Did you ever stop to think: How old is this wine? No, I don’t mean this bottle or even this medieval winery in Bordeaux? I mean, how long have people been imbibing? How did they stumble upon this wonderful drink?

 

The biochemical evidence

The “active ingredient” in wine (and beer, and hard liquor) is ethanol—yes, the same stuff that is supposed to power our cars in a few years. But think about it, ethanol is a foreign substance to our body. So, how come we have an enzyme (alcohol dehydrogenase) that is specifically designed to metabolize it? In fact, we are not unique in this respect—most organisms (even bacteria) contain a version of this enzyme.

The answer is that since very very ancient times, probably since complex aerobic organisms evolved and glucose became a source of energy (about a billion years ago), the sugar in dead organisms—both plants and animals—underwent fermentation to make ethanol. And since organisms feed upon each other, after the first exhilaration of getting drunk on the rotting food, cooler heads prevailed and realized that it was evolutionarily advantageous for them to be able to metabolize this elixir before it did them in.

So, humans were equipped to handle alcohol since they became a unique species (1 million years ago if you start counting from Homo erectus). But how much of a buzz could Uncle Erectus get from a rotting fruit? Probably not much; he would have had to ingest enormous quantities of the stuff. But Auntie Erecta, the fruit gatherer of the family, probably did ingest large amounts of the stuff, especially when times were hard and hubby failed to bring the bacon home.

 

The archeological evidence

Seriously, this is the most likely scenario. Women and children were tasked with gathering plants and fruits, while our macho forefathers were chasing animals, with very mixed results I might add. About 10,000 years ago, some very observant and patient gatherers, most likely women, decided that instead of running around for miles every day looking for edible wild plants, it would make a lot more sense to collect the seeds of those plants, plant them in small plots of land, and simply harvest the next generation. This was a momentous insight; that was the dawn of agriculture, and farmers, and villages, and the domestication of animals and plants, and yes, alcoholic drinks.

The earliest archeological evidence of wine production comes from Georgia—not in the U.S. but in the Caucasus. Ceramic jars containing residues of red wine and dating to about 8,000 years ago (6000 BC), were found in several archeological sites there. From there, the art of winemaking spread south to Bulgaria, Anatolia (in today’s Turkey), and Phoenicia or Canaan (today’s Syria, Lebanon, and Israel). It also spread west to Greece, Rome, and the Iberian Peninsula. In all of those places, there is solid physical evidence that red wine was produced and stored in large quantities. In fact, the ancients were quite sophisticated connoisseurs: Hieroglyphs in Egypt from the third dynasty period (about 3000 BC) document six varieties of wine and rate them according to quality.

There was a lively commerce in wine across the world of antiquity. The Phoenicians, a sea-going lot, brought wine to the archaic Greeks (the Minoans and Myceneans) about 1500 BC. In fact, the word “wine” probably originates from the ancient Semitic (Canaanite, Aramaic, Hebrew) word Yain (pronounced YA-in), which the Greeks called Oinos and the Romans later called Vinos.

 

Everything in moderation

The ancients recognized that wine was “good for you” in small quantities, but harmful in excess. In Greek mythology, only the Gods were allowed to drink to excess and get drunk. The variety of wine they drank was called Nektar (which etymologically is made up of two words: ‘away from’ or ‘escape from’ and ‘death’). It was supposed to confer long and happy life (and they didn’t even know about Resveratrol). Mortal Greeks had to drink their wine diluted with water. In the classical period (5th and 4th century BC), Greeks used to gather for philosophical and political discussions (those gatherings were called ‘symposia’), which ended with a meal and wine, the latter diluted one to four with water. Drinking undiluted wine was considered definitely decalassé.

The ancient Egyptian religion was obsessed with death and invested red wine with a religious meaning. They considered it the blood of their ancestors, which would be OK to drink in small quantities in order to commune with their spirits, but larger quantities could incur their wrath and cause delirium and death. Stripped of the religious mumbo jumbo—quite accurate!

The Bible (6th century BC) has many allusions to wine. The idiom for peace and prosperity was “each under his vine and under his fig tree.” And King Solomon in his infinite wisdom pronounced that “wine gladdens a person’s, heart.” But there are also many warnings of excess. My favorite actually comes from the Talmud, a commentary on the Bible. There is a Talmudic parable which says that Satan came one day to drink with Noah and slew a lamb, a lion, a pig, and an ape (oy vey) to teach Noah that, before wine is in him, man is a lamb; when he drinks moderately, he is a lion; when like a sot (hence ‘besotten’), he is a swine; but after that, any further excess makes him an ape that senselessly chatters and jabbers.

 

Drinking to excess

Drinking to excess can have consequences that transcend the individual; in fact, it can have consequences of historical proportions. Take the Romans, for example. As they became powerful and imperialistic, they exacted heavy dues on their vassal states. One of those was poor little Portugal. In a valley east of Lisbon, the locals were raising grapes and making a sweet variety of wine. The wine was then exported to Rome through the port city of Oporto, but this imported port wine was expensive and only the aristocracy could afford to drink it. And drink they did!

There is some poetic justice in this iniquity. The amphoras (storage vessels) in which the wine was shipped were painted with lead-based paints, and the stuff leached into the wine. Bone biopsies taken from skeletons of these pillars of the community revealed toxic amounts of lead. Chronic lead toxicity can lead, among other bad things, to chronic fatigue, cognitive deficits, and neurological disorders. Is it possible that those humble Portuguese vintners brought about the decline and fall of Rome? Unlikely, but for sure, they drove the Romans out of their mind.

Well, enough with the chatter; off to dinner and a glass or two of red wine. That’s still a lion on the Talmudic scale.


Here is a link to other TDWI posts on substance abuse and addiction.

This post was originally published on July 26, 2007. It was reviewed and updated on 06/24/2017.

It’s not unusual for recovery from drugs or alcohol to be complicated by a phenomenon known as “substitute addiction,” which involves trading in one bad habit (substance abuse or another behavioral compulsion) for another potentially dangerous one. But what really is substitute addiction, understood clinically, and what, more specifically, are the dangers? Moreover, how do you know when a seemingly innocuous or even healthy new habit, such as exercise, may be cause for concern?

 

Common types of substitute addiction

Substitute addictions can comprise a variety of behaviors that, when repeated compulsively and excessively, activate the same reward circuits of the brain that a former drug of choice once activated; exhibit withdrawal-like symptoms; and lead to negative consequences (physical, mental, social, etc.). These “process addictions” (as they are called) can develop around food, exercise, gambling, shopping, love, and sex—even religion, according to research—as evidenced by the following:

  • In a national survey of the substance abuse treatment population, roughly one in five people had developed a new addiction three years following substance abuse treatment.
  • The popular recovery movement catchphrase, “13th Stepping,” “may reflect the tendency to replace one’s drug of choice with sexual compulsion,” in the words of a 2008 study in the Journal of Drug Education.
  • The creators of Gamblers Anonymous and Sex Addicts Anonymous were reportedly abstinent alcoholics who developed substitute addictions to gambling and sex.
  • Both normal and overweight people who experience food cravings and/or exhibit overeating tendencies are more likely to report a previous history of substance abuse, according to the research.
  • A study by the sex addiction expert, Patrick Carnes, found that 42% of sexually addicted people were also chemically dependent, 38% had a comorbid eating disorder, 28% had issues with compulsive working, 26% were compulsive spenders, and 5% were compulsive gamblers.

