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Opiate Addiction: Detox and Withdrawal 

Opiate Addiction: Detox and Withdrawal

Today, opiate addiction is all too common. Both prescription and nonprescription sources, such as online or through unregistered merchants, have made it so easy to purchase these drugs. Regardless of how vital living a healthier life is, using drugs like opiates are more socially accepted in some cultures, especially Western ones. The spread and impact across the US has become an epidemic. And the likelihood is high that you or someone you know has struggled with addiction. That’s why understanding Opiate Addiction: Detox and Withdrawal is so important.

What Are Opiates and Opioids?

Opiates are a class of drugs that act as central nervous system depressants. They are typically derived from opium –a substance that is produce naturally from poppies.Opiates are also referred to as narcotics. They also occur in the form of opioids. Opioids are opiate-like medications that are chemically made.

Opiates and opioids block pain signals that your body sends to your brain. They do so by attaching to structures called receptors. They can target nerve cells in your brain, spinal cord, or other body parts.

How Does a Person Become Addicted?

The opiate stimulates the brain’s reward system in a powerful way. This is a critical reason why people can so quickly become dependent. It is highly addictive, especially in the early phases of misuse. With time,the need for opioids becomes stronger. It goes beyond a basic desire for pleasure.Tolerance and reliance are linked to this high drive.

Opiate addiction occurs as it triggers your brain to release the feel-good chemical, namely dopamine (video). That is why it is simple for anyone to develop a pattern of drug abuse and addiction. It happens to individuals, particularly while seeking to address problems from pain management to emotional worries and stressors. Sometimes innocently enough by way of medical treatment by providers who were ignorant or dismissive of the risks that can lead to numerous mental and physical health issues. There can be short or long term negative-effects from drug addiction.

What Happens If I Stop Using Opiates On My Own?

While opiates can relieve pain and create euphoria, they can produce numerous unwanted side effects as well. They may include sudden withdrawal symptoms, unmanageable agony, and suicidal thoughts. It can all occur when opiate usage is stopped or doses are reduced rapidly. Drastically cutting back or stopping abruptly can easily prompt withdrawal. The body requires time to heal after the addicted person quits using the drug.

Even well into recovery the withdrawal symptoms begin to appear. This is due to something called Post Acute Withdrawal Syndrome (PAWS). You could have detox symptoms like restlessness, tears, cramping, flu like symptoms, etc. And yes, it can happen even when the opioid dosage is progressively reduced.

 

Opiate Withdrawal Symptoms & How Long Do They Last?

Opiate withdrawal symptoms can be very unpleasant and intense. Medical detox is the safest , least uncomfortable and most efficient method of eliminating opiates or other drugs.

Within 24 hours after the last dose, a person will typically begin to experience a combination of the symptoms. The significant indications are flu-like, fever, sweating, and vomiting.

Pain in the muscles
Diarrhea, vomiting, or nausea
Restlessness
Sweating
Anxiety
Dilated pupil
Watery eyes
Cramping / abdominal pain
Increased heart rate
Frequent and excessive yawning
Goose bumps
Insomnia
Shakes / tremors

The symptoms may last from few days to a week or even longer. In any case, they will eventually subside and disappear. After the last opioids intake, opiate withdrawal symptoms often begin 12 to 48 hours later. The worst ones usually manifest between 24 and 96 hours. After discontinuing opiate use for 5 to 7 days, you will start to feel better. However, the detox process can continue longer for some patients.

Opioid Withdrawal varies depending on multiple variables during the medical detox process. It could rely on factors such as the type of painkiller being misused, the individual’s level of drug tolerance, the duration of their addiction if they used several drugs and their mental and medical histories.

Why Is Additional Care Crucial For A Complete Recovery?

People in active addiction typically reject that their drug use is a problem. They are hesitant to get help. In some cases, an intervention might inspire someone to seek or accept help. Professional and appropriate interventions seek to provide an organized opportunity to make adjustments and get treatment before circumstances worsen. In most cases whether with an intervention or not, it can be helpful to involve their closest friends or family to provide physical and mental support.

Keep in mind that addiction is extremely taxing on the mind and body of the person struggling with it. Desperation and feelings of hopelessness can be overpowering and sometimes people attempt to hurt themselves. At the front end of treatment, it is usually the recommendation to only pursue drug detox under the supervision of a medical professional.

Entering Detox and Effects on Family

The strain from detoxing from opiates, or any drug or alcohol, can tear apart happy, loving homes. For example, as relatives battle over how to interact with a child who has been taking opiates, conflict becomes norm. Trust erodes and starts to disappear. If a family member tries to stop using on their, they may be tearful, erratic or act aggressively.

During medical detox is not the time to have deep, constructive conversations. It’s too early for the person seeking recovery and often times it’s too early for the loved ones who are still raw from the chaos, fear and emotional upheaval in the family. Those detailed conversations can wait until the person enters Residential, PHP or IOP level of care. In each of these there will be clinical professionals to facilitate these re-connections in a healthy and safe way.

Rational discussions are hard between the intense emotions and fears of all involved and the biology at play in the struggling addict. A lot fo times there are years of pain, fear and hurt feelings to work through for everyone involved. Addiction affects the whole family. It can help to talk to someone who is professionally trained and experienced in working with families facing addiction.

Leaving Opiate Addiction Detox Too Early

Leaving opiate addiction treatment during detox can bring negative changes. Many people in detox treatment begin to feel physically better long before they have actually even begun the work it will take for sustained recovery. This is why so many people leave treatment after only a handful of days. This is a serious and critical issue because the person is very likely to fall right back into use and may even accidentally overdose without intending to. Leaving treatment early puts the person struggling with addiction is a very dangerous position.

Can People Die from Opiate Withdrawal?

Yes, if left untreated, persistent vomiting and diarrhea can lead to heart failure, hypernatremia (a high blood salt level), and dehydration. A professional, medical detox facility will pay very close attention to this and be monitoring the client day and night. Otherwise, unless you have other complicating medical conditions, opiate withdrawal symptoms, while intense and uncomfortable are typically not life-threatening.

