An Ounce of Prevention

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“An ounce of prevention is worth a pound of cure.”    ~Ben Franklin

Shi…oops, I mean, stuff happens. I’m referring to relapse, specifically. Relapse is a part of the recovery process. It is a crappy part, but a part nonetheless. It is extremely rare to have a patient enter treatment and stay on the straight and narrow without a single relapse at some point in his/her treatment episode. I state this fact not to give patients an excuse to relapse, but to help to avoid the guilt and shame that keep patients using illicit substances once they do relapse. Relapse, like shi…stuff…happens.

Typically when people make the decision to enter substance abuse treatment, they are “gung ho” about making changes and are “all in” regarding their recovery. In the field we call this the Pink Cloud stage. Being excited about recovery is a very good thing; the problem lies in the ennui that comes after the Pink Could stage ends and everyday normal sets in. When that Pink Cloud lifts, everyday normalcy can seem…boring, despite being exactly what they expressed they wanted most when entering treatment.

Education regarding what to expect throughout each stage of treatment is the best defense a patient can have to protect his/her recovery. Any counselor or addictions therapist worth his/her salt will arm patients with adequate knowledge from the very start of treatment. After all, it is easier to handle situations if one is expecting them and has a plan of action to deal with them when they arise. This should include identifying the individual triggers for illicit substance use. Knowing the things that make a patient want to use, and having a plan of action to avoid those things and for how to handle them when they are unavoidable, are important elements of any treatment plan.

For anyone in recovery, it is also important to have support outside of the treatment setting. This entails more than simply finding a sponsor. This means changing the people that one surrounds oneself with, which can be a painful process. It means cutting off people that are damaging to one’s recovery, even if they are viewed as friends. It means not frequenting the same places that led/lead to using, or that contain people that use. One needs to change one’s playmates as well as one’s playground. There are many avenues to finding recovery support. A simple online search can be a good starting point for finding support meetings in one’s area such as  A.A., N.A., Celebrate Recovery, etc. Any treatment center should also be able to provide referrals upon request. Regardless of where it’s found, outside support is essential for anyone in recovery.

Recovery is never easy. Few things in life that are worth having are. One of the most awful aspects of addiction is that it is fatal if left untreated, so the choice should be easy, even if recovery itself is not. The choice is yours: life or death. What’s it gonna be? I hope you choose life. There are many beautiful things left to see and do. There are people that need you. You are here on this earth for a reason. You are still here because you are meant to make a difference to someone. That is why we are all here. That is why we all have differing struggles and different talents, to aid each other in this place and on this journey, until we reach our final destination. And we don’t need to do it alone. That in and of itself is a beautiful thing, even when the world is not. Choose life; there is more beyond the struggle.

If Something Doesn’t Change, Things Remain the Same (aka “Duh”)

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I hear it all the time; on an almost daily basis. “Why does all this bad crap keep happening to me?” The therapist in me recognizes the external locus of control. For some reason people do not recognize the simplicity with which change can occur in their lives. In Catholicism we refer to it as “avoiding the near occasion of sin.” The concept is very similar; don’t put yourselves in a situation in which bad consequences are likely to occur.

Spelling out for people why “all this bad crap” has happened seems to make a light bulb go off. Recounting the series of events and bad decisions that have lead up to the present moment seems to bring about an “aha” moment. But why? Why did the potential for these bad consequences not occur to the person prior to thinking and acting in ways that lead to the bad consequences? The initial response when I try to point out to the person why things have unfolded in this particular way is indignation. “How dare you suggest that I caused this to happen to myself?” But then, the “aha” happens. Then the “wow, how did I not predict that?” moment occurs.

I think that the way society promotes instant gratification has a lot to do with the problem. Because people want what they want right now, they do not bother to think any further than how to get it. If people would visualize the scene and play it all the way through to the end, realistically calculating the potential for things to go wrong, they may get better final results and avoid the mess that ensues by not doing so. For instance, if I am on parole, and want to catch up with my friend, Jimmy, who is also a felon and a known drug dealer, and I decide to run over to his house and have a drink or two, which leads to snorting a line off of his glass coffee table and then getting into a fistfight with his girlfriend because she was also drinking and did a line and doesn’t like how Jimmy looked at me while I was leaning over the table, I shouldn’t be surprised when the cops are called by the neighbors who hear the ruckus, and I end up back in lockup with my parole violated. How does the famous historical quote go?… I think it was George Santayana who said it; and I’m paraphrasing…”Those who do not learn from the mistakes of the past are destined to repeat them?” Hmm, I think he’s got something there.

