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.
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 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.
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 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.
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.
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.
Forgiveness; Is This The Real Deal? – Live Better Live Now. Your life will require you to forgive and to be forgiven by others many, many, many times. The sooner you can learn this and also teach it’s practice to those you love – the sooner you and they can embrace a more free and happy life.
Here’s the “skinny” on what is and is not, forgiveness:
What Forgiveness Is NOT:
1. Condoning, dismissing or minimizing what has happened. Pretending it doesn’t matter only drives the negative inward, it doesn’t make it go away.
2. “Forgive and Forget”; this has got to be some of the worst of common wisdom out there. Forgetting is utter nonsense and foolishness. If you do not remember, you cannot learn and make better decisions ahead. Even the great religious texts do not ask us to forget. (ex. The bible specifies forgiveness, it doesn’t support forgetting…these two are very different.)
3. Reconciling. Keep in mind that forgiveness is a spiritual and internal act. It does not require the other person(s) involvement. Reconciliation is between the offending and the offended – this is a human exchange and unlike forgiveness, reconciling require reciprocity. Forgiveness is an action solely of itself. (forgiveness heals the self, reconciling heals the relationship – sometimes the relationship is not a safe or healthy one and it needs to dissolve).
What Real Forgiveness IS:
1. It’s hard to truly believe in or be open to forgiveness for ourselves when we cannot practice it for others.
2. The conscious choice to not only not seek revenge, but to not harbor the desire for it within ourselves.
3. Allowing whatever injustice we feel to be righted by an appropriate higher system and/or our higher power.
4. Allowing ourselves to see humanity, however flawed, of all involved and not just from a perspective as the offended.
5. Relating the story of what happened with consideration for the above (4) and not an account of accusation that continues to spread injury.
6. Asking, praying, meditating or hoping for healing for the offender – to whatever extent you can. This frees you to move forward in life.
(If you are having trouble wrestling with forgiveness, forgetting and reconciling in your own life, getting some professional guidance might be helpful).
The raves about yoga are more than just a current trend or a flash-in-the-pan fad. The physical and psychological benefits of yoga for stress management have been taking America by storm.
The regular practice of yoga can help decrease stress and tension, increase strength, balance and flexibility, lower blood pressure and reduce cortisol levels in the brain – which in and of itself is a very positive step in preventative health care. It also yields strong emotional benefits due to the emphasis on breathing, grounded and focused release of negative thoughts and the interconnection of mind, body and spirit.
Frequent practice of yoga for stress management can result in better sleep, help you not to focus on things beyond your control and spend more energy learning how to be mindful and live in the present. While it won’t erase or remove stressors – it can, in effect, makes a stressful event a lot easier to handle, whether it’s family, work, health, relationships – or something else.
Whatever misconceptions you have about yoga and stress management, perhaps they should take a back seat. While most people have the notion that you have to be flexible in order to do yoga, the truth is, anyone will benefit from yoga regardless of age. In fact, many times people who aren’t very flexible at all will actually see results even faster. It’s perfectly suited to all levels because yoga is a practice geared to helping you become aware of your own highly individual mind/body connection.
There are many different styles of yoga to suit your preference. Hatha yoga is one of the most flowing and gentle options that is a good choice as starting point. Vinyasa is more athletic while Iyengar concentrates on proper alignment. However, Bikram or “hot” yoga, is not recommended for beginners. (In fact, no one, regardless of fitness level, should begin any “hot yoga” practice without speaking with their physician first.)
It doesn’t matter if you join late in a yoga class. It’s not about doing it better or worse than the others, it’s not even a competition with yourself – nor a competition at all. It’s about how you feel in the moment of each stretch in your body. What matters most is how present and relaxed you can allow yourself to become.
Yoga is considered as a deeply personal practice and no two people can or should hold a pose in exactly the same manner. A person has to work at his or her own level of flexibility, one that is challenging but not overwhelming. If you don’t feel good with what the instructor is telling you to do, don’t do it. Your body will warn you if you are about to get hurt. It is important that you listen to your body, push the limits gently, but don’t let yourself be overcome by ego. Allow your body to guide you and be your friend.
The goal of yoga is to synchronize the breath and movement. When you inhale and exhale as you work through poses is important. Breathing only through your nose keeps heat in the body and keeps the mind focused. Concentrating on your breath is the key to yoga for stress management, as it helps you let go of external thoughts and anxiety, requiring you to focus on your body in this moment. The easiest way to bring yourself into the present moment is to focus on your breath. Feel how it goes down your nose and into your body. It helps you let go of the worrying thoughts.
Bear in mind that yoga is a slow process. Forget about expectations. Let go of competition and judgment. As yoga brings you into the present moment, you will experience joy not only in the physical movement and mental benefits but in spending time in the now.
What is my risk of addiction? The answer is layered and fairly complex. There are many variables involved in what makes a person more or less likely to become addicted to a substance. Some people, in general, are at a much higher risk than others due to the circumstances of their life, many out of their control. It is important to understand risk factors to have a better picture of addiction and to see how these risk factors may be reduced. Let’s consider the different elements that might contribute to an addiction.
First of all, there is drug availability. If the person lives in an area where drugs are readily available, it’s more likely that they will try them. Peers who use drugs might also be considered as a risk factor, especially in adolescence, where the person might not be directly pressured into using drugs, but may want to try it out to belong.