A Few Final Thoughts on Opiate Addiction

Any drug addiction, whether opiates, alcohol, benzos, cocaine or something else puts you at serious risk. Liver, stomach, kidney, heart and brain can all be damaged and a variety of other complicating medical problems can begin. The destruction on relationships and emotional health is no less severe.

It takes courage to look at yourself and admit you have a problem. And even more courage to step into the unknown and allow someone to help you. Stay open-minded. You don’t have to be perfect – you get to be human. Begin by being willing to begin something new.

The first step to a better life than you can imagine is to reach out and get professional help

Breathe. You CAN do this.

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Addiction Recovery Opiates (Heroin and Prescription Pain Pills) Uncategorized

What Is Vivitrol?

What Is Vivitrol?”  I get asked that more and more often. Vivitrol is the injection (shot) form of a medication known as Naltrexone. And it’s use has grown significantly over the past several years – and for good reason. This article is intended to give you a little info and hopefully provide some clarity too.

  • Most commonly used for Opioid and Alcohol Withdrawal and to inhibit cravings
  • Comes in oral (Naltrexone) and IM (Vivitrol) forms
  • Must be prescribed by an approved physician
  • Is not meant to be a “magic pill” cure
  • Like other Medication-Assisted Treatment (MAT) options – the highest successful outcomes are when it is paired with therapy/treatment and support.
  • It is very different than other MAT out there at this time. 

*If you or someone you love is struggling with addiction, please cheack out this resource page*

Stethoscope next to computer

Naltrexone is an opioid antagonist that has the highest affinity for the -opioid receptors. In addition to its ability to block the effects of opioids, this compound has very few, if any, inherent effects. In 1994, the Food and Drug Administration of the United States gave its approval for the use of Naltrexone in the treatment of alcoholism (Kranzler, Wesson, Billot, Clinical, & Research, 2004).

In spite of this permission, the studies that have been conducted to determine whether or not Naltrexone is effective in treating alcoholism have produced mixed results. Patients failure to follow the prescribed treatment regimen while taking oral Naltrexone is one factor that contributes to the treatment’s overall lack of efficacy.

Some studies have also shown that in order for subjects to have greater reductions in alcohol consumption and risk of relapse as compared to subjects who were treated with a placebo, they must be highly compliant with the Naltrexone treatment. Utilizing formulations that provide sustained release or depot treatment is one approach that can be taken to address this issue.

VivitrolTM, a depot injectible dosage form of Naltrexone, was approved by the FDA on April 13, 2006, for the treatment of alcohol dependence in patients who are capable of withdrawing from drinking in an outpatient setting and who are not actively drinking at the beginning of therapy. Patients must also not be drinking at the time treatment begins. The recommended dosage of Vivitrol is 380 milligrams, which should be injected once per month or every 28 days.

Both DepotrexTM and NaltrelTM are examples of alternative depot parenteral formulations of Naltrexone. Naltrel helped to promote abstinence and decreased the incidence of relapse in two samples of alcohol-dependent subjects, while Vivitrol was shown to be effective at reducing heavy drinking among alcohol-dependent males (Chick et al., 2000; Monti et al., 2001).

The use of Naltrexone provides a blockade against the intoxicating and reinforcing effects of opioid-like compounds, which, in theory, can result in the elimination of drug-taking behavior. It does not produce euphoric effects, and as a result, it is not abused. Additionally, it does not result in physiological dependence on the user.

Similar to the situation with alcohol, the primary challenge presented by the oral formulation of Naltrexone for the treatment of opium or heroin dependence is low compliance (adherence). Long-acting sustained release formulations of Naltrexone (injectable or implantable) may help to develop compliance and, as a result, augment the efficacy of abstinence-oriented treatments with Naltrexone for heroin or opium dependence. Following the completion of opioid detoxification, the administration of Vivitrol is done for the purpose of preventing a return to opiate dependence (B. A. J. T. Johnson & management, 2007).

Mechanism of Action 

Dopaminergic pathways, (which have their origins in the ventral tegmental area, relay to the nucleus accumbens with neuronal inputs from other limbic regions, and progress to the cortex), are responsible for mediating the reinforcing effects of alcohol, which are associated with the substance’s potential for abuse. An antagonist for the mu-opioid receptor, Naltrexone, reduces the positive effects of alcohol through two distinct mechanisms. First, it prevents alcohol from causing beta-endorphin stimulation of dopamine neurons directly in the nucleus accumbens. Second, it prevents beta-endorphin from disabling the tonic inhibition of dopamine cells caused by gamma-aminobutyric acid neurons in the ventral tegmental area (Koob & Research, 2003; Wise & Bozarth, 1987).

Oral Dosage Form and Its Effects 

In alcohol-dependent people who had recently stopped drinking, taking oral Naltrexone was effective at reducing the likelihood of relapsing and going back to drinking heavily. Its general effectiveness has been limited by two consequential factors, one of which is that the pharmacokinetic properties of oral Naltrexone lead to significant fluctuations in plasma levels with oral daily dosing. A medication adherence rate of at least 85 percent is necessary in order for there to be a therapeutic response. First, the low plasma trough level of oral Naltrexone reduces the efficacy of the drug, which may explain why this requirement exists. Second, it is believed that high peak levels are responsible for adverse events, and it is estimated that up to 15% of people who receive oral Naltrexone will discontinue treatment due to adverse events, particularly nausea (B. A. Johnson & Ait-Daoud, 2000).

Therefore, optimizing the pharmacokinetic profile of Naltrexone by developing a deep intramuscular injection that would release Naltrexone over the course of several weeks would make the drug more effective as a whole. Therefore, plasma levels would remain relatively constant, and while they would be low enough to cut down on the number of adverse events, they would still be high enough to produce the desired anti-drinking effects. In other words, even though it is not anticipated that the effect size of the long-acting, intramuscular formulation of Naltrexone will be greater than the effect size of oral Naltrexone, it is likely that the overall outcome will be improved because of the increased compliance and longer exposure to a therapeutic dose (Bartus et al., 2003).