So… I guess the answer lies in learning to think before we speak or act. It lies in learning to delay gratification. It lies is learning to contemplate potential outcomes, both positive and negative, prior to acting. So breathe…and think…and then proceed.

Judge Not…

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As an addictions therapist, I am frequently confronted with having to help my patients to navigate the judgment they face due to being labeled “addict.” My response usually involves educating the family members, significant others, or friends of the patient regarding the disease of addiction. It seems as if society has condemned those suffering from a substance use disorder as morally defective simply because they have become addicted. This continues to puzzle me. In this day and age of having instant access to information at our fingertips through the internet, it makes no sense that so many people have completely incorrect information about addiction.

The judgment faced by those suffering from a substance use disorder is one of the most frequently reported reasons that people wait to seek treatment. It perpetuates the stigma attached to addiction, and putting off treatment and continuing to use illicit substances can prove deadly. It’s a nasty game of Russian Roulette that people play when using drugs. Tolerance to the drug of choice builds, meaning the person must take more to get the same effect. So he/she continues to use more, and his/her body continues to tell him/her that he/she is not well without the substance. So the use continues.

It is important to note that just because tolerance goes up, does not mean that the amount that is his/her fatal dosage goes up. It does not. Every addict says, just before overdosing, “I know how much my body can handle.” That is false; he/she is wrong. Sometimes, DEAD wrong.

So, how can we prevent the knee-jerk reaction of judgment regarding those suffering from a substance use disorder? My first answer is, when encountering judgmental fu… um, sorry …folks…EDUCATE ‘EM! The second answer is to remember that it is only by the grace of God Himself that you are not sporting those shoes. (Each and every human being is wired for addiction. If something feels good, we want it, and we want it as often as we can get it.) I believe that God made us all different, with different talents and different issues, so that we would learn to help each other, not so we would use a person’s weaknesses to build our own sense of self-worth by inviting “better-than” thinking, or by using those weaknesses as a weapon.

God is the only one equipped to judge anyone. Let’s face it, we human beings are just not equipped. In fact, we suck at it. So maybe we can start a movement involving dumping the bullsh…pucky  attitudes and hangups, and agree to act out of love for the human race, and get ourselves back on a path toward progress and intellectual and emotional evolution. It doesn’t matter whether we agree on matters of politics, faith, morals, or whatever. We don’t HAVE to agree in order to get along, or in order to still honor and respect each other as also running in the same (and hard-as-hell sometimes) human race. I think if people would take a moment to truly think about it, they would realize that life would be so much easier if we start helping each other and stop trying to tear each other down. As the old adage states, “A joy shared is doubled; a burden shared is halved.” This aptly illustrates what being there for one another is all about.

Methadone Madness

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Originally Published (by me) on LinkedIn on August 26, 2016

Admit it. You had an image of that God-awful documentary Reefer Madness in your mind didn’t you? …And…you already associated the context of that with your errant notions regarding what you think you know about methadone. I’m telling you that if you think that methadone is evil, you’re wrong.

Methadone maintenance has been the red-headed stepchild of substance abuse treatment options for many years. It has received a really bad rap and doesn’t have a very good reputation or public image. It’s time that people learn the truth about methadone and how many lives it saves.

Methadone Maintenance Treatment is for people that have been dependent on opioids for at least a year. That does not mean using opioids for a year; it means dependent on opioids for a year. Opioid withdrawal symptoms include sweating, hot flashes, chills, watery eyes, runny nose, excessive yawning, goose bumps, muscle pain, headache, nausea, diarrhea, vomiting, crawly skin, irritability, anxiety…the unpleasant list goes on. Suffice it to say that opioid withdrawal is like the very worst case of flu you have ever had multiplied by a factor of 12, and it doesn’t relent. Imagine feeling that way and knowing that with one phone call to a friend of yours, who might happen to have some of his leftover pain pill prescription from having a tooth extracted and might agree to spot you some, you could feel better in a matter of about 15 minutes. Hmm, let’s see…flu symptoms…or…take a couple of pills and feel normal again? No brainer, huh?

