Jill: But do your research. Know what tolerance is. Know what some of the signs of dependency are. And so hopefully you did a little bit of homework on your own medication over this last week. If you want to get in on our conversation a little bit more, call us 770-226-0920 and it looks like we have a guest on the line. We asked Paul, who we talked to about a month ago about his story of pain pill dependency, and I asked Paul to give us call today and give us an update. Hey Paul, are you on the line?

Paul: I am.

Brian: Hey Paul, how you doing today?

Paul: Doing good how you guys doing?

Jill: Well how are you doing generally? How ya doing?

Paul: I’m doing good, I really am. There’s always moments where you feel a little weak, but I’ve done well and the Suboxone prescription pain pill addiction treatment has been a big help. I’m continuing therapy. It’s just a one day at a time thing, but it’s going well. It’s going good.

Brian: Well I’m really glad that you’re also including that therapy, to talk about issues that are going on with you. In fact, we’re going to be dealing with that very subject even today Paul, glad to hear you’re continuing to do that.

Paul: It’s helping definitely to dig down to figure out why I got so far into it when that was never the intention.

Jill: And I brought up something about you last week which actually prompted a phone call to the radio show Paul, I just wanted to let you know that. I was discussing about the online ordering and how they would send out 90 pills and for about 400 bucks and you could possibly use that up in 2-3 days and a woman called in saying, “Okay, I misheard you. How can someone use up to 30 pills a day?” So she was . . .

Paul: Yeah, the Lord was watching out for me without a doubt. I probably could have overdosed, but the problem is that the longer you take it, you have to take more and more to get the desired effect because you get so tolerant to it that in order for me to feel how I wanted to feel, I had to take 10, 12, 15 pills at a time just to get the desired effect and you do that a couple of times a day – in the morning and then again in the evening or whatever, and you will burn through 90 pills in just a few days.

And it’s funny you mention that online pharmacy and talk about things that can possibly trip you up. I just had my bank account the other day, went on line and it was frozen – I couldn’t do anything. I had to call the bank. Apparently the online pharmacy I was buying pills from decided that they were just going to go ahead and charge my card. Fortunately it looked suspicious and the bank blocked it. But they tried to charge my debit card $387 and they tried to do it twice and it got blocked – thank God. Now I don’t know if they were just trying to take my money, or if it had gone through I may have had 90 pills show up at my door. I don’t know if they were going to send it out or not. Fortunately it looked suspicious to the bank and they stopped it. Online pharmacies are relentless.

Brian: They’re criminal. If that is the case, that’s criminal. It’s really unfortunate.

Paul: I spoke to them several times telling them I didn’t want the medication anymore. They kept calling me and hounding me – they called me up to 4 and 5 times a day for a while and I finally threatened them with legal action and the phone calls stopped, and it was just several weeks later and here they are trying to charge my card again and send me pills I don’t want.

Jill: And just think. If those pills show up at your doorstep – talk about trigger!

Paul: Yeah, it would be very tempting if you had a bottle in your hand. You still struggle with it. You get used to – it’s very predictable. It’s a predictable thing in your life. You know what the effect is going to be and it’s almost like you have a relationship with the substance and it’s the one thing in life – I’m know how I’m going to feel when I take these.

Brian: It’s so predictable, isn’t it?

Paul: I don’t know, I can’t say exactly what I would do if they just showed up at my door. I would hope that I would flush them, but it would be difficult.

Jill: Having someone, a lot of people out there are thinking about having a sponsor or a loved one or someone that you can immediately call if that happens is probably a good idea, but you just said something about having a relationship. I just treated a young man last week did a Suboxone induction and on the second day of the Suboxone induction he was feeling wonderful and couldn’t believe it but he made the comment, “I just laid in bed last night and I kind of was feeling some grief almost like losing a lover or a relationship that you have with the substance.

Paul: Absolutely. I can relate with that 100%. These were constant things and part of your life, and when you decide to get clean, all of a sudden it’s gone. It’s a habit and you like the way it makes you feel and that’s it – it’s almost like a grieving process, like you lost something that you love even though it’s not doing you any good - like a bad relationship. Women stay in relationships where they’re getting beat or whatever, it’s that same type of thing . . . .