Patients are typically given 380 mg of the long-acting injectable (LAI) form of Naltrexone once every 28 days, and oral Naltrexone is typically titrated up to the target dose of 50 mg per day. Although the use of LAI Naltrexone does not require a trial period of oral Naltrexone, it is standard practise to determine the patient’s level of toleraance with oral doses before moving on to higher concentrations. It is possible that the use of LAI Naltrexone has benefits for adherence when compared to the use of oral Naltrexone. This is due to the fact that non-adherence is common among patients who are taking medication for alcohol use disorder.

3.1% of patients in the study were given any form of Naltrexone, but only 0.24% of patients were given LAI Naltrexone. This information was obtained from a study. Even though about 40% of people have experienced alcohol abuse of some kind at some point in their lives, very few people are actually receiving the help they need. According to the findings of the same study, the patients who were given the intramuscular injection were more likely to make use of both outpatient and inpatient mental health services. Patients battling alcohol use disorders who receive treatment that is both pharmacologic and makes use of mental health resources have better outcomes as a result of their treatment. These resources for mental health include individual drug counselling, care management, monitoring of a patient’s substance use, and intensive outpatient treatment, among other options (Aletraris, Shelton, & Roman, 2015; Marienfeld, Iheanacho, Issa, & Rosenheck, 2014).

More research is needed in order to find out the effects and outcomes of drug with the use of oral dosage form and other dosage forms. 

References 

Aletraris, Lydia, Shelton, Jeff S, & Roman, Paul M %J Journal of substance abuse treatment. (2015). Counselor attitudes toward contingency management for substance use disorder: Effectiveness, acceptability, and endorsement of incentives for treatment attendance and abstinence. 57, 41-48. 

Bartus, Raymond T, Emerich, Dwaine F, Hotz, Joyce, Blaustein, Marc, Dean, Reginald L, Perdomo, Brigido, & Basile, Anthony S %J Neuropsychopharmacology. (2003). Vivitrex®, an injectable, extended-release formulation of naltrexone, provides pharmacokinetic and pharmacodynamic evidence of efficacy for 1 month in rats.28(11), 1973-1982. 

Chick, Jonathan, Anton, Raymond, Checinski, Ken, Croop, Robert, Drummond, D Colin, Farmer, Roger, . . . alcoholism. (2000). A multicentre, randomized, double-blind, placebo-controlled trial of naltrexone in the treatment of alcohol dependence or abuse. 35(6), 587-593. 

Johnson, Bankole A %J Therapeutics, & management, clinical risk. (2007). Naltrexone long-acting formulation in the treatment of alcohol dependence. 3(5), 741. 

Johnson, Bankole A, & Ait-Daoud, Nassima %J Psychopharmacology. (2000). Neuropharmacological treatments for alcoholism: scientific basis and clinical findings. 149(4), 327-344. 

Koob, George F %J Alcoholism: Clinical, & Research, Experimental. (2003). Alcoholism: allostasis and beyond.27(2), 232-243. 

Kranzler, Henry R, Wesson, Donald R, Billot, Laurent, Clinical, DrugAbuse Sciences Naltrexone Depot Study Group %J Alcoholism:, & Research, Experimental. (2004). Naltrexone depot for treatment of alcohol dependence: a multicenter, randomized, placebo‐controlled clinical trial.28(7), 1051-1059. 

Marienfeld, Carla, Iheanacho, Theddeus, Issa, Mohammed, & Rosenheck, Robert A %J Addictive Behaviors. (2014). Long-acting injectable depot naltrexone use in the Veterans’ Health Administration: a national study. 39(2), 434-438. 

Monti, Peter M, Rohsenow, Damaris J, Swift, Robert M, Gulliver, Suzy B, Colby, Suzanne M, Mueller, Timothy I, . . . Research, Experimental. (2001). Naltrexone and cue exposure with coping and communication skills training for alcoholics: treatment process and 1‐year outcomes. 25(11), 1634-1647. 

Wise, Roy A, & Bozarth, Michael A %J Psychological review. (1987). A psychomotor stimulant theory of addiction.94(4), 469.

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Detox During a Pandemic: Challenges of Detox and Residential Addiction Treatment During COVID-19

Detox during a pandemic can sound impossible. The COVID-19 pandemic has impacted almost everyone in some way. But, if you’re struggling with opiate addiction, the implications of this pandemic can be even more challenging.

Even now, as restrictions across the country are starting to relax and facilities are beginning to re-open, it’s vital to understand that the pandemic threat isn’t over. As a result, many outpatient treatment centers (OTCs) will remain closed or provide limited services.

Detox can seem scary and dangerous if you feel you have to go through it on your own. If you were already in some addiction treatment program before COVID-19 hit, you might also be wondering what resources are available to you now.

Detox during a pandemic is possible, as long as you know what those resources are.

With that in mind, let’s look at how you can safely receive addiction treatment and detox during a pandemic.

The Rise of Telehealth and Digital Support

The American Society of Addiction Medicine has suggested that Opioid Treatment Centers remain open and available for patients during this time. However, they are also aware that those who work in such facilities need to stay safe.

As a result, a few changes have been made when it comes to addiction treatment. One example is the use of telehealth and digital support.

Naturally, this depends on your stage of treatment. If you are used to attending therapy or support groups to battle your addiction, being able to do it digitally is a great way to stay connected while you detox during a pandemic. (Many detox hospitals will accommodate you being able to stay connected to sober peers while in their facility). It will help you to realize you’re not alone. You can always reach out to someone when you need it.

Staggering Appointments

One of the challenges of detoxing during a pandemic is merely walking into a treatment center to get the help you need. But don’t let that keep you from seeking out treatment altogether.

