail about neuroplasticity and addiction treatment how the brain changes in recovery according to those doing research in this area.

 

Alcoholism and Anxiety Disorder

Alcoholism and anxiety disorderAlcoholism and anxiety disorder often go hand in hand. There are several reasons — one being that alcoholism and anxiety disorder can coexist. This means that a person has two diagnoses – alcohol use disorder and anxiety disorder. In this case of co-occurrence, alcoholism and anxiety disorder are both treated as separate conditions, although as I’ll write about below, they affect one another. If a person is an alcoholic with an anxiety disorder, the drinking makes the anxiety worse, although the person thinks the alcohol is helping the anxiety– it becomes a vicious cycle.

Most people get confused with a chicken/egg question — which comes first? Does anxiety disorder cause alcoholism? Does alcoholism cause anxiety disorder? There’s no evidence that anxiety causes alcoholism, but anxiety can complicate alcoholism. It’s long been known that anxiety causes some people to abuse alcohol, but there’s a difference between abusing alcohol and alcoholism. In the case of the person with an anxiety disorder who abuses alcohol in a misguided attempt to self medicate, if the person receives professional help to treat the anxiety, the person will likely stop abusing alcohol. In the case of co-occurring alcoholism and anxiety disorder, if the person treats the anxiety but not the alcoholism, the alcoholism will continue, and vice versa.

There’s some research showing that alcoholism might cause anxiety disorder, that both conditions relate to the same area of the brain that’s changed by alcoholism.  It becomes confusing, but understanding each condition and how they relate to one another is important when determining courses of action to deal with either or both. Drinking to alleviate social anxiety, panic attacks, or generalized anxiety only complicates the anxiety, and can make the anxiety worse — also, as mentioned above, if a person suffers from both alcoholism and anxiety disorder, treating one but not the other will not solve the problem.

When dealing with alcoholism and anxiety disorder it’s important to know that recovery won’t be easy, but when recovery does happen, very good things happen.

Opioids and Doctors

Doctors and OpioidsIt’s easy to blame doctors for the rise in opioid addiction, but this isn’t fair to doctors. The issue of opioids and doctors is tricky. Patients with chronic pain require pain medication, and the best pain medication is usually some type of opioid – opioids can be addictive. Doctors share some of the responsibility, though, especially if they’re “high intensity” prescribers. A recent study shows that patients in need of pain management are 30% more likely to become long term opioid users if they’re patients of high intensity prescribers. Below is an excerpt from a NYT’s article on the study:

Over all, researchers estimated that out of every 48 patients who were sent home with a prescription, one would end up using opioids long-term, which researchers defined as at least 180 days of medication over a year. Chronic opioid use, particularly in older people, can contribute to spiraling problems: constipation, confusion, falls and addiction.

 
I believe if doctors received more training on addiction in medical school, opioid addiction would significantly decrease. I should stop here and make a distinction between physical dependence on opioids and addiction to opioids. Many long term opioid users will likely develop a physical dependence, but addiction is more than just physical dependence. For those predisposed to addiction, using opioids will become a major problem — addiction being a chronic brain disease characterized by tolerance and continued, obsessive use despite negative consequences. Most pain patients who become physically dependent on opioids  don’t develop the obsession associated with addiction – they’ll detox off the medicine when it’s no longer medically useful. The addict, however, will crave the opioids even after they’re no longer needed — and the addict will use higher and higher amounts of the opioids. Even if the patient’s detoxed in a hospital, unless there’s some form of addiction treatment, the person will likely return to opioids.
 
With a better understanding of addiction, doctors can recognize more quickly the signs and symptoms of addiction and refer to treatment. Doctors can also use alternative means of pain management for patients who have a history of addiction. There’s evidence that Suboxone is good for long term pain management, and it’s also a replacement treatment for opioid addiction. Sometimes opioids are the best treatment for pain, but sometimes opioids cause long term damage. If government begins regulating the opioid problem, that might not be the best solution — it might be best if the medical field regulates itself.

