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Georgia Prescription Opioid and Heroin Epidemic

i Jan 24th No Comments by

Georgia in Top 11 Worst Off States for Opioid Overdoses

Georgia ranks #11 in states with most prescription opioid OD deaths549 opioid drug ODs in 2015 29 counties where drug OD rates outpace U.S. average 11 Georgia ranks among top 11 states with most prescription opioid OD deaths

Georgia ranks #11 in states with most prescription opioid OD deaths, with 549 opioid drug ODs in 2015 and 29 counties where drug OD rates outpace the U.S. average. Nearly half of young people who inject heroin start by using Rx drugs.  According to Partnership for Drug-Free Kids, some teens might try prescription medication at a party because they are curious or think it will make them feel good. Medicines most commonly abused are shown here: http://medicineabuseproject.org/medicine

Or they might start taking it legally, when it has been prescribed for pain. Habit quickly becomes dependency with these highly addictive opioids, and once legal prescriptions run out, affected teens will turn to illicit opioids, and then heroin.

Governor Deal recently expanded access to naloxone to reverse opioid OD’s after seeing the White Paper that I recently edited and produced for my client, Georgia Prevention Project. Please take a moment to read the Executive Summary up front. Then sit down and talk with your kids.

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Substance Abuse, Recovery, and Michael Phelps

i Aug 12th No Comments by

What does the word recovery really mean to someone like Michael Phelps?

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Michael Phelps swam past his substance abuse issues at 2016 Rio Olympics. Photo credit: edition.cnn.com

The phenomenal Olympian’s legacy was called into question over the past 8 years after he was charged with substance abuse.

What Happened?

Photographed taking a hit from a bong
Handed two DUI’s
Sentenced to an 18 month probation
Suspended from Team USA Swimming and forced to miss world championships in Russia
Spent six weeks in an alcohol rehabilitation program

What Next?
Girlfriend became his fiancée
Estranged relationship with his father improved
Peers elected him captain of Team USA
Developed reputation as a mentor at 2016 Olympics
Increased his Olympic medal collection to 26 (as of today)

Recovery is rewarding. But recovery is a hard word to swallow. A lot of people seem to believe the word brands them as addict, or alcoholic. Yet experts tell us that only the individual who has suffered from substance abuse can brand himself or state he is in recovery.
Michael Phelps rebranded Michael Phelps. The word recovery, in my opinion, should only be used in the context that Phelps recovered his career, his self-respect, respect of loved ones and peers, and most important, a rewarding relationship with his authentic self. His journey should be celebrated on multiple levels and bring a message of hope to families who struggle with loved ones who suffer from substance abuse. Congratulations, Michael Phelps. And thanks for showing those of us who want to recover our own self-image, that we can.

Substance Abuse Over Age 18. What Boundaries Exist for an Adult?

i Aug 4th No Comments by

Age 18 is an adult whose rights and privacy are protected by law. Talk with other parents in a similar situation. Start treating him like an adult, setting boundaries between you and the substance abuser. Many parents don’t act until a problem is full blown, fueling the behaviors with excuses or multiple ‘second’ chances. An addiction therapist told me 75% of her clients “didn’t practice the tough love necessary to help their loved ones engage in recovery and responsible behaviors.”

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Establishing boundaries with a substance abuser  are more difficult once a teen turns 18.

Some boundaries for young adults:

Removing privileges, such as:

  • Payment for phone, car, and tuition
  • Removal of personal devices, video game and computer equipment
  • Removal from the house and locking them out
  • A restraining order if they have stolen property, cash or medications or abused drugs and alcohol in your home – or if they have been verbally or physically abusive

Young adults are resourceful. Parents with a drug or alcohol abusing teen or young adult should credit their children with the survival instinct and act swiftly to enforce a zero tolerance attitude with actions.

The blog, “Take Good Care of Yourself”  http://www.tgcoy.com offers good insight into boundaries – what they are, who needs them, how to implement them. Here are some of the blog’s clear boundaries for a teen:

1.   “Yes, I’ll be happy to drive you to the mall as soon as you’re finished with your chores.”
2.   “You can borrow my CDs just as soon as you replace the one that you damaged.”
3.    “If you put your dirty clothes in the hamper by 9:00 Saturday morning, I’ll be happy to wash them for you.”
4.    “Can I give Joe a message? Our calling hours are from 9:00 a.m. until 9:00 p.m. I’ll let him know you called.”
5.    “I’m sorry; that doesn’t work for me.  I won’t be loaning you money until you have paid me what I loaned you previously.”
6.    “You’re welcome to live here while you’re going to college as long as you follow our rules.”