Family history of addiction is a significant risk factor. It is believed that addiction has a genetic component, increasing the likelihood that relatives of a person with addiction could develop this disorder. Even if the person is not genetically predisposed, having an addicted parent or close relative could influence their perception of substance use and teach a pattern that can be repeated in younger family members.
Men are more likely to develop an addiction than women. However, this doesn’t mean that women don’t experience this problem, as some data suggests that addictions tend to progress faster in women and that they might do more damage.
Trouble at home and absent parents also are risk factors, especially for young people. Parental absence or emotional unavialability can make someone turn to substances to feel better or as a temporary solution to their problems. A lack of guidance might also be a factor in choosing to use drugs. Another possible reason for why this is a risk factor is that parental abandonment and an abusive or neglectful household can be related to self-destructive behavior.
Loneliness and a lack of deep relationships with peers can also play a role in addiction. The person might use drugs as a way to fit in with a certain group or as a way to cope with feeling rejected and outcast.
Anxiety and depression are issues that might lead to heavy drug use, as the person might use substances to feel euphoric or to reduce their negative emotions. However, many drugs lead to a heightened anxiety or depression at some point, so the person might try to use more to recapture the feeling of pleasure. So, anxiety or depression can lead to drug use, which might in turn worsen the symptoms, leading the person to seek more substances. This can become a vicious circle.
Other mental health disorders can also increase the likelihood of developing an addiction. For instance, young people with ADHD are several times more likely to become addicted than their peers who don’t have ADHD. Bipolar disorder, especially the manic episodes can also lead to this problem, as the person might not not have the judgment to decide not to use. Post-traumatic Stress Disorder is another common issue co-occurring together with addiction, as people with this disorder might turn to substances to cope with their situation.
Poverty and education are other important factors. A person who lives in poverty and who does not have an education that will allow them to work or the chances to get an education is more likely to turn to substance abuse due to what is seen as an unescapable situation.
An important risk factor is the age of first use. Teenagers who start using drugs are at a higher risk for addiction and for experiencing more negative effects due to the substances than adults. Why is this? Teenagers still have a developing brain and the influence of the substances affects this development, for the worst.
A good example of this is the use of marijuana. Few adults who use marijuana get addicted to it, however, there are two circumstances in which the risk for addiction increases significantly – when the person uses it daily or when the person starts using it as an adolescent.
A risk factor can be the nature of a substance. There are some drugs which are more addictive than others and some that have a faster effect on the brian. For instance, cocaine is much more addictive than alcohol. There are also people for whom a single taste of a drug can spark a full-blown addiction.
Abuse and other traumatic experiences have also been linked to higher rates of addiction. A person that has been deeply hurt might be prone to self-destructive behaviors or turn to substances in order to cope with the experience. Young people who have been abused also might not feel like they can trust their parents or turn to peer groups for acceptance, even when those peer groups promote unhealthy behavior.
These factors do not occur separately, but often interact. For instance, an adolescent from a neglectful household who lives in poverty is less likely to receive or be able to access a good education and may be more likely to have fewer options to choose peers from and higher chances of a peer group that supports drug abuse. They may also start using drugs earlier and turn to heavier drugs, especially if those are made avialable in their community. In short, many risk factors appear together and increase the risk even more, so that an individual might have many thing stacked against them.
Risk of Addiction / Texas Recovery Support / Houston, Texas
Depression And Relationships – *an anonymous guest weighs in.
Depression can be a very lonely illness and your relationships are a key part of how you cope with your depression. Humans are, after all, communal creatures. So in times of depression, more than ever, you need a community of support. Not just good weather friends but friends who can support you when you’re down. If one of these friends is also depressed it is not necessarily a bad thing. You can understand each other and perhaps be there on each other’s bad days (but not if you’re having a bad time at the same time).
However, you need to be especially conscious when choosing romantic partners that your depression will have altered you as a person. It is likely that the person you get together with when depressed will not be the person you want to be with when you are better. When you are depressed you are a different person – at times you may feel as though you do not even know who you really are – but your partner will be with the person you are at that time. Also, depression alters your view of the world and therefore your view of other people, so your view of your partner will not be the same when you are better.
Now, I’m not saying that you shouldn’t ever start a relationship when depressed. In some cases, it could be the best thing for you – but that is likely rare. It may provide the stability you need to start working through your problems and you may be able to talk to your partner about things you can’t discuss with anyone else. Your partner may be the only person you can relax around and start to feel yourself again. Issues may arise that hadn’t before and wouldn’t have come up if you weren’t in a relationship. On the other hand, you may find that you keep up the pretence of being the person you think you ought to be. There is also the possibility that the relationship could fail before you are ready – perhaps due to your depression. And what will that do for your depression? It will likely only make things worse. Either way, the stability may give you the space to start seeing things differently and the confidence to start seeking therapy.
However, what I strongly advise is do not start a relationship with someone who is also depressed. I am not a doctor but I do have 25 years experience of depression and there are two likely outcomes of this sort of relationship. Firstly, one of you will get better, you will split and the other will get worse. The reason is this: if you are simply friends with another depressed person you can help each other and if one of you gets better you can still be there to help the other one with your understanding and advice. However, if you are in a relationship with another depressed person and one of you gets better and you split up then the other person will have suffered the end of their relationship plus the loss of their friendship and support. By all means be friends with other depressed people, we all need friends when we’re depressed, but wait until you have both recovered before you think about starting a sexual partnership.
