Get Clean. Stay Clean.

Teaching about Addiction in Primary Care

2010-03-18T13:02:00.000-04:00

Earlier this month I had the pleasure of speaking at the Virginia Nurse Practitioners Annual conference up in Reston Va. It was a very well attended conference with over 450 participants. I chose to speak on “Addiction in the Primary Care Setting”.

There is a lot of evidence that primary care practitioners, whether Physicians or Nurse Practitioners, are not very skilled at detecting alcohol or other drug addictions when they see patients in a primary care setting. Not only do they not detect the illness, but they frequently don’t know what to do when they do come across it. This is especially a pity because alcohol and other addictions are major factors in a large percentage of primary care visits. Frequently patients come in with anxiety, depression, stress, accidents, hypertension, GERD, or other problems that are directly caused by their use of addictive substances. You can add to this all the problems that the family members suffer with –depression and anxiety in the spouses, school problems for the children, etc. It is also important to add in all the diseases that are made worse by the patients’ substance abuse – their diabetes that is not well managed, their lack of exercise and poor nutrition, forgetting to take their regular medicines, and so on. When you add it all up substance abuse has a huge impact on our national health.

And yet Primary Care Practitioners almost never look for the disease, unless the patient comes in and actually asks for help – which is a small minority. When patients come in and ask for help it is usually only in the later stages of the illness, when a lot of damage has already been done and success rates are lower. It is so important then, that doctors look for the disease and diagnose it in the early stages when treatment can be most helpful.

There are many reasons for this. Many docs don’t fully accept that alcoholism and other drug addictions are illnesses. They often feel that alcohol and drug problems are not any of their business. They may feel they are being judgmental. They may be afraid that the patient will get mad and may leave the practice. It has also been shown that doctors often hesitate to investigate a problem or make a diagnosis if they don’t feel comfortable dealing with it. So if a doctor doesn’t know what to do if the patient does admit to a problem then the doctor often won’t bring it up. Often times Doctors and Nurse Practitioners just don’t have the knowledge base about addiction – they don’t have the information about what substance abuse really is. They frequently don’t know how to screen for the disease or how to diagnose the disease if the screen is positive. They often don’t know where to get help if the patient does acknowledge there is a problem.

So there was a lot to cover in my talk up in Reston. Fortunately the group of Nurse Practitioners who came to the talk were very eager to learn and participate. They asked very insightful questions and had very helpful feedback. We were all able to share our experiences and learn from each other. Hopefully they will have a little better idea of when to suspect there may be a substance abuse problem and they will be a little more willing to ask those difficult questions.

Now it is on to Physicians. Later this month we are starting a Webinar series for Primary Care Doctors to help teach them the same kind of material. If you know a physician who may like to participate please call Mike at our office to get more information.

Peter Coleman MD

Step 3 - “We became willing to turn our will and our lives over to the care of God as we understood Him”

2010-03-18T13:01:00.001-04:00

Step 1 is the beginning of the journey to sobriety with the admission of personal powerlessness. This admission paves the way for help from the outside…outside of the addict. In Step 2, the addict embraces the belief that a power greater than himself/herself can restore them to sanity. Finally, we come to Step 3…the ultimate decision. In this step, the addict makes the purposeful decision to turn their will and their life over to their High Power. It is at this point the addict can breathe a sigh of relief knowing that their life is now under the control of Power with more wisdom, insight, and power than they ever had!

If Step 3 sounds so good, why do so many addicts hesitate at this step to move forward? Simply put, Step 3 is not easy to take! In doing so, it is a confession that life under the addicts direction has failed. It is a confession that the addict’s best thinking kept him/her from successfully enjoying the addiction without devastating consequences. In short, Step 3 is an ego deflating step. And that is very good news!

There are several reasons to take Step 3. First, it releases the pressure of trying to make things happen without the power to succeed. Second, it helps the addict become right-sized understanding his/her right place in the world. Last, it is freeing allowing to give up the control they never actually had in the first place!

Through the history of addiction recovery, the stories remain the same. Although the details differ, one truth is a common thread that ties their success together, namely, allowing God to do for them what they could not do for themselves. In taking Step 3, the addict understands the truth of the Big Book when it says, “his defense [against alcohol/drugs] must come from a Higher Power” (p. 43).

Chris Newcoomb - Aftercare Coordinator

Substance Abuse Among Adolescents 12 – 17 Years of Age

2010-03-18T13:00:00.008-04:00

A recent clinical review presented the significance of substance abuse among adolescents, 12 to 17 years of age. According to the 2008 National Survey on Drug Use and Health, 9.3% of 12 to 17 year olds are current illicit drug users. Of those users, 6.7% used marijuana, 2.9% used psychotherapeutics, 1.1% used inhalants, 1.0% used hallucinogens, and 0.4% used cocaine. In addition to illicit drug use, more than one-half of Americans, aged 12 or older, reported being current consumers of alcohol. In 2008 alcohol consumption rates were 3.4% (12 to 13 year olds), 13.1% (14 to 15 year olds), and 26.2% (16 to 17 year olds).