Another perhaps more common example of substitute addiction is the reformed alcoholic who takes up running and gets hooked on marathons. Some authors have gone so far as to suggest that 12-step programs can function as a positive substitute addiction of sorts for at least some people in recovery.

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But substitute addictions can also entail chemical dependencies and the exchange of one previous drug of choice (or behavior) for another drug of choice. Relatively common examples might include the former heavy drinker who successfully quits the bottle only to become dependent on prescription drugs ten years later, the recovering cocaine user who smokes marijuana instead, or the athlete hooked on exercise who turns to opiates after an injury.

 

The health dangers of substitute addictions

Not all substance and process addictions involve the same health dangers. Some medical consequences are unique to the addiction, as is the case with love and sex addiction. Sex addiction—and love addiction, too, to the extent that it involves using sex as a way to get love—can raise one’s risks of contracting the HIV virus and other sexually transmitted diseases like genital herpes, HPV, syphilis, and gonorrhea. (Studies peg the number of Americans who suffer from sex addiction at roughly 5% of the general population. If that count is accurate, it means Americans suffer from sex addiction at higher rates than they suffer from bipolar disorder.)

Naturally, moreover, the health consequences of a binge eating disorder differ from the long-term physical damage associated with cigarette smoking. In the case of a binge eating disorder, the health risks can include high blood pressure, high cholesterol levels, heart disease as a result of elevated triglyceride levels, Type II diabetes mellitus, and gallbladder disease. In the case of cigarette smoking, the bodily risks can be more widespread, from cardiovascular and lung disease to cancers just about anywhere in the body, according to a CDC fact sheet.

Long-term changes to physical structure and physiology of the brain can be a shared feature of chemical dependencies and process addictions (although the precise nature of these changes may vary with the drug of choice or compulsion). For example, various substance and process addictions can directly or indirectly impact neurotransmitter function, according to compiled findings:

  • Cigarette smoking, other drug use, overeating, gambling, and sexual behavior, when repeated, may sensitize the brain’s dopamine response.
  • Excessive work and/or exercise increase adrenalin and possibly dopamine turnover—and, consequently, feelings of pleasure that can become addictive.

Over time, then, a new pattern of thought and behavior related to alcohol, drugs, or another pleasurable activity produces a withdrawal-like state, including cravings, irritability, and symptoms of anxiety and depression. In some cases, these symptoms of anxiety and depression can be severe and may require medical treatment. And in the longer term, the very structure of the brain and related functioning can be impaired.

Related Content:  If You Believe These Addiction Myths, You Are Part of the Problem

Tips for knowing when to get help

Many substitute addictions are thankfully treatable and can benefit from professional help. The question is, how do you know when a new habit is cause for concern and may require intervention? That question may be especially hard to answer when the new habit is something that, when done in moderation, is actually good for you, such as exercise. Below are some signs to look for that can help you determine whether a new habit may be a substitute addiction (and when to get help from a professional):

  • When deprived of the activity, you experience anxiety, depression, restlessness, guilt, discomfort, tension, or sleeplessness.
  • You are spending more and more of your time engaging in the activity, with the result that you are finding it difficult to fulfill work or family responsibilities or have lost interest in hobbies that you once enjoyed.
  • The activity is taking a toll on your physical health, causing injuries or leading to other risky behaviors that put you and/or others in harm’s way.
  • You find you are unable to quit engaging in the activity—even when it has caused negative social, emotional, and/or physical consequences in your life.

If one or more of the above signs is present, you may benefit from consulting a mental health professional. Substitute addictions can be dangerous, and can cause significant suffering and distress—but they don’t have to be a life sentence.

On November 13, 2013, Daniel Zorn shared a post on Facebook asking his siblings to wear special bracelets at his funeral. Three years and two months later, they honored his request.

Daniel wasn’t a cancer patient. He didn’t commit suicide. His death was due to a drug overdose.

Deaths from drug overdoses in the U.S. rose in 2015 to an all-time high of 52,404—greater than deaths due to car crashes (37,757) and gun deaths (36,252) that year. That number is just for drugs; it doesn’t include deaths from other addictions such as alcohol and cigarettes.

And yet, unlike terminal illnesses and mental illnesses, many people who suffer from addiction go untreated. Not because we don’t know how to fight the disease of addiction or lack the resources to do so, but because, as a society, we aren’t fully convinced the patients deserve the drug addiction treatment.

 

Blaming the patient with addiction stigma

Unlike other illnesses, addiction is one of the only afflictions where the patient is blamed for their condition. Consider a recent ad campaign that shows what it might be like if people with cancer or Parkinson’s disease were treated the way people suffering from addiction are treated.

Most people believe—consciously or subconsciously—that addicts are to blame for their addiction. If only they were smarter and made better choices, if only they exercised the willpower to resist drugs and alcohol, they wouldn’t be in this situation. They brought this one on themselves, the reasoning goes, so they should be responsible for fixing it and get treatment.

While it’s true that the decision to drink or take drugs is made by the person using them, the underlying motivation that drives someone to make that decision in the first place often happens subconsciously and is rooted in deep emotional or physical pain.

Unlike with a disease such as cancer, where the cause of the illness is clearly a tumor, addiction is a symptom of other underlying illnesses. Addiction can stem from multiple causes, such as:

  • A mental illness such as depression or anxiety
  • Trauma and PTSD
  • A physical illness like chronic pain that leads a person to become addicted to painkillers
  • A lack of purpose and/or healthy relationships that drives people to substances for escape and thrills

While scientists still struggle to find effective treatments for cancer and other terminal illnesses, the healing techniques that can cure addiction—and prevent it in the first place—are well-established and readily available.

So why don’t more people who struggle with addiction seek out the help they need?

 

No more shame – Fighting addiction stereotypes

The special items that Daniel Zorn asked his family to wear to his funeral were #NoMoreShame bracelets, which are part of a campaign to help end the stigma against those battling addiction.

Social stigma is defined as discrimination and prejudice towards a group of people based on negative assumptions and stereotyping. Because of the shame and blame that are tied to substance abuse, many who suffer from it are unwilling to admit they have a problem, which prevents them from seeking treatment.

Their family members also deal with the shame of having an “addict” in the family and often struggle on their own to get their loved ones the help they need, marking a noticeable difference from the usual support systems available to families battling other diseases.

For example, when have you ever seen a car wash fundraiser to raise money for addiction treatment for a community member? Would you donate to a crowdfunding campaign to help raise thousands of dollars for a single month of addiction treatment?

 

Ways to combat drug addiction stigma

Ending social discrimination against people with substance use disorders starts by changing our way of thinking about addiction and the people who suffer from it, and changing how we talk about it.