Depression is a difficult illness to really get rid of. Once you have had it there is always the possibility of a recurrence. If you have recovered from your depression but are still in a relationship with someone who is depressed it is very difficult to stay recovered. Also, you may find that you want to get out of the relationship but feel trapped because you know that the other person will get worse. The stress of this may send you back into depression. This is the second outome – you will both remain depressed.
There are two remaining possible outcomes – the first is that you will both get better and stay together. I believe this is highly unlikely but not impossible. You will both be different people when you are better, with different views and personalities from when you first got together. You may still like each other but want different things. It would be great if you both manage to help each other through depression and out the other side but the normal stresses and strains of a relationship make this unlikely.
The other outcome is that one of you will get better and you will stay together. I think this is the least likely to happen. If you recover from depression and live with someone who is depressed you are not likely to be really happy. You may still remember the feelings and understand but there may be an element of “I got through it so you should be able to as well.” We all know that’s unreasonable as part of depression is the feeling that you just can’t try any more but don’t people always say that ex-smokers and the worst critics of smokers?
Bear in mind that a long-term partnership is not necessarily a bad thing when you are depressed but please think about the consequences of getting together with another depressed person. Try to help each other and be there for each other but keep enough distance between you so that you help each other and not bring each other down. In other words, stay friends and don’t live with each other, at least, not until you know who you really are.
Anonymous in West Houston
Depression And Relationships / Live Better Live Now / *guest post / Houston
Nurses in recovery from addiction; when professionals need help.
Nurses are a population that we would not usually associate with addiction. However, the rates of drug addiction among nurses, as well as other health practitioners are quite high. Nurses have access to different sorts of medical substances that have different effects on the body. The addiction is not necessarily to cocaine or other drugs, but commonly to prescription drugs with different effects. Around 10% of all nurses struggle with an addiction. However, the rate may be higher for nurses who work in more stressful situations, such as the E.R. or with a psychiatric population, for instance. Nurses in different jobs may also have different types of access to substances and different ways of obtaining them. For instance, some nurses may dilute patient medication or use the leftover substance.
Nurses have a highly stressful job. Not only do they see ill and dying people, but they also have to deal with the many problems of their job, like irregular hours, highly demanding work, challenging and distressed patients/family members, and a high responsibility. All these factors make them prone to burnout and stress, which, combined with the access to substances they have, and other individual factors, makes it more likely for them to fall into addiction.
There is a stigma and a culture of silence surrounding this issue. It is understandable, considering that individuals in the healthcare profession may place their patients at risk by abusing substances and engage in a breach of professional ethics by stealing medications and using them on the job.
However, it is important that nurses are offered supportive and professional recovery services and can be helped overcome their addiction. A nurse who can not accept the problem or admit it out of a fear of losing everything that they have or out of the strong guilt they feel continues to put patients at risk. A nurse who is in recovery may not be apt for working with patients, so is not risking their lives or well-being while having a chance to get better.
Often, the first step is a report. Colleagues, patients or doctors may need to report a nurse that has an impaired state out of a responsibility to, firstly, protect the patients and the reputation of the profession and of the institution, but also, secondly, to protect the nurse who probably requires professional help. Colleagues have not only an ethical, but also a legal duty to make the report.
Nurses in recovery may have a difficult process ahead of them. Many institutions have been offering nurses the option to get treatment rather than lose their licenses, thus removing an important obstacle on the way to recovery – the fear of being fired, losing the license, losing the job, losing the respect of their colleagues and peers and of course, their livelihood. However, this is just a first step.
Many obstacles can complicate the recovery process. An important aspect is that nurses continue to work in an environment with a high accessibility to drugs, so a higher supervision is required. Another is the mentality many health care professionals might have, that their knowledge and expertise on the topics of drugs can protect them from addiction or give them more control. However, this slippery slope type of thinking can be what leads to a problem in the first place. It can also complicate the addiction recovery process, as a nurse might think that they can beat addiction easily due to their professional skills. Key point – addiction doesn’t discriminate.
Another aspect that needs to be addressed are the strong feelings of shame and guilt. While the person may have committed unethical acts, it’s important to focus on the recovery process, rather than to continue shaming and stigmatizing the individual, as this is likely to worsen the situation.
It may also be important to consider the special needs of nurses with addiction as a clinical population. Their knowledge, mentality, environment and feelings all will play an important role in the recovery process, which is why it becomes important to adjust this process to better help and understand how nurses experience their addiction and associated factors.
Addiction recovery services that don’t take into account the specific and individual needs of nurses and medical professionals in recovery, may not be quite as well-equipped or effective in providing the support basis truly needed for long lasting recovery. Need Detox? – Get Started Here.
Nurses In Recovery / Live Better Live Now / Houston, Texas
The controversy on whether addiction is a disease or not has continued for a long time and is unlikely to end soon. It is one of the most popular ways of conceptualizing addiction nowadays and it is one that research has shown some very positive results in support of. However, it is worth considering why is addiction considered a disease rather than something else.