With this in mind, the implications of substance abuse in the adolescent population are huge. According to the National Institute on Drug Abuse, one in every four deaths is attributed to alcohol, tobacco, or illicit drug use. Substance abuse also places a huge burden on the United States economy and healthcare system. It is estimated that substance abuse costs the U.S. economy four- hundred and fourteen billion dollars every year. Furthermore, five-hundred twenty-seven thousand dollars are spent every year on Emergency Department visits for illicit drug use.

Managing substance abuse amongst adolescents requires awareness about the issue, prevention efforts, adequate treatment interventions, and access to care. Issues facing primary care practitioners managing substance abuse include patient acknowledgement of the problem, patient motivation to receive treatment and adhere to the treatment plan, and insurance restraints surrounding coverage and funding for substance abuse services. Resources needed to effectively manage substance abuse include individual counseling, family therapy, centers offering detoxification, inpatient and outpatient treatment facilities, and self-help groups such as Alcoholics Anonymous, Narcotics Anonymous, Alateen, and Al-Anon. Such resources are imperative for both the primary care practitioner as well as the patient, in aiding the recovery process.

Practice implications for primary care practitioners include awareness about substance abuse in the adolescent population, maintaining current knowledge about guidelines and recommendations for managing patients presenting with substance abuse, recognizing which substances are most prevalent in the geographical area they are serving, screening all adolescent patients for substance abuse at each visit, and providing appropriate referrals and follow-up.

Stacy Baldwin, RN, CRC
Virginia Commonwealth University

Visvamitrasana

2010-03-15T08:25:00.000-04:00

Today in yoga class Ellie, my incredible instructor, had us working on a pose called visvamitrasana. If you think it’s hard to say and to spell, you should try doing the dang thing!

Ellie gently reminded class as we stretched to capacity and tried not to tip over to:

Keep Our Hearts Open,
Our Minds Accepting,
and have
Contentment with Wherever We Are.

It is the Process, not the Outcome that is important in the practice of yoga.
One of the things I love about yoga is that what one practices on the mat is meant to be applied to real life ‘off the mat’.

People can try to avoid difficult situations in life, but those who have faced the reality that drinking alcohol, using opiates or using benzos have the potential to ruin their lives, know it is time to stop.

At The Coleman Institute we combine state of the art addiction medicine with open hearts and acceptance for our clients who begin the Process of Recovery. We can help you stretch and keep you from completely tipping over through our Accelerated Detox programs.

Eric Clapton’s Autobiography is an inspiring book to read

2010-03-13T13:19:00.001-05:00

I just finished reading this inspiring book. Eric Clapton has been at the top of his field in the music world for many years but what many people don’t know is just how much his life was affected by his addiction.

The book starts with Eric’s earliest years. It describes his upbringing and the early influences on his music. His passion and his dedication to music come through very clearly. Of course he was good friends with George Harrison and many other top musicians, so it is interesting to read about that world.

But then his life starts to become consumed with his use of drugs and alcohol. It starts subtly, as it does for most people, but then gradually gets worse and worse. Initially it was alcohol, but then he developed a severe Heroin problem. He was able to get off Heroin but he just switched to alcohol, as many of our patients do. As his addiction progressed there were more and more negative consequences, especially his profound unhappiness. It reached a point where suicide seemed like a good option.

Fortunately he had friends who cared for him and helped him get into treatment and begin his recovery. It did take two trips to a treatment program but eventually he got the message and started to live the program.

The book nicely follows his recovery and what a profound change that has been for him. He has been in recovery for over 20 years now and the personal and spiritual growth have continued. The book shows clearly that he has worked hard for it. One of the nice things in the book are the pictures at the start of each chapter. The pictures show what an amazing transformation has happened - gone are the gaunt pictures of active addiction and by the end there are pictures and stories of a happy family man who has truly come to terms with himself and his place in the world.

He is still making fantastic music, but now his music is coming from a different - a deeper place. He is an inspiration to us all.

Dr Coleman

Honor Your Choices

2010-03-10T15:30:00.001-05:00

If you folks who are doing an accelerated detox with us weren’t mildly sedated, I’d probably try to get you to do some yoga. Not so much for the physical stuff, although it wouldn’t hurt to get a little good natural juice to your brains and limbs, but mostly for the philosophy. Today at class while we were all balancing precariously in half-moon pose, Ellie reminded us not to judge where we were. If we fell, that’s what we needed in our practice today; if the pose was strong and steady, own that without judgment as well. It is always the journey, the process that is important in yoga.

My friend Amy who’s an amazing person, being a school nurse these days sent me the following story. Although it was written by a guy in 1980 who probably never practiced yoga, the messages are strikingly similar:

THE STATION

By Robert J. Hastings

TUCKED AWAY in our subconscious minds is an idyllic vision in which we see ourselves
on a long journey that spans an entire continent. We're traveling by train and, from the
windows, we drink in the passing scenes of cars on nearby highways, of children waving at
crossings, of cattle grazing in distant pastures, of smoke pouring from power plants, of row
upon row upon row of cotton and corn and wheat, of flatlands and valleys, of city skylines and
village halls.