Here are a few steps we, as a society, can take to chip away at the stigma that surrounds drug and alcohol addiction:

  1. Instead of seeing addiction as a moral failing, view it as a treatable disease.
  2. Approach those affected with addiction with compassion instead of judgment.
  3. Empower people with the belief that they can get well, instead of seeing them as damaged or pitiable.
  4. Support people in recovery with education and employment resources.
  5. Don’t give up on people when they relapse.
  6. Provide preventative psychological support to people in need before trauma leads to addiction.
  7. Petition the criminal justice system to mandate treatment as an alternative to incarceration.
  8. Protect society by getting people into treatment, not abandoning them on the streets or in jails.
  9. Change the language you use: Eliminate terms such as “addict” and “substance abuser” that have a negative connotation.

The No. 1 thing that we can all do to end the stigma of addiction is to see those suffering from addiction as worthy of our assistance.

Human beings have a strong instinct for self-preservation. If someone is doing something that is harmful to themselves, something is wrong. Every person deserves to receive assistance when they are in need.

 

Eliminating addiction stigma can save lives

By eliminating the addiction stigma:

  • Those who are afflicted will be more willing to admit they have a problem and seek treatment.
  • Families will receive stronger support and resources to help themselves and their loved ones.
  • There will be a reduced burden on the criminal justice system.
  • Healthcare can be geared towards addressing the problem proactively.
  • There will be hope for a better future for those afflicted, their families, and their communities.

Drug rehab for addiction is available throughout the country. Effective treatment methods are well-established but also improving.

We know all too well how addiction destroys lives. It’s time we all embraced the #NoMoreShame movement and committed to wiping out the disease of addiction with the same resolve we apply to fighting other diseases that take the lives of our loved ones—lives like that of Daniel Zorn, beloved father, brother, and son.

To find out more information about the #NoMoreShame campaign, Daniel Zorn’s story, learn how to participate, or get an awareness bracelet, visit The Treatment Center.

After reading Dr. Thomas G. Kimball’s description of phone-addicted students on his college campus, I had an uneasy feeling. Where had I seen this picture before? Then it dawned on me. Of course, in the numerous plays and movies describing humanity under a future totalitarian regime, where people move robot-like, their minds controlled by some unseen, all-seeing malevolent authority.

How have we come to that? Have our minds been captured by some mysterious force, while we were asleep at the switch? The answer is quite surprising…and unsettling.

 

Is there such a thing as Internet Addiction?

All you have to do is look around. Anywhere you go, you see people’s faces glued to their cell phones, texting, scrolling, or just plain staring. But that’s not enough. To call somebody an addict is no simple matter because of the myriad consequences of such a diagnosis. Scanning the literature confirmed my suspicion: There is no standard definition of Internet Addiction (IA). And, not to be a stickler, but cell phones are not strictly internet devices. Leaving that aside, the general idea is clear: Whether strictly an addiction, or just a habit, there is an obvious phenomenon of problematic internet use. So why is it so widespread? Why isn’t reading books, or engaging in sports, or even watching TV, not as common as the new epidemic of online-itis (this is not a technical term)? To paraphrase Robert Allen Zimmerman (aka Bob Dylan), the answer my friend is written in the code. Let me explain.

 

Technology is neutral, how you use it is not

Computer code is a language and, as such, it is neither good nor bad; it just is. But the use of language is a different matter. As King David sagely said over 3000 years ago (Proverbs 18-21),

“The tongue has the power of life and death.”

But we don’t have to go that far back in time. Is chemistry bad? It depends on what is being synthesized (medications=good, street drugs=bad). Are computer apps good or bad? Again, it depends.

But is technology really completely neutral—totally innocent? Consider the following exchange between CNN’s Anderson Cooper and Tristan Harris, a former Google product manager, on a recent 60 minutes program:

“So Snapchat’s the most popular messaging service for teenagers. And they invented this feature called ‘streaks,’ which shows the number of days in a row that you’ve sent a message back and forth with someone. So, now you could say, ‘Well, what’s the big deal here?’ Well, the problem is that kids feel like, ‘Well, now I don’t want to lose my streak.’ But it turns out that kids actually—when they go on vacation—are so stressed about their streak that they actually give their password to, like, five other kids to keep their streaks going on their behalf. And so you could ask when these features are being designed, are they designed to most help people live their life? Or are they being designed because they’re best at hooking people into using the product?”

I, for one, have no trouble coming up with the answer: We are being manipulated, and we don’t even realize it. Do you think you are aware of the tricks? Think again.

Ramsey Brown is the founder of a software company aptly name Dopamine. Why Dopamine? Because it is the neurotransmitter for the reward system in the brain. Stimulate the release of dopamine, and you get to feel good. And when this feeling wears off, you want more. That’s the basis for addiction. Brown says there’s a reason texts and Facebook use a continuous scroll because it’s a proven way to keep you searching longer:

“You spend half your time on Facebook just scrolling to find one good piece worth looking at. It’s happening because they are engineered to become addictive.”

 

The health effects

An article in PLoS ONE examined a group of 27 university students who self-identified as intensive Internet users using a focus group approach. Each of the students spent more than 25 hours/week on the Internet for non-school or non-work-related activities. They had all reported Internet-associated health and/or psychosocial problems.

The students first accessed the Internet at an average age of 9 and had a problem with Internet overuse at an average age of 16. Sadness, depression, boredom, and stress were common triggers of intensive Internet use. Sleep deprivation, academic under-achievement, failure to exercise and to engage in face-to-face social activities, negative affective states, and a decreased ability to concentrate were frequently reported consequences of intensive Internet use/Internet overuse.

If you think that this is an affliction of mainly the young, let me disabuse you of this notion. A recent article reports on face-to-face interviews of 3,212 adults ages 16-64, 204 of whom were assessed as having an Internet addiction. The addicted group showed more frequent difficulty initiating and maintaining sleep, non-restorative sleep, and daytime functional impairment. Internet addiction with poor sleep quality was significantly associated with anxiety disorder and overall psychiatric disorders. And, here is the most jarring, albeit not wholly surprising, finding: Internet Addiction with poor sleep quality was significantly associated with lifetime suicide attempts.

 

Where is all this leading?

In “Nosedive”, an episode of the Netflix science fiction series “Black Mirror”, Lacie lives in a dystopian, not-so-distant future. In this reality, on social media via their smartphones, people instantly rate every encounter they have with another person. The highest rating you can receive is 5, and each encounter instantly recalculates your average social rating. Those with aggregate social ratings of 4.5 and higher enjoy special privileges. Lacie’s current rating is a 4.2, and she is determined to move into a dream apartment reserved for those who cross the 4.5 threshold.

Lacie is constantly monitoring her phone; she responds joyfully each time she receives a rating of 5. Of course, there is a cost. Lacie is a complete phony; she presents a veneer of perpetual agreeableness and happiness. But, in this dystopian world, beneath a surface cordiality rewarded by social media ratings, calculating individuals are seemingly incapable of normal friendships and true empathy for others.

This is happening in the real world, not just in science fiction. The technology for this dystopian society is readily available now. And, the insatiable addiction to ever increasing the number of “likes” or “friends” we accumulate is with us here today.

How do I close with a cheerful note? Pretty bleak.

Drug overdose is the leading cause of accidental death in the U.S., and opioids account for over 60% of those deaths. While opioids are effective pain medications when used in the proper setting, concerns arise when the patient’s condition lasts longer than three months, and prescribing more medication does not necessarily result in better pain control.

