Category Archives: Drug Treatment

When Emotional Pain Fuels Relapse

grief-and-lossPeople in recovery from addiction face very substantial stresses. The stress of trying to cope with cravings & urges, the stress of facing life and trying to resolve problems, and the common pressure of trying to make ends meet when finances are not in good shape.

While many addicted individuals find that they are more resilient than perhaps they ever believed, loss can sometimes be a particularly crippling experience. People from all walks of life suffer and struggle with losses – divorce, the death of a loved one, the loss of a job, income, security, or health.

A recent New York Times article briefly profiled a young woman released from prison who was trying to stay clean from heroin. She really missed her child who had been removed from her custody. While she loved her baby, she also recognized she was not yet ready to resume the pressures and responsibilities of parenting until she got herself on more solid, sober ground.

With the death of a loved one, the feelings run so deep that coping is sometimes beyond one’s inner resources. Grief has a way of overwhelming the senses and the heart such that making rational choices is much harder than would normally be the case. In extreme emotional situations, thoughts can become paralyzed and feelings intensified. Such a combination can make sobriety incredibly challenging.

Emotional pain is part of life. We have all felt it. Recovery teaches many principles that help to make life more manageable and which can help a person to hold on, to survive the lows of life. And for those that slip, life must go on. All is not lost. In 12 step meetings, they say “keep coming back”. In treatment, they say, “don’t give up”. While these may sound like annoying platitudes, they are generally true and correct sentiments that are there to remind us that pain subsides, and the human heart can find a way to survive and to be happy again.

How this happens varies greatly from one person to another. Support from others can make a huge difference. Prayer and connection with the proverbial higher power can make a difference. We are connected (or can be connected) to good people and good things if we try to open ourselves to them. It is not always easy when we are hurting. Therapy and counseling sometimes point us to answers that we didn’t know even existed. Spiritual support can achieve this as well. Whatever life brings us, good or bad, happy or sad, hopefully we can pause for a few moments to reflect on the small blessings that so often go overlooked and underappreciated.

The message for today is to remember that you are worth it! It can get better. Recovery is always here for you.

Benzodiazepines in the Methadone Program

factsBenzodiazepines are a classification of drugs primarily prescribed to treat anxiety and panic attacks. They have been in use for over thirty years and are typically utilized for short term periods from several days to three months maximum.

Benzodiazepines are sometimes administered just prior to medical procedures or surgery to help calm a patient. Common examples include valium, ativan, klonopin, librium, and xanax. These medications have also been used successfully on a short-term basis to help reduce alcohol withdrawal as patients undergo alcohol detoxification.

For opioid treatment programs, benzos present a particular risk due to the higher probability of abuse and overdose death when mixed with methadone, other opioids, or alcohol. Benzodiazepines depress the central nervous system and can shut down respiration when combined with other CNS depressants. This lethal drug combination has resulted in numerous accidental deaths – even among experienced drug users.

While limited and carefully monitored benzodiazepine use can be clinically justified in some cases, prescribing physicians (and methadone clinics) must be vigilant and cautious in their use of these medications due to their risk of abuse and overdose with opioid dependent patients.

Many opioid treatment programs around the country have adopted a no benzodiazepine policy and will not induct a patient with methadone until the patient has successfully detoxed off of any benz medications, and is able to test negative for the drug.

Some prospective patients have been on benzodiazepines for many years – long past any justifiable therapeutic or medical necessity. Several years ago, an OTP was approached by a client seeking admission who had been taking klonopin by prescription for 25 years. She had experienced several overdose episodes during that time period. The prospective patient voluntarily completed a successful detox off the klonopin, and she demonstrated incredible courage in pursuing this goal. She remained benz free and has tested negative for illicit substances for 3 years now. While she was afraid and doubtful that she could complete the benz detox, she surprised herself and the clinic staff in what can only be described as an incredible commitment to change and a new life.

For those patients diagnosed with a severe anxiety disorder, benzodiazepines may be indicated in select cases. Cognitive-behavioral therapy can also be effective in helping individuals learn to cope successfully with anxiety although it will require strong commitment to the therapy process and a considerable degree of work. With benzodiazepine treatment alone, the medication only manages the symptoms … but does not treat the underlying cause of the anxiety. For that reason, treating anxiety exclusively with benzodiazepines (at the exclusion of therapy) can be a disservice to a patient.

Physical dependency on benzodiazepines can be quite powerful and withdrawal from them dangerous. No one should ever try to self-detox from a benzodiazepine addiction due to the risk of seizure and possibly death.

