Medically-Assisted Treatment for Drug Addiction with Methadone, Suboxone and Vivitrol

Methadone, Suboxone and Vivitrol; Medically-Assisted Treatment (MAT) for Drug Addiction

Drug addiction in this country has reached a level so great that we now call it an “epidemic”. And in truth, it has spread as fast as many globally known contagions. So, what do we do about it?

The first step in fighting addiction to drugs such as heroin and substances like alcohol is to understand that once you become addicted to these substances, it changes your brain. Addiction becomes like a disease; a chronic ailment of a major organ or system (ie the brain). Many would say addiction is a disease.

While some of the damage can be healed with time, therapy, community support and medically-assisted treatment, others are permanent and will at most be brought to an “in remission” state (your brain does not un-learn what has traveled along it’s “reward pathway”). A better understanding of this brain disease goes a long way for someone fighting addiction as well as to help, inform and support their loved ones.

Opiates and the Brain

Once addictive substances enter our body they go strait to our brain and bind to opioid receptors in our brain. Our brain responds by producing a substance called dopamine. Dopamine makes us feel pleasurable and it is the substance in our brain that causes “the high” we feel under the influence of these addictive substances. With persistent use or abuse, our brain is reprogrammed to expect and crave for this pleasure. This craving and longing becomes the basis of addiction-in-action and if the body does not receive the substances it craves, it experiences withdrawal symptoms. This is the cause of not only the behavioral changes in addicts but also the bodily side effects such as nausea, vomiting, headaches and muscle aches. These reasons also make it clear that while use of these substances is by free will in the beginning, once a person is addicted, they are in fact struggling with a disease and require treatment to counteract the above mechanism.

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There has been a lot of controversy (and misinformation) in the addiction treatment field when it comes to methods of intervention and care. For the addict and family looking for treatment options, just trying to find the right treatment center or physician can in itself seem overwhelming. When it comes medication-based interventions and treatment it can seem almost impossible to determine what is research, what is opinion/personal account and where the line between them falls. Hopefully the information below will at least give you a basic run-down so you can feel better informed and prepared to talk with your doctor.

(*Please note; we do NOT support all of these treatments. This article is simply to give you some clear, basic information).

Methadone:

Methadone is a drug that belongs to the class of drugs (which includes heroin and morphine) that binds to the opioid receptors in the brain discussed above and causes the usual effects that these drugs produce. Methadone is an “agonist” – an opiate used to treat an opiate. However, these drugs reportedly don’t produce the same high associated with drugs such as heroin. In this way they are used to reduce the cravings associated with addiction and limit the withdrawal effects seen in drug abuse. Methadone dosage is carefully adjusted and tapered off with recovery and abandonment can cause resumption of the withdrawal symptoms.

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However, methadone is itself a habit forming drug and is intended only to be taken under the supervision of doctors and with proper counseling. Moreover, alcohol should be avoided when taking methadone. It can also cause slow breathing, alter heart rate and cause dizziness or weakness. If overdosed or severe side effects are seen, a physician should be contacted immediately as overdose has the capability of being fatal. Methadone is a “lifetime” treatment – meaning it is used for maintenance and being eventually off it is rarely a part of the treatment plan.

Suboxone:

Suboxone is a combination of Buprenorphine and Naloxone. It is a partial agonist opioid treatment. Suboxone acts in a similar manner as Methadone by attaching to the opioid receptors and causing the above mentioned effects in the same manner. However, Suboxone is a partial-agonist opiate and causes these effects “partially”. This means that the intensity of the effects are not the same level as when using Methadone even though the general effects are the same. Reportedly, if you increase the dose of Suboxone beyond a particular level, the strength of any side effects will not increase any further even though the dosage is increased. This makes Suboxone much safer for use as any overdose or abuse is not nearly as potentially harmful as with Methadone. However, patients who were addicted to extremely high doses of opiates may not benefit as these drugs won’t produce the intense effects they crave. Additionally, there are concerns that some physicians may be prescribing the drug as a “maintenance” treatment, like Methadone – which is very expensive and to many is contrary to many of the missions of addiction treatment in that this prevents the addict from ever really becoming drug free.

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Vivitrol:

Vivitrol is a non-addictive drug, unlike both Methadone and Suboxone, and helps prevent drug use or relapse. Vivitrol blocks the opioid receptors in the brain and is said to be an antagonist – having no opiate properties at all. By blocking the receptors it blocks the high or pleasure one normally feels with drug abuse and helps eradicate withdrawal symptoms. It is taken as an intramuscular injection (IV) every month which is intended to stop any chance of abuse or overdose and also makes successful compliance much easier for the patient.

