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Author Archive: aenriquez

Opioid-Dependence Implant: New Treatment Option

A new treatment option for addiction is Probuphine (buprenorphine), a 6-month implant that delivers a small dose of daily medication. Buprenorphine was first approved by the Food and Drug Administration in 2002 for the treatment of opioid addiction. Probuphine was developed by Braeburn and Titan Pharmaceuticals.

Opioid Dependence What to do?How does Probuphine Work?

The implant involves 4 one-inch-long rods placed under the skin of the upper arm. This procedure is done in the doctor’s office. The implant provides 6 months of continuous buprenorphine dosing. Probuphine works by binding to opioid receptors in the body to prevent physical withdrawal from opiates, blocking the effects of opiates, and limiting cravings for opiates.

Does Insurance cover Probuphine?

Most of the larger health insurers are covering Probuphine. The implantable device costs around $5,000 or $825 per month. However, some insurance companies are not yet covering the implant, citing that pills cost less. Probuphine is cheaper than Vivitrol, which is a form of naltrexone injected once a month. Vivitrol currently costs around $1,000 a month.

What are the Most Commonly Overdosed Opioids?

The most common drugs involved in prescription overdose deaths are:

  • Methadone
  • Oxycodone (OxyContin)
  • Hydrocodone (Vicodin)

What does the Statistics on Overdose Tell Us?

Overdose deaths involving prescription pain relievers have quadrupled since 1999 in the United States, and so have the sales of these drugs. From 1999 to 2015, more than 165,000 people died in America from prescription opioid overdoses. In addition, more than 14,000 people died from prescription opioid overdoses in 2014 alone. Overdose rates are the highest among individuals age 25-54 years. Men are more likely to die from an overdose, but the mortality gap between women and men is closing.

In 2015, around 2 million people in the U.S. abused or became dependent on prescription opioid medications. Around 1 in 4 people received prescriptions for pain relievers for non-cancer diagnoses. In addition, each day in the U.S, more than 1,000 people are treated in emergency departments for misuse of prescription medications.

How are Probuphine Implants Inserted and Removed?

The Probuphine rod implants are inserted and removed only by a specially trained physician. The doctor numbs the skin of the upper arm using a local anesthetic. A small incision is made, and the implants are placed under the skin. After closing the small incision with sutures, a bandage is applied, which must be kept clean and dry for 3-5 days. You can apply an ice pack to the site for 20-30 minutes several times a day to relieve pain.

The doctor will give you a patient identification card, which you must carry with you at all times. The card contains the date the implants were inserted, and the date they must be removed. You will schedule an appointment with the doctor for removal. The procedure involves a simple office procedure, much like the insertion procedure.

Does Probuphine Work?

According to a phase 3 study by the manufacturing companies, Probuphine is quite effective for treating opioid addiction. The study involved 177 participants who received either Probuphine implants or sublingual buprenorphine tablets for six months. According to the study, the efficacy rate for Probuphine was 96.4% compared to 87.6% for the sublingual buprenorphine group.

In another clinical study, buprenorphine implant patients had significantly more negative urine drug screens during weeks 1-16. The Probuphine implant patients had 40% more negative urine tests for illicit opioids. Participants who received buprenorphine implants had fewer clinician-rated and patient-rated withdrawal symptoms experienced a greater change in ratings of severity of opioid dependence and had lower patient ratings for cravings.