Building a strong doctor-patient rapport can help facilitate tough conversations with patients about opioid prescriptions and reduce risks that could lead to malpractice suits. The Doctors Company reviewed 1,770 claims that closed between 2007 and 2015 in which patient harm involved medication factors. In 272 of these claims (15%), the medications were narcotic analgesics. Sixty-four percent of these claims were in the outpatient setting, including:

  • Physicians’ offices and hospital clinics (78%).
  • Ambulatory and day surgery (10%).
  • Emergency room (9%).
  • Patient’s home (3%).

The admitting diagnoses for these outpatient narcotic-related claims were pain not otherwise specified (NOS) (24%), spine-related pain (22%), joint/extremity-related pain (9%), mental health issues (6%), and drug abuse/dependence (4%).

Patient allegations for these claims included improper medication management or treatment (70%), wrong dose (9%), and wrong medication (3%). Final diagnoses in these claims included poisoning by methadone, heroin, and opiates/narcotics NOS (76%) and drug dependence (8%).

Communication problems are among the patient-contributing factors that lead to injury, appearing in 40% of claims. Incomplete or unclear communication can compromise patients’ ability to understand the doctor’s instructions and, especially in the case of pain medications, also make them feel as if the doctor doesn’t care about their issues or concerns.

These tips can help when dealing with opioid requests and prescriptions:

  • Don’t make the mistake of jumping to conclusions that the patient is a drug seeker because the patient is there repeatedly for the same pain complaint. It could instead be a situation of missed diagnosis. Treat this patient like any other patient. Take a good history, including a very detailed medication history. Do a thorough physical examination. See if something was missed on previous visits.
  • Your prescription drug monitoring program (PDMP) is a valuable tool, like checking allergies and old records. Use the PDMP to learn about your patient’s prescription patterns, not just to check for doctor shopping.
  • Medication refills for chronic conditions should have a medication agreement. ONE doctor and ONE pharmacy should prescribe controlled medication given for three months or more. This is true for dental pain, fractures, fibromyalgia, cancer, anxiety, and ADHD. If you see a patient for the third month of a controlled medication, start a medication agreement if you plan on continuing this therapy.
  • Opioid withdrawal is uncomfortable but not life-threatening. New patients who present to a new pain specialist should not immediately be given the pain medications they state they need. A pain specialist typically completes thorough research before making medication recommendations and it could be two weeks before the patient is placed on a regular regimen. You may find it necessary to send a patient home without a pain prescription if that patient has already received one in the past month from a different provider.
  • When patients say that their medication is not working, ask the patient, “How are you taking the medication?” You’ll be surprised how many patients used 400mg of ibuprofen twice a day and it was not enough. Taking a detailed medication history and providing patient education about the right dosage, right timing, and side effects to be aware of is essential to medication safety.
  • When you hand a patient a prescription for a controlled medication, add a few words to let the patient know that these are serious medications: “I will give you a prescription for Norco. Please realize that this is a medication that can be abused. Keep it secure, take it only as prescribed, and do not drive if not fully alert.
  • Be aware of the level of health literacy of the individual patient, and adjust your language appropriately. Ask patients to repeat back the information you gave to ensure they properly understand.
  • Communicate the risk of medication theft to patients. Patients who are on a chronic treatment plan should know to watch their medication as closely as they would their money.

 

Good answers for specific patient questions and situations:

PATIENT DOCTOR ANSWER
“Can I have something for pain?” “Yes, let me check your medical record for the best choice.”
“The medicines don’t work.” “Can you please tell me how you take the prescription?”
“My prescription was stolen.” “Did you file a police report?”
“I have chronic pain.” “For your safety, you need your medications coordinated by one doctor and one pharmacy.”
“I received extra pain medications elsewhere.” • “Let’s do a drug specimen today.”
• “I see you received 20 pills from the emergency department, what happened?”
• “OK, to stay on the same schedule, this month I will write 100 tablets (120 minus 20).”
A case of clear doctor shopping “I am concerned because your medications can be addicting. I am going to refer you to someone who can help with this.”
A case of need to stop an opioid prescription “The medication no longer appears to be as beneficial as it once was. As the benefits of the opioids no longer outweigh the risks, we need to discontinue this approach and together find a safer and more effective means of dealing with your pain.””

More safe prescribing resources are available at www.SanDiegoSafePrescribing.org. You can learn more about effective doctor-patient communication at httpss://www.thedoctors.com/askme3.


This post was sponsored by The Doctors Company, the nation’s largest physician-owned medical malpractice insurer.

Unless you work with large mammals, are involved in law enforcement, or consider yourself a narcotics expert, you’ve probably never heard of carfentanil. Consider yourself lucky.

Carfentanil is an unbelievably powerful synthetic opiate, manufactured for use as a tranquilizer for large mammals, like elephants. Basically, it’s man-made heroin on steroids. Ten thousand times more powerful than morphine, a few grains of the substance are considered a lethal dose for humans. Unlike other commonly abused opioids such as oxycodone, fentanyl, and hydromorphone, there is no practical human use for this pharmaceutical. The United States classified carfentanil as a Schedule II Controlled Substance, and it is highly regulated. So how is it responsible for deaths across our country?

Carfentanil is used to increase the strength of heroin

Our nation is in the midst of an opiate crisis. The abuse of narcotics including heroin and prescription painkillers is surging among middle-class, young adults. Just like its cousin fentanyl, carfentanil is being mixed with heroin to increase its strength, thus increasing the profit margin for dealers. Fentanyl made an appearance on the opiate scene in the past few years as another dangerous heroin substitute, but the potency of carfentanil is unprecedented. Dealers love it because it makes sense from a business perspective to mix stronger synthetics into heroin, driving up its potency and increasing sales. But typical drug dealers are far from chemists, so mixing lethal chemicals with drugs is far from an exact science. As pushers experiment to find the right potency, users can never be sure of which substance they are using or in what amounts. Even without the danger of synthetics, opiate addicts are always at risk for overdose. This new danger adds a whole new element of uncertainty to the growing epidemic.

Like fentanyl, carfentanil is a colorless and odorless granule or powder that is undetectable by the daily user. Since dealers often mix carfentanil into heroin along with other ingredients, buyers have no way of knowing how much is in their dose. For example, if a gram of heroin is 10% carfentanil, someone could theoretically consume 1/10th of that gram and only ingest carfentanil. Since a lethal amount can be the size of a poppy seed, the danger here is obvious.

The epidemic’s ravaging the Midwest, especially. In Ohio, public health and advocacy groups have issued warnings in several counties following a string of several overdoses last summer. Confiscated heroin has tested positive for carfentanil in at least six other states, reinforcing fears that the dangerous substance will continue to spread.

But how could a highly regulated veterinary medicine even make it into a street-level heroin dealer’s hands in the first place? Chinese vendors are largely responsible for the influx of spiked heroin in the United States and Canada. Law enforcement believes it is being manufactured in China and imported into Mexico or South American countries, mixed in with Mexican heroin, and then trafficked into the United States.