Historically, addiction used to be conceptualized from a moral perspective. It involved looking on the addict as lacking in moral fiber and having deep, intrinsic personality defects that led them to become addicted. There was a strong religious component to this idea as well. Addicts themselves were viewed with disdain, an attitude that often appears even today. However, the issue with this concept was that it did not allow for treatment or had only inhumane or ineffective treatment options. After all, there would be no point in treating someone who is lacking in morality and who is, by nature, doomed.
Thankfully, there was a shift from this paradigm, but for a very long time the moral component stayed strong. Addicts were seen as flawed human beings, so many treatments or programs were focused on shaming the individual and working solely with the issue of willpower. This approach, in general, was not effective, because it did not consider the different mechanisms of addiction and the process that real recovery necesitates.
With time and with the development of psychiatry and psychology, new and better treatments became available. More and more was discovered on addiction until the present concept of addiction as a disease was developed.
So, where did it the idea of addiction as a disease originate?
Why is addiction called a disease? Well, it has to do with the idea of mental health disorders and of physiological elements of these disorders. There is a neurobiological mechanism for addiction, involving the brain’s reward system and neurotransmitters such as dopamine. There are also changes in the brain, some of which are irrversible or at least long-lasting, that occur due to substance use and substance abuse. In short, addiction was found to have a strong neurobiological element and a mechanism for addiction that occurred in the brain.
The reward circuit of the brain releases dopamine, which makes us feel pleasure and happiness. A drug like cocaine prevents the dopamine from being reabsorbed, leading to very high dopamine levels which induce a state of euphoria. However, as time passes and the person continues to use drugs, the brain starts producing less dopamine on its own and requires the drug to feel happiness. A mechanism known as tolerance begins to act and the person’s nervous system becomes accustomed to smaller doses. The person starts taking larger doses, which does more damage and eventually may end up in a tragic outcome, such as an overdose. Different substances can affect the brain differently, but heavy use can end up in brain damage, cardio-pulmonary collapse, kidney/liver failure and so on.
So, addiction has a biological mechanism.
The person might choose to use the substance at first, but at a certain point the individual’s will power or judgment are significantly reduced due to the effects of the use.
Some studies have suggested that addiction is also genetically predisposed. This means that some individuals who consume alcohol or try a drug will not get addicted, while others have a higher likelihood of developing this disorder. A genetic component can also support the idea that addiction is a disease.
However, the element that many argue about is that addiction has a lot to do with a person’s choice and with a person’s way of thinking. Some people argue that many addicts consciously begin using substances they knew were dangerous, so can we really call it a disease?
This is the aspect in which addiction is closer to other mental disorders. While problems like depression or anxiety also have a genetic element and a chemical imbalance, emotional and cognitive aspects also play a role. Mindfulness Cognitive-Behavioral Therapy (MCBT) can be used to improve the symptoms of these issues, because they change the way a person thinks. In a way, the thought process and irrational decisions and cognitions can be linked to other mental disorders, as well as to addiction. In general, it can be said that even though addiction involves distorted thinking and decision making, often starting with poor choices, that does not mean it should be considered as a wholly different mental disorder nor that it in any way needs to be considered from a moral perspective. A person with addiction needs to receive medical and psychological help, as well as a treatment that is confidential and adequate to the person’s individual needs.
Today’s model of addiction as a disease, while strongly supported, is not without its problems and will continue to change in the future. At the moment, however, it is a model that does take into account the neurobiological elements of addiction, as well as the processes involved in this condition that make it such a dangerous problem. Specifically, the concept of addiction as a brain disease can explain why addiction occurs and why people can not overcome it without help in most cases. Looking at addiction as a disease with biological, social, emotional and psychological components, it’s possible to develop an integral treatment model that recognizes that addiction is not a choice and that it involves a problem which can not be overcome with sheer will power. The model of addiction as a disease can be used to study addiction, to understand how it appears and develops and to provide treatment, which is why it is a widely used model today.
Why is addiction called a disease? / Live Better Live Now / Houston, Texas
Why is counseling needed for recovery from a disease?
Today the importance of counseling for disease is more widely recognized and recommended than ever before. Many hospitals and rehabilitation centers offer counseling programs for people who are battling cancer, struggling with addiction or are facing other serious health problems. This raises the question of why would a person with cancer or addiction benefit from a service that works with a person’s mental health.
It has been established that most diseases have some sort of psychological component. In many cases, this involves stress. Let’s take as two examples, two very distinct illnesses, such as cancer and addiction.
Example One: Counseling for Addiction
In the case of addiction, it seems easier to establish the need for counseling. The person who has a substance abuse problem usually has certain alteration in the brain, but also specific flawed ways of thinking, deeper problems that may be masked by the addiction, other mental health disorders and other issues might also be present that might benefit from counseling. Let’s take a closer look.
A addict who is active in their disease may frequently engage in flawed ways of thinking. They may deny the problem or try to minimize, justify it or rationalize it. The person might feel angry or sad and not know how to handle these emotions. There commonly are also other factors that contribute such addiction in the family or a trauma history. An experienced and well-trained counselor can help the individual explore the ideas that have led to addiction and may be supporting it, changing negative thinking for a more positive thinking process and learning to adopt new behaviors that support recovery. Counseling can also give the individual tools for the healthy expression of emotions and healthy relationships with others.
Often, addiction appears together with other issues in the person’s life. These issues might involve loneliness, family troubles, low self-esteem or as mentioned earlier, a history of trauma and abuse. Counseling can address these issues, helping the person overcome these situations without using substances as a way of coping.