Resources
CDC. Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics; 2016. Available at http://wonder.cdc.gov.
Centers for Disease Control and Prevention, National Center for Health Statistics. Multiple Cause of Death 1999-2014 on CDC WONDER Online Database, released 2015. Data are from the Multiple Cause of Death Files, 1999-2014, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed at http://wonder.cdc.gov/mcd-icd10.html.
Frenk SM, Porter KS, Paulozzi LJ. Prescription opioid analgesic use among adults: United States, 1999–2012. NCHS data brief, no 189. Hyattsville, MD: National Center for Health Statistics. 2015.
Ling W, Casadonte P, Bigelow G, et al. Buprenorphine Implants for Treatment of Opioid Dependence: A Randomized Controlled Trial. JAMA: The Journal of the American Medical Association, 2010; 304 (14): 1576 DOI: 10.1001/jama.2010.1427
Ossiander EM. Using textual cause-of-death data to study drug poisoning Ossiander EM Am J Epidemiol. 2014 Apr 1;179(7):884-94. doi: 10.1093/aje/kwt333. Epub 2014 Feb 1112.)
Substance Abuse and Mental Health Services Administration, National Survey on Drug Use and Health, 2014.

Everything You Need to Know About LSD

Lysergic acid diethylamide (LSD)Lysergic acid diethylamide (LSD) is sold on the street under names such as Blotter, Dots, Trips, and acid. The designs on the blotter paper also influence the name, such as Purple Dragon. LSD is an odorless, colorless, bitter tasting synthetic drug that has been around since the 1930s. It is a potent hallucinogen and is manufactured from lysergic acid found in ergot (a fungus) on rye and grains. LSD is diluted as a liquid for oral use or produced in a crystalline form that is mixed with excipients.

The National Survey on Drug Use and Health (NHSDA) in 2010 estimated that more than 6 percent of surveyed adults ages 18 to 25 used LSD at some point of their lives. This number was down significantly from 16 percent in 2002, however. For youth, the rate of LSD use during the last month is less than 1 percent.

LSD Uses and Effects

LSD is usually taken as a recreational drug, entheogen, or for psychedelic therapy. It has been used by psychiatrists who value the therapeutic effects in the treatment of cluster headaches, alcoholism, to enhance creativity, and for spiritual purposes. Also, LSD can help a patient to “unblock” subconscious repressed memories, leading to benefits in psychotherapy.

LSD effects are unpredictable, and use is considered to be an experience or “trip.” When it’s not pleasant, it’s considered a “bad trip,” versus a “good trip” when all goes well. These “trips” can last for up to 12 hours, and the first effects of the drug are experienced approximately 30 to 60 minutes once it is used.

The user will have varying emotions, mood swings, extreme changes in mood, impaired depth and time perceptions, and distorted perception regarding movements, shapes, colors, sound, body image, and touch. If taken for an extended period of time, the drug produces hallucinations and delusions. LSD causes physical changes also, such as high body temperature, dilated pupils, sweating, nausea, increased blood sugar, elevated heart rate, high blood pressure, dry mouth, tremors, and sleeplessness.

LSD Health Hazards

LSD use makes a person lose the ability to make sound judgments and view danger. After using LSD, a person suffers depression and/or anxiety, and may also experience flashbacks, which are re-experiences of the “trip days or months after consuming the last dose. If a flashback suddenly occurs, it is often without warning, and the hallucinogens are more common in a chronic LSD user or those with an underlying personality disorder. Healthy individuals who occasionally use LSD also have flashbacks and bad trips. In addition, LSD produces tolerance, and users need to take larger and larger amounts to achieve a state of intoxication. This, however, is a dangerous way to use LSD, as it is an unpredictable drug.

LSD is not seriously addictive, as it does not lead to compulsive drug-seeking behavior. Addiction to hallucinogens is quite a rate but does occur. Because LSD produces a tolerance, some users report that they need to take higher doses each time. Also, LSD is illegal and possessing it leads to disciplinary consequences, fines, and heavy prison sentences.

Consequences of Heroin Addiction

Heroin is a powerful, illegal opioid drug that has serious side effects, produces major addiction, and results in many negative consequences for the user. According to the National Institutes of Health, heroin use is up in the United States, with around 20 million people admitting to using this deadly drug.heroin addiction

Your Brain on Heroin

Repeated use of heroin changes the physical structure of the brain, and it also affects the brain’s function and physiology. Long-term imbalances occur in the brain’s hormonal and neuronal systems that are not easily reversed. With heroin use, studies show that there is deterioration of the brain’s white matter. This affects the ability to regulate behavior, decision-making abilities, and responses to stressful situations.

