Is Suboxone effective in detoxifying prescription pain pill addicts?

Suboxone is without a doubt the best option to help people who have become addicted to prescription pain medications. Using this FDA approved drug to detox opiate users is virtually painless and the most effective tool in the arsenal against drug addiction. The dependence just goes away in very short period of time and all of the withdrawal symptoms and side effects are effectively eliminated.

We have been using Suboxone in conjunction with therapy and behavioral modification for approximately four years and have an unbelievably low relapse rate. We have treated countless patients and after conversing with others at our treatment facility, we are aware of very few relapses. The clients that relapsed chose to do the Suboxone detox alone and received none of the benefits of individual therapy, education or cognitive behavioral therapy.

While it is often referred to as a “miracle drug”, one cannot forget that there were underlying issues that were responsible for driving the addiction initially. Some of our patients are consequential victims of addiction and others chose opiates as a recreational drug of choice. In either case, a physical dependency is always accompanied by a psychological dependency. Some started taking prescription drugs for pain management. The drug use continued after the pain had been dealt with and like all opiate addictions, they became progressively more physically addicted and greater quantities of the drugs were required to avoid the painful withdrawal symptoms.

Consequential or recreational, they both end up with in a severe dependence that can be life altering.

What is Suboxone and how does it work?

Suboxone is comprised of Buprenorphine and Naloxone.

Buprenorphine is a partial opioid agonist. A partial opioid agonist can both activate and block opioid receptors, depending on the clinical situation. Under appropriate conditions, partial agonists can produce effects similar to those of either agonists or antagonists. Buprenorphine’s opioid effects are limited compared with those produced by full opioid agonists, such as oxycodone or heroin. A full opioid agonist stimulates activity at opioid receptors in the brain that are normally stimulated by naturally occurring opioids. Naloxone is an opioid antagonist. An opioid antagonist prevents molecules of other drugs/medications from binding to the opioid receptor in the brain. Antagonists can also displace other opioids and can precipitate withdrawal, or block the effects of other opioids. Naloxone is included in Suboxone to discourage opioid dependent people from dissolving the Suboxone and injecting it. When Suboxone is placed under the tongue, as directed, very little naloxone reaches the bloodstream, so what the patient feels are the effects of the buprenorphine. However, if naloxone is injected, it can cause a person dependent on a full opioid agonist to quickly go into withdrawal.Who can prescribe Suboxone?There are a limited number of doctors that are approved to prescribe Suboxone. The physician must be compliant with the Drug Addiction Treatment Act (DATA) of 2000. This act states that the prescription use of medications in the treatment of opioid dependence is limited to physicians who meet certain qualifying requirements. Furthermore, they must have submitted written notification to the Secretary of Health and Human Services of their intent to utilize Buprenorphine HCL for the treatment of opioid dependence.

Some physicians involved in general and family practices are licensed to prescribe Suboxone. We find that in many cases however that these doctors are not totally familiar with the most effective treatment protocol. Suboxone is rarely effective when the patient simply receives a prescription for the medication and is not monitored closely. Opioid dependence often varies in severity and must be monitored to insure that the proper dosage is given. Some patients will initially need only 4 mg while other more dependent patients may need as much as 16 mg to avoid opioid withdrawal symptoms. We are often sought out by clients that have started Suboxone treatment with other physicians and feel that the treatment that had been prescribed was inadequate.

How is Suboxone most effectively induced in new clients?

At Breakthrough we have one of the most effective treatment protocols in the country. We conduct a pre-induction interview and meeting to establish the level of dependence and provide instructions for the induction. The client comes in the day of the induction in mild opiate withdrawals. We start the induction in incremental dosing stages. The dosages are increased throughout the next few hours until withdrawal symptoms have subsided. The client spends the entire day with us in a quiet comfortable room and we monitor their condition and withdrawal symptoms. When the client is comfortable for an extended period we provide the last dosage for the day and the client goes home or to their suite. The client then returns the next morning for the second day’s dosage. We start with the dosage that we found to be effective from the initial induction. If this dosage is found to be adequate the patient is free to go.

The initial dosage will be continued for a period of time and then will be tapered in 2mg increments over the next weeks or months until the dependence is eliminated. The duration of the total treatment will generally take two to five months.

Why is counseling and behavioral therapy important?

As I said in the first section of this article, consequential or recreational they both end up with in a severe dependence that can be life altering.

We find that the vast majority of our clients are dealing with underlying psychological issues that drive their addictions. Whatever the underlying issue, they all seem to culminate in moderate to sever depression. There are reasons that the drug use became excessive and reasons that they accelerated. Other psychological issues are rooted in the addiction itself. These often include guilt from the deceptive behavior and actions that had become necessary to provide the drugs and conceal their excessive use from friends and loved ones.

Through counseling, we embark on a discovery process that uncovers the layers of psychological issues. The problems are sometimes singular in nature but more often are comprised of a mixture of things. Among these are anxiety, grief, remorse, shame, guilt, post-traumatic stress and depression. Our therapists work with the client to resolve the past and help them to focus on a brighter, happier and more productive future.