Methadone Program Profile – Alcohol and Drug Services (ADS)

ads-methadone-treatment2There are many hundreds of methadone clinics in operation across the entire United States. Wherever there is addiction, there are suffering addicts and concerned friends and family in search of answers … and treatment.

Methadone.US would like to profile a highly regarded opioid treatment program located in Greensboro, North Carolina. This program is part of a non-profit substance abuse services agency known as Alcohol and Drug Services (ADS).

ADS has been helping the Guilford County and surrounding Triad community for over 40 years. While ADS offers a range of addiction treatment and drug prevention programs, they excel in the area of treating opioid addiction through a combined use of opioid replacement medication (methadone) and structured counseling.

ADS has achieved CARF accreditation, is licensed by the State of North Carolina’s Division of Health and Human Services, and is an approved Medicaid and multi-MCO authorized provider. But ADS’ most outstanding accomplishment is the depth and quality of their opioid program services and the professionalism of their compassionate & committed staff.

Methadone medication offers safe & effective relief from opioid withdrawal symptoms when properly administered through a quality, structured program. Unfortunately, some methadone clinics are too lite on their counseling and case support components, which are key ingredients in any comprehensive opioid treatment program.

ADS has a longstanding history of helping clients gain a thorough knowledge of their addictive illness and in helping clients to develop valuable coping skills for managing their lives and achieving personal goals. ADS treats indigent and low income patients who might otherwise be unable to pay for methadone services out-of-pocket. The ADS Methadone Program offers psychiatric services, limited medical services, free HIV testing, and substantial case support assistance to help with major issues like housing placement.

Alcohol and Drug Services’ methadone program in Greensboro, NC is comparatively small in relation to some of the local private, for-profit methadone clinics. ADS typically serve between 180-200 active clients.

The organization recently launched a new website to inform the community of their various programs. The website is: www.ADSyes.org. The agency gratefully accepts charitable donations of any amount through their website.

Visit the ADS Blog and the ADS Google + Page

Methadone Treatment Requires Strong Commitment

methadone-treatmentThe decision to utilize methadone dosing to manage opioid withdrawal is a choice that will require considerable personal commitment. As methadone dispensing for opiate addiction occurs within the structure of a methadone clinic, each patient must travel to the clinic daily to check-in and receive their medication in person under supervision.

In addition to the daily commute, one must also make arrangements for payment of their methadone program fee. A majority of methadone programs across the country are private, self-pay programs. Many of them offer a variety of pay plans with a fair number of patients opting to pay their program fee each day when they arrive. That fee generally ranges from $8.00 to $15.00 per day.

There are a considerable number of State and Federally subsidized methadone programs that are funded though medicaid or state dollars earmarked for mental health & substance abuse services. These programs usually have very low fees and some of them actually have no out-of-pocket cost to the patient. As one might imagine, state supported programs usually have a finite number of available openings whereas medicaid generally does not operate with the same caps and can accommodate many more patients. However, qualifying for medicaid is not necessarily easy with healthy adult males typically not meeting eligibility requirements.

While methadone dosing provides effective relief from withdrawal sickness, it’s the counseling component of methadone programs that helps patients develop improved skills and a realistic plan for long term recovery from addiction.

When committing to methadone treatment, patients are most excited about the benefits of methadone medication and its usefulness in eliminating the sickness of opioid withdrawal. But, it’s the participation in group and individual counseling that make the greatest difference in developing a new & improved view of one’s future and the possibilities that lie ahead. Opiate replacement medications like suboxone and methadone are an important piece of the recovery puzzle, but learning to cope with one’s feelings, thoughts, and life circumstances comes from the unique benefits of the counseling experience.

Commitment to counseling and learning new skills are key elements in your pursuit of a drug free, improved life. Methadone and suboxone help to remove the huge obstacle of daily withdrawal sickness. Once that hurdle has been jumped, then one can truly walk the path of recovery and discover the many good things that await along the road of life.

Couples in Opioid Treatment Together

womens-recoveryIt is good news when an addicted couple find their way into treatment. Opioid addiction is a very lonely journey, and alienating friends and family comes with the territory when one is deep into a drug addiction.

With severe addiction, it is not uncommon for both members of a couple to be struggling with an opiate dependency. While this bond is certainly not a healthy one, it is one that makes sense for the couple, who often find themselves feeling like it’s “us against the world”. As they plow through addiction, sometimes one hour at a time for years, a bond is formed … like two friends going through a war together each watching the other’s back in a never ending fight to stay alive.