Repeated heroin use almost always results in full-blown addiction. A chronic relapsing disease, addiction goes beyond physical dependence. It is characterized by psychological, uncontrollable drug-seeking behaviors that continue regardless of consequences.

Withdrawal Syndrome

Heroin produces profound degrees of tolerance, as well as physical dependence. Tolerance occurs when a user takes more and more of the drug each time. With physical dependence, the body grows adjusted to heroin and adapts to the presence of the drug in the bloodstream. Because the body gets dependent, withdrawal syndrome occurs after 4-8 hours since the last drug use episode.

Major withdrawal symptoms occur between 24-48 hours after the last dose of heroin. It takes 5-7 days for these symptoms to subside, but studies show they can persist for months. Symptoms of heroin withdrawal include:

  • Muscle and bone pain
  • Restlessness
  • Insomnia
  • Nausea and vomiting
  • Diarrhea
  • Cold chills with goosebumps
  • Involuntary leg movements

Loss of Work

Drug use is associated with loss of employment, and heroin is no exception. People who use/abuse this powerful opiate have problems functioning on the job, either due to the effects of heroin or the withdrawal symptoms. Heroin use leads to being fired, laid off, or quitting jobs, simply due to the severity of its addiction potential.

Loss of Family and Friends

Heroin has serious social and family consequences for the user. Heroin addicts often steal from friends and family members to fund their habits, or they cannot contribute financially, and become a dependent person in the friendship or family unit. This leads to resentment, anger, and conflict among the user and his/her friends and relatives.

Health Problems

Heroin bought on the street often is mixed with other substances, some of which can be toxic to the body. Heroin users are at risk for lung, liver, kidney, and brain damage. These organs become permanently damaged from the substances mixed with the opioid drug. In addition, IV drug users and those who snort heroin are at risk of contracting hepatitis B or C or even acquiring the HIV disease.

Legal Problems and Incarceration

Because heroin is an illegal substance, being caught with it could lead to many legal problems and/or incarceration. A person using heroin could have a car accident, resulting in a vehicular assault or homicide charge. Because it changes thinking and behavior, users are at high risk for committing theft, assault, and/or homicide.

Heroin Overdose

Heroin users are in danger of fatal overdose, or many end up in the emergency room or hospital, barely surviving a respiratory depression. According to the National Institute on Drug Abuse, 11 Americans die every day due to a heroin overdose. Because the drug is majorly intense, users cannot tell that there is a problem until it is too late. Heroin affects a person’s breathing, and this drug slows breathing until a person no longer takes breaths.

Resources
National Institute on Drug Abuse (2015). Nationwide trends: Heroin. Retrieved from: https://www.drugabuse.gov/publications/drugfacts/nationwide-trends

The Stages of Relapse

Relapse is associated with many feelings, attitudes, and behaviors. There are 10 stages involved with relapse that has been identified by experts.

Stage1: Unhealthy Emotions

When you stop using drugs and develop a recovery plan to stay clean, you initially do fine. However, at some point, you may come upon a problem and not be able to adequately cope emotionally. These unhealthy emotions are often called “stinking thinking” because you feel down and out but do not understand why.

 

RelapseStage 2:  Denial

Instead of recognizing that you are stressed and emotionally unable to cope with these feelings, you use denial to convince yourself everything will be alright. However, this mechanism is similar to what you use when you are dealing with addiction and confronted with uncomfortable feelings. Denial of emotional stress often leaves the recovering addict feeling overwhelmed. If you use recovery tools, you will know that sharing these feelings help you get over these emotions.

The worst thing a recovering addict can do in the denial stage is isolated him- or herself from support persons. You may overreact and focus on internal issues, causing you to relapse quicker. Don’t distance yourself from your support network during the denial stage. Learn how to recognize it and move forward. During recovery, you may feel like you are on a roller coaster of your emotions. This is the stage of relapse where you often feel anxious and have much sleeplessness and sadness. These ups and downs are part of the denial stage of relapse.