Please visit these sites for more information on boundaries for teens

http://www.tgcoy.com/addiction/parenting-tips/1393.html

http://www.boundariesbooks.com/boundaries-with-teens/setting-boundaries-teen-substance-abuse/

Experts Provide Clinical Overview of Drug Recovery Experience

i Jul 30th No Comments by

Reporting on CORE Conference Summer 2016

I attended this conference on Amelia Island Florida in July. The membership goal is to improve accessibility to and the quality of addiction treatment and to promote recovery solutions.

Ivanka Grahovac, Executive Director, Austin Recovery

I am with Ivanka Grahovac, Executive Director, Austin Recovery. She shared her own recovery experience from heroin to advocate for change at the CORE conference.

The conference is “structured as a forum to increase the collective understanding of the addiction recovery processes.” Participants are eager, in general, to improve addiction treatment outcomes by better integrating abstinence-based practices and Twelve-Step principles into therapeutic initiatives.

Four themes emerged during the four day event.

  1. Abstinence versus medication assisted treatment for recovery

More often, meds are being delivered in a physician’s office, administered in many cases by the physician’s assistant. Atlanta has seen this trend with Adderall. Used to be, a psychologist or psychiatrist would diagnose ADD or ADHD and submit the treatment plan with a prescription. Nowadays, people can get a prescription, without the rigorous assessment that was required formerly. In the case of opioid addiction, many physician’s assistants are writing the treatment plan. And many are not necessarily trained to develop it.  Doctors’ offices are focused on harm reduction, which is good. But do they understand the cravings? Do they understand how medication could actually threaten authentic sobriety? These were the sorts of questions and issues that were explored.

  1. Suboxone in the wake of a national opioid addiction trend. Just how helpful is it?

Suboxone is used as a detox agent, and it represents a $1.5 Billion market. Doctors wrote 9 million prescriptions last year. One expert stated, “And guess what? It’s harder to kick than heroin.”  Insurance companies encourage its use, allegedly, because users don’t need to go into detox, which costs insurance companies money. Many experts rejected claims of its benefits, because “it undermines the brain’s ability to present as one’s authentic self.”

Without “full surrender to abstinence, people cannot engage in recovery and 12-step (programs) as their own, real, authentic selves,” said the CEO of a recovery program. Otherwise, claimed many experts, people trying to recover can remain isolated and addicted.

  1. Twelve step programs and the role of a higher power in addiction. The most compelling speakers, across the board, advocated for complete abstinence to support this notion of showing up as yourself, no one else, because it is the surest way to remodel the brain and change behavior. No surprise that drug manufacturers and insurance companies were not present at CORE. Unless they were under the radar. Is “Big Pharma” too busy selling “meds” to physicians’ offices and using Public Relations to sell only part of the story to consumers, so that consumers will be the very people asking for those drugs? And is that a good thing?

“Full surrender” to medication-free recovery made a suboxone prescription sound sketchy, at best. But there is no question that some specific co-occurring disorders warrant medication.

4.   Pornography addiction is a big ugly taboo problem. It is impacting a lot of folks, particularly 12-16 year olds who watch online. It has serious implications for brain receptors, in terms of the stimulation, even compared to what certain drugs do to the brain. I don’t know anything more, but will keep you posted.

The many dedicated professionals were on hand at CORE who are committed to helping people recover and lead full and happy lives – they were nothing short of inspiring. I am so glad I was able to attend and learn more about what they do, how they help others. Want to learn more about CORE?

http://core-conference.com/about-core/

Ways to Deal with Anger over your Teen’s Substance Abuse

i Sep 22nd No Comments by

You are not alone. But it’s time to get help, whether you think you need it or not. Talbott Recovery Atlanta and Aspen Group provided me with the same document on Anger. It offers rich insight and advice.

The document suggests first answering these 5 questions:

Do you feel guilty for your rage?

Do you feel remorse for hurting others?

Are you or others embarrassed by your behavior?

Are you disappointed in yourself?

Are you afraid you may hurt someone in anger?

Do you feel hopeless and/or full of shame?

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Managing anger over a substance abuse situation is a challenge, but patience and simple steps can help a family recover.

