Posts Tagged ‘Addiction’

New TPC! Forum

Sunday, May 22nd, 2011

Recently, hundreds of thousands of spammed messages paralyzed our message boards, where many recovering addicts come to seek help and support, and parents come for basic information.  As That’s Poppycock! has grown, we have had to resort to more sophisticated methods of handling spam and other issues, and so we have decided to switch to a new message board service.  There are several perks to the new forum system:

  • Full integration between TPC! and the forums allowing users to utilize one single username instead of two different usernames
  • Simpler, extremely easy-to-use interface
  • Most importantly, integration with a sophisticated spam processing service

We hope that users will welcome this transition and help get the message boards started again.  The forum can still be accessed at the same URL, and through the link in the navigation bar.

Thanks,

TPC! Management

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Drug Rehabilitation

Friday, December 18th, 2009
  1. Introduction
  2. Ingredients of Effective Drug/Alcohol Treatment
  3. Overview of Different Types/Stages of Treatment
  4. Wikipedia: Drug Rehabilitation

I. Introduction

Detoxification and rehabilitation from drugs is considered by some people to be the single hardest thing one will ever encounter in life. Many people will try detoxifying from drugs at home, and equipped with a hefty stash of over-the-counter “comfort” medicine, as well as some benzodiazepines, a valid attempt is made. Some may last a day or two, others will succeed, but the majority will need some sort of outside help. Unfortunately, many people will say, “I can’t go into a drug rehab! I need to work!” Drug abuse negatively affects every aspect of the addicts life, as well as those around him or her. Pretty soon, that addict may find himself without a job. Thankfully, there are ways of getting help for drug addiction, even if completely broke.

“Ensuring Solutions to Alcohol Problems, a research-based project at George Washington University Medical Center, reviewed research literature and consulted with professionals in the treatment and rehabilitation industry to identify 13 active ingredients of effective alcohol treatment,” said About.com about the Ingredients of Effective Alcohol Treatment. The following, though it talks about alcohol treatment, applies to opioid depedency treatment as well, and is a good starting point in judging whether or not a facility is effective.

II. Ingredients of Effective Alcohol Treatment

  • Early detection, including screening and brief interventions (for non-dependent problem drinkers). The earlier the treatment for drinking problems begins, the better the chance for success.
  • Comprehensive assessment and individualized treatment plan. Treatment for alcoholism and drug abuse is not a one-size-fits-all proposition. Not all patients require the “acute care” approach.
  • Care management. Treatment programs need to be carefully managed every step of the way, sometimes involving family members and friends, from the initial assessment through continued follow-up after the intervention program ends.
  • Individually delivered, proven professional interventions. Several interventions, based on different treatment philosophies, can be effective in reducing alcohol consumption depending on the patient’s gender, severity of dependence and motivation to change. Effective treatment programs will offer more than one approach.
  • Contracting with patients. Also called contingency management or behavior contracting, contracting with patients to reward good behavior and to punish bad behavior can improve treatment outcomes.
  • Social skills training. The basis for cognitive behavioral therapy, people with alcohol problems can be taught to recognize stressful situations, in which their drinking has been a problem in the past, and skills to help them cope with those situations.
  • Medications. Medical treatments cannot “cure” drinking problems, but they can be combined with other interventions and therapies to produce treatment that is even more effective.
  • Specialized services for medical, psychiatric, employment or family problems. Treatment programs need to be targeted at the individual needs of the patient through “problem-to-service matching.”
  • Continuing care. Most who enter treatment have at least one relapse. Follow-up contact, as well as participation in support groups, have both been shown to improve long-term treatment outcomes.
  • Strong bond with therapist or counselor. Research shows that counselors and therapists who bond with patients through empathy, rather than confrontation, are powerful motivating influences in alcohol treatment.
  • Longer duration (for alcohol dependent drinkers). How long a patient stays in treatment matters more in most cases than if a patient is treated in an inpatient or outpatient setting. Studies indicate that outpatient treatment lasting less than 90 days results in poorer outcomes.
  • Participation in support groups. Project MATCH and other studies in the 1990s definitively proved that participation in support groups, such as Alcoholics Anonymous, can be an active ingredient of treatment– both during a professional intervention and after.
  • Strong patient motivation. All approaches to alcoholism recovery depend on the desire of the person to get and remain sober. Effective treatment programs enhance this motivation with intervention and therapy.