Single-dose Naloxone is not enough

Another frightening aspect is the fact that Naloxone, the only approved medicine to reverse opioid overdose, is often not powerful enough in regular doses to be effective. Individuals frequently require multiple doses to be revived because of the sheer potency of their narcotics. Naloxone, also known by its trade name Narcan, was developed for a typical heroin or opiate overdose. Unfortunately, the medicine sometimes isn’t enough for this deadly new chemical. Even those who keep Narcan on hand can’t always revive a loved one because the newer synthetic opioids are just too powerful.

There is a glimmer of hope, however. China has classified carfentanil and a few other synthetic opiate analogs as controlled substances, effective March of 2017. This substance will still be extremely hard to regulate because it is usually created in secret laboratories, but the new laws abroad are a beginning for international cooperation.

In the past, trace amounts of this deadly chemical have been undetectable, which is why it is hard to pinpoint its presence when combined with other drugs. It is difficult for law enforcement to affirmatively say that a synthetic opioid caused an overdose rather than the heroin itself. Recently, though, a toxicologist in Franklin County, Ohio has recently developed a test that is capable of detecting minuscule amounts of carfentanil within a sample of heroin. This test is predicted to have a hugely positive influence on the problem. If developed into a field test, it would allow police to detect opiate analogs in confiscated drugs and charge the criminals who possess it accordingly. It would also put an exact number on overdoses that occur from each opioid variety. Having reliable statistics can help convince lawmakers that the problem goes deeper than Mexican cartels and street level dealers in America, but can be traced all the way to secret manufacturing facilities in Asia. Passing legislation and encouraging cooperation between countries and agencies can help to prevent the manufacture and import of these chemicals and save many lives in the process.

There is little doubt that more designer drugs and analogs will be created, imported, and passed around on American street corners. There will need to be more cooperation between government agencies and even countries to classify them as controlled substances to establish consequences for those who import and export them.

Every person struggling with addiction can recover from their disease if given a chance

It is important now more than ever that resources for those struggling with addiction and alcoholism are affordable and readily available. Hospital participation is pivotal to getting those suffering from substance abuse into rehabilitation programs where professionals can treat them.

In addition, people who may encounter overdosing individuals should be trained to spot an overdose and potentially save a life. Even though one treatment of Naloxone is sometimes not enough to reverse a carfentanil overdose, the more individuals who are trained to administer this medicine, the better. In many states, over-the-counter Narcan is available for purchase in pharmacies.

Advocacy, education, and treatment are essential to battling this disease. With no sign of this epidemic slowing down or stopping, it is important to remember that every person struggling with addiction can recover from their disease if given a chance.

Keep calm and…don’t stress out.” How many times have you heard or read something similar? The “Keep calm and carry on” motto started in Britain during World War II to emphasize that problems are better solved when people are calm and collected. This theme can also apply to the recovering alcoholic.

When recovering from alcohol addiction, everyday problems can seem insurmountable when factoring in the additional stress of staying sober. Thus, remaining calm and stress-free is especially important for alcoholics during recovery. Yet, that’s easier said than done. To keep anxiety under control, it is important to incorporate lifestyle changes that can help with stress management.

Lifestyle changes don’t have to be difficult if you can seamlessly incorporate them into your daily life. Here are six tips that can reduce your stress and help you to stay sober.

1. Breath deeply

As you breathe, concentrate on using your diaphragm rather than your chest. You should feel your stomach rise as your lungs fill from the bottom of your lungs. This type of breathing stimulates the vagus nerve activating the parasympathetic nervous system. Relaxation ensues and the levels of cortisol are reduced helping an alcohol-laden brain to heal.

2. Sleep soundly

The value of a sound night’s sleep cannot be overstated. In order to achieve this deep sleep, you must be aware of factors that contribute to healing rest. These sleep factors range from reducing naps and caffeine, establishing routine times for meals, and creating a positive bedroom ambiance. In addition, staying away from blue light screens—such as televisions, cell phones, and computer monitors—for one hour before bedtime can help to relax your eyes and your mind.

3. Eat healthy

Dietary advice is not a cookie-cutter stamp that can be applied the same to every individual. Still, there are basic guidelines that recovering alcoholics can use to eat healthier meals and snacks. If you have known food allergies, you should avoid those foods so you do not stress your body. In addition, you should stay away from junk food except for occasional exceptions.

Focus on fresh fruits and vegetables as well as healthy grains and protein sources. Don’t eat until you are full. Develop the practice of not giving in to every temptation for food. This will help you to deny yourself alcohol when you are tempted to drink. My own experience with limiting food choices helped me to say “No” to alcohol when offered.

4. Meditate quietly

Whether you call it meditation, prayer, or mindfulness, the ability to be still and reflect is vital to reducing stress. It is in moments of silence that we are most in touch with our inner selves, our aspirations, and our challenges. Mindful meditation can provide benefits that are essential to stress management.

The part of the brain that regulates stress and anxiety is the amygdala, and practicing meditation can positively affect this function. Meditation can also stimulate the hippocampus, controlling memory and learning. For some recovering alcoholics, such as myself, meditating in a framework of prayer provides an additional benefit. By incorporating a spiritual aspect, I found that I was able to call on a higher Being rather than just my own thoughts. This provided an extra measure of belief structure and support to deal with daily stress.

5. Socialize positively

Being around other people can be either productive or counterproductive to staying sober. Early on, I learned that I needed to choose my friends carefully, especially when recovering from addiction. Friends who did not take my commitment seriously soon realized that I made excuses not to be with them. I even learned to avoid some family members because they would bring me a beer when I was struggling with alcohol recovery.

Instead, I sought out friends and family who understood what I was going through and who could support my vows to remain alcohol-free. Sure, there were some hurt feelings, but, eventually, they were happy when I attained my one-year sobriety goal. If a recovering alcoholic focuses on more active forms of social involvement, such as dancing, sports, or volunteer activities, then the temptation to sit passively and drink alcohol is diminished.

6. Exercise actively

Many people think that they are too busy to exercise while in recovery, but the benefits far outweigh the drawbacks. Remaining sober is easier when exercise regime is included in stress management. One benefit is the increase in endorphins after exercising. These endorphins trigger positive feelings in your body, providing a kind of natural high.

The feeling of well-being that accompanies exercise can be an alternative to the negative effects of drugs and alcohol. Setting and reaching new goals for running or weightlifting can help to improve self-confidence. Even if you can’t get to a gym, try to walk every day outside for the exposure to nature and fresh air.

By employing these six tips to manage stress, recovering alcoholics can reduce the anxieties of daily life. This management program is designed to take the burden away from mundane stress so recovering alcoholics can keep their focus on staying sober.

“Keep calm and…don’t stress out” – a motto to live by.

Groundbreaking discoveries about the brain have revolutionized our understanding of compulsive drug use, enabling us to respond effectively to the problem.”1

I have hope that someday we will live in a world where the above statement, from the National Institute on Drug Abuse, is true, particularly where we respond effectively to the epidemic of substance dependence across our nation (i.e., the problem).

However, despite almost a century worth of study, those who suffer from severe substance use disorders or addiction continue to be a marginalized population in our communities. This marginalization takes the form of continued stereotypes and myths about addiction, as well as what I consider unfair and unethical legal penalties for non-violent drug offenders. Another profound way those who suffer from addiction are marginalized is our collective snubbing of information, based on the science of addiction and recovery, on how to provide effective treatment for those who suffer.