However, it is only started after the patient has stopped taking the substance for seven to ten days. Care should be taken that no substance abuse is carried out while taking Vivitrol because serious withdrawal symptoms can occur. Side effects include damage to the liver and hence if any symptoms associated with liver damage such as nausea, vomiting or jaundice occur, a physician should be contacted. (Vivitrol can be started while in a residential treatment program and before discharge. You can speak with your physician to determine if this is right for you).

It is important to note that it is ill advised and potentially deadly to begin and/or continue the treatment of addiction by yourself. This should only be done under the supervision of physicians and counselors who will help you decide and locate the best treatment options available based on your personal situation and need. Detox should always be done in a safe, professional and medically monitored environment.

Author’s Note:

And keep in mind, abstinence is the best path, over time. Any treatment for addiction that sees medication as a long-term treatment or “maintenance” should be treated very cautiously. Addiction recovery isn’t easy – anything worth doing rarely is. So, if someone is “selling” you a fast cure, in all reality, it probably isn’t. Medication for addiction recovery is like a cast for a broken limb; it may be needed for a brief period to hold things in place while healing begins – but who wouldn’t question wearing one for several months or years? Talk to a seasoned, addiction professional and also talk to a doctor or psychiatrist who is actually trained and boarded in addiction medicine.

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Depressed Teen at Home?

Depressed Teen at Home?

The teenage years are emotional mine fields. Sometimes you might feel that your teenager is always depressed because that seems to be the mood they project a most of the time. Does it seem like they just don’t want to be with the family?  Or maybe they spend most of their time at home closed up in their rooms? Perhaps they seem to do nothing but stay plugged in to their smart phones, tablets or gaming systems? An adolescent suffering from depression can be hostile to you, exceedingly grumpy or easily lose their temper. But then, this sounds like a lot of teenagers, doesn’t it?

So, what’s the difference is between this behavior, which seems like their normal attitude lately, and a full blown depression? The truth of the matter is that it’s sometimes difficult to tell just where their teenage angst ends and real depression begins.

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Common Signs of Concern

A teenager suffering from depression may show signs of hopelessness, cry often, be tearful, or may begin to write dark poetry and become interested in dark themed music and movies. They may begin to feel that life is not worth living, to the point that they neglect their personal hygiene because it’s simply not worth their effort. A depressed adolescent can feel as though this dark cloud over them will never leave and therefore their future is bleak. Boredom and the loss of any enjoyment from previously engaging activities is another sign of depression

Low self-esteem is common in a teen suffering from depression. Their sense of self-worth, which is always difficult to maintain during the teenage years anyway, takes a huge hit when depression creeps into the life of a teenager. Depressed teens may feel worthless or that they’re simply not good enough. Feelings of guilt can overwhelm them when things go wrong, as though every bad thing that happens is their fault.

Feelings and Emotions

Teenagers are already susceptible to feelings of inadequacies. When a perceived rejection occurs to a depressed teen whose sensitivities are already heightened, it can result in a devastating emotional spiral.

Bouts of irritability, lashing out at those around them and isolating themselves from friends or family can also be signs of depression. Sometimes a depressed teenager will ‘reject’ their own family in an attempt to preempt being rejected by them.

Traumatic events can also be a causal factor – especially those suppressed and not talked about or shared in a safe environment. And what teenager do you know that tells everything to their parents? If you know there have been some pretty scary or painful events in your teenager’s life talking with an teen counselor or working within a group may be helpful for them. When trauma or loss is involved, you might consider adding EMDR to your toolbox to help your teen.

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A decline in grades or behavior at school can also be a warning of more serious problems. Especially if they become hostile when approached about the situation, it could also be a sign of depression. There are so many traits in depression that can mimic normal teenage phases. It can be difficult for parents to determine whether or not a teenager is suffering from a major depressive episode.

In the Family?

A teenager who is suffering from depression probably has one or two parents at home who are also struggling with this mental health issue. Genetics/biology play a role and but so does environment/exposure. If you feel your teenager, or a teenager you care about, is in danger, please contact their parents, their school counselor or religious leader so that they can receive the help they need.

Chemistry as Agonist

Drugs and alcohol are not always in play when depression is on the table. But let’s be clear – it’s a common risk especially for teens and young adults. If your teenager is using drugs and/or alcohol – this will only increase emotional and other problems. Parents sometimes dismiss this, attributing “recreational” use as a seemingly normal part of youth. But whether dependency, abuse or recreation; mood altering substances always wreck havoc in the long run.

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It’s what many call the “play now, pay later” principle and the price gets very steep when the turmoil of adolescence and depression are in the recipe. In addition, we now know that use of drugs and alcohol during teenage and early college years (while the brain is still developing) has a permanent effect on the brain. If these are part of your teen’s current picture, don’t minimize the seriousness of the risk it holds for the kid you love.