Source: Ensuring Solutions to Alcohol Problems, The George Washington University Medical Center. The Active Ingredients of Effective Alcohol Treatment (PDF). June 2003.

III. Overview of Different Types/Stages of Treatment

  • Detoxification (i.e. detox) – This is the first step toward a better life. At a detox, the patient will rid themselves of the drug in a safe, clean medical environment. Often comfort medications are provided to make the transition a little easier. Some places may use methadone or buprenorphine for a few days to help ease withdrawal symptoms. At the end of this phase, the patient may be on some sort of maintenance therapy, but will be clean of their drug of choice with, hopefully, few lingering physical symptoms.
  • Inpatient drug rehab – Treatment for the behavioral, social, and psychological problems associated with drug use will be taken care of at this stage. This is a very hard period, many times marked by intense, frequent cravings, lingering withdrawal symptoms, and a complete reprogramming. Drug addicts often lose all coping mechanisms, to the point where if a problem arises, he or she compulsively turns to drugs to fix the problem, which only worsens things. At this stage, the patient is learning how to live again, without drugs. Some places are very strict as far as male-female contact, what time to get up in the morning, keeping the room clean, making the bed, etc. The support groups at residential drug rehabs are very helpful, and it is important to attend all of them. Don’t worry! It’s not as bad as it sounds!
  • Extended care – Extended care includes any programs attended after leaving the inpatient (residential) facility. Most programs include attending a few support groups a week, seeing a therapist, and/or a psychiatrist. This usually continues anywhere from three months to a year depending on circumstances.
  • Faith-based groups – Alcoholics Anonymous (AA), and Narcotics Anonymous are included in this group. Many opioid addicts actually prefer AA over NA because it’s easier to find a meeting, and there are usually more people with more clean time. For some people, the idea of submitting to a “higher power” is not conceivable, so alternative groups are used. SMART Recovery is probably the best one out there. (http://www.smartrecovery.org)
  • Halfway houses / sober houses – Halfway houses are more restrictive than sober houses, but both promote a sober lifestyle. The good thing about something like this is that the recovering addict is surrounded by people in the same situation, so there is a degree of empathy, and understanding. The bad side is that there are rules, and they must be followed. TRUTH – this part of treatment has saved many lives!

IV. Wikipedia: Drug Rehabilitation (written by external sources)

Drug rehabilitation (often drug rehab or just rehab) is an umbrella term for the processes of medical and/or psychotherapeutic treatment, for dependency on psychoactive substances such as alcohol, prescription drugs, and so-called street drugs such as cocaine, heroin or amphetamines. The general intent is to enable the patient to cease substance abuse, in order to avoid the psychological, legal, financial, social, and physical consequences that can be caused, especially by extreme abuse.

Drug rehabilitation tends to address a stated two-fold nature of drug dependency: physical and psychological dependency. Physical dependency involves a detoxification process to cope with withdrawal symptoms from regular use of a drug. With regular use of many drugs, legal or otherwise, the brain gradually adapts to the presence of the drug so that normal functioning can occur. This is how physical tolerance develops to drugs such as heroin, amphetamines, cocaine, nicotine or alcohol. It also explains why more of the drug is needed to get the same effect with regular use. The abrupt cessation of taking a drug can lead to withdrawal symptoms where the body may take weeks or months (depending on the drug involved) to return to normal.