 

Addiction is a chronic disease of the brain

Scientists have done their part and taught us that addiction is a chronic disease of the brain. According to the National Institute on Drug Abuse,

“As a result of scientific research, we know that addiction is a disease that affects both the brain and behavior. We have identified many of the biological and environmental factors and are beginning to search for the genetic variations that contribute to the development and progression of the disease. Scientists use this knowledge to develop effective prevention and treatment approaches that reduce the toll drug abuse takes on individuals, families, and communities.”1

Despite our knowledge that addiction is a chronic disease, treatment providers and third-party payers (i.e., insurance companies) continue to treat the problem using acute care, or short-term models. For example, most insurance companies provide 28 days of coverage for addiction treatment. Some may extend treatment for 90 days which includes outpatient treatment, but these cases are rare. And, most disconcerting, the vast majority of people who meet the criteria of severe substance dependence do not have the resources to access treatment at all.

Continuing to treat addiction acutely is like stabilizing a diabetic patient in the hospital, giving them 30 days of insulin, and then sending them home to attend support meetings with other diabetics.

Nothing against peer support meetings, which I fully believe in, but it isn’t quite enough. If we treated the chronic disease of diabetes from this kind of acute model, we shouldn’t be surprised when the diabetic comes into the emergency room in a diabetic coma and/or needs emergent care continually. This makes absolutely no sense to anyone, would cost more money, and has terrible patient outcomes. Yet, this is how we continue to view and treat addiction sufferers.

The very nature of chronic diseases, like diabetes and addiction, is that they are always complex, moving targets that continue across a lifetime, and need consistent monitoring and support. Implementing chronic care models (or CCMs) to combat chronic diseases not only saves and improves the quality of life for individuals and families, it also saves money and resources for everyone over time. Proponents of CCMs advocate for a “redesign of healthcare to provide continuous, coordinated multi-faceted systems of health service delivery.”2 A redesign is exactly what we need.

 

What if we applied the chronic care model to addiction?

What would happen in a world where a chronic care model was applied to the chronic brain disease of addiction? In my estimation, implementing this type of model would have three important impacts.

  1. Extending the continuum of care: Providers and third party payers would support and implement extending the continuum of care for several months, and where appropriate years, post treatment. The impact of providing post-treatment support and care long term is a game changer when it comes to providing care for this population. For example, by extending the continuum of care, recovery professionals could intervene and prevent use events/relapses before they occur. Just as important is providing support and care immediately following a use event, preventing further decompensation and difficulty. By staying in contact and providing support to recovering persons, these types of preventative measures naturally occur preventing possible severe consequences and death from relapse. Extending the continuum of care also saves money by keeping people moving forward in their recovery and reducing the frequency and need of emergent care.
  2. Communication and coordination: Providers and third party payers would support the coordination and communication between multiple healthcare providers/systems, so all professionals providing care would be on the same page and have access to the same information. Being able to coordinate care between treatment professionals, primary care physicians, psychiatrists, therapists, counselors, nutritionists, and peer support providers would minimize confusion and maximize effectiveness with improved outcomes and decreased decompensation/progression of the disease of addiction. Absent of this coordination, care providers work in silos, almost blind to the perceptions and efforts of other potential care team members.
  3. Gathering data and doing recovery research: Extending the continuum of care allows recovery professionals to gather longitudinal data, and analyze that data to refine treatment models and to provide improved support. Technological advances in providing recovery support, via telehealth and/or video health, make data gathering better than historically used methods. In addition to these active ways of gathering data, data can now be gathered passively via computer software platforms, mobile phone applications, and internet surveys—making it even easier to collect real-time data. Gathering and analyzing recovery data is an essential but not often talked about component of chronic care models.

I still hope that someday we live in a world where our “groundbreaking discoveries” about the chronic brain disease of addiction are translated into treating and supporting addicts and those who love them long-term. Extending the continuum of care long-term would have a substantial impact on individuals, families, communities, and our nation as a whole. If we continue to treat addiction through acute care models, we will continue to get the same devastating and epidemic outcomes.


References:
  1. National Institute of Drug Abuse: https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/preface.
  2. Martin, C. M. (2007). Chronic disease and illness care: Adding principles of family medicine to address ongoing health system redesign. Canadian Family Physician53(12), 2086–2091.

Even though exercise is recognized as one of the healthiest activities you can do, for some people, it seems like a chore. When you are going through recovery, just thinking about adding exercise to your daily activities may feel overwhelming. However, small adjustments to your life, in the form of regular short workouts, can carry you miles when it comes to maintaining sobriety.

When a person embarks on the path to recovery, their body and mind may still crave the feeling of euphoria produced by drugs, particularly narcotics. Exercise stimulates the body’s production of endorphins, chemical messengers produced by the brain, that reduce your perception of pain. These substances also trigger a sense of euphoria that some refer to as the “runners high.” The feeling has been likened to the sensation produced by morphine. It is admittedly less strong, but it is also without the addictive potential. Research suggests that adding exercise to your addiction treatment may boost the effects of the therapy.

Beyond euphoria

In addition to stimulating endorphins, here are 6 more reasons why exercise can help you through the process of recovery from addiction:

1. Exercise keeps you busy

When you start giving priority to physical activity, it can eventually end up taking a good chunk of your daily schedule. This is a good thing. Scheduling regular workouts mean that you have to be on time, committed, and focused on the task, without any distractions or any bad habits to pick up.

Aside from this, it also keeps boredom out of the way (not to mention the troubling thoughts and daily stress that may lead a person to use again). Even if these activities don’t seem or feel like the best things to do at first, try to keep in mind the overall benefits that come post-workout: You’ll notice an increment in your energy, a better mood overall, considerably less stress, and a clearer mind.

2. Better sleep

One of the worst effects of addiction is the way it disrupts several body processes, such as the circadian rhythms. This causes the person to struggle for good sleep unless they consume a dose of whatever it is they are on. After starting therapy and recovery, the body will slowly and gradually begin to restore to a healthier state. And with exercise, this process will speed up; it will also help restore the normal sleep cycle faster. As a result, your body will heal faster when you are well rested.

3. You’ll heal your body and mind

It is no secret that a person who regularly exercises has a lower chance of suffering from a variety of diseases such as heart conditions, type 2 diabetes, as well as several types of cancer and overall greater immunity. In addition, recent research has shown that exercise stimulates neurogenesis (growth of new nerves) in the area of the brain responsible for cognition. This may make it easier to concentrate, meditate, and focus on everything you try, including your recovery tasks. Many say they feel more motivated and have more energy overall when they incorporate exercise into their lives.

4. Exercising provides an outlet for your anger

Two of the most common elements of people going through recovery are anger issues and deep frustration. And, in many cases, those feelings were part of the initial reason that person went into substance abuse. As a result, they do not know how to deal or express these emotions in a healthy way. Exercise provides a wonderful release for all the emotions you might have built up inside. You can try going for a run or go to the gym and take it out on the punching bag or lift some weights, or even a combination of the three! All the while healing yourself and getting in great shape.