At some point, one member of the couple will have the good thought about entering treatment and may push their partner to seek treatment together. Sometimes this works out and sometimes not. When it does work, the couple will begin dosing with methadone or suboxone and hopefully attempt to re-orient themselves to a sober way of living. This is a beautiful experience to behold when two people are ready, and they encourage each other to make better choices.

In 12 Step recovery circles, recovering couples are strongly encouraged to seek their own individual recovery apart from their partner. Couples often resist this suggestion, but it is a very wise approach. It is so easy to relapse when one’s partner goes back to using. So, having one’s own circle of support outside of this relationship can be critical in helping a person to remain drug free when their partner has relapsed. It actually helps the relapsed partner too when he or she sees their spouse not compromising on recovery principles and continuing to make appropriate choices.

With stable couples who have methadone take homes or who receive the same psychotropic medication, there can be the occasional temptation to swap each other’s medications. When they were actively using, they shared works, pills, anything and everything. Now that they’re stable, it may not seem like a big deal to to take a partner’s medication if one has run out or misplaced their own. However, it is a big deal and should be always avoided. Successful recovery is not easy. It requires personal discipline and a strong commitment to do what is right, even when doing the right thing is challenging and difficult.

While couples in treatment can be a complicated affair, it can work and does work everyday around the country. It is important to note that a couple may not progress at the same rate. While one partner stabilizes quickly on methadone and discovers their cravings & withdrawal disappear, the other partner may have uncomfortable withdrawal symptoms and struggle with urges to use illicit drugs for a period of time.

Good methadone programs will strive to support the couple’s mutual effort to be drug free together, but they will also work with each patient separately. This will include being in separate treatment groups and having separate individual counseling sessions.

With private self-pay programs, there are instances in which a couple may not have enough money for each person to dose on a particular day. This can pose a stressful dilemma for the couple and there is often no easy answer. One member of the couple may just go without. While there is typically an apprehension that missing a day of dosing will bring about immediate withdrawal sickness, this is often not the case. Since methadone has a long half life and is designed for extended duration, some people discover that they are comfortably maintained even through a missed day of dosing. This is not a recommended practice since missing doses is often correlated with illicit drug use, but it is an interesting and useful piece of information.

In the final analysis, a “couple” can suffer for years with simultaneous opioid addictions and a severely compromised quality of life. Choosing to enter drug treatment, either as a couple or as separate individuals, is a positive decision that should be supported wholeheartedly by family, friends, employers, recovery self-help programs, and the treatment community.

Opioid Addiction in the United States

methadone-counselingThe U.S. has experienced a steady rise in the number of people being prescribed opioids and in the number of individuals becoming physically addicted to these medications. In the 1970′s and 1980′s, the typical methadone program client was someone who had graduated to daily IV heroin use.

Fast forward to 2013 and the typical methadone program participant may well be someone who has never used heroin or any kind of injectable drug. With the rise of oxycontin over a decade ago and other popular painkillers, opioid addiction in America moved to unprecedented levels. With this new epidemic level of opiate addiction has come an increasing number of overdose deaths.

Within the last 10 years, Tennessee was for several of those years the nationwide leader in the number of prescribed opioids per resident and the number of opioid overdose deaths. Many of these fatalities were the resulting combination of mixing opioids with benzodiazepines like xanax, klonopin, and ativan. Today, many opioid treatment programs and independent physicians are using much greater caution in prescribing benzodiazepines in their practice, and some have opted out of this completely due to the significant medical risk involved.

As the resulting need for treatment options began to grow, the availability of local methadone programs increased as did the total number of U.S. physicians who were approved to prescribe suboxone. Both methadone and suboxone have been enormously beneficial in helping addicted people gain a new lease on life. These opioid replacement medications, combined with counseling, provided hope for a life after opioid addiction. Unless someone has experienced the ravages of a drug addiction, they may be unable to fully comprehend the benefit provided by opioid treatment using methadone or suboxone.

In the final analysis, we as a nation must guard against the overuse of prescription painkillers. And individuals must exercise due caution and care since there is no substitute for personal responsibility and good personal judgment. As America moves forward in the coming year, we must strive to prevent drug abuse where we can through education and prevention efforts. We must also recognize and support the concept that addiction is a treatable illness, and that methadone and suboxone are an essential element in the opioid addiction solution.