Psychological dependency is addressed in many drug rehabilitation programs by attempting to teach the patient new methods of interacting in a drug-free environment. In particular, patients are generally encouraged or required not to associate with friends who still use the addictive substance. Twelve-step programs encourage addicts not only to stop using alcohol or other drugs, but to examine and change habits related to their addictions. Many programs emphasize that recovery is a permanent process without culmination. For legal drugs such as alcohol, complete abstention–rather than attempts at moderation, which may lead to relapse–is also emphasized (“One drink is too many; one hundred drinks is not enough.”) Whether moderation is achievable by those with a history of abuse remains a controversial point but is generally considered unsustainable.

Various types of programs offer help in drug rehabilitation, including: residential treatment (in-patient), out-patient, local support groups, extended care centres, and sober houses.

Pharmacotherapies to a greater or lesser extent have come to play a part in drug rehabilitation. Certain opioid medications such as methadone and more recently buprenorphine are widely used and show significant efficacy in the treatment of dependence on other opioids such as heroin, morphine or oxycodone. Methadone and buprenorphine are maintenance therapies used with an intent of stabilizing an abnormal opioid system and used for long durations of time though both may be used to withdraw patients from narcotics over short term periods as well. Ibogaine is an experimental medication proposed to interrupt both physical dependence and psychological craving to a broad range or drugs including narcotics, stimulants, alcohol and nicotine. Some antidepressants also show use in moderating drug use, particularly to nicotine, and it has become common for researchers to re-examine already approved drugs for new uses in drug rehabilitation.

Drug rehabilitation is sometimes part of the criminal justice system. People convicted of minor drug offences may be sentenced to rehabilitation instead of prison, and those convicted of driving while intoxicated are sometimes required to attend Alcoholics Anonymous meetings. There have been lawsuits filed, and won, regarding the requirement of attending Alcoholics Anonymous and other twelve-step meetings as being inconsistent with the United States’ Constitutional mandate of separation of church and state, although there is no such provision in the Constitution itself. Opponents cite a personal letter from President Thomas Jefferson, and attribute it to the First Amendment right. (source: http://www.usconstitution.net/jeffwall.html) (source: http://www.loc.gov/loc/lcib/9806/danpre.html)

Some psychotherapists question the validity of the “diseased person” model used within the drug rehabilitation environment. Instead, they state that the individual person is entirely capable of rejecting previous behaviours. Further, they contend that the use of the disease model of addiction simply perpetuates the addicts’ feelings of worthlessness, powerlessness, and inevitably causes inner conflicts that would be easily resolved if the addict were to approach addiction as simply behaviour that is no longer productive, the same as childhood tantrums. Drug rehabilitation does not utilize any of these ideas, inasmuch as they intrinsically contradict the assumption that the addict is a sick person in need of help.

Traditional addiction treatment is based primarily on counselling. However, recent discoveries have shown that those suffering from addiction often have chemical imbalances that make the recovery process more difficult. Often times, these imbalances may be corrected through improved diet, nutritional supplements and leading a healthy lifestyle. Some of the more innovative treatment centres are now offering a “Biochemical Restoration” process to supplement the counselling portion of treatment.

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Suboxone vs. Methadone

Friday, December 18th, 2009

  1. Overview of Suboxone & Methadone
  2. Advantages and Disadvantages
  3. There’s no miracle cure for addiction!
  4. “Don’t meth it up, get subport!”
  5. “We all have belly buttons, but your’s looks funny!”
  6. Comments & User Experiences

I. Overview of Suboxone & Methadone

Methadone
(Methadose)
Buprenorphine
(Suboxone)
Classification Full Agonist Partial Agonist/Antagonist
Half-Life 8-59 hours 24-60 hours
Other Active Ingredients None Naloxone (opioid antagonist)
U.S. Legal Status Schedule II Schedule III
Dosage Schedule Typically Daily Varies (Every 1-4 days)
Visit Setting Clinic Doctor’s Office
Visit Frequency Typically Everyday (Varies according to program length, state laws, and other factors) Monthly – Biweekly
Abuse Potential High Moderate
Severity of Withdrawal Severe Mild-severe
Ceiling Effect No Yes