Addiction often co-occurs with other disorders. Frequently, these disorders are ADHD, bipolar disorder, depression, anxiety and many others. Counseling can work with the symptoms of the other disorder, improving the person’s overall state and condition, which can also benefit the treatment for addiction. In general, it is now generally an accepted best practice that co-occurring disorders need to be treated in tandem, together, to achieve a significant and lasting improvement in the person’s life.
For example, a person with bipolar disorder might consume alcohol during their manic episodes, as one of the characteristics of this state is the increase of euphoria and engagement in pleasurable activities, but that may have dangerous consequences. The same person may then again drink during their depressive episodes, where they may use alcohol, mis-guidedly so, as a pick-me-up or simply to mask or hide from their feelings. If the person does not receive treatment for the bipolar disorder, for instance, receiving mood stabilizers, it’s likely that it will be difficult for them to comply with the treatment for substance abuse due to the shifting mood and the specific symptoms of each episode. However, a joint treatment of the comorbid conditions can more effectively benefit the person.
In general, few people deny that addiction requires counseling, not just medical help. In the case of cancer and other diseases which are viewed as being purely “medical”, there may be more controversy.
Now let’s take a look at why counseling can help a person with a disease such as cancer.
Example Two: Counseling for Cancer / Serious Medical
The first thing that counseling can offer is dealing with the grief of having such an illness and going through a process that culminates in acceptance. Many diseases confront the person with their own impermanence or mortality and with many regrets, pain and fear. Counseling can help the person live through this process, avoiding additional damage and providing a safe environment.
A second aspect of counseling for recovery is that stress and negative emotions play a big role in the progress of disease. While there is no clear link between stress and cancer, it does affect the person’s health indirectly. Constant stress wears down the body, reduces the effectiveness of the immune system and has many other negative effects that could be dangerous to the health of the individual. Stress often is not connected just to the situations a person lives through, but also to their interpretation of this situation, their beliefs and ideas.
For example, let’s consider a cancer survivor who has been a workaholic throughout most of their life. This might be a person who places a high value on working “till you drop” and that doesn’t know how to relax. This is an attitude that might bring them problems if they find it hard to adjust it to their new life circumstances. Counseling can help them develop a new attitude that they are more comfortable with and that is not harmful to their health, reducing stress. It can also help the person use strategies for relaxing and for establishing their new workload. This may be especially important during periods of chemotherapy and/or radiation treatment.
Counseling for disease can help with the adjustment process in general, helping the person accept the changes that have occurred in their life, solidify their commitment to resilience, address their emotions and talk about the many things they may not be comfortable sharing with their family members or friends. The counseling process can help the patient and their loved ones not only to move forward, but also to make the most of the experience.
Counseling for disease can be said to engage the higher executive functions. A disease can bring forward and activate some of the more deep and unconscious parts of our minds, such as our limbic system and the body’s fight-or-flight response. The person might feel overwhelmed with fear, so a process such as counseling that favors integration and engages higher functions related to the prefrontal cortex, for instance, can help the person ground themselves in reality and overcome their difficult emotional state to give them hope for the future.
There are many good counselors out there. You will find the one who is right for you. Whomever you choose, take the time to be sure they are experienced, seasoned, appropriately trained/licensed, communicate clearly, honestly and with compassion.
Thank you for reading. Our heart and prayers are with you on your path wherever it takes you.
“Survival Is Science, Living Is Art”
Counseling for Disease / Live Better Live Now / Houston, Texas
Benjamin is the owner of Practice Improvement Resources, LLC under which he has built two initiatives: Live Better Live Now and Texas Recovery Support. He has served as a founding board member with Greater Houston Area Treatment Providers / GHATP (the largest independent behavioral collaborative organization in Houston), as an active member of Houston Group Psychotherapy Society / HGPS, and is the Founder and Lead Administrator of Greater Houston Wellness / GHW (a focused collective of seasoned specialists in the Houston area). He is also the founder of a unique human behavior consultative service for business and law; called ESI.
Benjamin Carrettin has been working in the mental health field since 1992. He has worked in a variety of settings including private practice, private and grant-funded intensive outpatient programs, partial hospitalization programs and full inpatient hospitalization. Benjamin earned his undergraduate from the University of St Thomas and attended Texas Southern University under a full scholarship for his Masters in Clinical Psychology. He is a fully and independently Licensed Professional Counselor (LPC) in the State of Texas as well as a Licensed Chemical Dependency Counselor (LCDC). Ben is nationally Board Certified by the NBCC, is a Certified Anger Resolution Therapist (CART) and has received intensive training in Critical Incident Stress Debriefing (CISM). In 2012, Benjamin completed a sixteen week Lay Chaplaincy training program in pastoral care with a specialized focus on the hospitalized, infirm and terminally ill and their loved ones. Benjamin is an active volunteer with the Texas Society of Addiction Medicine (TSAM); the state chapter of the well-known national organization and has served on several other community boards, service groups and task forces. He has completed advanced training in stress and pain management for medical patients as well as over seventy-two hours of direct training in Positive Recovery (a specialized program blending best practice addiction recovery with neurologically-supported principles of Positive Psychology).