Brian: Exactly. Well let me ask you something Paul, since you seem comfortable about this because you had mentioned that you were working through some issue, this is certainly a big issue, how do you work with this whole event of grief, the fact that you have chosen not to use anymore and you’re realizing what a vital role that this drug played in your life, how do you deal with that grief?

Paul: It’s probably different for everybody, but for me the biggest thing is staying busy. Boredom is my enemy. I need to stay busy and then there’s times when I do think about it or I’m tempted, you know a big part of me getting well was coming clean with those people in my life that I knew cared about me and I told them what was going on so that helps too, because I know if I stumble and screw up, now I got to come clean again – and I’m going to be disappointing people. And I have a son and I can’t expect him to stay away from drugs if I can’t. So it’s those things that I try and steer my thinking toward when I’m struggling.

Brian: Well I really like that idea that in prescription pain pill addiction treatment we work with others in our program, we talk about responsibility and accountability and I really like the way that your dealing with this – you’re taking responsibility and asking other people to hold you accountable to them. That’s a very powerful and practical way to help yourself stay clean and sober.

Paul: They ask me, every time I talk to them, they ask me how I’m doing – are you clean.

Jill: Well Paul, we’re coming down to the end of our segment. I wanted to just tell you thank you so much and we’d love to just keep in contact with you. I’m sure there’s people that have followed your story.

Paul: Thank you, you too. You guys take care.

Jill: We’ll be right back.

Jill: Welcome back to the Breakthrough Addiction Recovery Hour. My name is Jill Mattingly . . .

Brian: And I’m Brian Fujii.

Jill: And Brian, I just got to tell you that this show on addiction is changing the way the government is doing their work. Okay? I just thought I’d let you know that.

Brian: Well, of course it is!

Jill: We came up with a show, we talked to a teenager, we talked about teen drug addiction and prescription drugs running rampant in the schools, and then we found out that the debut from the Office of National Drug Control Policy came out with their commercials covering the same things a couple of weeks later. I think they’re listening to our show.

Brian: Hello?

Jill: Let me just say this, I think Representative Ron Stephens, he’s one of our State Senators from Savannah, or maybe he’s a Representative, but he is actually listening to our show too I think. So anyways, Mr. Stephens, or Representative Stephens, if you’re listening today – good job! And let me tell you why.

He actually put some legislation out on the floor last week for the senators and the representatives to look at and they called it the Georgia Prescription Monitoring Program Act, it’s House Bill 455, and it is going to establish a program for law enforcement, medical licensing boards and retail pharmacists to monitor the way powerful drugs are prescribed and dispensed. It is called trying to put and end to the doctor-shopping phenomenon. So listening to our show, I know that’s when he came up with the idea and put that on. But if you would like to call your representative and say, “Please, push that legislation through,” after hearing Paul’s story or reading it if you go to our website today, look at that because when someone starts to fall into the dependent phase of drugs such as Oxycontin, Lortab, Xanax, Soma, all of those, then you really can’t continue getting enough to satisfy your dependencies.

Brian: We heard that with Paul. It’s really amazing where he said that he took 15 and right there, right in the morning, and then possibly another 15 . . .

Jill: Yeah, he would use up a prescription in 2 or 3 days. He said that at the high point he was seeing 22 doctors – 22 different doctors – and I think even in different states that he had available to him to get him prescriptions. And of course if you get one unscrupulous doctor, I don’t think I said that right, but if you get one doctor that doesn’t care what the rules are, they may be writing too many prescriptions even though their license is on the line doing that.

But let me just say this about this legislation. This is going to be something similar to what they have in Kentucky I think, where a pharmacist has a client come in, or a patient come in, and they want 120 Lortab, and there will be a database where they can see that that patient 4 days ago got 120 Lortab. The thing is if they go from pharmacy to pharmacy, sometimes they can get out from under that. They can’t go to the same pharmacy and say give me the same prescription, so they go to different pharmacies or the go to different doctors, but now, with this database, they’ll be able to see: it’s not time for you to get 120 Lortab. Now there can probably be overrides by a medical doctor if someone who’s really struggling or loses their prescription, but I’m sure the safeguard is really going to cut this down, don’t you think Brian?