What is Anger?

Well, it’s quite simply a response to stress that usually comes from inaccurate perceptions of events. And contrary to what some might think at a given moment, it is generated from thoughts and beliefs that CAN BE CHANGED.

Anger Is Called the Great Manipulator

It is often used to manipulate others into getting what they want, kind of the way bullies bully people to get what they want. And it might win in the short term, but rarely in the long term. Anger, sadly, can make people feel powerful and in control, even when they are not.

Anger is a Bad Habit

We make ourselves angry by engaging in angry thinking:

Judging an event as unfair or hurtful

“Can’t standing”

Demanding (should and shouldn’ts/always and never)

Blaming

You Know Your Triggers, So Move from Anger to Thinking

Breathe and count to 10 before responding

Take a time out away from the situation to cool off and gain perspective

Wash your hands in cool water and drink cool water

Ask for help from someone nearby who is calm

Then…

Set a time to talk or use a mediator

Choose your “battles” wisely

Have structure in place that outlines rules and expectation

Use an “I feel” statement

Take verbal accountability for hearing your anger: say “I’m sorry” and talk about what you choose to do differently

Enter a safety contract with your family to outline your strategy for intervening to stop acting out of anger

Anger Hurts Teens

It leaves a teen feeling powerless, unable to change, fearful, alone, embarrassed, humiliated.

As a result, teens can feel revengeful, betrayed, falsely accused, rejected, stressed, inadequate, frustrated and guilty. It’s important to get on track and stay on track with teens.

Here are some self-help books that the document recommended.

Calming the Family Storm: Anger Management for Moms, Dads, and all the Kids by McKay and May bell

When Anger Hurts Your Kids by McKay, Fanning, Paleg, Landis. And check out these sites:

www.talbottrecovery.com

www.aspengroup.com

What to Look for in Teen Recovery Services

i Sep 17th No Comments by

The Substance Abuse and Mental Services Administration (SAMHSA) is a remarkable organization dedicated to helping Americans, particularly recovery professionals and people in crisis, to better navigate substance abuse issues with better tools and information. It also performs research on programs and tracks and reports outcomes. This checklist is beneficial to any parent who is trying to make a decision about what comes next for their teen in crisis. Whether a parent is alone in this journey or working with a therapist, law enforcement office, or school counselor, the list is a dependable guide to understand quickly what one must look for in terms of support services.

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Knowing the right type of program for your teen to recover is important. Inpatient? Outpatient? Read on…

When you are looking for a recovery program for your teen, here is a list of services that you should feel are required.

Primary Focus of Provider

  • Substance abuse treatment services
  • Mental health services
  • Mix of mental health and substance abuse services
  • General health services

Services Provided

  • Substance abuse treatment
  • Detoxification
  • Methadone maintenance
  • Methadone detoxification
  • Buprenorphine used in treatment
  • Halfway house

Type of Care

  • Hospital in-patient
  • Out-patient
  • Partial hospitalization/ day treatment
  • Residential short-term treatment (30 days or less)
  • Residential long-term treatment (more than 30 days)

Special Programs/ Groups Offered

  • Adolescents
  • Persons with co-occuring mental and substance abuse disorders
  • Persons with HIV/ AIDS
  • Gays and Lesbians
  • Pregnant/ postpartum women
  • Women
  • Men
  • Residential
  • DUI/ DWI offenders
  • Other, Criminal justice clients

Forms of Payment Accepted

  • Self payment
  • Medicaid
  • Medicare
  • State financed insurance (other than medicaid)
  • Private health insurance
  • Military insurance
  • Access to recovery voucher

Payment Assistance Available

  • Sliding fee scale (Fee is based on income and other factors)
  • Payment assistance (Check with a facility for details)

Special Language Services

  • ASL or other assistance needed for hearing impaired
  • Spanish
  • Native American or Alaskan native languages
  • Other Languages

Steps to Plan an Intervention for Substance Abuse

i Sep 12th 2 Comments by

When planning an intervention, it is important that certain steps are followed in order for it to be effective. The last thing you want to do is come across as ambushing your teen. In order to have an effective intervention, we recommend the following 7 steps be taken. These steps were gathered by experts at the Mayo Clinic.