Throughout his career Benjamin has continued to improve his knowledge and expertise through advanced training courses, field application training, specialized training in corporate and legal processes, as well as additional graduate level coursework and advanced training programs. The areas of his focus include neurology/biology, behavioral cues of deception, positive psychology and epigenetics (gene expression), cancer resilience, medical meditation, violence in the workplace, bio-mechanical basis of behavior, Eastern philosophy and the mind, critical incidents in industrial and corporate settings, first responders and traumatic events, opiate addiction recovery and much more. He is also a professional trainer in the area of social media and ethics.
In addition to working in mental health, Benjamin has also worked in behavioral managed care, both in a clinical capacity and as a Federal Network Manager as well as State Network Manager for Texas. One of his many duties included investigating concerns regarding physician and clinician quality of service, adherence to best practice guidelines, as well as both business and clinical ethics issues of contracted hospitals, physicians and clinicians. To this end, Benjamin is keenly aware of current best practices in the field of counseling as well as up-to-date, proven techniques to increase successful outcomes for his private clients. He continues to be actively sought for by behavioral health hospitals, physician groups and facilities to assist them towards more effectively negotiating their contracts with insurance / managed care organizations (MCO) as well as conducting private training workshops for private practitioners, teaching them how to build and improve their practice and work more successfully with insurance companies.
Beyond the more commonly known field applications for a specialist in human behavior, Benjamin Carrettin provides behavioral analysis and solution-oriented services for business and law. Employee Assistance Programs (EAP), Human Resource (HR) professionals, Law Firms / Plaintiff Attorneys and Business Leadership can access the follow services; Voir Dire Consultative Services, In-Service Training and Workshops, New Hire/Employee Assessment, Public Speaking and Presentation Skills for Leadership, Pre-Trial Focus Group Video Analysis, Clinical Assessment / Resource Identification and Workforce Transition Coaching. Benjamin’s own experience working in the business sector and the field of human behavior, his graduate education in Clinical Psychology as well as advanced training in Human Resources, Organizational Psychology, Strategic Management and Pre-Trial Focus Groups have helped him to successfully support clients across a much wider array of industries.
In his private practice, Benjamin still provides individual, couple and family services for cancer patients and their families, heart disease and depression, peace officers/first responders (traumatic events), professionals in addiction recovery, complicating anxiety/fear, grief and bereavement, survivors of suicide (SOS), death/dying and life transition.
Ben Carrettin is a Nationally Board Certified and Licensed Professional Counselor and is the owner of Practice Improvement Resources, LLC; a private business which offers an array of specialized counseling, evidenced-based clinical and targeted Business and Professional Services to individuals and businesses.
Written and Posted by Live Better Live Now editorial staff
Writer’s Curse – passion, drugs and literature by Christopher Flakus
Drugs and literature have been the two great passions of my life. For a long time they were inextricably bound. In my mind, I thought one could not exist without the other. I believed I had found a fierce sense of liberty in using drugs, a certain outlaw status that reminded me of my heroes: guys like Lenny Bruce, Charlie Parker, Hubert Selby Jr, Jerry Stahl, Hank Williams, Sid Vicious and just about every other famous druggie in the long line of famous druggies. I believed that writers who drank to excess and took drugs wrote the most interesting work. Their writing seemed dangerous, immediate, and relevant…or so I believed. In the Beat Poets I found a sense of personal adventure, a daring rejection of the status-quo which made me feel at home. I devoured the works of the beat movement, especially the writings of junky scribe, William Burroughs. Filmmaker John Waters once said of Burroughs, “Sure he romanticized drug use… Did anybody read Naked Lunch and try heroin? Probably.” Definitely, I was one of them. Doesn’t mean it isn’t a great book, or an important book…it simply means, that like all great art, it is not to be read with impunity.
My fascination with writers and drugs propelled me through College. I read and wrote voraciously. I drank and used drugs with this same fervor. I often spent whole nights with my coke-numbed nose buried in a book. I often read until the sun came up, my bottle and my bag of dope always by my side. Somehow, I made it through the first few years of School, just barely functioning enough to make my grades (at least most of the time). My Literature Thesis was a comparative look at Tennessee Williams’ “The Night of the Iguana” and Malcolm Lowry’s novel “Under the Volcano.” Both books revolved around tragic alcoholic protagonists. Both books were written by tragic, alcoholic authors. I knew I did not ever want my life to reach the kind of misery that Lowry had endured in writing “Under the Volcano.” Despite myself, I couldn’t help believing that his pain somehow informed him…the book itself was a descent into the depths of addiction, an almost mystical voyage into a boozy heart of darkness. I wonder if I was aware, at that time, that I had already begun the first league of that journey myself.
I started using heroin at nineteen, my freshman year of college. I was mystified by what I saw as a philosopher’s stone which inspired writers since Thomas DeQuincy. I had been a heavy drinker, pot-smoker, pill-popper, and coke sniffer…but heroin was the game-changer. The trajectory of my ever increasing use will be familiar to any addict. I was the “I just smoke it don’t shoot it,” guy. Until of course the day came then I was the, “I only shoot it once in a while, special occasions” guy, until I ended up the “I am hopelessly addicted to junk” guy. My apartment quickly dissolved into the kind of junky squat I had read about, though now that it was real, the shiny veneer drug-use once held for me was quickly peeled off. As it turned out, junkies were not just social iconoclasts and pillars of hip…they were greedy, sick, disloyal characters who turned on each other over virtually anything. I was certainly not above scheming my dope for the day through any number of shady doings. Lying became part of my life, just something I did. It was second nature, as natural as breathing. I lied to myself, to my family, to the few straight friends I had left who were watching my quick descent. Sometimes I lied, just for the sake of the lie.