5. Less stress

Stress is something you have to deal with every day, whether it is your job, personal relations, or other uncomfortable situations. They all add up to the regular tension you need to handle as a recovering addict. Exercise can be key here, as it can become your default stress-reducing tool. It will help you compose yourself and start being more proactive in regards to your recovery. It can help in times of crisis, too. It doesn’t matter if it is a major or minor one, having a workout regimen planned out can be great to carry you through tough times. It is important to make the distinction that this is by no means an escape; it merely is a tool to help keep you focused and balanced.

6. Exercise helps build self-confidence

It does not matter if you have never felt like the athletic type; there is a start for everyone. Taking it slow is the way to go. Try simple power walks for 10-15 minutes and progress from there. You can slowly increase the duration up to 45 and even 60 minutes. And you can advance from doing it a couple of times a week to doing it daily. You can even try a gym routine or get into muscle building and strength gaining; you can try Crossfit or hard endurance practices (like martial arts) if you want to get a bit deeper into exercise.

As time goes by, you will want to increase your regimen because exercise will push you to be better and increase your practices. Because, just like with recovery, each step forward will make you feel like you can accomplish even more. However, it is important to keep in mind that exercise is just another tool of the many you have available in your recovery process. What is your favorite exercise to implement in your daily routine? Have you used exercise as a tool for managing stress or addiction recovery? Share your story and let us know in the comments below.

Related Content: What My Addiction Recovery Taught Me About Living Healthy

As of the 2016 election, 28 states have legalized the use of medical marijuana, including Florida, Montana, North Dakota, and Arkansas just this past year. This countrywide push toward the acceptance of marijuana as a medical treatment has changed and saved lives across the 50 states.

So just how important is medical marijuana, and how is it saving lives?

 

Reduced opioid overdoses and deaths

Deaths and reported overdoses related to opioid are on the rise. According to the Centers for Disease Control, deaths related to opioid overdoses increased by more than 9% just between 2013 and 2014.

Since then, multiple studies have found that the introduction of medical marijuana and the prevalence of medical marijuana dispensaries have reduced overdose-related deaths. Some of these studies estimate that the reduction in deaths is anywhere from 16% to an astonishing 53%. Most researchers speculate that this is due to the number of patients utilizing marijuana for pain relief, instead of relying on synthetic opioid pain relievers like morphine.

By providing an alternative to these addictive and exorbitantly expensive pain killers, medical marijuana has already started preventing unnecessary drug-related deaths in the states where it’s legal and available. The four states mentioned above, which just passed their medical marijuana legislation, are not included in this statement since they have not yet begun distribution yet.

Related Content: Can Medical Marijuana Help Curb the Opioid Epidemic?

Seizure treatments for all ages

This is easily one of the most heart-wrenching and hopeful stories you’ll hear all year. A small child named Charlotte was suffering from seizures starting from the age of three months. The seizures would continue for hours and lead to repeated hospitalizations. She was later diagnosed with Dravet Syndrome, a form of seizure that can usually not be controlled with medication. The seizures were preventing her from reaching her milestones, and around the age of two, she started to experience some cognitive decline.

By the time medical marijuana became an option in her home state of Colorado, she was having upwards of 300 grand mal seizures every single week, and her family had signed a do-not-resuscitate order in the event that her heart stopped while in a hospital. They were at the end of their rope and finally decided to apply for medical marijuana.

A small supply changed her life. A low-THC, high-CBD cannabis oil stopped her seizures for more than a week.

This small application of medical marijuana quite literally turned her life around. Little Charlotte went from being unable to eat, talk, or walk on her own to a thriving, 6-year-old girl who only has seizures a few times a month, mostly in her sleep.

This same strain of low-THC marijuana is being used to help change the lives of patients with epilepsy, cancer, and Parkinson’s disease. Its name? Charlotte’s Web

 

Relief for Parkinson’s patients

Parkinson’s disease is a movement disorder that causes tremors, stiffness, and problems with both movement and posture. Actor Michael J. Fox brought a lot of awareness to the disease after his own diagnosis. It makes everyday actions like eating or dressing difficult or even impossible to complete, depending on the severity of the disease.

The use of medical marijuana can be extremely beneficial for Parkinson’s patients in helping them control their tremors and relieve other symptoms.

Go watch this video of a gentleman in the UK who suffers from Parkinson’s disease. Go ahead, we’ll wait.

Just a small amount of medical marijuana, around 30mg, was enough to calm the tremors most commonly associated with Parkinson’s disease, with little to no side effects.

Other treatments for the disease include drugs with harsh side effects or even brain surgery, which is risky on the best days.

The use of medical marijuana isn’t a new concept. In 2004, The Movement Disorders Journal completed and published a study that showed the benefits of medical marijuana when treating patients with Parkinson’s disease. Almost 46% of the trial participants showed a reduction in symptoms after using medical marijuana.

 

A token for mental health

Mental illnesses are some of the hardest conditions to treat, and many of the people suffering from them go undiagnosed or untreated because of the negative stigma surrounding them. Medical marijuana can change all of that.

Studies have shown that the use of marijuana can be beneficial for patients suffering from:

  • Depression
  • Anxiety/Panic attacks
  • Psychosis
  • Schizophrenia
  • Suicidal thoughts or tendencies

One study, completed in Denver by the University of Colorado, found that in states where medical marijuana was legal, suicide rates dropped by 9-10%.

Medical marijuana can also help these patients without any of the short- or long-term side effects caused by the medications used to treat those conditions.

We’ve still got a long way to go. A little over half of the states in this country have medical marijuana legislation on the books right now, but only eight states have legalized its recreational use. With so many life-changing applications, all we can do is cross our fingers and hope the remaining states wise up and realize they can help their citizens with a simple signature on a piece of paper.

According to the U.S. Department of Health and Human Services,

“Our nation is in the midst of an unprecedented opioid epidemic.”

Opioid abuse and dependency and opioid overdose death rates are skyrocketing. This latest spike in opioid addiction and deaths are the next evolution of the widespread chronic disease of addiction. It’s scary.

Addiction, including this opioid epidemic, is ripping the hearts out of families all across the nation. Why? Because when someone we love suffers, we suffer right along with them. This is the nature of love, particularly as it relates to those who we consider our ‘family’. This rule of familial love is always true no matter what the disease is or which family member suffers.

In an important work by the Substance Abuse and Mental Health Administration, we learn that the impact of substance abuse on families goes beyond the immediate family. It reads:

The effects of substance abuse frequently extend beyond the nuclear family. Extended family members may experience feelings of abandonment, anxiety, fear, anger, concern, embarrassment, or guilt; they may wish to ignore or cut ties with the person abusing substances. Some family members even may feel the need for legal protection from the person abusing substances. Moreover, the effects on families may continue for generations.

Researchers have also identified patterns of interaction that are prevalent in families where the disease of addiction has manifested. Patterns include negativity, parental inconsistency, denial, expressions of anger, and self-medication. These patterns are highly understandable given the fear generated when someone we love suffers and we don’t know what to do or how to respond.