We also provide extremely effective cognitive behavioral therapy. This therapy includes education on the neuro-chemistry of addiction, anti-relapse skills, sobriety skills, rational thinking and extensive work on relationships.

I woke up early this morning and was enjoying my coffee while waiting for the Sunday paper to be delivered.  I turned on the TV, watched the news and then started flipping through the program guide.  I found an infomercial that was coming on Court TV in a few minutes called “The Addiction Cure”.  Being involved in the treatment industry as well a recovering alcoholic, I was immediately curious.  I read a book by a gentleman named Chris Prentiss a couple of years ago called “The Alcoholism and Addiction Cure” and wondered if this paid infomercial might have some affiliation. 

As the program started, the host displayed a copy of the aforementioned book.  He gave a brief overview and then introduced Mr. Prentiss.  Chris Prentiss is the co-founder and co-executive director of Passages Malibu, a very expensive and upscale treatment center located in Malibu California with his son Pax.  Passages treats addictive behavior by addressing underlying psychological issues.  Their treatment is quite lengthy and very involved.  According to their website, they have a host of therapist with different specialties.  Among them are marriage and family therapist, hypnotherapist, chemical dependency counselors, spiritual therapist, continuing care counselors, acupuncturist, doctors, nurses, and client supervisors.  The facility is located on the Pacific Ocean and features a very upscale environment with manicured grounds and gourmet meals.   The cost of treatment at Passages is rumored to exceed $50,000 per month and is private pay.

The infomercial touts this book as a definitive permanent cure for addiction.  Mr. Prentiss states in his interview that by simply reading his book and applying it’s teachings that you can cure any addiction, regardless of the severity or peculiarities of the problem.  He says that it works for gambling, sex, drugs, alcohol, tobacco, dietary and any other addiction or compulsive behavior. 

He also tells the television audience that you can read the book and cure yourself.  He says that the book can be used by people that might be too busy at work or can’t find a babysitter so that they can go into treatment for their addiction.  I sat and watched all twenty eight minutes in total disbelief.  Why would someone with a high profile treatment facility like Passages resort to an infomercial to sell books?  I thought at first that it might be a genuine effort to help people defeat their chemical dependency but as the program progressed I was left with the impression that this was not the case but rather was designed to sell books at an inflated price.  At the end of the infomercial, the book was offered for $24.95 plus S&H.  It is listed as a $29.95 value.  I checked on Amazon and indeed the list is $29.95 but Amazon sells it for $19.77 in hardback and $10.85 in paperback.   

As I said earlier, I read the book a couple of years ago.  I consider it a very good and informative book with a non-traditional approach to recovery.  It is entertaining and an easy and compelling read.  The first few chapters describe in detail the addiction issues that Pax, the son, dealt with for a number of years.  Pax was cross addicted to several drugs during his youth and his particular problems culminated in Heroin addiction.  The remainder of the book talks about his recovery and the underlying reasons that were driving his addiction. 

“The Alcoholism and Addiction Cure” is an interesting book but it is far from a “cure” for alcoholism or addiction.  Chris Prentiss states in his infomercial that alcoholism is not a disease and that it was classified that way only to make it coverable by insurance companies.  If it is not a disease, how did he come up with a cure?   

Passages Malibu states on their homepage that they have the “highest success rate in the world” but they also employ “continuing care” counselors.  There is also an outpatient alcoholism treatment center in Atlanta that states that their program is eight times more effective than the national average.  They bill themselves as “The Nations Leading and Most Effective Alcoholism Counseling Alternative to 12 Step Alcohol Addiction Treatment and Counseling Programs”.  After completing their program and attaining one year of sobriety you are rewarded with a coveted “Gold D” for your efforts.  They say that after attending their program you are not in recovery, but “recovered”.

One would have to assume that neither of these facilities has any clients that relapse or returned to dependency.  I seriously doubt that this is the case.  I also have no idea how either of them can legitimately make the success claims of being “Number One.”  There are no ways to measure themselves against other treatment centers or programs.  Most treatment centers are not aware when a client relapses after an extended period of time because contact is usually lost.  I went through three treatment centers for alcoholism and never heard a word from any of them after I left the program.  AA keeps no records, nor do most other non-12 step support groups.

There are many treatment centers, programs and philosophy’s available to deal with addictions.  Some are very effective and some are not.  12-step or AA style of treatment works for some and is totally ineffective for others.  One must remember that AA has a phenomenal success rate when you consider that it is free and run by a group of recovering addicts with no psychological or professional training.  Most effective treatment centers that utilize the12-step treatment philosophy also provide counseling, medical, psychological and after care elements.  It is my belief that there is no definitive or perfect way to treat the disease.  Our treatment has many components and is individualized for each person.  All clients have different needs and it is our belief that there is no “one size fits all” answer.