But uppermost in our conscious minds is our final destination--for at a certain hour and on a
given day, our train will finally pull into the Station with bells ringing, flags waving, and bands
playing. And once that day comes, so many wonderful dreams will come true. So restlessly, we
pace the aisles and count the miles, peering ahead, waiting, waiting, waiting for the Station.

"Yes, when we reach the Station, that will be it!" we promise ourselves. "When we're
eighteen. . . win that promotion. . . put the last kid through college. . . buy that 450SL
Mercedes-Benz. . . have a nest egg for retirement!"

From that day on we will all live happily ever after.

Sooner or later, however, we must realize there is no Station in this life, no one earthly
place to arrive at once and for all. The journey is the joy. The Station is an illusion--it
constantly outdistances us. Yesterday's a memory, tomorrow's a dream. Yesterday belongs to a
history, tomorrow belongs to God. Yesterday's a fading sunset, tomorrow's a faint sunrise. Only
today is there light enough to love and live.

So, gently close the door on yesterday and throw the key away. It isn't the burdens of today
that drive men mad, but rather regret over yesterday and the fear of tomorrow. Regret and
fear are twin thieves who would rob us of today.

"Relish the moment" is a good motto, especially when coupled with Psalm 118:24, "This is
the day which the Lord hath made; we will rejoice and be glad in it."

So stop pacing the aisles and counting the miles. Instead, swim more rivers, climb more
mountains, kiss more babies, count more stars. Laugh more and cry less. Go barefoot oftener.
Eat more ice cream. Ride more merry-go-rounds. Watch more sunsets. Life must be lived as we
go along. The Station will come soon enough.

Ellie finished the class with this thought: Honor the choices you make. Minute by minute, day by day. Call if we can help or if you have any questions.

Joan Shepherd

Comparison of oral and implant Naltrexone - Colquhoun – 2005

2010-03-07T13:18:00.002-05:00

Dr Colquhoun recently published a nice paper on the effectiveness of Naltrexone implants. The study was performed in Australia and it was in a very real world setting similar to the clinics and physician’s offices in this country.

The study involved 83 patients who had all been recently detoxified off Heroin and other opiates. The patients wanted to use Naltrexone to help them stay off Heroin and other opiates. Half of them took oral Naltrexone daily with the help of a support person who agreed to witness the medication everyday. This group of patients agreed to take the oral Naltrexone for 6 months. The other half had Naltrexone implants made by George O’Neil’s group. The O’Neil Implants are a bit larger than the ones we use here in the US. Some patients got a single implant which has been shown to last 3 months and some got a double implant that delivers adequate Naltrexone levels for 5 months.

The patients were followed and outcomes were determined by self report with corroboration from their support persons. Relapse was defined as when patients used more than 1 or 2 times (they determined that some patients used one or two times to test out the implant). Patients who couldn’t be contacted were assumed to have relapsed.

The results were very impressive:

Contacted and had not relapsed

At 6 months -

Naltrexone Implant 81%

Supervised Oral Naltrexone 45%

At 12 months -

Naltrexone Implant 61%

Supervised Oral Naltrexone 40%

These are very impressive results – actually in both groups. Compared with traditional treatment without any Naltrexone the results are very good. The strong results held up even after the Naltrexone was stopped after 6 months. A large number of patients were still able to maintain their abstinence.

Some of the other data from the study is quite interesting. The patients who relapsed in the group taking oral Naltrexone usually stopped their oral Naltrexone within 2 weeks. It could be that they were unable to deal with their Post acute withdrawal symptoms or perhaps they weren’t very motivated in the first place.

The patients who relapsed in the implant group were more likely to have had a history of selling Heroin, and were more likely to have a history of previous physical or sexual abuse. They often tried to use with the implant in place and reported that they would try to get over the blockage or if they couldn’t feel anything they liked to try anyway.

Dr Coleman

Chad's Story

2010-03-05T08:22:00.000-05:00

Chad came in today for his 5th naltrexone implant. He’s been clean since his Accelerated Opiate Detox in February. He is a big burly bear of a guy. Here’s how he’s doing in his own words:
Day in day out we think about using. When we get clean we see things differently. But yet we have to go on about our life and now deal with it. I used to use whatever it may be to escape reality for just awhile; maybe a day or a weekend. Smart enough knowing that my problems and whatnot would still be there when I came around..but just wanting that release and free time. Now I deal with in constructively making use of my time, improving my home, time with kids, working etc. Yet, daily stress, anger, aggravation of normal life makes me want that release and escape. I find myself now dealing with it in what works for me as before mentioned. Not craving it-is so much freedom! But if I was to go back that is only existing and not living. I like living life. It’s not fair and it can be hard, but living life is wonderful.