This is the dilemma people with Opioid Use Disorder face daily. They can be hellaciously ill and in bed, unable to be a parent, or employee, or functional anything, or they can score a few pills (or fentanyl, or heroin) and be normal…for a few hours anyway. Therein lies the rub: you have to amass enough medication to keep you normal. That’s what the “chase” is all about. You chase more pills in hopes of having a sufficient amount to keep you functional so that you can be whoever it is you are required to be. That is what keeps you using. You want to stop, but you don’t have the time or the inclination to be sick for very long. So you get a few pills, or grams, or whatever “just to get you through the day.” Then you’ll quit…later. The problem is, tolerance builds and the amount you used to take to be fine, no longer works, and you need more at a time to keep you fine. This costs more money, and more of your time. Then, the more you use, the more your tolerance builds, and the more you need. The other problem is, at some point you’ll reach your fatal dosage.

Methadone has been around for a really long time, and has been intensely studied and tested, and retested. Can it be abused? Yes, like a lot of helpful medications, it can be abused. Does that mean it isn’t suitable for use? No. Methadone is a miracle drug for many, many people suffering from Opioid Use Disorder. When patients come into a clinic for treatment, they are evaluated for their appropriateness for the program, and if so, they see the clinic physician, and are started on an initial dosage, which cannot exceed 30 mgs on their first day. They are required to attend the clinic daily to have the effectiveness of their dosage assessed and adjusted up or down as needed, to be monitored for signs of sedation or possible over-medication, and to begin treatment planning and counseling.

The initial goals of treatment include harm reduction and stabilization of the medication. Stabilization refers to the point at which the patient’s dosage keeps him/her from craving the drug of choice and alleviating withdrawal symptoms for a 24 hr period. Stabilization takes time. Methadone stays in the system (i.e., will keep a patient from withdrawal symptoms and cravings) for 24-36 hours. (It may stay in the system regarding showing positive on a drug screen for much longer than that.) This is the reason for the initial dosage not exceeding 30 mgs, and the reason that the dosage has to be adjusted slowly, in order to avoid overdose. It is also crucial for a patient to be educated on the dangers of potentiation. Potentiation refers to two or more substances increasing the effect of each other when consumed together. Certain substances potentiate each other, including opioids, benzodiazepines (like Xanax, Valium, or Ativan), alcohol, and barbiturates (like Phenobarbital, or Fiorocet). Basically, it means that taking two of these together leads to an equation of one plus one equals six, or eight, or ten. The amount of medication in the system is exponentially increased, and this substantially increases the risk of overdose and death. The risk of overdose is highest during the stabilization period because a patient who may not yet be getting 24 hours of relief can be tempted to supplement his/her methadone with other substances in an attempt to get additional relief. This is why most clinics require a new patient to see the counselor daily in order to learn about what to expect to feel physically, emotionally and psychologically while they are stabilizing, and to learn how to manage symptoms without resorting to illicit substance use.

Patients in Methadone Maintenance Treatment are required to submit to random weekly urine drug screens to monitor whether they are still using other illicit substances or alcohol, until they show compliance in the program as evidenced by having an observed urine drug screen whose results indicate no illicit substance use. (An observed drug screen is one where a counselor of the same sex as the patient goes into the restroom with the patient to ensure that the urine sample given is authentically that of the patient, and that the urine has not been obtained and brought into the facility.) If they show compliance for a period determined by the facility (usually for a minimum of 30 days), the patient is then placed on a random monthly drug screen schedule, where he/she is asked at a random and unannounced point once each month to provide a sample. If he/she continues to test positive for illicit substances after the 30 days, he/she is required to remain on a random weekly drug screen schedule to closely monitor the illicit use and to provide more interventions as needed.