You cannot permanently “cure” alcoholism or drug addiction.  Once you have crossed the threshold into chemical dependency several things occur both physically and psychologically.  It is not possible for an alcoholic to drink casually or responsibly, a Heroin addict to take pain pills, a gambler to go to Vegas or a sex addict to go to a brothel without returning to the dependency.  Addictive patterns can be altered, psychological issues can be addressed and dealt with, chemical substances can be removed from the system, the body can heal and a happy productive life can be resumed but alcoholics and addicts can never be totally cured.  If resumed, alcohol and drug consumption may be controlled for a short time but will eventually end up with the addict resuming the addictive behavior and again being fully involved in dependency. 

Many people who complete treatment for alcohol dependency blame relapses on unbearable cravings for alcohol.  The dependent person has usually been drinking for a reasonably long time and has a conditioned response to the alcohol cravings.  When actively drinking, the cravings were easy to deal with but what do you do now that you have been detoxed and treated for alcohol abuse?  One drink will virtually always culminate in a full blown relapse.  Some are short in duration and are caught prior to redeveloping physical alcohol dependence, others land the person back in the hospital for yet another detox. There are many tools available to help with cravings.  This article will discuss some of the methods and products available.   

Therapy – Traditional treatment rarely includes any therapy to modify behavior other than the twelve steps of Alcoholics Anonymous.  More contemporary and progressive treatment centers use psychotherapy and incorporate cognitive behavioral therapy.  Much of the alcohol dependence mechanism is controlled by repetitious or habitual behavior.  Most alcoholics have specific drinking conditions where the reward of alcohol has been used daily.  Modifying these conditions and helping the brain to learn a new behavior is extremely effective in remaining sober.  Cognitive Behavioral Therapy is used to help the dependent person learn new ways to react and behave that do not include alcohol. 

Medications – There are pharmaceuticals available which are effective in helping deal with alcohol cravings.  Among them are Naltrexone, Vivatrol, Campral and there are some early indications that Chantix may also be an effective anti-craving medication.  All of these drugs are used to occupy specific neuro-receptors that are responsible for the cravings.   

Naltrexone is an oral medication that occupies the opiate receptors in the brain and is also available in an injectible form known as Vivitrol.  This drug has proven very effective in helping reduce cravings in the majority of problem drinkers.  Many report that substantially all cravings have been abated but a small percentage of the people who have tried these medications report that they notice no reduction. 

Campral (acamprosate calcium) is another oral medication available to help reduce cravings.  The manufacturer states that the mechanism of Campral is not totally understood.  Alcohol inhibits activity of receptors called NMDARs (N-methyl-D-aspartate receptors) in a way which overproduction of these receptors is caused by excessive and prolonged alcohol consumption.  When alcohol is suddenly not present, these NMDARs become more active than normal.  Withdrawal from alcohol creates a surge in the release of neurotransmitters such as glutamate.  Campral is believed to help reduce this glutamate surge.  Again, it is effective in reducing cravings in some and in others it seems to have no effect. 

Some recent studies have indicated that promise is shown for a tobacco cessation medication called Chantix in treating alcohol cravings.  Chantix (varenicline) is a nicotinic receptor partial agonist that reduces the cravings and pleasurable effects of nicotine.  This drug is not currently indicated for alcohol cravings.  

Education – Most alcoholics have no idea what is going on with their body and brains as a result of their continued alcohol consumption.  Every attempt should be made to educate these individuals on the neurochemistry of alcohol addiction.  The more one knows about the effects that the abuse creates the more likely they are to make the difficult decision not to resume drinking. 

Nutrition – Nutrition plays a critical part in recovery from alcoholism.  Alcoholics tend to neglect nutritional needs in favor of alcohol.  The caloric content of alcohol often satisfies hunger and the dependent individual drinks rather than eating.  Alcohol contains no nutritional value and the body immediately converts any alcohol consumed into sugar.  The rapid introduction of sugar into the system raises blood sugar levels and gives the alcoholic a feeling of well being.  Rather than consuming protein and carbohydrates that are more gradually metabolized, the alcoholic drinks.  The alcohol burns rapidly and blood sugar drops dramatically causing the dependent person to feel weak, anxious and shaky, similar to the feeling a normal person gets when they are extremely hungry.  The metabolism of alcohol also depletes many vitamins and minerals.  Most alcoholics that enter treatment are severely deficient in many areas that are necessary in normal bodily functions.  Many are also pre-diabetic or hypoglycemic.  During early sobriety it is critical to address these deficiencies and resume a diet high in quality nutrients.  Supplements are also recommended to aid in the healing process.  Blood sugar irregularities are often confused for alcohol cravings. 

After accessing the individual’s specific needs, we use a combination of any or all of these components in early sobriety.  Psychotherapy, cognitive behavioral therapy, medications, education and nutrition can all play critical parts in recovery.  Often Campral and Naltrexone are used in combination to deal with cravings.  Pharmaceutical intervention and being nutritionally sound can virtually eliminate physiological cravings.  Psychological factors such as changing destructive behavior, dealing with issues that drive the addiction and understanding what is happening with your brain and body are the other often to frequently overlooked components.  Long term sobriety is rarely achieved by pharmaceutical intervention alone and must be accompanied by physiological and cognitive behavioral therapy.