 

Stage 3:  Compulsive Behaviors

In the downward progression of drug use, a recovering addict first tries to cope with emotional stresses by engaging in certain compulsive behaviors rather than using appropriate recovery tools. During this stage of relapse, you will find your thinking going back to the old, insane ways associated with drug and/or alcohol use. You know you don’t want to get back on drugs again, but you are also not using the techniques to cope that you learned in rehab.

Emotional relapse is associated with compulsive behaviors. These are things we do to attempt to repair ourselves, slowly abandoning the recovery program and returning to drug use. During this stage of the relapse process, you make irrational choices, use poor judgment, and become argumentative and defensive. Signs of emotional relapse include sleeping more, ignoring personal hygiene, and having distorted thinking.

 

Stage 4:  Triggers

Triggers are things, places, and situations that remind you or prompt you to use drugs or drink alcohol. In a solid recovery program, you do not use the right techniques to avoid and ignore triggers. During this stage, you need to avoid places that remind you of your using days. Triggers snap you and set you off. During this stage, you should attend a meeting, contact a sponsor, or turn to a higher power to remove the obsession for using drugs or drinking.

 

Stage 5:  Interior Chaos

When a person is triggered to use drugs, their stress level goes up and erratic emotions control thinking. This leads to interior chaos, which is part of mental relapse. During this stage, thinking patterns are more distorted and insane, with the obsession to use drugs becoming stronger. The reality of your condition is obscured by fantasies of the good old days of drug use.

During stage 5, you need to remind yourself of why you wanted to get clean in the first place. You need to go back and remember how the disease rendered both your body and mind abnormal. Also, you need to stay focused on the program in hopes of maintaining recovery. It is crucial that you remember that it is not external issues that lead to drug use, but it’s your inability to cope with emotions and thoughts that drive you toward drugs.

 

Stage 6:  Exterior Turmoil

If you remain in a state of mental relapse, you may at some point realize that your frame of mind is not right. You know that you are slipping out of recovery and having feelings of shame, fear, or even pride. Eventually, your addictive thinking ways cause problems with your outside world. This is when you have fights with family members, get into arguments with co-workers, and feel bitter.

 

Stage 7: Loss of Control

If you try handling your problems without help, they may overwhelm you until you feel fed up. You may feel that you are getting out of control again. Life may become troublesome, and you are at crises. Once you recognize that you are out of control, you may have a chance at staying clean. This is a crucial point during relapse to identify the problems and refrain from drug use.

 

Stage 8:  Addictive Thinking

At this stage of your relapse, you use all your addict defense mechanisms. The disease convinces you that recovery is not working, and that you should just do what you want. You may feel miserable and fail to understand what is really going on. Deluded feelings convince you that recovery is too hard and not enjoyable. The disease makes you avoid support persons, skip meetings, and think about using more and more. To avoid responsibilities, you think about leaving your spouse, quitting your job, and using drugs.

 

Stage 9: High-Risk Situations

By this stage, your mental relapse is full-blown. Your emotions are in turmoil and your thinking is distorted. You believe it is alright to go back to visiting places where drugs are, and you get to be around the drug scene. You justify your behavior and put yourself in real high-risk situations.

 

Stage 10:  Relapse

When you actually relapse, you revert back to your old ways of thinking, feeling, and behaving. You find yourself abandoning your recovery skills and using drugs and/or alcohol again. The way you see it, you can use or commit suicide. Relapse is not a failure, however. Rather, this is just a minor setback. At this point, you need to go back into inpatient treatment, where you can work through your problems and get clean again.