Phase 2 Naltrexone Implant Study is Underway

2010-03-01T13:20:00.012-05:00

Last year we began studying some Naltrexone Implants that were compounded for us by a pharmacy in New Jersey. These were 1.4 gram implants. The results were quite encouraging because 80% of the implants lasted at least 2 months. However we realized that the ideal implant lasts at least 3 months or even longer. So, in consultation with the pharmacy, we have helped them to modify the implants to make them have a longer duration. We have now begun the phase 2 study on these new improved implants.

The study is to draw blood levels in 5 patients with the new and improved implants. The patients will come in every 2 weeks and have blood drawn. We have already enrolled 3 patients and should have final results in the next few months. This is very exciting for us because as we get better and better implants it becomes a lot easier for patients to stay in recovery. Our goal of course is to help patients get clean and stay clean. We want to make sure that patients have an alternative that works - so they don’t have to use Methadone or Suboxone.

Dr Coleman

Boundaries: Drawing a Line in the Sand

2010-02-25T10:12:00.002-05:00

The year was 1987. A curious event took place at a local Richmond, VA high school. I remember it as if it was yesterday. The high school I attended was a Catholic Military School. Part of the “fun” of military school is the experience of being hazed as a freshman to include things like excessive push-ups, cleaning the school bus with your nose, and eating in absolute silence during lunch. However, on this day, lunch did not remain silent for long. Allow me to explain…

As some of you may remember through your high school experience, people tend to sit in groups based on social status. For example, there are several diverse groups such as jocks, popular kids, geeks, emo kids, science nerds, stoners, and artsy kids, to name a few. True to the norm, I sat in my social group which, much to my dislike, was the “geek” section. I remember another “geek” section across the room that included a high ranking member of the “jock/popular group”. I never understood why he would denigrate himself to sit with those of less social status than himself. I came to find out that he lived near those kids so he could get away with sitting next to them. But, to save face, he had to verbally berate them daily to keep them in their places. But, on this particular day, the Geeks rose up in defiance and would have none of it!

Imagine a quiet lunch room and the only sound is forks against plates and the sounds of dishes being washed in the kitchen when all of a sudden you hear a loud CRASH that pierces the silence like a gunshot that echoes through the woods. I looked up from my otherwise dull lunch to see the popular kid’s head covered in spaghetti with a mixture of sauce, meatballs, and blood running down his face. Across from him, the nerd he berated for days on end was standing up defiantly and held the remnants of his lunch plate now snapped in two that he used to encourage the young man to leave him alone. The whole place broke out in applause! And, I, for once, breathed a sigh of relief and flashed a victory sign in my mind seeing that we just might be able to take back our social dignity and get through this thing called high school!

I tell this story because it is relevant to our topic of discussion this month which is the book Boundaries: Where You End and I Begin by Anne Katherine. Katherine makes the point that each of us deserves basic human dignity and respect. We maintain that dignity with the use of boundaries. There are 5 main boundaries that we all get to keep regardless of who we are or where we came from. They are physical, mental, emotional, spiritual, and sexual boundaries. Maintaining our boundaries is important because, as Katherine notes, it helps us realize our love and acceptance of ourselves. It teaches us that we have value and deserve the best for ourselves.

Properly setting boundaries can help addicts to stay sober. Boundaries keep them from going back to unsafe people, places, and things which can result in a relapse. They also help replace bad behaviors with good ones. For example, you can choose to set the boundary of a 10pm bedtime instead of pulling all-night drug binges!

The hard work of setting appropriate physical, emotional, mental, spiritual, and sexual boundaries can seem daunting and pointless at first. However, in time most addicts realize that a boundary kept is oftentimes a life saved!

Chris Newcomb - Aftercare Councelor / Coordinator

New Webinar for Doctors

2010-02-23T13:49:00.000-05:00

In March we will be starting our series of internet seminars for primary care docs. We recognize that most primary care physicians see a lot of patients who are suffering with alcohol and other addictions, but they often don’t feel very comfortable bringing it up or talking about it. They often report that they don’t really know what to do.

There is quite a lot of evidence that physicians don’t often make a diagnosis of a disease, or even explore a problem, when they don’t have a readily available solution to that problem.

So we decided we could help close this gap. If we can help physicians know what to do with alcoholics and patients with other drug addictions then they will be more likely to look for these problems. Hopefully more patients will be able to get the help that they need.

The first seminar will be in March and will deal with the causes of addictive diseases and how to make the diagnosis in an office setting. In subsequent seminars we will discuss specific drugs including opiates, sedatives, alcohol, cocaine and other stimulants.

If anyone has any comments or questions please feel free to comment.

Dog Therapy

2010-02-22T08:30:00.000-05:00

OK, sometimes I admit I go for forgiveness rather than permission.

Last week the CEO of The Coleman Institute saw a large boxy head with dangling tongue sticking out from the door of one of our beautiful treatment rooms. He’s a smart guy and recognized instantly it was not a human, but a very large dog’s head.