Many people research how to detox themselves from alcohol.  Keep in mind that there is a huge difference between occasional or sporadic alcohol abuse and true alcohol dependence.  If you abuse alcohol occasionally you can sometime just quit drinking, survive the hangover and recover without any medical intervention.  If you have become alcohol dependent, it is a totally different story.  Alcohol Dependence is defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is the American handbook for medical professionals, as meeting at least three of seven criteria within a twelve month period. The criteria are:

1.      Narrowing of the drinking repertoire.

2.      Increased salience of the need for alcohol over competing needs and responsibilities.

3.      An acquired tolerance to alcohol.

4.      Withdrawal symptoms.

5.      Relief or avoidance of withdrawal symptoms by further drinking.

6.      Subjective awareness of compulsion to drink.

7.      Reinstatement after abstinence. 

If three of these criteria are met, you have become alcohol dependent and it is unsafe and potentially life threatening to detox yourself.  Many things happen when alcohol is withheld from a dependent person.  The degree of withdrawal problems will vary for each individual but the common problems incurred will include; dramatic increases in blood pressure, nausea, tremors, headache, dementia and hallucinations, seizures, heart failure and strokes.

Most good intentioned alcohol dependent people swear off alcohol many times and are determined to quit drinking on a daily basis.  Within hours of abstinence, symptoms begin to occur.  The person will have a splitting headache, be sick to their stomach and begin to tremble.  The great majority of these people are unsuccessful in there attempts to quit.  They decide to have one drink to feel better and they are off to the races again.  When the alcohol dependent person has this “one drink” their symptoms abate very rapidly.  The shaking stops, the headache goes away and they feel better.

There was an article in yesterday’s paper about a woman who died while in custody of the Phoenix Airport Police Department.  She was on a flight from New York to Arizona where she planned to enter an alcohol treatment program in Tucson.  She was arrested for disorderly conduct and unfortunately died in a holding cell.  The article was not specific about the cause of death but it was undoubtedly alcohol related.  I suspect that her disorderly conduct arrest was probably due in fact to alcohol induced dementia or delirious tremens (DT’s) which are usually interpreted as extreme intoxication.  When symptoms such as these accompany withdrawal, a stroke or seizure is almost inevitable without medical intervention.  This is a very common story and it often ends in death.

Alcohol detox must be done under medical supervision.  There are two basic types of detox methods ambulatory detox and outpatient detox.  Ambulatory detox can be safely accomplished when done under medical supervision and administration of appropriate detox drugs.  Vital signs must be taken and dosing must be done frequently to safely detox in an outpatient setting.  The alcohol dependent person must be monitored at all times during the detox and cannot be left alone.  The other detox method is done in a hospital setting.  Hospitalized detox is necessary when there is a history of DT’s or in cases where other medical problems are present.Medical protocols for detox patients will vary depending on the person’s specific medical history and severity of dependence.  In all cases, anti-seizure drugs are induced to mitigate the risk.  A variety of other medications will be used to treat symptomatic problems such as nausea, insomnia and anxiety.

In short, there is no way to safely detox yourself from alcohol if you are alcohol dependent.  Do not be fooled by advertising claims or holistic remedies.  It is a life and death situation and cannot be done safely without medical intervention.

The Gateway Drug Theory is best defined as the belief that a lower class drug can lead to subsequent use of harder drugs.  It is also defined as a drug sometimes used in a first or introductory experience.  The two drugs most frequently labeled under this definition are marijuana and alcohol. 

More people enter substance abuse treatment centers each year for treatment of alcoholism than all other substances combined.  It is available, plentiful, easily obtained, legal and socially condoned and in some cases, socially encouraged.  Thousands of people enter treatment each year for cannabis addictions but the numbers pale in comparison.   

Alcohol addiction is progressive in nature.  It takes more and more to achieve the same effect.  As the consumption levels increase, the dependence transcends one of a psychological nature and it also becomes a physical dependence. 

While many who experiment with marijuana never progress to harder drug use, just as many will progress to more addictive drugs.  Some remain with marijuana as their drug of choice and become dependent on marijuana alone.  The most common progression is marijuana to cocaine.  After using cocaine for a period of time, most coke users also become dependent on alcohol and/or benzodiazepines.  The cross addictions normally occur as a result of the users efforts to self-medicate for the sever depression or “crash” that is experienced when coming down from cocaine.  Methamphetamine users have progressive drug use and in most instances it goes form marijuana to cocaine to crack to meth.   

Once someone has become dependent on any substance to a point that treatment is necessary, they must realize that they are much more vulnerable to the potential addiction to other addictive substances.  Many treatment centers report that clients return with relapse problems that are not their original drug of choice.  They might have completed treatment for alcoholism and relapse on opiates or cocaine. 