Exams and Tests for Drug Abuse and Dependency

A high index of suspicion is required for patients who show signs and symptoms of drug abuse or dependency. A complete evaluation of the patient is necessary, including physical examination and laboratory investigations. The clinical diagnosis of the patient is facilitated by the presence of specific signs – for example, nasal ulceration in cocaine abuse. Nevertheless, it is common for patients to have non-specific complaints related to drug withdrawal. A wide range of signs and symptoms has been attributed to drug abuse, including constricted or dilated pupils, coarse voice, abnormal heart rate, enlarged liver and collapsed veins.

Drug Addiction Treatment San DiegoDiagnosis of drug abuse is largely dependent upon the identification of important clues from patient history. For example, these may include frequent road traffic accidents, workplace absences, episodes of domestic violence, chronic pain with no underlying cause and a recent onset of seizures. The CAGE questionnaire is helpful in the diagnosis of alcohol dependence, and ideally, should be used to ensure the documentation of important information regarding alcohol dependency in a patient. It is also used as a screening tool to identify alcohol abuse and dependency. In terms of drug abuse, the Conjoint screening test is the tool of choice.

Substance abuse, in general, can lead to neuromuscular symptoms such as tremors, seizures, and rigidity. Psychological symptoms include nervousness, anxiety, confusion, slurred speech, irritability, a staggering gait, and hallucinations. Psychological problems always arise with CNS-acting drug abuse and confuse the clinical picture. The inspection of body and clothes of patients can provide additional evidence regarding drug abuse, for example, an alcoholic odor in the person’s breath, needle marks on their arms, residual cocaine around the nares and clothes that are stained with alcohol.

Laboratory investigations should be suggested if a clinical suspicion arises. Laboratory tests do not have diagnostic accuracy in detecting drug abuse. A few tests can help in identifying patients with drug abuse and they can also give information about chronic intake of specific drugs. They are also of value for the detection of organ damage from chronic drug abuse. Blood samples can be taken to run drug toxicology screens and measure Mean Corpuscular Volume (MCV). The toxicology screens identify the pharmacological class of drugs.

 Drug metabolites are accurately detected in saliva and urine, therefore urine samples are useful in measuring hourly drug clearance. Positive findings in toxicology screens emphasize the need for confirmatory tests. Enzyme-mediated Immunoassay Technique (EMIT) is also used to confirm the presence of drugs in the bloodstream. In most cases, only metabolites of a particular drug are detected in significant quantities; traces of parent drug or complete absence thereof can make interpretation difficult, as metabolites of two or more different drugs can be similar. False negatives are common and can be brought about by additional drugs taken for the sole purpose of elimination. These drugs act as a ‘mask’ for the original drug being tested.  Other tests, such as gamma glutamyl transpeptidase and carbohydrate-deficient transferrin (CDT), have a role in identifying alcohol abuse.

Crystal Methamphetamine; How it Works?

Crystal methamphetamine, also called methylamphetamine or desoxyephedrine, is in the form of the chemical n-methyl-1-phenyl-propan-2-amine. On the street, it is simply known as “meth.” In the crystalline form, this drug is known as Ice, Tina, Glass, or Crystal. Typically, users smoke this drug in a glass pipe, but it is often dissolved in water and injected, snorted, or swallowed. Many women use crystal meth to lose weight, but the effects are usually short term. The body grows a tolerance to this drug, so the weight loss stops after six weeks of regular use.

According to a recent survey by the National Institute on Drug Abuse (NIDA), over 12 million people in the U.S. have tried methamphetamine at least once, but over 1 million people used it on a regular basis the year prior to the 2012 survey. There are serious psychological, medical, and social consequences associated with methamphetamine abuse, as it can lead to memory loss, psychotic behavior, malnutrition, and serious dental problems. This drug also contributes to an increased risk of obtaining a blood-borne disease, such as hepatitis or HIV.

Methamphetamine AddictionYour Brain on Meth

Crystal methamphetamine increases dopamine, a powerful neurotransmitter, which is involved in motivation, reward, pleasure, and motor function. This drug has the ability to release the dopamine rapidly, so the brain produces a quick “flash” of reward. This leads the user to become addicted and experience chronic relapses and compulsive drug-seeking behavior.