Brian: Absolutely. And when I heard about Paul’s statement about how people are trying to tap his own account, this would be some great ways is going to bring some legislation and protection for the general public. And I know they’re out there right now and trying to do some doctor shopping, they’re probably going into a panic attack right now trying to figure out where they’re going to get their next meds, but for the general public and for us to know how to protect individuals. On the good side, if people are listening, if they don’t have easy access, maybe they’ll try thinking ‘I need the help. I can’t get at the same sources I had before. Maybe it’s not too late. Maybe I can get in there, get some help, get off of this and be able to get my life back.

Jill: Free consultations. We do free consultations at Breakthrough Addiction Recovery, we’re up in Norcross. Our office number is 770-734-8091. You can come up and say, “Look, before I add 22 doctors to my repertoire, I want to sit down and talk about this.”

Because you will find out if you try to stop on your own, it’s probably not going to be successful because of the nature of dependency. And that is just amazing, Representative Ron Stephens is the person bringing this bill to the floor, and I’m going to try to get him on with us next week or maybe the week after to talk a little bit about this, don’t you think that will be great, Brian?

Brian: That will be excellent, a person like that to come on board and be able to let us know what the legislation is all about and on top of that is what we can do to help, because we’re going to need to do some advocacy just like any other legislation. They need that support from the general public and especially the advocates. We have a lot of family advocates out there – talk with their own legislators.

Folks if this is really touching a nerve, give us a call here at 770-226-0920, or 1-888-920-2665. That’s another piece too Jill, we as healthcare professionals, we need to be advocates in the areas just like this – talking, writing letters, making telephone calls so that we can support legislation just like this, because I’m telling you if the general public is silent, things like this don’t get through. Yet somehow something like this may not make the front page, they don’t necessarily always see it as being really important, I’m telling you if people don’t bring it up, if they’re not advocating on behalf of people out there that are truly addicted and like you said, they really can’t help it. They cannot help it. And 22 doctors, that’s an amazing amount and then even more. So I think it’s very important that we have someone like this on board and telling us what we can do to make this happen.

Jill: I think that would be great. So we are starting a new subject today. We are talking about co-occurring disorders, and this is a little bit on the clinical side of the house. Tell me a little bit about that, Brian.

Brian: Wow. The big word: co-occurring. Well Jill, I really appreciate you talking about that because you know many times what we find is that when people come in to prescription pain pill addiction treatment, that they’re not just coming in only because they want to stop their drinking or they want to stop their drugging. It’s usually because sometimes they have what we call a psychiatric co-occurring, or something that is going along with their issues of addiction. So, example: if someone is depressed, or someone is anxious, and they’re trying to get rid of that anxious feeling but they didn’t want to go see a doctor about getting some medications for their depression, or they didn’t want see someone about some anti-anxiety medication, so they’ll end up taking alcohol for example, as a way . . .

Jill: A glass of wine at 5 o’clock.

Brian: Ah yes, and everything gets calmed down, everybody feels really good. The trouble with that obviously, is that once that wears off, the feelings come right back. And so we’re finding out many, many times that people who do come into our program, in fact there’s some statistics show that about 90% of the people who have addiction to either alcohol or to other types of drugs usually will have a dual disorder. And that dual disorder means that they have approximately one or two, or maybe more, usually one or two psychiatric conditions along with their drinking or drugging.

Jill: And I seem to see when I’m doing their medical intake and talking with them, most of the people that come in are on Lexapro, they’re on the Xanax, they’re on something because it seems like depression and anxiety are huge in terms of the people that come through programs like ours. And it’s not even fully diagnosed. Their internal medicine doctor knows that they were a little depressed so they started them on Lexapro, but they never went further and found out specifically what kind of depression it is, could it be related to something else. A good medical doctor though will be doing lab work to find out if something else is going on.

Brian: That’s correct. We’ve talked a lot about this, about the idea of trying to encourage the primary care physicians to take a look at some ways to do some screening and I know we talked about this on some other shows.

Well it looks like we’re coming close to another break here Jill, so if you are out there listening and wanted to participate in this discussion, call us at 770-226-0920 and we will be right back.