Addicts must realize that once they have crossed the line and become physically and mentally dependent to a mind altering substance that they can just as easily become addicted to a new drug.   

Virtually all relapses begin with alcohol.  It is very difficult to get people who have never had a problem specifically with alcohol to understand that it is very dangerous to drink if you have ever had problems with other substances.  They often say that they rarely drink and they really don’t enjoy the taste.  The problem surfaces when the person consumes alcohol and reduces their inhibitions and ability to make rational decisions.  Most jokes start with “This guy in a bar…” or “This drunk…”  There is a reason for this.  When people drink they do things that they would not normally do when sober.  Drug relapses usually happen after a couple of drinks.  People who were successfully treated for drug dependence often become alcoholics.  Alcohol is also a mind altering substance and is the most common drug available. 

There is another common misconception with recovering alcoholics.  Many think that they can enjoy N/A beer.  These products are marketed under many brand names such as O’Doul’s, Sharps, and a host of others from virtually every brewery.  While these brands contain a reduce alcohol content, they still contain alcohol.  The small amounts of alcohol combined with the real beer taste often lead to relapse.  A normal beer sold in

America will have an alcohol content of approximately 5% with some such as Sam Adams Double Bock ranging as high as 8%.  N/A Beer usually has an alcohol content of about .5%.  While they are sold as non-alcoholic beverages, they contain alcohol and can easily trigger a relapse. 

Addict or alcoholic, it is a much safer plan to avoid all alcoholic beverages.  “Non-alcoholic” beverages will lead to a relapse for virtually any alcoholic and alcoholic beverages will be a major contributor in most drug relapses.

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Many of the people who enter and complete treatment each day are still dealing with unresolved grief that creates a great sense of emptiness and a void that is extremely difficult to fill.   

Someone very close to us has died and left a big hole.  We keep fondly remembering the wonderful times that we had with our friend.  No one has ever been closer, more dependable or understood our thoughts and feelings more. 

We are constantly reminded of the great times and the fun we had.  We can’t go to the ball park without remembering all the smiles and laugher we enjoyed together.  We miss them on our fishing trips and somehow it just isn’t the same without them being there.  The Super Bowl and NASCAR will never again be enjoyable without that special someone by our side.  The great times we had at the clubs dancing like a couple of fools. 

If you haven’t figured it out yet, I am talking about our old friend alcohol.  For people recovering from alcohol dependence this is a huge problem and is the precursor to most relapses.  Everything we have done in our adult life has centered around alcohol and we don’t have any idea how to enjoy life without it. 

It seems that the older you are and the longer your love affair with alcohol, the more difficult the problem.  Most alcoholics started drinking at a reasonably young age and most of their adult memories are centered around events where alcohol was present and usually abused.  For some the problems came soon in our drinking careers, for others it took longer.  When we finally got sober, we didn’t quite know what to do or how to have fun. 

Young alcoholics face an even greater challenge, especially if they are single.  It seems that in our society most functions for young, single adults revolve around alcohol.  You take a case of beer water skiing.  You go to the sports bar with your buddies to watch the game.  You go to the club to meet members of the opposite sex.  How do you participate in these activities without drinking?  Won’t you stand out like a sore thumb?  Our non-alcoholic friends can do all these activities without getting smashed or drinking to excess. 

We feel somehow cheated that we cannot drink and have fun like everyone else.  What we often fail to realize is that we are not like everyone else.  With a little introspection we realize that we are different.  If you are an alcoholic, can you ever remember leaving an unfinished drink at a bar?  A half full glass of wine at the table of the restaurant?  Pouring out a beer that got warm?  Of course you can’t because it never happened.  That is why we can’t drink and have fun like everyone else.  Everyone else doesn’t even think about alcohol or if they have drained the last drop from the container.  They can take it or leave it. 

Most that have entered treatment have a great deal of anxiety and fear.  They don’t really understand how or why they ended up spiraling out of control.  The realization of fact that you will never be able to drink again is huge and it is a life changing event.   

This is true not only for alcoholics but all substance abusers.  Alcohol is always the gateway drug to relapse on the drug of choice for non-alcoholic addicts.  People that have a different drug of choice have a couple of drinks and their inhibitions are lowered.  In their altered mental state it is easy to rationalize using their drug of choice.  Most relapses start this way.  “One little joint never hurt anyone.”  “I can do one line or smoke one little rock without having a problem.”  “My back really hurts today; I think I can take a couple of Vicodins without getting addicted again.”  “I never had a problem with Xanax before.”  As Emeril would say “Bam” and we are off the wagon and under the wheels.  We hear these stories every day.   

We never seem to remember the bad things that we experienced during active addiction.   Most that have entered treatment have just as many bad memories of drinking or drugging as we do good memories.  We just choose not to remember the bad things, which is normal for all thought processes.  If it were not this way we would never try anything a second time.  When you learned to ride a bike and fell and hurt yourself you didn’t quit because you recalled the rush of going fast and the wind in your face.  Alcohol and drug addiction are no different.  We remember only the fun times we shared with our dear friend. 