The research and information in this area sometimes perpetuate the myth that those who suffer from addiction come from ‘bad’ families—this is simply not true. The truth is individuals who manifest with the disease of addiction come from all types of families. In my work with many families over many years, I have found that it is incredibly unproductive to try to figure out how and why someone suffers from the chronic brain disease of addiction. The factors contributing to why one person manifests and another does not are complicated and highly individual. However, what is productive is to discuss what family members can do once they realize there is a concern.

3 key points to dealing with addiction

If you have a family member who has an addiction, these 3 points can help you.

  1. Understand that addiction is not your fault and you are not alone

Many of us understand what it is like to love someone who suffers. We also have asked ourselves if it is our fault. These are natural feelings that are part of the process of understanding what is happening to our family. All of us know what it is like to feel afraid and overwhelmed—these are universal feelings. When you begin to understand that you are not alone and this disease is not your fault, you are better positioned to move forward and reach out for help.

  1. Reach out for help for yourself

Family members need to find the courage to reach out for help for themselves and learn how to offer recovery support to their loved one. Without you being well and having a plan of self-care and/or recovery, it will be difficult to know how to help your family member. There may be many extended family members and friends who can and will give you needed comfort and support. There are recovery fellowships, church communities, and therapeutic groups who can offer needed direction. These professionally trained counselors and therapists have worked with hundreds of families, and they can help you calm the fear and chaos so you can determine the best choices and best steps to make.

  1. Learn to be proactive instead of reactive

If you can understand you are not alone and addiction is not your fault, as you reach out for help, you will learn to be proactive instead of reactive. We react when we feel stressed, emotionally upset, and afraid. It takes time and energy to learn to stay in the moment, to be present in the now, and to engage in good self-care. As you acquire these new coping skills, you will be more proactive in dealing with the addiction that your loved one is fighting and you will be able to understand the position your loved is in as well. To be proactive means to be emotionally prepared in order to anticipate problems and ready to adapt and adjust to change.

Nothing about loving someone who suffers from addiction is easy. The above suggestions can certainly help. As far as the opioid epidemic is concerned, we, as a nation, need to recognize we are not alone.

The help needs to come from community and governmental agencies being proactive and making Naloxone, the life-saving opioid analgesic, more readily available for all emergency overdose situations. We also need to provide access to treatment for all those who need and desire it. We need to remember, we are in this together.

Unparalleled numbers of overdoses and deaths from opioid abuse have led the U.S. Department of Health and Human Services (DHHS) to conclude that the nation is in the midst of an unprecedented epidemic. Since the turn of the century, at least 500,000 people have died from drug overdoses—almost as many had died during the Civil War—that claimed more American lives than any conflict in our nation’s history.

Opioids, a class of drugs used to treat pain, often cause feelings of euphoria, are highly addictive, and have claimed some notable lives—Prince, Philip Seymour Hoffman, Chris Kelly, Michael Jackson, and Heath Ledger all died with some form of opioid in their system. The most commonly abused varieties are hydrocodone, morphine, codeine, oxycodone, and fentanyl.

The use of opioids often spurs a vicious and relentless cycle wherein some people start using prescription pain medications for legitimate reasons (e.g., after accidents, following surgery, or to help manage chronic pain). But because of the highly addictive nature of opioids, when some individuals lose access to a prescription, they turn to heroin as a substitute. Heroin, also an opioid, is often easier to obtain and cheaper on the streets than other alternatives. It is estimated that 4 out of 5 new heroin users got their start by using prescription opioid pain medications.

Fighting the opioid epidemic is a top priority for many organizations, including HHS. National efforts include the creation of opioid prescribing safety guidelines, enhanced statewide drug monitoring programs, new best practices in handling overdoses, and Medication-Assisted Treatment (MAT) to assist those dependent upon opioids.

 

Medication-Assisted Treatment

MAT is a hotly contested issue in the addiction recovery world; one side strongly advocates for MAT and the other side vehemently opposes it. One side believes that MAT should never be used, including never using drugs to help addicts go through detox. The other side believes in using medication beginning with detox and tapering down over a period of time as the dependency lessens. Still, others believe that use of drugs for long-term maintenance and stability yields the best results.

Proponents of MAT hope that patients experience decreased cravings and do not abuse opioids. The reduction in cravings, whether MAT is used in detoxification or in on-going maintenance, may reduce illicit use, crime, and help people stay in treatment and long-term recovery.

It’s a tricky, complicated issue. With approximately 1 in 4 Americans either directly or indirectly affected by the epidemic, it is important to understand the facts.

The Substance Abuse and Mental Health Services Administration (SAMHSA) states:

“Medication-assisted treatment (MAT) is the use of medications in combination with counseling and behavioral therapies for the treatment of substance use disorders. A combination of medication and behavioral therapy is effective in the treatment of substance use disorders, and can help some people to sustain recovery.”

MAT for opioid addiction primarily uses one of the following medications: methadone, buprenorphine, and naltrexone.

Methadone

Methadone is dispersed through special treatment centers often referred to as methadone clinics. Methadone is seen as preferable to using other opioids because it is long acting and is metabolized slowly. It can stabilize individuals and prevent withdrawal, which can include flu-like symptoms including fever, body aches, nausea, and dehydration.

Some people believe that methadone has strong potential for abuse, or that it creates ‘walking zombies’ due to the stupor it can sometimes cause. This stupor may be a matter of monitoring and dosage; it is extremely important to titrate the dosage in order to control cravings and manage withdrawal, however, very few clinics make these types of fine dosing adjustments. They tend to err on the side of prescribing too much rather than too little, thus causing the adverse side effects.

Buprenorphine

Buprenorphine is commonly used in detox situations to reduce symptoms of opioid withdrawal. It is also used to control long-term symptoms through extended maintenance programs. It can be used in treatment centers or at home through a prescription. Many advocate for buprenorphine as a safer alternative to methadone due to its ‘ceiling effect’—that is to say, individuals do not develop a tolerance above a certain dosage level. Like methadone, buprenorphine is long-acting and slow metabolizing, which removes the high as well as the subsequent withdrawal of short-acting opioids.

Advocates believe that buprenorphine normalizes the brain and that patients do not walk around high or in a drug-induced stupor. However, those opposed to its use claim that it can act as a gateway drug to other addictions if the individual has not used other opioids.

Naltrexone

First approved for use in alcoholics, naltrexone is also used to treat opiate abuse. It decreases cravings and the desire to use; however, a downside is it appears to block cravings in some individuals and not necessarily in others.

These drugs are not to be confused with naloxone, which has received a great deal of attention in the media recently due to its successful use in reversing the effects of life-threatening opioid overdoses. Naloxone has no potential for abuse and has already saved thousands of lives. Anyone can be quickly trained to administer naloxone, making it ideal for emergency overdose situations. Lately, however, reports have emerged that the drug has increased in price, preventing some small communities from being able to purchase it.

As our nation fights the opioid epidemic, more and more of us have begun to feel its
impact. Addiction, a chronic brain disease, has long been misunderstood and MAT, while controversial, is another component to an illness historically weighed down by stigma. The use of MAT will likely remain controversial, and whether it is prescribed will—and should—be up to individual healthcare providers on a case-by-case basis. Regardless, both advocates and opponents of MAT agree that behavioral therapy, group therapy, recovery support, community support, and a general wellness plan are just as important when fighting addiction.