A charming patient (I’ll refer to her as Melissa from Minnesota) was here to detox from oxycodone. She wasn’t taking as high a dose as we have seen many patients take. Nonetheless, she was unable to get free from the 40-60mg a day she’d escalated to after a fairly routine knee surgery two years prior to her contacting us.

Melissa-like all of the clients we serve at TCI-had several reasons for wanting to be opiate free. Most everyone who comes through is just sick of the lifestyle of being a slave to the addiction. Work, money, relationships, and general vitality all take a toll when a person is physically dependent on narcotics. But the other thing driving Melissa was a deadline looming two weeks from her detox: she had a book signing with Barnes and Noble as her first novel is being published.

She had traveled across the country with her husband and Butch, her well behaved canine to do a detox with us and get a naltrexone implant.

It is so fun to come into a room all day long and see a sweet dog! And even though our detox process makes things very tolerable, I think it really helps to have your beloved dog with you. In the two years I’ve been at TCI, I’ve seen a toy poodle, 2 mastiffs, a beagle, a bull terrier and a couple others I can’t identify. I wish someone would come in with a Bernese Mountain Dog.
I suspect Butch will be accompanying Melissa on her book signing tour; he’s that kind of dog.

Joan Shepherd - FNP

Cora's Story

2010-02-19T11:23:00.000-05:00

I was going to write a little blurb about this patient who’s here for her 3rd naltrexone implant, but then thought she could say it even better in her own words:

“After years of using pain pills and brief periods of abstinence I looked at my life and felt so hopeless.

My only means to function at all was chasing drugs; it consumed my every thought. My marriage had crumbled. I was unemployed and I couldn’t properly take care of my kids. I was so desperate to live a “normal” life. I just didn’t know how to or how to get there.

After researching online I found The Coleman Institute with the Accelerated Opiate Detox and naltrexone implant. In June of 2009 I did undergo the detox and got my 1st implant. This was the first step to getting my life back. Now 5 months later with the help of God and a program I’m finally happy. My husband can trust me again, we are working on our marriage and so can my kids and my parents. With the years of lying and manipulating I never thought I could say that. My kids can depend on me again. I’m working now, teaching school. I’m a productive member of socity and I feel great about where I am. Not everyday is wonderful but my worst day today beats my best day out there using! “ CR.

Joan Shepherd -FNP

The Coleman Institute Expands into Louisville, KY metro area

2010-02-18T13:00:00.004-05:00

New, full-service branch of the nationally acclaimed addiction treatment center to open in Louisville metro area

February 9, 2010, Richmond, VA—The Coleman Institute, the nationally acclaimed addiction treatment center based in Richmond, Virginia, announced today that it will open up a new, full-service office in Jeffersonville, Indiana on February 15, 2010. The Coleman Institute has four other offices nationwide (in West Virginia, northern California, southern California and Illinois) and this new office in Indiana will be a branded branch, providing all of The Coleman Institute’s proven addiction treatment services to southern Indiana and the surrounding areas, including the Louisville, Kentucky metropolitan area.

“I am really excited to bring The Coleman Institute’s unique services to the people of southern Indiana and the surrounding states,” said The Coleman Institute’s founder, Dr. Peter Coleman. “Unfortunately, the illness of addiction is very prevalent in this area. I hope we can bring some help and relief to many individuals and families over the coming months and years.”

The Indiana branch of The Coleman Institute will be led by Joseph Koenigsmark, DO, MBA, or “Dr. K” as he is better known by his patients. Dr. Koenigsmark is a Board Certified Family Physician trained in Osteopathic Medicine from the Midwestern University of Medicine in Chicago. He has held a variety of medical positions over the last 25 years, including a solo medical practice as well as Medical Examiner for the Commonwealth of Kentucky. Dr. K also earned an MBA, allowing him a better understanding of insurance programs and government medical programs. More recently, Dr. Koenigsmark provided medical evaluations to the disabled veterans of Kentuckiana at the Louisville VA Medical Center. This experience, especially, gave him direct experience treating addictions induced by pyschological and physical pain.

“I am proud to partner with Dr. Coleman and his team. This is a wonderful opportunity to not only open and develop The Coleman Institute in Louisville and the surrounding cities, but offer innovative and, most importantly, effective addiction treatment services to the area,” Dr. Koenisgsmark said. “As a long time resident and physician in Kentucky, I understand the extent of the addiction problem in the area and I look forward to being able to bring these much needed services to the community.”

The Coleman Institute has successfully treated thousands of drug and alcohol abusers since its establishment in 1998, and is hoping to make a similar impact on the residents in the greater Louisville metropolitan area. The new branch of The Coleman Institute be located at 1035 Wall Street, Suite 204, Jeffersonville, IN and is scheduled to open its doors to patients on February 15, 2010.

For more information regarding this partnership between Dr. Joseph Koenigsmark and The Coleman Institute, please contact Mike Stevens at 877.77.DETOX (877.773.3869) or visit http://www.thecolemaninstitute.com/.