When you become drug or alcohol dependent you normally have more bad memories than good.  In time, these memories fade, which again is a normal thought process.  You don’t remember the damaged relationships, the DUI’s, the throwing up, the shaking, and the total inability to perform normal functions.  When we remember going to the game and enjoying a dozen beers we rarely remember being bent over the bumper of the car in the parking lot throwing up later the same evening.  We don’t remember having to get up and have a drink to stop shaking so we could shave or put on makeup.  We don’t remember counting pills before a weekend trip to make sure we would not go into withdrawal.  We don’t remember getting a secret credit card and a P.O. Box so we could make online pharmacy dope purchases.  We don’t remember going to a questionable area of town looking for illegal drugs and putting ourselves at risk of being seriously injured or killed.  We don’t remember driving home with one eye shut so that we didn’t see two of everything or driving around drunk with our kids in the car.  We don’t remember having phone conversations, not remembering them and then having to fake our way through a conversation while trying desperately to remember.  These are but a few of the glamorous memories we alcoholics and addicts all share.  The list could go on for pages and the examples would get a lot worse. 

What we have to understand is that we are not like other people.  They are not alcoholics or addicts and do not experience the same things that we do.  They are not dependent and alcohol or drugs do not even occupy their thoughts. 

While we do not have to put ourselves in a position where drugs are being used, the case is different with alcohol.  Alcohol is socially accepted and encouraged in almost all areas of life.  We as alcoholics and addicts have to understand that if we choose to have a drink, we will end up in the same situation again and again.  The brain will heal and the resentment and cravings will abate but it takes time.  Sooner than you think the thoughts of using will leave and you will learn how to enjoy life sober.  Everything in your life will improve.  You will feel good physically, be mentally alert and sharp and friendships and relationships will once again blossom.  Stay strong, smart and remember that you and only you are in control of your own destiny.  It is possible to have fun without being high. 

When you look in the mirror, what do you see? For many addicts and alcoholics the picture is not a pretty one. Years of substance abuse usually has a catastrophic effect on the self image of the individual.

With addiction comes a lot of baggage. Addicts live a life of deception during their active use. The circumstances are different for each individual but they all culminate in a self-image that has been severely impacted. Many programs don’t address this problem, which I consider one of if not the most important components of a successful recovery and acquiring an attitude that will help the addict avoid relapse.

Virtually all addictive substances take a major toll on the addict’s ability to think clearly and process information. You will find that the use of alcohol and all drugs of abuse are progressive in nature, meaning that the frequency and quantity of use accelerates the longer the individual is actively using. For many addicts their drug of choice is not always available and they are forced to fend off withdrawal with drugs that are more easily available or socially acceptable. We often see poly-substance addiction in treatment. An example would be a cocaine user. Cocaine is not readily available in some instances and often the user is in an atmosphere that the use of their drug of choice would be prohibitive. To help cope with the extreme depression or withdrawal symptoms the cocaine addict often resorts to benzodiazepines or alcohol. As these situations become more frequent the addiction to cocaine also becomes benzodiazepine or alcohol dependence.

Addicts will go to extreme measures to protect their addiction. All addicts and alcoholics have events in their addicted life that makes them have feeling of self-loathing or be disgusted with themselves. Alcoholics have to hide their addiction to loved ones and the people they work with. They cannot go extensive periods without alcohol without going into withdrawals so they hide bottles and 99.9% of the addicts that enter treatment have switched to Vodka to avoid the alcohol on their breath being detected. Many times they have put themselves and others, including their family, at risk by operating vehicles or other dangerous activities while under the influence. They will use multiple liquor stores so as not to appear to have a problem and will drink heavily before going to a social event where alcohol use would be inappropriate.

Drug users also put themselves in harms way to obtain their drugs. The obvious would be a heroine user that has to obtain the drugs for dealers on the street. The less publicized are the pain and anxiety medication users that have multiple doctors prescribing them medications and are buying from numerous online pharmacies.

When you are an addict you can often see no way out and feel hopeless. Your self-image is that of an alcoholic or addict. As self-esteem is lowered, most perpetuate the problem by accelerating their use and their distorted image of themselves becomes a self fulfilling prophecy. They see themselves first and foremost as an alcoholic or addict.

When the dependent person enters treatment at a typical treatment facility they are detoxed to remove the mind altering substance from their body safely. They then enter the psychological treatment stage which usually consists of minimal counseling and a great deal of 12-step work. Traditional Alcoholics Anonymous style of treatment mandates the addict to take a moral inventory of themselves. During this process the individual has to recall all of the inappropriate conduct that occurred during their life as an addict. In most cases this style of treatment reinforces the addict’s self-image of being a loser and a person that is terminally flawed. Self-esteem is rarely worked on and is not even on the agenda in most treatment programs.