Treatment centers across the country are figuring out ways to stagger appointments. The goal of this is to keep patients safely six feet apart in waiting rooms. Other centers are trying to keep face-to-face contact as limited as possible. And most have adopted new protocols for even more intensive cleaning and safety.

If you need treatment, call your local addiction treatment center to learn more about what they are doing in response to COVID-19, and how they can help you. You just need to ask. Once you have the information, you can easily make the best decision for you and your recovery.

A Helpful Assessment Tool

Another challenge that those going through detox or addiction treatment might face is knowing what type of treatment or services they honestly need. Recently, the ASAM has released a free online addiction treatment needs assessment.

It is a 13-question assessment you can take from the comfort of your own home. The questions relate to substance abuse, your environment, and your behaviors. The goal is to help you make an informed decision about your treatment options and what might work best for you if you are seeking help.

Substance abuse treatment is not a “one size fits all” solution. This assessment helps to make sure you can get the treatment you need, not someone else.

The Next Step

This pandemic has forced businesses, organizations, and even healthcare facilities to change how they do things, mostly to keep people safe. Opioid treatment centers are no different.

There are challenges to overcome during these uncertain times. Yet, don’t let those challenges keep you from getting the help you need to fight back against your addictions.

If you’re looking for more information on how to detox during a pandemic or want to know about addiction treatment options, please contact me. Or, visit my page on Opiate Addiction to learn more about how I can help.

Feeling alone during this time of social distancing is no surprise. But help is always available when you’re trying to beat your addiction. Here is a link to some info on Family Involvement and Addiction .

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Is It Time for An Addiction Intervention? – How to Tell

Addiction is serious, no matter what. If someone you love is going through struggles with drugs or alcohol, an addiction intervention can be the best way to kick start the treatment they need.

However, an addiction intervention needs to happen at the right time. If someone you care about feels ambushed or that they’re not being understood, it could end poorly, and they could refuse to get any help.

It’s never easy to see someone you love struggle with drugs or alcohol. So, when can you know if it’s the right time for an addiction intervention? Let’s take a look at some of the signs.

Sudden Behavioral Changes

Let’s face it; you know your close friends and family members. You know how they typically act—their normal behaviors, their personality, their preferences, etc. One of the best ways to tell if it’s time for an addiction intervention is simply to pay attention.

Has their behavior changed? Does something about them seem off? These subtle changes can be a good indicator when it comes to some of the first signs of an addiction. It’s essential to find out whether it’s an addiction causing the shift in behavior or something else. But, sudden behavioral changes are nothing to take lightly.

Stuck in a Fog

Has the person you care about become increasingly “foggy?” Do they have a hard time keeping up with conversations? Do they get confused easily? Maybe they’re struggling at work or school and can’t stay organized or be on time.

These are all vital signs that shouldn’t be ignored. It might be easy to make up excuses for someone, suggesting they’re just tired or stressed. If these signs become consistent, however, they might be turning to drugs or alcohol, and it could be the right time for an addiction intervention.

Isolation from Friends and Family

Common indicators of addiction are when someone stops doing the things they typically enjoy and isolates themselves from the people they love.

An addict often knows that what they’re doing is problematic. They can become ashamed or feel like no one will understand them. Isolation is often more comfortable for an addict than it is to face reality or people.

If someone you care about is spending much of their time alone, avoiding friends, making excuses to stay by themselves, it could be a sign of a bigger problem.

Talk to Someone About It

If you feel worried about your loved one, there’s a good chance someone else is, too. Don’t be afraid to talk to another close mutual friend or family member about your worries.

One of the worst things you can do is to keep your concerns to yourself. Or, to wait until the signs become extremely obvious, and your loved one is even deeper into their addiction.

Instead, pay attention to some of these warning signs to know when it’s time for an addiction intervention. Make sure you understand what the intervention itself should look like. You can choose to perform a “soft” intervention that is a bit more positive with fewer consequences, or a “hard” intervention that may require the one you love to get professional help to overcome their addiction.

It’s okay to be nervous about launching an addiction intervention for someone you care about. But you don’t have to do it yourself. A trusted therapist can help you to understand some of the signs indicating our loved one is dealing with addiction.

If you’re not sure how to navigate an addiction intervention, feel free to contact me or visit my page on addiction interventions to learn more.

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Your Addiction: 5 Important Reasons Why You Should Get Help Now

It’s easy to ignore things that are hard or don’t always feel good. We all procrastinate or avoid from time to time.  And when you’re struggling with addiction, it’s really easy to ignore all the reasons why you need to get help now.

The addiction takes center-stage and demands all of your attention. All your focus on is getting your next drink, your next fix – so that you feel “normal” or “better.”

But the truth is; you will never truly feel better.

Not in the midst of the drinking/using and all the chaos that comes with it. It doesn’t matter how convincing you are – this isn’t about will power. There is a reason why addiction is called a “brain disease”.

And eventually, it will always take more drugs or alcohol to get even close to the same effect you had the first time you used.

There is an end point to this terminal disease. And it isn’t pleasant or happy or freeing. So don’t succumb to it – stand up and get help.

It may be hard to believe – but you CAN do this and there are a lot of folks out there who can help.

If you need some important reasons why you should get help for your addiction—now – then here you go…

1. Improving Your Health

The first important reason to consider is your health. Addiction only makes your health worse, not better.

If you are young, you may not have noticed much of a difference yet. But, as time goes by, you will see and feel dramatic changes happening to your body.

For example:

  • Your liver starts having a harder time processing the alcohol and can’t do its job properly to the point where you experience liver failure
  • You become more vulnerable to a heart attack or stroke
  • Your skin tone and quality changes
  • Your lung capacity diminishes
  • You have a greater possibility of contracting HIV/AIDS due to sharing intravenous needles
  • Your life expectancy is shorter

Clearly, addiction is not good for your health.

2. Strengthening Your Relationships

Another reason to get help is the relationships that you hold most dear. Whether it’s your partner, children, parents, or friends, addiction causes tremendous hurt and pain to the people you love.