About The Coleman Institute

Since 1998, The Coleman Institute has helped hundreds of patients detoxify and recover from the effects of heroin use and other narcotics such as Methadone, Oxycontin, Percocet, and Vicodin. The combination of The Coleman Institute’s Accelerated Detoxification Technique with Naltrexone therapy is what makes it unique among addiction treatment centers—and its success rate so high.

“By the Power of Grayskull…I have the Power!”

2010-02-18T13:00:00.003-05:00

I was like any kid growing up in the 1980’s. I had my Swatch watch, my “Zips” tennis shoes, and my action figures. From G.I. Joe to Star Wars, I had every possible figurine up to and including the massive He-Man. A 6 inch mass of plastic muscle, long blond locks, and the ever embarrassing “Speedo” swimwear trunks, He-Man, the twin brother of She-Ra fought to defend Eternia and the secrets of Castle Grayskull from the evil army of Skeletor. We had many adventures together, He-Man and I, but he came to an unfortunate premature demise when a friend’s bic lighter sent him to the afterworld in a blaze of glory! So much for Grayskull!

This month we tackle Step 2 from Alcoholics Anonymous which says that we, “came to believe in a power greater than ourselves could restore us to sanity.” Often times, people struggling with drug and alcohol addiction feel like they are locked in a cosmic battle between good and evil and right and wrong. They know they want to be good, strong, sober people but they lack the power to do so. So, they spend all their time obsessing over new ways to control or overpower the disease only to end up flat on their back for a 10 count. There is a better way!

The essence of Step 2 is that the addict needs help. DUH! The addict needs someone or something that has the edge over the addiction. This is the key to getting free from addiction. It does not have to be a religion or specific belief system as some believe. Rather, it is a higher power of your own understanding! This can be He-Man, She-Ra, Buddha, Jesus, or Santa Claus. It can be the 12 step group you regularly attend or the principles of the program in the 12 steps themselves that serve as your high power. The point is letting go of our own lack of power and embracing the power of our high power allows us a daily reprieve from addictive behaviors with drugs and alcohol. The Power of Grayskull indeed!

Relapsing with narcotic pain meds - Dr P Coleman

2010-02-18T13:00:00.001-05:00

This last week I have had the pleasure of training Dr Joe Koernigsmark from Indiana. He is the Medical Director in our new office in Indiana. He is a fabulous doctor and I am very excited to be working with him.

During our training, I was amazed at how many patients we saw who had relapsed because they had to take opiates for legitimate medical pain. We saw at least four patients who had relapsed in this way. They had all taken the narcotics as prescribed but then found themselves physically dependent and quickly needing the medicines just to avoid withdrawal. Eventually their use developed to the point of causing problems and needing detox and more treatment. I have changed the details of these patients for confidentiality reasons.

We saw a health care professional who had over 5 years of clean time. She had been going to NA and really working a good program. Unfortunately she developed foot pain and required surgery. She warned her doctors that she was a recovering addict. The post-operative pain was quite severe and she needed strong narcotics for quite a long time and became physically dependent. Over time she felt guilty and made some bad choices, fearing what would happen if she told people what was happening. She started taking Suboxone to avoid using street drugs and has now become very dependent on that. We are trying to wean her down off the Suboxone but she is having a very difficult time. Now she has lost her license, feels terrible, trapped and very depressed.

We saw another health care professional who quit alcohol about 15 years ago and was doing beautifully. Unfortunately he injured his back on the job and has had chronic pain for over 5 years now. He has seen many doctors and had numerous surgeries but none of these have provided good pain relief. Through all of this he became very dependent on opiate painkillers and started having severe withdrawal whenever he didn’t take his medicines. He also was having a lot of side effects from the medicines. He had sleep problems, low energy, felt depressed, mental fogginess, and many other symptoms. In addition to this, he was still in a lot of pain. So we detoxed him over 5 days with our Accelerated Detoxification. The detoxification went beautifully and he has done well. He is now off all opiates for about 3 months. His side effects have all gone away, but he has still having considerable pain and may require more surgery.

Last week we finished a detox on a lovely young lady. We had detoxed her about 5 years ago and she used Naltrexone implants. She did beautifully but unfortunately developed some complications after her last baby. She had severe abdominal pain and needed narcotics. Fortunately she is now back on track again.

These patients, and others like them, have become dependent on opiates because of legitimate and real medical problems. It is not their fault. These patients teach us a number of very important things. They teach us just how powerful this disease is. Re-exposure to mood altering drugs can very quickly reactivate the disease. They reaffirm for us that people who have this disease of Chemical Dependency really are vulnerable to relapse when they take any mood altering substance, even when they take it as prescribed.