 

Sober Community

sober communityIn almost every town, if not in every town, there’s a sober community made up of people in recovery. Most often it’s people who attend Alcoholics Anonymous, or a church group that provides a sober community for recovering addicts, but sometimes it’s just a group of people who know one another and are all living the sober lifestyle. When a person chooses abstinence from alcohol and other drugs, their lifestyle doesn’t have to change drastically, but going to bars sober is not the same if everyone around you is high.

If, though, you have a network of friends who’ve also chosen abstinence, then going to a nightclub to dance is just as fun, if not more fun. Among people who drink and do drugs, there’s usually the idea that fun’s associated with some type of mood-altering drug, as if we don’t have what it takes naturally to have fun. It’s a very sad statement that human beings require an artificial stimulus to have fun. Not only is it sad, it’s not true.

In larger cities, there are recovery clubs, places where a community of people meet who’re living the sober and clean life. There’s also online sober communities. It’s not a crutch — it’s a chosen association. I often have people who can drink socially with no problem talk as if sobriety is an imposed burden — they believe that living sober is difficult, and that I must miss it and struggle to stay away from it. When I stopped drinking years ago, I thought people who didn’t drink or do some kind of drug were weird, a different kind of animal. I also thought people who had a problem and quit were always tempted. What I found in the sober community were people just like me. They chose to live drug-free. For the most part, the people I met in recovery were well-adjusted, happy and a little wiser as a result of overcoming something that had taken their freedom. They didn’t want to drink or use some other drug — they were satisfied and fulfilled in sobriety.

Freedom was one thing I noticed right away. I was inspired by the idea I didn’t need alcohol. I didn’t have to arrange things around my drinking — I wasn’t spending money I didn’t intend to spend (money I needed to pay bills) — I wasn’t paying legal costs for drinking related offenses — I wasn’t suffering the physical complications of heavy drinking and poor nutrition — I wasn’t letting people down by breaking promises or missing important occasions — I wasn’t expending energy lying, keeping up with the lies and despising myself for the dishonesty.

The sober community is a free community — Some of the best people and best friends I’ve met have been those who had a drug problem and are now living free from alcohol and all other drugs. It doesn’t mean I have no friends or associates who drink — I do, but I don’t have the same mindset as those who still believe that in order to have fun, relax and socialize you have to drink alcohol or use some other mood altering drug. I’m very grateful for this.

When Recovery Becomes Real

When recovery becomes realAt NewDay Counseling we have a slogan – With Each New Day, Recovery Is Possible – that sounds a little corny, but the truth behind this corny slogan is powerful and real. When a person understands the “new day” concept, this is when recovery becomes real.  I’ve witnessed thousands of patients/clients through the years go through the treatment process and embrace recovery from addiction. Recovery is more than getting the drug out of the body — it’s a transformation. Each person’s recovery is a little different, but there are common factors, too.

Addiction can be like a long, continuous nightmare. There’s a newness to recovery that’s like the start of a new day. The difference is that the things which happen during addiction are all too real. The nightmarish quality of addiction begins to dissipate only when the person accepts reality and becomes willing to change. No one can tell a person how to change. Each person recovering from addiction chooses their own path. Many use support programs like Alcoholics Anonymous or Narcotics Anonymous, and some choose their church community, while other might utilize a network of family and friends.

If you’ve ever had a bad day, or a string of bad days, and it seems like nothing will change, but then wake to a beautiful “new day” that inspires hope, then you understand a little about recovery from addiction. Hope is powerful when you’ve suffered from the emptiness and anxiety of hopelessness. The “new day” experience is a deeply human experience — it’s the realization that things can change, that life doesn’t have to stay the same.

Recovery becomes real when the recovering addict becomes honest, open and willing. Of course, nothing changes dramatically once and for all with no further effort. The “new day” experience is the acceptance that one “new day” at a time, a person can stop using alcohol or other drugs, repair the past as best possible and achieve goals. As I’ve said, I’ve witnessed thousands of people recover — it’s real, and when recovery becomes real, things change — there’s hope.