So, now you know a bit about Methadone Maintenance Treatment and how programs work. I can hear you saying, “But these patients are just trading one drug for another.” That’s not the whole story. After years of using and/or abusing opioids, a person’s opioid receptors become dysregulated. Methadone works on a patient’s dysregulated receptors to normalize the patient. Patients are not getting high in treatment, they are getting normal. You wouldn’t tell a diabetic person, “Just lock yourself in a room for ten days, tough it out, and you’ll be fine. You won’t need that insulin anymore.” I can hear you saying, “That’s different.” It isn’t. Insulin normalizes the system of the diabetic person and keeps him/her from being sick. Methadone normalizes the system of the person with Opioid Use Disorder and also keeps him/her from being sick …with withdrawals. You say, “But the opioid addict did that to themselves. He/She shouldn’t use medication.” Okay, then, I guess you also believe that someone who smokes like a chimney for a lot of years and gets lung cancer shouldn’t get treatment either then?  …Thought provoking, isn’t it?

Addiction is a disease. It is primary, chronic, and fatal if left untreated. It bears repeating…FATAL IF LEFT UNTREATED. In the case of Opioid Use Disorder, it is a disease with horrible physical symptoms. Methadone makes people suffering from this disease functional and productive members of society again. They are better spouses, better parents, better family members, better employees. I promise you that you know someone on methadone, and you probably don’t even realize that you do. I work at a Medication Assisted Treatment facility that offers methadone and suboxone. We treat people of every kind, all races, religions, economic backgrounds… Addiction is an equal opportunity destroyer. It can affect anyone, no matter your upbringing, your intelligence, your socioeconomic status. For Opioid Use Disorder, Methadone Maintenance Treatment has the highest efficacy, and the best outcomes. I have seen it change so many lives for the better.

If you know anyone suffering from Opioid Use Disorder, you now have the knowledge to help them to get the help they need. You may locate a clinic by going to the SAMHSA website (www.samhsa.gov), and clicking on the treatment locator. You can put in your location, and then specify Methadone or Suboxone (buprenorphine) services on the pull-down menu once you open the link. You’ll want to ask the facility if they are CARF accredited before you seek admission.

Thank you for your time and attention. I appreciate your consideration.

-Tricia Gordon CAC II, NCAC II

Keepin’ It Real

Just a snippet about me. Who I (think I) am, what I do, and why I am the way I am.

I’ve been a Clinical Addictions Counselor working at two different methadone clinics since 2008. Let’s just say I’ve seen a few things. And let me thank God right now for my sense of humor, because without it, I wouldn’t have made it this far! I’m currently a Clinical Supervisor at a methadone clinic, which means I’ve been doing this long enough to know what I’m doing, to know sh…poop from Shinola, and to have been promoted.

So…I’m gonna get on my soapbox for a minute… People suffering from addiction …argghhh… I mean, Substance Use Disorder (thanks for the mouthful, DSM 5, I truly appreciate that) deserve the same dignity and respect as everyone else. In general they consist of good people suffering from a bad disease. Yes, addiction IS a disease. (Even the medical community has realized this and affirmed it now. Check out the updated ASAM definition of addiction. Go ahead, google it. I’ll wait.) It is a disease that is chronic, progressive, and FATAL IF LEFT UNTREATED! There are many reasons someone may become addicted. Yes, those people choose the behaviors that lead to their addiction, but once they become addicted, there is no going back. There is no cure, only management. And it doesn’t take very much effort to go from using drugs recreationally to becoming addicted. If something makes us feel good, we humans want more of it, and want it more often. It seems that we’re almost wired for addiction…whether it’s to drugs and alcohol, or something else, like food, technology, sex…The difference is, drug addicts and alcoholics can’t as easily HIDE their addictions as can those addicted to those other things. And for some odd reason those people addicted to those other things don’t get the same bad rap as those addicted to drugs or alcohol. So maybe our instant judgement of those we so casually label “junkie”  warrants reconsideration. People who suffer from addiction (sorry dsm 5, it’s an easier term to use) need help and support to get their lives together, not criticism and judgment.

Okay, I’m done. I’ll get off my soapbox now. For a short while anyway.