Addicts and alcoholics are no different than any other people. They have just had events in their life that they found difficult or impossible to deal with and resorted to mood altering substances in their efforts to self-medicate the problems away. Their self-medicating efforts resulted in a physical addiction. The normal perception of the alcoholic is that of a homeless person who is dirty and mentally deranged and drug addicts are perceived as being emaciated junkies that rob and kill to support their habit. Nothing could be further from the truth.

Effective treatment must include extensive work on rebuilding a positive self-image. Most addicts and alcoholics are good, caring, loving people that simply developed a substance abuse problem. They are fathers, mothers, brothers, sisters, husbands, wives, employers, employees, coaches, teachers, healers, spiritual leaders… For them to regain control of their lives and maintain long term sobriety, the issue of self-perception must be dealt with. Positive reinforcement of the good aspects of their life is critical in helping them focus on a healthy recovery.

While you can get sober at the urging of a loved one, you must care enough about yourself and hold yourself in high enough esteem not to relapse and return to the life of self destructive addiction.

An alarming number of people who have elected to have gastric bi-pass are finding that they are experiencing problems with other addictions, alcoholism being one of the primary manifestations. Some studies have indicated that as many as thirty percent of these people are experiencing what is termed “addiction transfer”. The term addiction transfer simply means that they have traded their compulsive addiction to food for another unhealthy addiction such as alcohol, drugs or gambling.

This concept is not new in studies of addicts. This type of behavior is explained as the individual seeking a new substance to fill an inner void. The fact is that a large number of these people haven’t had any therapeutic help in addressing the issues that were perpetuating their eating disorder. Many sought comfort in food and when the stomach is dramatically reduced in size that is no longer an option. In order to fill this void many turn to alcohol, which brings with it a whole new set of problems.

There are many physiological explanations for this phenomenon. It is thought that the brain’s pleasure center for these people was stimulated by food. When they consumed something that they enjoyed they stimulated their dopamine system. Dopamine is a neurotransmitter that produces pleasurable feelings when rewards are presented. It is believed to provide a teaching signal to the sections of the brain that are responsible for acquiring new behavior. Thus, the person would seek a pleasurable sensation by eating. This behavior is now being transferred to another behavior that produces the same dopamine release and emotional sensation.

One of the primary problems with alcoholism for the bariatric patient is one of a physical nature. After the surgery, the stomach is very small and the way that alcohol is metabolized is severely impacted. Alcohol is normally contained in the stomach when it is consumed where it is partially metabolized with the aid of the enzyme alcohol dehydrogenase. It is release slowly into the intestines. The length of time that the alcohol stays in the stomach is impacted by the much smaller stomach and more of the alcohol enters the intestines where it is absorbed rapidly due to the large surface area of the intestines. This causes intoxication at an accelerated pace, some studies have indicated almost twice as fast. Alcohol triggers the same dopamine release that the patient formerly received by eating. The alcohol induced dopamine release becomes the new addiction and alcohol dependence rapidly develops.

When the decision is made to have bariatric surgery the patient should consult with a psychotherapist and get the help necessary to modify compulsive behavior and treat any underlying issues that may be present. If therapy is not part of the treatment, the resulting and desired weight loss will occur but the danger of addiction transfer is substantial.

Twelve step treatment is based on the principals of Alcoholics Anonymous. While I respect and admire the fine work of AA, I find that many people cannot grasp this style of treatment. Many have tried these principals only to relapse time and time again. Some studies suggest that as many as 95% of the people that try a 12-step treatment program relapse within the first ninety days.

Traditional treatment is based on spirituality and seeking help from a higher power to resolve addiction.

The first step is admitting that you are powerless over your drug of choice and that your life has become unmanageable. Without this step it is impossible to recover with 12-step therapy. Many have a problem grasping this step. They might be very high functioning and they feel that their life is not unmanageable, just their problem with a particular substance. The great majority of the clients we treat are very successful in their chosen field.

The second step looks to a higher power to restore sanity. Again, many don’t feel that their sanity is in question, just their chemical dependency.

Step three has the person make a decision to turn their will and their life over to the care of god as they understand him.

The remainder of the steps involve taking a moral inventory and working with the god of their understanding to deal with their past and make right all of their misdoings.

This program works for many people if they embrace the philosophy and follow the program. Alcoholics Anonymous teaches you to work these twelve steps over and over and to attend meetings the remainder of your life to reinforce these teachings and carry them to others who are still active in their addiction. They also encourage members to avoid any circumstances that might put them in an atmosphere where alcohol and drugs are used. While this is typically not a problem for drug use, it is often very impractical for alcohol since it is legal and permeates every aspect of normal life.

It is very rare that someone has substance abuse without having accompanying psychological disorders. These problems range greatly but all lead to moderate to severe depression. When the addict or alcoholic uses their substance of choice it becomes a vehicle that takes them away from their problem. Traditional treatment does nothing to address the co-occurring disorders and has a tendency to actually heighten anxiety and depression due to admitting past transgressions to one or more peers.