Jill: Welcome back to Breakthrough Addiction Recovery and we are talking about something called co-occurring disorders. These are things like depression, anxiety and even more when we talk more in depth about this we’ll be talking about bipolar disorder also, and these are things that can come along with dependency or addiction to a substance such as alcohol, prescription drugs, and what we’re trying to do is get down to helping people understand that sometimes when you address that co-occurring disorder you can actually see the craving for the substance fall to the wayside and if you’re someone that was treated successfully for say depression or anxiety and notice you’re dependency on the alcohol at the end of the day or having the Xanax went by the wayside because of your effective prescription pain pill addiction treatment, call us. I’d like to hear your story, 770-226-0920.

Sometimes it’s not even medical prescription pain pill addiction treatment, sometimes it’s things just where you want to get a good physical exam and found out there’s something else going and that lifted that feeling of depression or took away that anxiety, and then you stopped using the alcohol or the drugs to tamp that down. So Brain, you were going to talk a little bit about patterns of the co-occurring disorders.

Brian: That’s right Jill, and you know many times when you’re talking about how people may have had a certain level of psychiatric intensity. A lot of times you just think, ‘Oh my goodness, unless I’m also thinking about committing suicide, that’s the only time I need to get help.’

That’s not true because many times there’s different levels of intensity when it comes to psychiatric disorders, so you could have depression but it could be maybe mild depression and maybe just exercising and eating well and getting the right balance of nutrients within you can really bring some balance back into your life and you begin feeling better. Other times you might actually have a more moderate type of depression where now you might be needing some medications along with some maybe some psychotherapy and that way you combine those two things together in such a way that people now start feeling better and also begin understanding what is going on and what struggles they can address. Of course the hardest part is when you end up realizing that this is really becoming out of hand and many people realize that maybe a time of being in-patient might be very helpful. So there are different levels of prescription pain pill addiction treatment and I think the work that you all do especially on the medical side when people come in and you give them a full physical assessment making sure that, I like your statement, you look from the neck down but also from the neck up.

Jill: Let’s clarify that a little bit. As you know, internists, we do physical exams from the neck down. It’s kind of how we like to put it because we’re looking at the cardiovascular systems, and all the physiological manifestations that could happen, and then Dr. Neal Johnston, who is actually our psychiatrist, says okay now they need the examination or the assessment from the neck up. So he does the thinking, their emotions and all of those, and when you put those two together it’s a very powerful way to find out how the person is operating emotionally, cognitively, all of those things are so important to identify some of the reasons a person might be dependent on drugs.

Brian: It’s so interesting you say it that way too Jill, in fact even the studies indicate that many times people will come in, they’re not really interested in stopping the drinking, they’re really interested in just stopping the feeling. Stop the feeling of the depression. Stop the feeling of the anxiety. Just give me a pill, let’s all be able to feel better. But they’re not really wanting to stop the drinking. And we do know that if people continue to drink excessively, we do know that it really impacts those neurotransmitter balances, those delicate balances in the brain and as a result can actually cause those important things like dopamine and seratonin begin decreasing production and therefore they need more and more of the alcohol in order for them to feel better.

Jill: If you’re experiencing things like depression, anxiety and notice that you’re alcohol or drug use has increased because of them, you can call us and we’re talking about this today. You can get in on the discussion, or make a comment, or ask a question at 770-226-0920. And I talked earlier about doing a physical exam from the neck down, you’d be amazed at how many things physical can cause depression and you brought up nutrition – nutrition is huge. If you’re not getting the vitamins that you need, if you’re not getting the proteins that you need in your diet, you can actually set yourself up for depression. You can set yourself up for anxiety also. Hypoglycemia, which is a problem with glucose metabolism, can cause depression. Problems with not getting enough amino acids, that’s from your protein in your diet, and if you’re drinking a lot of alcohol you actually get rid of the amino acids that you need to keep, and so . . .

Brian: A lot of people don’t know that. That drinking a lot actually depletes the amino acids in the body.

Jill: And guess what amino acids do? They build those neurotransmitters, like seratonin and norephenephrine are very important. If those are out of whack, you’re going to have an emotional discrepancy in your behavior. The other thing is vitamins. You’re talking about B-complex vitamins. Since we’re coming to a break, I’m going to come back with that and tell you a little bit about what alcohol does to your vitamin intake. So we’ll be right back. Stay with us.