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If you are a parent of a struggling teenager or college-aged young adult, listen to your heart. If you are seeing signs of concern don’t ignore them. Reach out, ask questions, get support – be active and get involved. You cannot afford to be their friend – you have to be a parent. If you need more support, reach out to a friend or family member. If you need more information or guidance, a counselor can be a great help as well.

Cancer & Emotions Part IV: A Guide for Patients and Family – Cancer Self Care

Cancer & Emotions Part IV: A Guide for Patients and Family
Cancer and Self Care

Now it’s time to take care of you. Not the physical you, but the personal you. Cancer self care is as important as almost any part of your treatment plan. Take it seriously and commit to it. This article will highlight a few common sense, but not often enough applied, self-care and emotional-care tips, strategies, and techniques to help you through the depression and anxiety that are a normal part of the journey.

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Social Support

Getting “support” from others has many meanings and can be achieved through so many different avenues. You just have to choose the method that works for you. Let me explain. Keeping in touch with a social support network (e.g., friends, other people going through cancer) prevents you from isolating yourself. Less isolation equals less depression and anxiety. The reason I say that the type of
social support you get has to work for you is because if you agree to, let’s say, join a cancer support group, but you don’t love talking in front of lot of people or aren’t ready to listen to other people’s struggles, then odds are, you won’t frequent the group. Maybe you prefer smaller groups or one-on-one contact with a mentor. Ask your doctor or go online and search for resources for cancer patients in your community.

If you don’t want to go alone at first, ask a friend or family member to go with you. Find a method or meeting format that you’re comfortable with and get out there. I often tell my clients, “it’s got to have the 3 P’s”; purpose specific to your needs (ie a cancer support group, etc), presence (you gotta show up regularly) and participation (if you aren’t active and engaged then you are missing the most important part),

Activities

This might be the last thing you feel like doing if your treatment leaves you tired and/or you’re too stressed to think about (much less do) anything “fun.” This tip is not meant to be fun…at first. The point here is to pick an activity that you are able to do and that you somewhat enjoy or have a special interest in. This includes (but is not limited to) cooking, knitting, fishing, scrap booking, swimming, hiking, cycling, or drawing. You get the idea. You should pick an activity that is accessible to you (i.e., you don’t have to travel far to participate, it doesn’t cost too much money) and that you can do at least two to three times weekly.

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You might be wondering, “What does this have to do with depression and anxiety?” The idea is that when you engage in certain novel activities, different parts of your brain are activated and stimulated. This neurological activity is like rocket fuel for the parts of your brain that protect you from depression and anxiety. It’s like your brain juices start flowing (i.e., neurotransmitter release) and this makes you feel better.

A Note On Knowledge

This just means educating yourself about depression and anxiety. This tip is good in moderation because there is such a thing as overdoing it here. Inform yourself through reliable online material and books and get several opinions, but then stop. I say this because it’s important to not obsess over learning about depression and anxiety. You want to become an expert at applying what you have learned to your every day life. Knowledge is great, but what you do with that knowledge is more important.

Do I Really Need Counseling?

Seeing a licensed mental health professional can be helpful if you are dealing with depression and anxiety throughout your cancer treatment. Even if you are fortunate enough to have a great support group of family and friends, sometimes it’s still a good idea to seek the objective and neutral feedback and treatment from a therapist. Talking to your support network is important, but serves a different purpose. Sometimes you can’t (or don’t want to) vent or discuss sensitive topics with family or friends because they will have their own feelings and emotional reactions to anything you tell them. In other words, if you’re sad or worried, your family/friends might respond to you with equal (or greater) sadness and worry.

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Cognitive-Behavioral Therapy

There are many different therapy models and treatments for depression and anxiety, but a common (and effective) one is Cognitive-Behavioral Therapy (CBT) (and even Mindfulness Cognitive-Behavioral Therapy or M-CBT). CBT is a short-term therapy approach that looks helps you look into how your thinking and behavior influences the way you feel. It might sound simple, but studies on the effectiveness of CBT for people dealing with depression and anxiety have been pretty impressive. An experienced counselor who specializes in working with cancer patients and their families will include M-CBT or CBT as well as other approaches, tailored to your individual and personal situation.

One Last Thought

Remember to talk to your doctor about your depression and anxiety. Avoid doing what (unfortunately) many people dealing with depression and anxiety do: They keep it to themselves as if they were the first and last person in the world dealing with it. And yes, a lot of times it may feel exactly like that. This tendency to keep depression and anxiety hush-hush is probably related to the stigma surrounding mental health (but this is a topic for another article). Talk to someone if you are feeling depressed or anxious during your cancer treatment. There are so many options and solutions out there for you. Stop, Take A Moment, Breathe, You Can Do This !

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