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II. Advantages & Disadvantages

Methadone Buprenorphine
Allows addict to temporarily avoid withdrawal symptoms Yes Yes
Allows addict to obtain medication in a safe, clinical environment as opposed to the streets Yes Yes
Eliminates many health risks, such as those associated with IV administration Yes Yes
Dosage can be controlled and gradually reduced Yes Yes
Available at a relatively low cost Yes Not Usually
Level of addiction High Moderate-high
Daily clinical visits required Yes No
Causes euphoria Sometimes Rarely
Level of withdrawal Severe Moderate to mild-severe
Short duration for withdrawal No No

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III. There’s no miracle cure for addiction!

The information listed above is intended to help guide anyone seeking to start an opioid replacement therapy regiment, whether the purpose is maintenance or complete detoxification. It’s extremely easy to run around the World Wide Web collecting facts about addiction, and reading peoples’ experiences with opioid withdrawal, only to scare the desire to quit right out of your bones; however, we must remain confident and remember that this is exactly what our addicted mind wants us to do. We will convince ourselves somehow, someway, that we need to stay on drugs, that “this isn’t a good time to quit,” and we are “better off” taking opioids on a daily basis.

Whether a person is taking Suboxone or methadone, the body will still be physically dependent on opioids as long as this treatment is continued, but it can make all the difference in the world to some folks — if there is a desire for freedom from addiction. Neither drug will work wonders by itself. Recovery is a process that, much like a car or truck, requires constant tuning and retuning, reflection, effort, persistence, and a good knowledge base. Coupled with an experienced drug counselor, support group meetings—whether Narcotics Anonymous, Alcoholics Anonymous, or SMART Recovery—and a positive attitude, methadone or buprenorphine can help pave the highway to a drug-free life, a life worth living.

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IV. “Don’t meth it up, get subport!”

There are horror stories on both sides of the fence. Both Suboxone and methadone offer their own unique benefits; however, most of the stories about individuals coming off of Suboxone pale in comparison with coming off of methadone cold turkey. Your mileage may vary—this is largely dependent on the individual. In my own personal life, I have found Suboxone to be the better treatment for opioid addiction. I have experience with both drugs; I used methadone for detox on one occasion, and took Suboxone in the long-term. Suboxone helped me to break old habits, and it definitely prevented a relapse or two! I won’t reiterate the advantages again, but I will say one thing: if you have to choose one, make sure you do extensive research and consider all variables.

If at all possible, don’t use either drug. Suboxone and methadone should be reserved as tools, your last resorts. It is counterproductive to use either drug during active addiction (to those out there that use it in between fixes). This drug is here to help break associations with the drug underworld and get people back on their feet again, and using it any other way creates negative connotations in your mind. A lot of doctors are too quick to prescribe these medicines. For people with small to medium-sized hydrocodone habits, taking Suboxone or methadone is akin to using a saw to cut your sandwich in half—overkill. Long-acting opioids like buprenorphine and methadone are very tough to withdrawal from, and if you can stick it out for a week without using any short-acting opioids, you’ll be much better off.

A lot of people who start Suboxone end up being on it for six months or even two years when the intention was to stop after a month or two. That’s way too long for most people. An eight week program (or less) should be sufficient to reduce withdrawal symptoms to a bearable level. During those eight weeks, the patient should be involved in an intensive outpatient program. An intensive outpatient program usually includes attending support groups (NA, AA, etc.) three days a week, seeing a psychiatrist as needed, and speaking with a drug counselor. If the root programs, those which (a) led to drug use, (b) were exacerbated by drug use, (c) hidden by drug use, and/or (d) caused by drug use, are not acknowledged and fixed, the patient will likely find himself in a neverending cycle of misery and despair.