7 Steps to Planning a Successful Intervention

Step 1: Make a Plan

A family member or friend proposes an intervention and forms a planning group. It’s best if you consult with a qualified professional counselor, addiction specialist, psychologist, mental health counselor, social worker or an interventionist to help you organize an effective intervention. An intervention is a highly charged situation with the potential to cause anger, resentment or a sense of betrayal.

Step 2: Gather Information

The group members find out about the extent of the loved one’s problem and research the condition and treatment programs. The group may initiate arrangements to enroll the loved one in a specific treatment program.

Step 3: Form the Intervention Team

Teen_InterventionThe planning group forms a team that will personally participate in the intervention. Team members set a date and location and work together to present a consistent, rehearsed message and a structured plan. Often, non-family members of the team help keep the discussion focused on the facts of the problem and shared solutions rather than strong emotional responses. Do not let your loved one know what you are doing until the day of the intervention.

Step 4: Decide on Specific Consequences

If your loved one doesn’t accept treatment, each person on the team needs to decide what action he or she will take. Examples include asking your loved one to move out or taking away contact with children.

Step 5: Make Notes on What to Say

Each member of the intervention team describes specific incidents where the addiction caused problems, such as emotional or financial issues. Discuss the toll of your loved one’s behavior while still expressing care and the expectation that your loved one can change. Your loved one can’t argue with facts or with your emotional response to the problem. For example begin by saying “I was upset and hurt when you drank…”

Step 6: Hold the Intervention Meeting

Without revealing the reason, the loved one is asked to the intervention site. Members of the core team then take turns expressing their concerns and feelings. The loved one is presented with a treatment option and asked to accept that option on the spot. Each team member will say what specific changes he or she will make if the addicted person doesn’t accept the plan. Do not threaten a consequence unless you are ready to follow through with it.

Step 7: Follow Up

Involving a spouse, family members or others is critical to help someone with an addiction stay in treatment and avoid relapsing. This can include changing patterns of everyday living to make it easier to avoid destructive behavior, offering to participate in counseling with your loved one, seeking your own therapist and recovery support, and knowing what to do if relapse occurs.

A successful intervention must be planned carefully to work as intended. A poorly planned intervention can worsen the situation — your loved one may feel attacked and become isolated or more resistant to treatment. The Mayo Clinic also recommends that consulting an interventionist can be beneficial.

Substance Abuse Recovery Programs – Which Type is Right?

i Sep 2nd No Comments by

Figuring out what program, what approach, is right for your teen or young adult — is no easy decision and is best evaluated with a professional substance abuse counselor. NIH National Institute on Drug Abuse states, “Research studies on addiction treatment typically have classified programs into several general types or modalities. Treatment approaches and individual programs continue to evolve and diversify, and many programs today do not fit neatly into traditional drug addiction treatment classifications.”

Most, however, start with detoxification and medically managed withdrawal, often considered the first stage of treatment. Detoxification, the process by which the body clears itself of drugs, is designed to manage the acute and potentially dangerous physiological effects of stopping drug use. As stated previously, detoxification alone does not address the psychological, social, and behavioral problems associated with addiction and therefore does not typically produce lasting behavioral changes necessary for recovery. Detoxification should thus be followed by a formal assessment and referral to drug addiction treatment.

Because it is often accompanied by unpleasant and potentially fatal side effects stemming from withdrawal, detoxification is often managed with medications administered by a physician in an inpatient or outpatient setting; therefore, it is referred to as “medically managed withdrawal.” Medications are available to assist in the withdrawal from opioids, benzodiazepines, alcohol, nicotine, barbiturates, and other sedatives.”

NOTE: If your child does not need to detox, he still might need intensive residential treatment. So first assess the extent of the problem. People who need to detox can die if they skip that step. Here are some programs. For detail, visit this NIH link about different types of programs.

Types of Recovery Programs

Long-Term Residential Treatment

Long-term Residential Treatment programs provide care 24 hours a day, generally in non-hospital settings. The best-known residential treatment model is the therapeutic community (TC), with planned lengths of stay of between 6 and 12 months.

 Short-Term Residential Treatment

These programs provide intensive but relatively brief treatment based on a modified 12-step approach. These programs were originally designed to treat alcohol problems, but during the cocaine epidemic of the mid-1980s, many began to treat other types of substance use disorders. They consisted of a 3- to 6-week hospital-based inpatient treatment phase, followed by extended outpatient therapy and participation in a self-help group, such as AA.