You may have said or done things that you later regret and, thus, strained these relationships to the breaking point.

What’s happened in the past is done. However, by getting help, you have the power to strengthen those relationships and keep or bring those people close to you.

3. Saving Your Career

Did you spend years and thousands of dollars getting to where you are in your career? What would you do if you lost your job?

Addiction takes a toll on your work as well. At first, it’s occasionally showing up a little late or missing a project deadline. A reprimand or even a poor performance review doesn’t help. In fact, they may spur you forward in your addiction. Then, it’s more consistent absences or a blow-up at the office. Eventually, your employer will decide that it’s better to let you go.

If this scenario happens a few times, it can be damaging to your career. And once unemployed, you most likely resort to other means of feeding your addition and getting the substances you crave.

4. Bringing Joy Back Into Your Life

Remember a time when you felt happy and joyful? Was it while pursuing a hobby or sport that you like?

When struggling with addiction, it’s hard to feel happy at all. In fact, many also develop depression alongside their addiction.

There are several reasons why this occurs:

  • You are more isolated from those you care about
  • Hobbies, sports, and other recreational activities no longer have the same appeal
  • Your focus is now on getting more drugs
  • Your health and physical appearance have declined

It’s easy to focus on the obvious things that you lose with addiction. However, joy and happiness are just as important as your health, relationships, or even your job. Don’t let it slip through your fingers.

5. Having Peace of Mind

Finally, your peace of mind is certainly a reason why you should get help now for addiction. You probably feel sad, angry, and anxious with addiction.

Although when under the influence, you may experience a heightened state of pleasure—it doesn’t last. Most of the time you are in a more miserable state of mind. You may even recognize that you are miserable and need to get better.

Is that how you want to live your life?

Ultimately, you can list all of the reasons in the world why you should get help – thinking about it is easy. Talking is easy too. But until you’re willing to act – to actually get the help, real relief and real change simple will not follow. So, whether your personal motivation comes from the inside or outside—find your reason to change and take action!

Please, contact me to start your addiction recovery. Or, visit here to learn more about how I can help you.

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Addiction Intervention

Addiction Intervention

Compassionate Intervention Consults (aka “soft interventions”)

So you are trying to decide whether or not to organize an intervention for a loved one? Choosing to confront a loved one about their addiction is a difficult decision and most people are at their wits’ end by the time they start looking at intervention as an option. You need reliable and targeted information to help you determine what’s best for your loved one. And perhaps more importantly, for them to be able to see the severity of their current situation. I have worked in this field, in this city, for over 22 years and I know the resources available locally, within and outside of Texas.

Before You Start

When you start planning an intervention for a loved one struggling with addiction you want to be sure the  professional you work with looks at your family dynamic in its entirety. There are a lot of different certifications, licenses and types of interventionists out there – very few of them are fully and independently licensed and even those who are credentialed rarely are licensed in both mental health and addiction. Fewer still have the precision that comes with years of counseling professionals struggling with addiction or having served for years as the Clinical Director of an inpatient medical detox hospital.

“Recovery is an evolutionary process of the self.

It requires change, commitment, community and time.”

BW Carrettin, 2013

Whomever, you consider – be intentional. Ask questions; interview them. You are trying to do the best you can for the one you care about – it’s okay to be thorough. Here’s a hint/hack for you; if the professional cannot weather a little scrutiny and direct questioning from you, how could they ever be successful in an intervention?

It’s also helpful to keep in mind that getting sober is only a fixed state (think is or is not), but staying sober is a gradual, ongoing process. To fully embrace and maintain true, life-changing recovery requires a commitment to whole life recovery as a way of living. This isn’t accomplished in a single week or even a month or two of treatment in a facility. But it can certainly begin there. The person who is addicted will ultimately need to commit to major lifestyle changes in order to return to enjoying a full life and ongoing success. In the beginning, just getting into treatment is a start in the right direction. While I definitely want those who need it to go to treatment, I want more. Whether it’s alcohol, opiates, cocaine, synthetics or something else, my goal is to have them understand for themselves why they need it and to make that choice. They are the only person who can ultimately decide if they will stay sober/clean. I believe it helps if they decide to start the path as well.

A Different Kind of Intervention

In my practice, I provide in-office, compassion-driven intervention consultations and therapeutic services for adults struggling with addiction. Through my practice, I also provide counseling for clients after they complete treatment and work with spouses and families of loved ones in active addiction and early recovery. Through my work I help families prepare to undertake a substance abuse intervention and also find the best possible treatment options for the adult who is in crisis. With over 20 years of experience working with individuals and families in crisis I am uniquely qualified to help you develop the best possible treatment plan for your loved one. My non-confrontational, invitational approach to intervention is proven effective and allows for a family to lovingly, effectively and compassionately encourage a loved one to get the help they need.

Please note, I do not use “tough love” or other adversarial, aggressive approaches. I have seen these work only insofar as, occasionally getting a person to agree to go to treatment and shortly after admitting, leaving against medical advice and relapsing, which can ultimately be life threatening. That is not to say that getting a person into treatment isn’t a first step or that harder approaches have not been successful for some and may be what your loved one needs. But if force is the flavor you intend to use, I am not the best option for you.

“Sobriety is a state of condition. Recovery is a way of living.”

BW Carrettin, 2003

Knowing the Options

I have developed relationships with many hospitals, residential treatment centers, intensive outpatient programs, physicians, and sober living houses over the years and have acquired inside knowledge of all these options. Each year, I dedicate time to personally visiting, evaluating and re-evaluating programs so that I can stay up to date on what they are doing and how they are doing it. This helps me to effectively support you and help you select the most effective programs available for your loved one’s needs. We work together so that you have the best information from the intervention through the treatment process and into aftercare to make it less stressful for you. The goal is to do everything possible to ensure you have the best information and support possible.