It is very common for people with substance abuse problems to feel a great deal of guilt associated with their addiction. While protecting and perpetuating their dependency many have lived a life of deception that creates this guilt. Drugs and alcohol share the common bond of depressing the central nervous system and lowering inhibitions. When the addicted person becomes dependent on the substance they will go to great extremes to protect themselves and insure that they are not discovered or interrupted. Many have lied or taken other deceptive measures to obtain or protect their drug of choice. Some have stolen or concealed the amount of money spent on the substances to the detriment of their family and loved ones. Most have hidden drugs or alcohol or gone to great lengths to cover their tracks and not reveal their dependency.

Traditional treatment encourages that all of these feelings of guilt and shame be exposed and shared with others in an attempt to cleanse the soul and it also encourages the addict to make amends wherever possible. This divulgence process is repeated over and over for the life of the person.

AA utilizes many sayings to help their members remain sober. “One day at a time”, Keep coming back, it works if you work it”, “Easy does it” are among them. Many have suggested that with this style of treatment you trade your addiction to drugs or alcohol for an addiction to 12-step. Many feel that this idea may have merit because most addicts that get sober and remain sober with 12-step teachings tend to stay that way only when they remain active in the AA lifestyle. If the lifestyle is discontinued many relapse and resume their addictions.

Addicts and alcoholics should be encouraged to face their past and deal with the issues that might be impeding their recovery, but they must understand that the past is just that, the past. While unpleasant memories can in some instances help keep the person sober, they cannot be changed. Reliving them and dwelling on them is counter productive and harmful. Issues that cause anxiety and depression must be resolved or the addict will seek their old friend alcohol or drugs to help them escape the mental anguish. Many have been dealing with psychological issues for the majority of their life and their drug and alcohol addictions have manifested in an attempt to escape the issues by self medicating.

Drug and alcohol abuse have numerous negative impacts on the human body. Many physical effects become glaringly apparent. Alcoholics will generally exhibit one or many symptoms of the disease. Hypertension, gastro-intestinal problems, lower back pain, bronchial infections, trembling and shaky hands are but a few. What few people realize is the tremendous impact these substances have on the addict’s mental state. Alcohol and virtually all drugs dramatically impair the body’s neurotransmitters that are responsible for one’s psychological state. Primarily affected are the serotonin and dopamine systems which are utilized in normal feelings of well being and joy. Both are dramatically impacted and there presence and normal function slow and become minimized. Neurotransmitter function will continue to decrease as the addiction continues and intensifies. The continued and accelerated use of the drugs and alcohol only increase the spiral of depression.

As the drug and alcohol use progresses and the depression continues the addict begins to experience feelings of hopelessness. Their self-esteem plummets and they begin to accept the role of being an addict or alcoholic. They wonder how this all happened but feel that there is no way out because they have become dependent on their drug.

Every tool possible should be employed to help addicts get control of their substance abuse issues and addictive issues cannot be addressed without simultaneously addressing the causes. Attempts should be made to expose any and all underlying problems. Treatment should include psychiatric, psychological, physical and social assessments. When the issues are disclosed, the appropriate treatment and therapy should be utilized to help the person resolve all of the issues. One of the most important aspects of treatment and cognitive behavior therapy is to restore a sense of pride and raise the dependents self-esteem and self-image. The alcoholic or addict cannot achieve their desired goal of sobriety without caring enough about themselves not to go back to the dependency they have escaped with treatment.

Many times treatment fails because the dependent person is trying to get sober for their spouse or family. Until the person truly wants sobriety for themselves their addictive issues will continue and sobriety will be short term at best. This simple fact is true not only of 12-step treatment but of all treatment. Addicts and Alcoholics must understand this. When physical discomfort and cravings are addressed and psychological issues are dealt with, the dependent person starts achieving clarity and the feelings of despair and hopelessness are replaced with optimism. As sobriety is sustained, cravings diminish, the brain and body heal and the person once again becomes whole.

Pain Killer Addiction and the Relative Ease of Supporting the Addiction

There have been several articles in the news recently revolving around the abuse of Prescription Pain Killers and Anxiety Medications. The US Government launched a new ad program during this year’s Super Bowl to warn parents and family members of the likelihood of their kids obtaining Opiates and Benzodiazepines from their own medicine cabinets and bathroom drawers.

We recently treated a young man who wrote the story of his travel through Opiate addiction. His addiction started with treatment for a sprained back. He was experiencing some psychological issues and found the Opiates to be very comforting. His addiction continued and he eventually was doctor shopping and using on-line pharmacies to obtain the vast amount of pain killers that were required to support his addiction and avoid withdrawal symptoms. These sources soon became inadequate and he resorted to attending real estate open houses and rummaging through peoples bathrooms to steal their drugs.

The new government advertising campaign is very accurate in its depiction of many juvenile drug addictions starting in the medicine cabinets of their own homes. You can read Paul’s story here.