For the most part, I was a middle-man, always orchestrating buys and hanging around for hours in deserted parking lots waiting for my man. I cringe to think of how much time I rendered utterly useless, smoking cigarettes in my car and compulsively checking my phone every couple minutes to see if he had called or texted. As the Velvet Underground song had clearly warned me, “He’s never early, he’s always late…the first thing that you learn is that you always gotta wait.”
Scoring for a group of junkies was advantageous in that I usually had a chance to pocket either a little extra cash or an extra pinch of dope for myself. It didn’t feel dishonest. It was my finder’s fee.
I went on like this, for years. I didn’t finish school. I worked a string of dead end jobs, almost all of which eventually fired me. I couldn’t manage to show up on time, and when I did show up I was often so high I could barely keep my eyes open.
Things got progressively worse. I lost friends, my girlfriend, a good job, and ultimately my own sanity. The bottom really came flying up on me once I began using intravenous methamphetamine. I was trying to stay off heroin, but unwilling to give up the quest for an immaculate high…my search for alternatives to heroin brought me crashing down. I smoked crack, synthetic marijuana, snorted bath-salts…anything that I could get my hands on. I had an open-door policy when it came to drugs, I simply did not discriminate. If it changed the way I felt, I took it. Within a few months of shooting meth, I was locked in a mental health hospital after a psychotic episode. I had not slept in days, and was hallucinating shadowy figures breaking into my house. I was so
convinced my life was in danger that I leapt out of my bathroom window. I lived on the second story. I plummeted down fifteen feet, crashing into a thorny bush. I spent a month with the loonies in a schizophrenic ward of Houston’s Harris County Psychiatric Center. As soon as they discharged me I was back on the streets and my drug use only escalated. Pretty soon, I was on heroin again, still shooting meth, and drinking from the time I woke up (assuming I had even been to sleep) until I collapsed onto my pillow more dead than alive. I had always been a beer drinker, generally speaking, but now I was onto hard liquor as well and lots of it. I was prescribed a narcotic triumvirate of vyvanse, suboxone, and alprazolam at this time. I swallowed the speed (vyvanse) to boost my meth high, and smoothed it out with downers (alprazolam) and heroin. It didn’t matter to me if the drugs were purchased on a street corner or in a pharmacy. I still see no distinction between street drugs and pharmaceuticals. Dope is dope…the end result was always addiction.
I had been using suboxone as a maintenance program for three years. During that time I would sporadically come off the suboxone and get back on heroin. I would sell my strips to other junkies, turn around, and spend the money on dope for myself. At this point, the writing had been completely replaced by drugs. It felt like I had not read a book in years, and if I had, I either forgot entirely or retained very little of what I had read. Everything in my world existed in the shadow of my junk habit.
I had begun using heroin seduced by the myth that it lead to creative wonders. I began shooting speed, inspired by Kerouac’s Benzedrine-fueled marathon writings and the spontaneous prose of “On the Road.” I foolishly thought that on the right drugs, I would unlock secrets to internal poetry which would have otherwise have been out of my reach. Of course, that didn’t happen. The little I did write was tired and lifeless…more whimper than words.
I am sure I would have died. The way I was using, there didn’t seem to be any other outcome. I had given up hope of ever getting better until another, more violent and unpredictable bout of drug psychosis landed me in jail. My detox was agony. I shivered out the poison on a steel cot with nothing to keep me warm but a thin wool blanket. It was winter, and the air from outside seeped into our 24 man tank through vents along the walls. During the summer, not enough air got in through these same vents and the heat was stifling. During winter, there was no keeping the cold out. Maybe it was designed that way to make it an even more hellish place for us.
My withdrawals seemed to last that entire first month I spent in jail. The first couple weeks I spent in my bunk, just holding on to anything I could. A fond memory, a warm thought, a joke…anything I could cling to in my mind that took me away from where I was and what I was feeling. The third week I started stretching my legs, walking around and getting to know the other inmates I was locked up with. Ultimately, it was these men I credit with my decision to get clean. I had suffered dope sickness dozens of time before, only to slip up and use again. Although this cold-turkey jailhouse detox was by far the most miserable kick I had ever experienced, I knew I wouldn’t stay clean because of it. The other inmates, their stories, and their encouragement…these things provided the springboard I needed, not only to get clean, but to start writing again.
The man I call my first sponsor was an inmate named Jonathan, a speed-freak from Dallas. He had been picked up in the Midwest and driven cross-country in a paddy-wagon back to Texas to serve out his sentence. The charges were old, and he had already gone into recovery by the time he was stopped by the police. Jonathan had a certain sense of serenity. He remained calm in his situation. We were all losing our minds with uncertainty, but Jonathan managed to take it all in stride. He conducted his own informal NA meeting in the tank, and I began attending. He would brew a warm coffee for me, and we would spend an hour or two discussing my addiction and potential recovery. The men I met in jail had suffered a hundred times what I had. Many of them were in and out of prison, unable to shake the disease even after years of incarceration. I saw in them the dreadful future that awaited me if I continued to drink and use drugs.