My Services

The consulting services I provide are both individualized and comprehensive. I assess each individual’s and family’s strengths and weaknesses to develop a plan that most effectively addresses their treatment needs. I meet you where you are in the intervention process and tailor a plan that helps you achieve your goals for success. Collaboration is key and I often consult with other professionals and utilize a team approach to develop a comprehensive, multi-disciplinary plan to most effectively meet your individual needs. Additionally, I can follow up with the program while your loved one is in treatment and coordinate aftercare plans for after they have completed a program.

In addition, I am a Nationally Board Certified counselor, fully and independently licensed therapist, licensed addiction specialist, have advanced training in traumatic loss and am trained in critical incident stress management. This means that I am uniquely qualified to assess programs and match individuals to the right type of services for their individual needs. I also work closely with the family after the intervention in order to support you through the treatment and recovery process and prepare you for your loved one’s eventual return home.

If this sounds like I may be the right person for you, please give me a call.

MORE RESOURCES FOR YOU

Ben Carrettin is a Nationally Board Certified Counselor (NCC), Licensed Professional Counselor-Supervisor (LPC-S) and Licensed Chemical Dependency Counselor (LCDC). He is the owner of Practice Improvement Resources, LLC; a private business which offers an array of specialized counseling, evidenced-based clinical consultation, Critical Incident Stress Management (CISM) and targeted ESI-based services to individuals and businesses.

Categories
Addiction Recovery

Addiction Recovery

Addiction Recovery – for Professionals

If you are reading this, you are already taking a step in the right direction. Whether you are struggling with addiction yourself or love someone who is, getting more information is a good place to start. Addiction is a devastating disease that affects not just the addict but the entire circle of family and friends who care about them. And yes, addiction is a disease – a disease of the brain. The actual changes in physiology and neurochemistry are there – it is not a choice. However, just like a person fighting cancer – choice is involved in treatment and follow through. Genetics, lifestyle and and experiences all play a part, but once addiction is awakened, it’s a devil that doesn’t just go away. Lives change in it’s wake. Whether they change in bad ways or healthy ways is the choice an addict has in their addiction recovery – but sometimes that choice cannot even be discussed until the brain has been detoxed from the substance of abuse and begun to heal. Whether alcohol, prescription opiates, heroin, cocaine, marijuana or designer/synthetics – if you are committed to your recovery, or are the loved one of someone struggling with any of these – I’d like to help.

Addiction And The Brain 101

So, in simple terms, by the time addiction is in play – the brain sees the need for the alcohol or drug as an issue of actual survival. Seriously, the same part of the brain that tells you to jump back from the rattlesnake or get out of the way of the oncoming truck is lit up like a bonfire during a craving episode in addiction. This is old brain – old world brain – it’s the part of the brain that essentially makes up the brain of a reptile. We all have it. It’s concern is survival (and aspects around that) and nothing else. And in addiction, it trumps logic, reasoning, emotions – everything. During addiction the reptile part of the brain that usually sits in the back seat, jumps up and grabs the wheel.

So, how on earth can you expect to reason with old brain crisis-response wiring? Ultimately, you can’t. Not while the substance is still in control. Although the survival response comes from the non-dominant part of the brain, when it triggers the life-or-death survival button – it takes over and no argument or heartfelt plea is going to overcome it.

That being said, there are strong windows of opportunity to springboard addiction recovery. Sometimes it’s when an addict has hit an incredible wall of losses, sometimes it’s the edge of losing everything, sometimes it’s a wearing down to a few moments of openness amidst despair – it can come in many forms and no, it doesn’t require hitting “rock bottom”. If the addict is willing – don’t wait. No holiday, or inconvenience is worth an opportunity to get in front of this disease and begin to heal all the lives it is hurting. Whatever the excuse – remember that the risk is ultimately, death.

What The Different Levels of Treatment Looks Like

There are many levels of care and below I have listed from highest to lowest, the more common titles. There may be hybrids and extensions out there – but these are the core:

*Detox – Inpatient
*Residential-Inpatient
*Partial Hospitalization-Outpatient (although some with overnight exist)
*Intensive Outpatient Program (IOP) – Outpatient
*Counseling/Psychotherapy
*Community Support Orgs (12 Steps, SMART, Celebrate Recovery, etc)
*Sober Living (this provides housing environment to support any/all outpatient services above and I highly, highly recommend this for no less than 3-4 months in a reputable Sober Living residence)

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Why Discharge Plans and Recovery Plans Are Critical

Far too often, patients are so excited and looking forward to getting out of treatment and back home that they fail to put the amount of focus, investment and commitment into the ongoing plan for their recovery after they leave inpatient treatment. Remember the reptile brain we spoke of earlier? Well, here’s the kicker – he isn’t really restrained until 18 months after the last use. (and for life it’s a risk) But it gets better – it’s 18 months after the last use of any mood-altering substance – not just the one the addict happened to be dependent on. Although the first 60-120 days are likely to show the greatest improvement (longer with meth and a few other substances) – the old brain “reptile” is still going strong and the risk of relapse is great. Perhaps even greater because to the addict and many around them – life is already so much better and so our vigilance relaxes a bit.

After a residential treatment stay, I would encourage most people, especially those in treatment for the first time, to definitely go to an Intensive Outpatient Program (IOP). This helps to bridge the experiences and tools learned in the secure and protected environment of inpatient or residential with the transition back into the open community where the environment poses many more risks to the recovering addict.

Sober Living Homes

(*in a safe, professional and reputable establishment) are a must in my book. If you want to significantly raise the chances of long term recovery then this extends the intensive support frame during those critical months and gets you ahead of the game. Sober living provides an extension of the organization and security, in part, that an inpatient treatment level gives but allows for the recovering addict to return to work, school and family. Many professionals dismiss this as being intrusive, others do not want to burden their families in their absence and even collegiates will say they don’t want to lose a semester. Stop. Losing all of the progress that has been made with a fast relapse back to use, or worse, is what is at stake. Loved ones, this is your arena too, don’t let convenience keep you from supporting what is necessary. Compassion is not about what is wanted, but what is needed. Be clear about this.

evoNemot12 Step and Community Support Groups

A word about 12 Step and other community support organizations. While I strongly support these the fact remains that they are not a replacement for counseling – and counseling is not a replacement for them. These groups are built as communities of mentors and peers – it is a communal path of support. Counseling is a clinical service delivered by professionals – it addresses emotional, psychological and complex cognitive issues. They are not the same and most long term recovering addicts will tell you they have used both. (be very cautious about a representative of either group who maligns or diminishes the other – this is your recovery path, get what you need from it.)