Brian: Welcome back to the Breakthrough Addiction Recovery Hour. My name is Brian Fujii and my co-host is with me, Jill Mattingly, and we’re going to get right back to your comment about the vitamins, but we’ve got a call right now from Melinda in Atlanta. Welcome Melinda, to 5the Breakthrough Addiction Recovery Hour.

Melinda: Thank you.

Brian: What’s your question today? How can we help you?

Melinda: I think that my husband has a drinking problem and I have talked to him about it and he doesn’t think he does and I was just wondering how do you know if it actually is alcoholism?

Brian: Well there certainly are some signs and symptoms that you could be looking for. Perhaps you might be able to help us with this. Are you finding that he’s drinking more and more and finding that his responses are maybe getting less or just staying the same?

Melinda: Yes, he’s definitely drinking frequently and alone and it’s affecting him more.

Brian: Well let me ask you this. This is kind of a little screen that we like to use. Let me ask you 4 questions that might help me to understand he situation. Has he ever tried to cut back and found it very difficult to do so?

Melinda: Yes, he promised me several times he would quit and it never lasts more than two weeks.

Brian: Do you find him getting annoyed whenever you bring it up to him, ‘Hey I think you’re drinking a little bit too much and I think you may need to cut back or quit?’

Melinda: Yes, he always agrees with me and says he can still quit and then he doesn’t.

Brian: How about some guilt? Is there much feelings of guilt or remorse at the end of the next day after he goes through a drinking bout?

Melinda: He doesn’t really talk about it with me. I would think so, but it’s all real secret and he doesn’t drink in front of me, I mean I could tell he’s been drinking.

Brian: And one last piece, this is the biggie, do you find him drinking in the morning? Does he do drinking in the morning?

Melinda: No, it’s just like after we get our kids to bed at night, but it’s pretty regular. Like you were saying about having the glass of wine at 5 o’clock, it’s like going outside and coming back in I can smell alcohol on his breath at 7:30 every night.

Jill: And this is happening daily is what you’re saying?

Melinda: Probably at least four times a week.

Jill: And have you ever noticed that when he tries to cut back, at least for you and you’re sure he hasn’t been drinking, does he get irritated and anxious?

Melinda: Yes.

Jill: Okay.

Melinda: I was also wondering when I called, because I think he was real depressed with his job, and I could see him starting to drink more then. And now he’s got a new job and he says when I get my new job I’ll stop drinking, but it hasn’t stopped. Maybe there was a trigger there.

Jill: Many times when you see the effects of that irritability and anxiety when someone is trying to stop drinking, that is a clear indication that a dependency has set up in terms of how the brain is working. And it may be that he’s not as depressed because of the new job, but still what happens with a dependency you have kind of a neural circuit that says if I feel depressed, I’ll drink. If I feel happy, I’ll drink. If I feel stressed, I’ll drink. What could have replaced the depression now is the stress of having a new job. So in answer to your questions, you’re asking about the old term “alcoholic” and we use alcohol dependency as opposed to use and addiction and it does sound like he’s entered into a kind of dependency based on the questions Brian asked. And many times that calls for him to come and say okay, I want to make a change. I want to talk to someone about it.

Brian: Has he opened up to you the possibility of maybe getting some help or at least talking to someone about the situation.

Melinda: Yeah, we talked to someone on staff at our church, but he didn’t really have any background with it. And we went to marriage counseling, but again his specialty was not addiction, but yet he encouraged him to go to AA and he went like a couple of times and said he just hated it and said he couldn’t relate to the people there and he wasn’t an alcoholic and he did like the meeting format. So he was open to it some, but I don’t know if it wasn’t the right people or the right place, or . . .

Brian: It sounds to me that at least he’s trying and that’s great. At Breakthrough, we really offer a really informal type of consultation. There’s no charge – it’s free. And what you can do, if you and he are willing to come in, we can just sit down and talk with him and let him know some of the options and I hear what he’s saying – I get this a lot from many of my clients that come in to our program. They’ve tried that situation, it didn’t work very well. Maybe what he needs is just some time to take a look at some of the reasons why he’s using and then be able to find some coping skills that he’d like to develop and this is done in a very structured way, and yet in a very informal way. Usually what he’ll find out, especially if he just comes in to the consultations, we can really go over a lot of the various prescription pain pill addiction treatment options that we can have, and they go from the least restrictive to some of the most intensive that we have. So we’d like to invite you to give us a call and if you’d like to take our telephone number down, it’s 770-734-8091.