Outpatient Treatment Programs

These programs vary in the types and intensity of services offered. Such treatment costs less than residential or inpatient treatment and often is more suitable for people with jobs, school commitments, or extensive social supports. It should be noted, however, that low-intensity programs may offer little more than drug education.

Group Counseling

Group counseling capitalizes on the social reinforcement offered by peer discussion and to help promote drug-free lifestyles. Research has shown that when group therapy either is offered in conjunction with individualized drug counseling or is formatted to reflect the principles of cognitive-behavioral therapy or contingency management, positive outcomes are achieved.

Wilderness Programs

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Insurance might not cover wilderness programs. Many programs have limited or no outcomes reporting, partly because relapse comes with addiction. Explore options.

These programs are exactly what they sound like. Wilderness programs use wilderness expeditions for the purpose of therapeutic intervention. A range of programing exists, and the philosophy behind it is to use “experiential” outdoor education to create positive outcomes in the areas of self-concept and self-esteem, along with improved social behaviors in areas such as trust and mutual support. Many therapists I have encountered believe this is an “efficient” approach for teen and young adult males, relative to other options.

Insurance providers in general offer limited or no coverage for these programs. Even court ordered programs usually require an out-of-pocket spend.

Substance Abuse Incident, What Next?

i Aug 21st No Comments by

There has been an incident with your loved one involving substance abuse. Quick – what are the first 5 steps you should take immediately?

  1. Make sure the person is out of physical danger
  2. Identify the facts about what exactly happened
  3. Remove any substances or items that could cause additional harm, including an automobile, if necessary
  4. Seek the counsel of an experienced substance abuse counselor
  5. Assess the degree or extent of the problem
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The first five steps after a substance abuse incident can save a life and help people think and act more clearly.

If your teen is on your phone plan, then start monitoring their call, text and internet activity. Start a record to track habits and calls. Start exploring the best course of action. Now.

Law enforcement or Student Conduct might dictate the next step, giving you no choice regarding what to do next. Unfortunately, depending on the community or school, some teens will be forced to attend mandatory, often inadequate DUI schools, which in many cases feel so punitive, that they hardly inspire sobriety or improved behaviors. What’s more, law enforcement might also impose community service, which could add fuel to feelings of humiliation, particularly if it is a service that does not necessarily fit the transgression or the behavior.

Intensive out-patient programs (IOP), which combine therapy, group therapy, counseling and medicine dispensation, along with other programs are available. Look for details forthcoming. Here is a start, in the meantime.

  • Weekend outpatient
  • Inpatient recovery programs, which usually involve detox for addicts, alcoholics. Detox needs to be medically supervised, or death could result in severe cases
  • Comprehensive residential addition programs
  • Wilderness programs, 20 to 90 day recovery centers that focus on intensive outdoor forms of therapy, combined with individual/group therapy
  • 12-step programs or communities

Will Ban on College Campuses Curb Alcohol Abuse?

i Aug 17th No Comments by

In January of this year, the New York Times ran a story about Dartmouth banning hard liquor on it’s campus. Since then, I have been meaning to write about this.

So banning hard alcohol at frat parties and on campus will help “arrest bawdy behavior and reduce sexual assault”? Hmmm… who said so? Addiction therapists and experts at many respected facilities advise clients that it is alcohol, more than other substances, that wreaks the worst havoc on young adults and families. Beer, wine, or booze, they pretty much have the same impact. Heroin is an exceptional substance because it kills from overdose and has more addictive characteristics than many other substances. But alcohol, regardless of the form, is often more damaging.

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Dartmouth College attempted to curb alcohol abuse by banning booze on campus.

In fact, the most dangerous substance abuse problem on many campuses is allegedly alcohol mixed with Xanax. So what does Dartmouth expect to accomplish with a ban on booze, but not beer and wine? Does the action placate wealthy alums who expect action but don’t understand the real facts surrounding substance abuse? Hard alcohol is easier to conceal than a case or a keg. That doesn’t mean that banning it will help.

How about institutionalizing programs that support prevention and teach and enable students to intervene if a friend is getting into hazy territory? How about mandatory group substance abuse counseling on Sunday night at the Frat house? How about a sober tailgate? Sponsored by the likes of Coke or Pepsi or Ford, and other big brands that want to target young and millennials and be part of a healthy, even a party culture?

Come on Dartmouth, show a little leadership. Show a little resourcefulness. Get real on young adult behaviors and alcohol abuse.