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image by Nick Niles

The broken wave of progress

On the morning of November 8, 2016, my wife and I and our two kids dressed in white to honor the suffragettes and went to vote for Hillary Clinton. On that rainy fall morning, it felt like the U.S. was riding a swelling wave of progress. We were still fresh from the Supreme Court decision protecting the right of all Americans to marry. Eight years earlier, we had celebrated the election of Barack Obama who had expanded healthcare and won a second term. I remember in the days after the 2008 election, sitting in a pub where stately images of Obama were flashing across the screen. A black boy, age 11 or 12, was with his family looking up at these images. This boy’s world, I thought, has been forever changed. …


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Drug overdose deaths and new cases of coronavirus in the United States

For those of us in the field of addiction, the notion of living through an epidemic is nothing new. In the last 25 days, about 800 Americans have died of coronavirus, but during that same period, an estimated 4600 have died from drug overdose. In 2017, I wrote a blog piece titled: “We should be marching in the streets over the state of opioid use disorder treatment.” Although we now suffer nearly 70,000 drug-related deaths per year and roughly half a million people have died from opioid poisoning since 1999, federal and state governments have done very little to make sure that patients with opioid use disorder have access to the type of medical treatment that is best able to prevent death and promote recovery. …


Transcript:

From the outside, we can easily tell that something has gone wrong when a person becomes addicted to alcohol or drugs. A kind person becomes mean. An honest person deceptive. A hard-working and reliable person inconsistent or neglectful. How does addiction cause these disturbing changes?

It might be helpful to think about the human motivational system as a car. We crave things that promise reward or relief — that’s the gas pedal. But not everything that provides reward or relief is consistent with a person’s values, goals, or sense of self. If we eat everything that tastes good, we will become unhealthy. If we have sex with everyone we find attractive, we will have trouble maintaining a stable or committed relationship. If we roll over and go back to sleep when our alarm goes off, we may lose our jobs. …


Committing to a 12-step Program

A client of mine (let’s call him David) recently returned from completing an elite professional degree. He had also achieved more than a year of sobriety. When David first got sober, I don’t think either of us imagined him coming so far in such a short time. At that time, he had been in treatment for several months, and although he’d had some periods of sobriety, he had recently suffered a severe relapse. He came to the clinic suffering from psychotic symptoms and an infected abscess from IV drug use.

We almost never discharge people for using drugs or alcohol. That would be like a cardiologist refusing to treat because of high blood pressure. But when it is clear that someone is getting worse, not better, we do require them to enroll in a higher level of care. When our medical director and I met with David, he refused to enter residential treatment. He said he’d already been to the best residential treatment centers in the country and that they hadn’t helped him. We told him that acute illness requires acute care (no matter how many times) and that we could no longer offer ineffective treatment. …


Disclaimer: This article is informational purposes only. Speak with a licensed physician if you believe you need medical treatment for an addictive disorder.

https://www.youtube.com/watch?v=217Jj6EIWy8

Therapeutic Effects

Methadone is an opioid agonist. It activates the brain’s opioid receptors to reduce or eliminate withdrawal symptoms and opioid cravings. Chronic heroin use involves a rapid physical cycle progressing from withdrawal “sickness” to intoxicating “high” and back to withdrawal, often several times a day. When properly administered, methadone can create a steady state of neural activiation in which a person maintains alertness without craving or drug preoccupation and experiences no intoxication or withdrawal. …


Disclaimer: This is article is informational purposes only. Speak with a licensed physician if you believe you need medical treatment for an addictive disorder.

Therapeutic Effects

Naltrexone is an opioid antagonist. It binds to and blocks the brain’s opioid receptors, creating a neural blockade. Unlike both methadone and buprenorphine, naltrexone does not activate the opioid receptors, so it produces no high and no chemical dependency. If a person uses any opioid, including heroin, while taking naltrexone, it will have little if any felt effect.

Formulations

Naltrexone comes in two formulations—a daily oral dose and a 28-day depot injection called Vivitrol®. The oral formulation has not generally been shown to be effective for opioid dependence due to problems with compliance. By blockading the opioid receptors for up to 28 days, Vivitrol® greatly reduces the problem of medication compliance. Individuals on Vivitrol® must nevertheless make the monthly decision to comply with a medication that prevents the use of opioids and offers no felt reward. …


Disclaimer: This article is informational purposes only. Speak with a licensed physician if you believe you need medical treatment for an addictive disorder.

https://www.youtube.com/watch?v=NLLfVXn7ILs

Therapeutic Effects

Buprenorphine is a partial agonist. It activates the brain’s opioid receptors but it also binds to and blocks the effect of opioid agonists such as heroin and methadone. This partial antagonism means that buprenorphine cannot be combined with other opioids to get high.

Buprenorphine also manifests a ceiling effect at which additional buprenorphine causes no additional respiratory depression. This ceiling makes buprenorphine safer than heroin, methadone, and other prescription opioids which have no protective ceiling. …


Disclaimer: This is article is informational purposes only. Speak with a licensed physician if you believe you need medical treatment for an addictive disorder.

Naltrexone / Vivitrol®

Therapeutic Effects

Naltrexone is an opioid antagonist. It binds to the brain’s opioid receptors and blocks the effects of heroin and prescription pain killers. Naltrexone does not activate the opioid receptors, so it produces no high and no chemical dependency. One of the most addictive effects of alcohol use is the artificial “endorphin rush” that it causes. Naltrexone diminishes or eliminates this “buzz” and by doing so diminishes the reinforcing effects of alcohol. Additionally, naltrexone diminishes a person’s cravings for alcohol by blocking the endorphin activity associated with euphoric recall or anticipation of alcohol’s effects. …


Rock bottom versus Drive Reduction

Traditionally, there have been two approaches to treating alcohol and drug addiction. The first was to assume that an individual would not be able to break from the grasp of addiction without hitting “rock bottom.” From a neurobiological perspective, “rock bottom” is that point in person’s life when he or she has experienced so much pain and loss and faces such bleak prospects as a result of alcohol or drug addiction that the limbic-generated fear of continuing to use becomes stronger than the addictive drive. …


in addiction recovery

Introduction

People use drugs to get high. It is therefore reasonable to think that people who are addicted to drugs are driven by the desire to get high over and over again. However, if you ask a person coming to treatment for addiction why they continue to use drugs, they often say things like: “I use so that I can feel normal” or “I haven’t gotten pleasure from the drug in years.” If people use drugs to get high, then addiction is paradoxical—as the pleasure of drug use fades, the drive to use grows stronger and stronger. …

About

Ned Presnall

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