Melinda: And do you have a website?

Jill: Good luck, and thank you for your call. I think this will make a big difference for him.

Melinda: Thank you, okay. Bye-bye.

Jill: Well, that sounded so much like a lot of our spouses that are coming through, and one of the things I’m very encouraged about is that he has tried. He went to his pastor, AA. And just because he doesn’t find in the first try, the person or physician or something that can help him, he is going to find help because he has shown he has an initiative to do that. And so I just encourage anyone out there that has a story similar to Melinda’s, we do this consultation that really helps to educate the person about where they are in their dependency. A lot of people come in and it’s really not dependency. You just really need to look at why you’re abusing it and you may not even need prescription pain pill addiction treatment, you may just need someone to delineate where you are in your use and how to cut down.

But anyways, I was talking a little bit about the vitamins and I think I’m going to have to do it after this next break because we’re coming to another one. So stay with us – I’m going to talk about B-complex vitamins when we come back.

Jill: Welcome back to the Breakthrough Addiction Recovery Hour. We are going into our last segment and we’ve been talking about co-occurring disorders and kind of touching more on depression and anxiety. I told you at the end of the last break I’d say a little about B-complex vitamins. There’s so much to say about them and we’ve got like 5 minutes, so I am going to say this. We are going to do a whole show on nutrition and how impacts not only depression, anxiety, bi-polar, but also how substance addiction can affect even good nutrition and how bad nutrition can lead to substance addiction. It is so intertwined, it’s enough for one whole show.

Brian: It’s with that neuro-chemical balance.

Jill: Absolutely, and I want to say also Brian, we have a psychiatrist, Board certified in addiction, he’s an addictionologist, his name is Dr. Neal Johnston, and I’m going to twist his arm and get him to come on the show next week as we talk about co-occurring disorders. Talk about a wealth of information. He has seen everything and can take calls and answer questions also. So, what are some of the effects that co-occurring disorders have on a person’s life?

Brian: I’m glad you asked that Jill, because many times when people are struggling they’re really not sure: is it my drinking that’s causing this or am I just depressed and that’s what’s causing me to have the problems. Give you an example: a person may be drinking and have a hangover the next day, maybe this is the final straw . . . the boss says, “You come late one more time, your job is gone.”

And so here we have an individual, because of the drinking, they have a hangover, they can’t get to work, they lose their job, the financial situation especially in these economic days, can become highly stressful. And as a result, they blame their job and they start saying, “If this is the way it is, I’m going to start drinking some more.”

And all it does is just exacerbate the problem. It becomes more and more problematic. Now they’re probably getting into areas where they’re having a lot of conflict with the family, arguments are increasing, and you know we seen this - so many times then we move into family violence. And that’s when it becomes a major problem. Now we got children involved, and possibly even spousal addiction. This becomes really problematic, not only just for the person who is drinking and trying to just cope with those emotional issues, but they have so many different ramifications that impact the family as a whole.

Jill: I think what you’re talking about is what comes first – the chicken or the egg. Are they depressed and starting to drink, or are they drinking and become depressed, and that’s what a really good physical exam and psychiatric exam is going to reveal.

Brian: That’s the reason why we have to do it together. Because if your not addressing . . . it doesn’t really matter which came first, the point is it’s happening now together. And that’s why it’s called co-occurring. Both of those, substance addiction along with the psychiatric disorder is now occurring simultaneously and the prescription pain pill addiction treatment needs to be done simultaneously.

Jill: I had an experience with someone that was smoking marijuana, heavily, heavily smoking marijuana, and said there is a possibility that you might have bi-polar disease. And when discussing this with Dr. Johnston, he said there is no way to tell if this is bi-polar until we can get the heavy marijuana use in the distance, in the past. Basically not necessarily a detox, but get them away from the substance to see what the manifestations are. So it is so important to have a team of professionals working towards understanding why this person is picking up alcohol or picking up the prescription drugs, or picking up the marijuana.

This has been a real interesting show Brain.

Brian: We will continue on with this next week for sure.