We believe that Chemical dependence is a disease characterized by a genetic vulnerability. The genetic vulnerability seems to have two components. There is an initial increase in pleasure effect when addictive substances are taken – a dopamine effect. This high pleasure that addicts feel seems to make them more likely to repeat the experience, and be more willing to keep doing it even when there are negative consequences. This is, of course, the hallmark of addiction – continuing to use even when there are negative consequences form the using. The second genetic component in people with a vulnerability to addiction seems to be that these people have a more difficult time stopping, and more painful withdrawal symptoms. This is what happens to someone who is in a healthy recovery but gets re- exposed to addictive medicines. Their withdrawal symptoms are worse and they have a very difficult time stopping. There are animal models of this phenomenon. Scientists are able to breed rats which have much more difficult withdrawal symptoms. These tendencies are passed down genetically.

So what can recovering people do if they need narcotics?

Here at the Coleman Institute we frequently help patients get through these situations. When patients call us asking for assistance, we almost never have problems with them becoming re-addicted. There are a number of key things patients can do when they have to take addictive medicines:

1. Plan ahead – if you know you will need surgery or need narcotics then enlist help from people who can help you. This includes your physician, your spouse or family member, or someone from your support network. (I personally already have an AA member who has agreed to monitor medicines for me if I ever need to take them.) If it is an emergency situation like an accident or kidney stone, then enlist help as soon as possible.

2. Have your doctor use non- addictive medicines whenever possible – it is amazing how much Ibuprofen helps pain when people are not looking for a narcotic effect. There are now many other non-addictive medicines to help with pain.

3. Use non-drug techniques to help with pain as much as possible – ice, splints , rest, TENS, epidural steroids, acupuncture, etc

4. If you do need narcotics, use the lowest dose for the shortest time.

5. Be honest and open – with your doctor, your family and support people. Tell them how much pain you are in and how many pain meds you are actually taking.

6. Have a family member or a friend hold the medicines so you have to ask someone to get them – not to be cruel, just to have another check and balance.

7. Follow up with our office or your doctor within 1 -2 days after surgery. The specific goal for this follow up visit is to evaluate how much pain there really is and how many narcotics really need to be taken.

8. Continue close follow up visits, usually once or twice weekly, until the narcotics are no longer needed.

In our experience, when patients have followed these guidelines they have never gotten re-addicted unless the pain condition went on a very long time. And in these situations they can be detoxed again fairly easily.

Remember, we are available any time to help with these situations. We do it all the time, and we are delighted when people reach out to us for help.

Peter Coleman MD

Family Program

2010-02-15T10:55:00.000-05:00

We are planning a weekend program in April for family members of our patients, or anyone who has been affected by active addiction or alcoholism.

The program will cover:

· What is addiction?

· Why do some people become addicts?

· Why can’t they just stop even when it is killing them?

· What can I do to help them?

· How can I stop being pulled down by someone who won’t get help?

If you are at all interested in this program please call our office at 804.353.1230 or leave a comment at the end of this blog. Space is limited so please call soon.

Digging Your Hole Deeper

2010-02-12T11:17:00.000-05:00

Consider a man digging a hole. It starts as a shallow curve then becomes deeper, deeper. Imagine him standing inside the hole he is digging. The faster, harder, longer he digs, the deeper he is in. At some point, he looks around his hole and realizes he wants out. The only tool he knows is his trusty shovel. He clutches this shovel furiously and digs sideways, upwards, harder, deeper, longer still. Clearly, the shovel’s not working.

This is the pattern so many of our patients fall into when they try to stop using opiates. Attempt after attempt to stop on their own has put them deeper into their own personal hole: financially, spiritually, emotionally, and professionally. If you or a loved one is ready to ‘drop your shovel’ and explore a more workable solution, please call us at The Coleman Institute. Ask about our Accelerated Opiate or Benzo detox. It may be time to use a new tool.

Joan Shepherd - FNP

Yoga in treatment programs for anorexia

2010-02-10T11:09:00.000-05:00

I just read a very interesting article about a program that started adding daily yoga for their patients suffering from Anorexia Nervosa. This was an inpatient program with girls who were very unwell. Many of them were very underweight and had failed a number of other programs and were too unwell to be treated on an outpatient basis. As soon as they added the Yoga, the girls started getting better. They felt better, they had better self esteem and they started to gain weight. Interestingly when the girls were asked why it helped them so much they gave comments like, “You know this is the only time during our day that we are able to not think about our weight, or food, or all the other negative things going around and around in our heads.” It seems that the concentration that is needed during the poses was enough to lift them out of their minds. It is a type of meditation. It is so powerful. I am sure that the yoga also helps with developing a healthy relationship between the mind and body. Let’s hope other programs start to add things like this.

Dr Coleman

Junk food turns rats into addicts

2010-02-08T11:10:00.000-05:00

A fascinating study gives us some insights into how drugs and food affect the brain. This study shows that after the brain gets used to getting hyper (extra) stimulated it continues to require extra stimulation just to feel normal. This study looked at how junk food – high fat, and high calorie - hijacks the brain just like Heroin and other addictive drugs. This study was from Paul Johnson at Scripps Research in Florida. He gave rats unlimited junk food. Sure enough the rats developed compulsive eating habits, ate twice the number of calories and became obese.