I began reading in jail. A few good friends still wrote letters to me, and bought books online to send to me. I read the Russians, authors I had always wanted to read in depth but was only superficially familiar with. I read Gogol, Tolstoy, Bulgakov, Solzinitsyn, and Dostoyevsky. I also caught up on my Borges, and another wonderful Argentinian author, Julio Cortazar. Their words became my only means of escaping confinement. Dostoyevsky had spent time in a Siberian Prison, and Solzinitsyn’s novel “A Day in The Life of Ivan Denisovich” described his life in one of Stalin’s Gulags. I read these stories, not as lofty literature, but as the voices of fellow prisoners whose strength served as an inspiration to get through each long, hard day inside. As long as I was reading, writing, and exercising…keeping busy, staying out of trouble, I felt I was getting somewhere. Would it sound funny to say, I even began to enjoy life again? Even in a place like a county jail in Texas, I was able to laugh and relate to the people around me. There were many dark days as well. There was violence, ugliness, there was abuse of power and degradation…it was still jail after all, but for the first time in years I felt like some kind of man inside.
I was released from jail under the condition that I go directly to rehab. That sounded fine to me. It had been nearly four months locked up, three of which I had spent sober (There was a little jailhouse hooch going around that first month) making it the longest uninterrupted period of sobriety in my adult life. I knew rehab was the best decision, and I arrived at Houston’s PaRC (Prevention and Recovery Center) with a newfound sense of freedom and determination. I made friends quickly. At first, the transition from jail to rehab was a little overwhelming…there was a cafeteria with great food, and snacks, and I didn’t get woken up by guards in gloves shaking down my bunk. Instead I was greeted with warm smiles, could eat as much as I liked, and was welcome to spend time in a “Serenity Garden” where patients congregated to smoke cigarettes and share stories. I found it laughable when I overheard a couple girls over by the salad bar (yes, there was a salad bar!) describing the food as “inedible” and the counselors as “fascists.” Honey, I thought to myself, you wouldn’t have lasted a day where I just come from…
As a pretty staunch Atheist, I was concerned that the 12 Steps wouldn’t work for me. Luckily, I found a very open and understanding environment in rehab, and I was encouraged to take what I could from the program and leave the rest. I do not use a “higher power” in my recovery, but volunteer work (Service Work, as it is called in AA) and helping others is not only a wonderful way to give back to the community, it is also a healing experience which I have found enforces my own sobriety. I forged new and lasting friendships in rehab. So many of the stories I heard so closely mirrored my own. I felt accepted…if anyone had earned their seat, I had. I discovered that for all my fascination with drug literature there is in fact, only two universal stories of addiction: “I used, I got hooked, and I got clean…or I used, I got hooked, and then I died.” Even if the drugs don’t kill you outright…a life spent perpetually addicted is no life at all. And let’s face it, we junkies aren’t exactly known for our longevity.
There are three quotes by great artists who got clean, that have helped carry me through these first months in recovery. The first is by the great Hubert Selby Jr. (Who struggled with heroin addiction and health complications for most of his life, and managed to get clean and even refused Morphine on his death bed) who said, “Once you quit the drugs and booze, that’s when you find out how dark you really are.” This was important to realize, as a writer. I still had a fear that without the drugs, I would lose some of my eccentricity, or edginess. Tom Waits said it best, when describing his own experience with early sobriety: “One is never completely certain when you drink and do drugs whether the spirits that are moving through you are the spirits from the bottle or your own. And, at a certain point, you become afraid of the answer. That’s one of the biggest things that keeps people from getting sober, they’re afraid to find out that it was the liquor talking all along.” The truth is, my addiction punched a great big hole in my creativity. For years I hardly managed to write or perform at all…I used to sing in a punk rock band, I did spoken word, and even appeared on television for Austin’s Poetry Month. That reading of my poetry on TV was a memory I used to cherish, though it brought me great sadness as well during my many years spent isolated and using. I felt I had blown it. It hurt to remember my success, as much as it hurt to realize I had failed.
I have found, the only real way you lose, is if you die. If you are struggling with addiction, keep struggling…there is a nobility in the fight, even the days it kicks your ass. Especially on those days. Which brings me to my final quote, from the author of ‘Permanent Midnight,’ Jerry Stahl:
“This was the history of the world. Recovery and collapse, despair and relief. The dialectic of clean and dirty. Every time is worse than the time before. The bad things come, days and nights and days and nights get so unbelievably fucked up, unbelievably fast, but in the end– if there is an end– everybody’s best self just slogs forward, one stagger, one fall, one day, one ‘what the fuck just happened?’ moment of oblivion and soul-broken joy at a time. All we have to do is not die.”
For the first time in almost fifteen years, I can enjoy life without a joint, a drink, a pill, or a needle in my arm. It has been a decade since I first smoked heroin as a 19 year old freshman poet…here I am now, ex-jailbird writer living in a sober house with eight other addicts. I have been out of jail and in recovery four months…making it nearly eight months since my last taste of dope. I have a relationship with my father and mother. Many of my truly good friends have re-entered my life and seem proud of me. I’m still fighting and the fight isn’t easy…most days it is damn hard. In the end, it is worth everything to me. I finally found my own story, one worth telling, and worth living.
Christopher Flakus / Writer’s Curse – passion, drugs and literature