Why Loved Ones Need Help Too

Parents, partners, family – loved ones. This is called a “family disease” for a reason – it affects the whole family. No matter how strong or removed from it you may think you are – it affects the family; everyone. Many addiction recovery situations are made so much more complicated and jeopardized because of the false beliefs that the addict “is the one who’s sick” or “it’s their problem” – and so the hurt, confusion, resentment and pain just sits and ferments in all those around them. If you are a loved one of an addict – in addiction recovery, in treatment or actively using – you need support and information too, a lot of it. The denial that addicts have in the midst of their disease is less insipid because everyone but the addict sees it. The denial held by the loved ones is much harder because usually very few see it and even fewer will call it out and confront it. The very best gift you will ever give yourself and the addict you love is to get some help – private counseling, a support group of other loved ones of addicts – there are lots of resources out there. If you or a loved is struggling with the disease of addiction and you are ready to make changes and get your life back, I am here and I can help you.grief

Ben Carrettin is Nationally Board Certified, a Licensed Professional Counselor and Licensed Chemical Dependency Counselor with over 20 years of experience. Ben has worked in the arena of addiction/emotional health and the corporate world for many years. He works with both addicts and with the spouses, partners and parents of addicts – ask about his “What Now?” workshops for loved ones or his recovery consults for professionals. If you have reached a point where you are ready for change, Ben is here to help.

Call Now (346)-493-6181

Addiction Recovery Counseling and Support

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Ben Carrettin is a Nationally Board Certified Counselor (NCC), Licensed Professional Counselor-Supervisor (LPC-S) and Licensed Chemical Dependency Counselor (LCDC). He is the owner of Practice Improvement Resources, LLC; a private business which offers an array of specialized counseling, evidenced-based clinical consultation, Critical Incident Stress Management (CISM) and targeted ESI-based services to individuals and businesses.

Categories
Opiates (Heroin and Prescription Pain Pills)

Opiate Addiction and the Brain

Opiate Addiction and the Brain

As human beings we have a long history of using opiates, such as morphine. And if a person gains unlimited access to opiates, they can easily and quickly become tolerant and addicted to it. The drugs have an intense effect on the human brain. Prescription opiates are after all intentionally designed and created to make a person feel good within a short period of time. The drugs increase the level of dopamine released in the brain and copy the effects of endogenous opioids. More often than not, people who have taken opiates with consistency often have difficulty feeling normal without taking the drugs and little or no knowledge of what really happens with opiate addiction and the brain.

Endorphins and Dopamine

Our brains produce a natural morphine known as endorphins. They stimulate the opioid receptors to lift our mood when we are under stress; helping us feel more motivated and relieving pain when there is an injury. These hormones are produced during excitement, exercise, feeling loved, orgasm, pain, or even eating spicy food.

The production of endorphins also leads to the discharge of dopamine, which is the chemical that activates the reward system of our brain. Dopamine acts as natural “go system” that helps humans pursue stuff that we need to survive. Our brain also has a “stop system” found in the prefrontal cortex at the front of our brain. It helps us determine the consequences of our impulses. When a person is addicted to opiates, the “go system” of the brain acts on its own, and the “stop system” can no longer control it.

Some Examples of  Opioids

Heroin

Codeine – ingredient found in many cough syrups

Hydrocodone – Vicodin, Lortab or Lorcet

Oxycodone – Percocet, OxyContin or Percodan

Hydromorphone – Dilaudid

Morphine – MSContin, MSIR, Avinza or Kadian

Propoxyphene – Darvocet or Darvon

Fentanyl – Duragesic

Methadone

What Opiates do to a Person’s Brain?

Opiate drugs activate the dopamine pathway (also known as the reward pathway) that sends out a rush of pleasure chemicals to the brain. When talking about opiate addiction and the brain, opiates are much more stimulating than natural endorphins, which is partly why they are so addictive. Once a person uses opiates, the brain stops creating natural endorphins because the body thinks that there are already enough levels of it in the brain. Within six to 12 months of using opiate drugs, the cells that produce endorphins can be significantly reduced in size and even die off.

One of the most commonly abused illegal opiate drugs is heroin. When it is injected into a vein, heroin reaches the brain within 15 to 20 seconds. It then binds itself to the opiate receptors found in the different parts of the brain that include, you guessed it; the reward pathway. When the receptors in the reward pathway are activated, the person feels a brief and very intense rush of euphoria. This is followed by several hours of what many report as a “contented and relaxed” state. This feeling of euphoria is what draws people back to opiates again and again.

The effects of opiates are similar to the ones from naturally occurring opioid peptides. When used for medical purposes, opiates can stop diarrhea, depress breathing, and relieve pain. They come with side effects that include vomiting and nausea. But when used in large doses, they can make breathing shallow or even make it stop altogether. Thousands of opiate addicts have died due to overdose. And mixing alcohol with opiates only increases the risk of death.

Opiate Addiction and the Brain vs. Opiate Dependence

Dependence happens due to the normal adaptations to prolonged exposure to opiates. Do not confuse the term dependence with addiction – they are not the same. Dependence is a physical condition. Addiction is described to be the compulsive seeking (psychological) and use of the drug that results in deadly consequences. Addiction usually includes some type of dependence (physical) as well.

Another way to understand it is this: dependence is typically acute and holds the potential to be resolved or cured. Addiction on the other hand can be acute or in remission – but it is always chronic and life long (i.e. it is not cured or removed). This is why we say a clean/sober person is “in recovery” and not that they are “recovered”.