But he wanted to study how this junk food had effected their brains. So, next he inserted electrical wires into their pleasure centers. They could feel pleasure from an electrical signal going through these wires, but the experiment was that they had to run on a little wheel to give themselves the pleasurable signals. He was able to measure how much work they had to do on the wheel to feel good. What he found was that the rats who ate the junk food had to run on the wheel a lot longer to be satisfied with the stimulation to their brain’s pleasure center. Within only five days the junk food had caused their brains to become accustomed to high levels of pleasurable stimulation and now they needed extra electrical stimulation just to be satisfied. Sadly the effects of the junk food lasted for weeks after the junk food was stopped – just like our patients with drug addiction. This study is very important and illustrates what our patients are going through in early recovery. Their brains are so used to being stimulated at high levels that “normal” activities seem to be boring. If they aren’t very careful they can easily relapse because to them using drugs may seem like the only way to feel normal.

Dr Coleman

Son’s of obese mice are fatter and have increased anxiety

2010-02-05T11:11:00.000-05:00

In an interesting experiment, Dr Bilbo at Duke University gave some regular mice a diet high in saturated fats. These were not genetically obese mice, they were just fed a heavier diet and they became obese during the pregnancy. Their offspring were more anxious and also considerably fatter. The obesity in the offspring continued into adulthood even though the offspring were switched to a low fat diet. So it seems that when a pregnant mother eats an unhealthy diet it causes long lasting effects in the offspring. Some of the decisions we make and the actions we take can have very profound and long lasting effects.

Dr Coleman

The Coleman Institute Expands to Indiana

2010-02-04T10:31:00.000-05:00

The Coleman Institute is please to be able to announce the opening of our latest facility, to be located in Southern Indiana and a stone’s throw from downtown Louisville Kentucky.

Located at 1035 Wall Street, Suite 204, Jeffersonville, IN 47130, this facility will officially open February 15^th 2010, and will offer all our Detoxification and Addiction Treatments, including Detoxification for Opiates (Heroin, Oxycontin, Methadone, Suboxone), Benzodiazepines, Alcohol and Naltrexone Treatment.

The facility will be managed by Dr Joseph Koenigsmark, Regional Medical Director – Indiana.

Please call Jennifer at 1-877-773-3869 to schedule appointments with Dr Koenigsmark.

Dr Koenigsmark joins The Coleman Institute

2010-02-03T10:43:00.004-05:00

Dr Joseph Koenigsmark - Dr Peter Coleman

The Coleman Institute is pleased to announce that Dr Joseph Koenigsmark has joined the company to become the Regional Medical Director, Indiana.

Dr. Koenigsmark, or Dr. K as he likes to be called, is a Board Certified Family Physician trained in Osteopathic Medicine at the Midwestern University of Medicine in Chicago. For the last 25 years he has had a wide range of medical positions, ranging from a solo medical practice to being a Medical Examiner for the Commonwealth of Kentucky. He also earned an MBA so he could work with hospitals and physician, helping them understand the intricacies of insurance programs, and government medical programs, and how to get appropriate reimbursement. Most recently his training brought him to work with the veterans of Kentuckiana working at the VA Medical Center in Louisville. There he provided medical evaluations so disabled veterans would receive the compensation they deserved for defending our country. It also helped him to understand the extreme psychological and physical pain these individuals can be under, and how this can lead to many forms of addiction.

Customer Service

2010-02-01T15:28:00.000-05:00

I’m telling you guys, if you are thinking about coming for an accelerated alcohol, opiate or benzo detox, don’t worry about accessibility to our staff. I am sitting at home enjoying this magnificent snowfall and needed to contact a patient. I called Jennifer, our intake coordinator to see if she could get the phone number for me as I don’t have a snow worthy vehicle to get in to the office. She answered my call en-route to a cheerleading competition out of state with her daughter and what sounded like 12 other cheerleaders-- and maybe a live band. I figured she would be unable to help me with the phone number but instead she laughed and told me she was tricked out and could run a mobile office from ANYWHERE. True to her word, in 5 minutes she was calling me with the information I needed. Just a small taste of the customer service you can expect from The Coleman Institute!

Exercise protects the Dopamine part of the brain from damage

2010-01-25T11:10:00.000-05:00

Judy Cameron at the University of Pittsburgh studied the effect of exercise on the brains of monkeys. In her experiment some monkeys remained sedentary and others exercised for five hours per week. After 3 months the monkeys were given a neurotoxin that kills dopamine cells in the brain. As expected, the sedentary monkeys had considerable brain damage but amazingly the monkeys who had exercised showed almost no brain damage at all. The more intense the exercise, the more protection there was from the brain damage. The results continued to hold up even when the experiment was extended longer. It is not known if exercise protects our brains from damage from other poisons, but these results sure are encouraging.

Dr Coleman