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V. “We all have belly buttons, but your’s looks funny!”

Methadone will help some people, and buprenorphine will help others. Every human being has a unique body chemistry, and some may tolerate one drug better than another. Before making any decision we recommend talking to people and finding out what worked for them. Make sure the people you are getting advice from are clean, and involved in some sort of recovery program, if possible. Do plenty of research and read the “Prescribing Information” for each drug. Talk to individuals in support forums online, and read stories… you get the picture. Before deciding on anything, educate yourself and remember, these drugs are not miracle cures, and without any extra effort & support, these drugs will be but a candle in the wind.

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Addiction FAQ

Friday, December 18th, 2009

What is addiction?

Addiction is typically defined as compulsive, and uncontrolled use of a drug even in the face of negative consequences; however, not all healthcare professionals agree with this interpretation. Traditionally, addiction could only occur when a psychoactive substance was involved, but today, some people have expanded the definition to include other behaviors, such as gambling and sex. In addition, addiction usually involves both physical and psychological dependency.

Physical dependency will eventually occur with repeated use of opiates, and is defined as a state where withdrawal symptoms will appear upon abrupt cessation. After a person becomes physically dependent on opiates, discontinuation causes withdrawal symptoms which may include runny nose, gooseflesh, muscle pain, and diarrhea. Some drugs may cause physical dependency, but not addiction. For example, loperamide (an opiate) was originally categorized as a controlled substance because discontinuation of long-term, high doses induced morphine-like withdrawal symptoms; however, the compulsive and uncontrolled behavioral aspects which characterize addiction were not present.

Psychological dependency is noted when upon cessation psychological withdrawal symptoms, such as cravings, irritability, insomnia, depression, and anxiety, appear. “Rewarding” activities such as gambling, sex, and shopping can induce the same sort of psychological withdrawal symptoms as a drug, and are all thought to be due to the effect on the dopamine, a chemical in the brain thought to cause feelings of pleasure. Psychological dependency may also occur when a drug or activity is used to take the place of a typically undesirable activity, making it a habitual behavior. Others consider it to be an emotional, social, or psychological dysfunction, taking the place of “normal” positive stimuli not otherwise present.

How does habitual drug use produce changes in the brain that may lead to drug addiction?

Key Terms

  • dopamine — a neurotransmitter present in brain regions that regulate movement, emotion, motivation, and the feeling of pleasure.
  • locus ceruleus — a region of the brain that receives and processes sensory signals from all areas of the body; involved in arousal and vigilance.
  • noradrenaline — a neurotransmitter produced in the brain and peripheral nervous system; involved in arousal and regulation of blood pressure, sleep, and mood; also called norepinephrine.
  • nucleus accumbens — a structure in the forebrain that plays an important part in dopamine release and stimulant action; one of the brain’s key pleasure centers.
  • ventral tegmental area — the group of dopamine-containing neurons that make up a key part of the brain reward system; key targets of these neurons include the nucleus accumbens and the prefrontal cortex.

The “Changed Set Point” Model

The “changed set point” model of opioid addiction is based on alterations in the neurobiology of dopamine neurons in the ventral tegmental area and of noradrenaline (also called norepinephrine) neurons of the locus ceruleus during early withdrawal and abstinence. The focal point in this model is that drug abuse changes a biological or physiological setting. One variation of this model is based on the idea that neurons of the mesolimbic reward pathways are naturally “set” to release enough dopamine in the nucleus accumbens to produce a normal level of pleasure. When opioids are introduced into this “stable environment” the natural set point is changed; thus, reducing the release of dopamine during typically pleasurable activities (eating, playing, etc.) when opioids are not present. A change also takes place in the locus ceruleus, but in the opposite direction, such that noradrenaline release is increased during withdrawal. This model accounts for the drug liking (increased dopamine levels, decreased noradrenaline levels) and drug withdrawal (decreased dopamine levels, increased noradrenaline levels) aspects of drug addiction.

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