A person who is dependent on opiates will experience some type of withdrawal symptoms when the use of the drug is suddenly stopped or reduced. The symptoms can be mild to severe. Withdrawal symptom includes flu-like discomfort, stomach cramps, unpleasant mood, diarrhea, and severe muscle pain, just to name a few. The withdrawal symptoms are most commonly managed medically through the use of a slow drug taper.

Dependence & Tolerance

Dependence is often accompanied by tolerance, which is the need to take higher doses of the drug in order to get the same effect. Once a person experiences tolerance, it can be difficult for the health care provider to evaluate whether the patient has a drug problem or if there is really a need for higher doses to control one’s symptoms. This is the reason physicians are attentive and vigilant to their patients’ symptoms, as well as the level of functioning to provide them with the most accurate information needed to prescribe the appropriate treatment.

Connection of Opiate Addiction and Brain Damage

While it has already established that opiate overdose can result to slow breathing, its effects on brain function are still being studied by researchers. Depressed respiration can affect the oxygen level in the brain. Researchers are still trying to determine the long-term effects of opiate addiction on the brain. Previous studies have shown that there is some deterioration of the white matter among heroin users that affect their ability to respond during stress situations, regulate behavior, as well as their decision-making abilities.

“One of the worst health epidemics facing this country is the belief that successful pain management actually means the absence of any pain at all.”

BW Carrettin, 2003

Getting Off Opiates

Once a person stops using opiates, the natural chemical system of the body can’t turn on right away. It has already been damaged, and it will take a while to recover. The person will go through severe withdrawal that can last up to a week. Then the person will also undergo a long process called post-acute withdrawal syndrome that can last several months or even years.

When the person is suffering from withdrawal, they are typically depressed and with no motivation to do anything. Removing opiates from their system will suddenly bring lots of pain because there is no base level of endorphin found in their system. Professional treatment centers who specialize in opiate detox can help the withdrawal experience be much more comfortable.

Treatment for Opiate Addiction in Houston, Texas

Opioid addiction is a chronic disease, like diabetes or heart disease, and like all chronic diseases it is a medical condition for life. While it can be managed and kept in remission – it cannot be cured and will not go away. However, a person with an addiction can regain a healthy, active and productive life.

There had been a lot of growth and improvement in the field of addiction treatment and one aspect of that is medication-assisted treatment or MAT. Because of a lack of up-to-date training, antiquated ideas about addiction and a general ignorance of neurology and physiology – many people, even those in the addiction treatment field, find the idea of medication-assisted treatment to be controversial. This is sad and detracts from the core intention of recovery work.

It’s important to know that the overall goal of medication-assisted treatment is to help someone begin to recover from addiction. These medications, prescribed and monitored responsibly, do NOT replace one addictive substance with another. They provide a safe and controlled level of medication to overcome the use of a problem opioid. Medication-assisted treatment only works if all three of it’s equally important parts are upheld: medication (monitored and taken as prescribed), counseling (with a seasoned professional who specializes in addiction) and community support (recovery meetings as well as family and friends)

Medically Assisted Treatment (MAT)

In the past, the standard treatment for opiate addiction involved the use of methadone. (Even in the face of better options methadone is still widely used today for treatment of opiate addiction.) Methadone is a long-acting opioid that is used to keep the withdrawal symptoms at bay. It also controls the craving and relapse of the patient. Whether methadone treatment is actually an effective tool for rehabilitation remains a subject of great controversy.

Another medication used in the rehabilitation of opiate addicts is Buprenorphine. It contains a partial agonist opiate, has a weaker effect on the receptors in the brain than some newer medications and has a limited high, which some health care providers believe can deter the addict from abusing the medication. This medication is also surrounded by controversy – some have suggested it is due to improper use, others suggest negligent monitoring by treating physicians.

Naltrexone and Naloxone are used as antagonists at opioid receptors to block the pleasurable effects of the opiates. These do not contain opiates nor do they produce a high. When coupled with counseling or other therapeutic treatments these blockers have more recently been reported to help people quit their opiate addiction. There is an intramuscular injection (IM) version called Vivitrol which lasts approximately 30 days and has been reported to successfully block highs and help to control not only opiate cravings but alcohol as well.

Succeeding in Recovery from Opiate Addiction

For addiction recovery to be successful over a lifetime requires a great deal of desire, commitment, persistence, humility and support. One of the most widely available community-based support organizations is 12 Step with meetings across the globe and in nearly every city in the United States. Churches, community centers and many other venues are also available depending on your area.

A seasoned and experienced counselor who specializes in chemical addiction can also help the recovering addict through the challenges that arise in the recovery process. If the counselor is also licensed and experienced in mental health, they can also assist with issues such grief, anxiety or relationship conflicts that may come up during treatment and recovery. Counseling or psychotherapy is helpful not just for the addict but also for the partners, friends and family who love them.

Breathe. You Can Do This.

Change is hard and for many it can also be a bit scary. Patience and compassion, but not coddling or excusing, is necessary. Learning how to set good boundaries – new boundaries – is important for everyone involved. Remember – getting better doesn’t mean back to how things were. It will never be the same way it was in the past. That was the past. But it can be better, more than better. It can be really good.

If you or someone you know is struggling with opiates, or any drug or alcohol, reach out and get help. A better life is possible and attainable. I’ve worked in this arena for a long time and I’d like to help you.

Stop.    Take a moment.    Breathe.

You CAN do this.

Call Now (346)-493-6181

For More Resources

Ben Carrettin is a Nationally Board Certified Counselor (NCC), Licensed Professional Counselor-Supervisor (LPC-S) and Licensed Chemical Dependency Counselor (LCDC). He is the owner of Practice Improvement Resources, LLC; a private business which offers an array of specialized counseling, evidenced-based clinical consultation, Critical Incident Stress Management (CISM) and targeted ESI-based services to individuals and businesses.

Opiate Addiction and the Brain