Methamphetamine Effects

Many methamphetamine users enjoy this drug because it produces a long-lasting high and causes numerous neurotransmitters to be released in tissues of the brain, which leads to a sense of euphoria. That high often lasts up to 12 or more hours, depending on the person and how the drug was originally taken. As a popular stimulant drug, crystal meth improves energy, concentration, and alertness, but decreases appetite and fatigue. Many meth users report an increased enjoyment in sexual activity and libido.

There are several associated effects linked to pure methamphetamine use. Crystal meth is never pure, so the dangers associated with this drug go beyond regular side effects and known signs. Commonly reported immediate effects include:

  • Diarrhea
  • Nausea
  • Euphoria
  • Increased alertness and energy
  • Loss of appetite
  • Insomnia
  • Jaw clenching
  • Increased libido
  • Elevated heart rate, blood pressure, body temperature, and blood sugar levels

The effects of chronic use include tolerance, temporary weight loss, drug cravings, the rapid decay of teeth (“meth mouth”), and drug-related psychosis. When a person overdoses on crystal meth, they experience a sense of flesh crawling, paranoia, delusions, hallucinations, brain damage, muscle breakdown, cardiac arrest, stroke, and/or hyperthermia.

The Ingredients

Methamphetamine is available by prescription for attention deficit hyperactivity disorder, obesity, and narcolepsy. This street drug is made in illegal labs in homes, however. The making of crystal meth involves the use of pseudoephedrine or ephedrine, which is an allergy and cold medicines. The “red, white, and blue process” is where red phosphorus, white ephedrine, and blue iodine are used to make hydroiodic acid. This type of drug is highly dangers, as the phosphorus with sodium hydroxide produces a poisonous phosphine gas, which can autoignite or blow up in the home. In addition to these substances, makers often use ether, chloroform, acetone, ammonia, methylamine, hydrochloric acid, lithium, and/or mercury to make crystal meth.

Alcohol Abuse and Treatment

It isn’t what you plan, but sometimes, drinking causes you to cross the line from the occasional use or social use to problematic everyday drinking. This leads to alcoholism or alcohol abuse, which is related to genetics, social environment, and psychological issues. Certain ethnic groups are more at risk for alcohol abuse than others, such as Native Alaskans and Native American Indians. Alcoholism tends to run in families, too, and heavy drinkers suffer from numerous mental health issues, such as bipolar disorder, anxiety, and depression.

Do I have a Drinking Problem?

Drinking is more acceptable in many cultures and the effects of alcohol use vary from person to person. When social drinking becomes problem drinking, then the alcohol is in control. You may suffer from alcohol abuse if you:

  • Lie to others or hide your drinking habits.
  • Feel ashamed or guilty regarding your drinking.
  • Need to drink for the purpose of relaxation.
  • Experience “blackouts” after drinking.
  • Have family members or friends who are concerned about your drinking.
  • Drink to excess on a regular basis.

Signs and Symptoms of Alcohol Abuse

Substance abuse physicians and counselors do not consider alcohol abuse to be the same as alcohol dependence, which is essentially alcoholism. Alcohol abusers do have the ability to limit their drinking, whereas alcoholics do not. However, excessive use of alcohol is dangerous and self-destructive either way. The common signs and symptoms of alcohol abuse include:

  • Continuing to drink regardless of problems in relationships, work, or other.
  • Repetitively neglecting responsibilities due to the drinking.
  • Using alcohol while driving or operating heavy machinery.
  • Having repeated legal problems due to the drinking.
  • Drinking to relax or reduce stress.

Alcohol AbuseWhen Alcohol Abuse turns into Alcoholism

Not all people who use or abuse alcohol develop full-blown alcoholism. However, frequent abuse of this substance is a major risk factor for alcoholism. Certain losses or tragedies often trigger binge drinking or other substance use issues. When a person becomes reliant on alcohol in order to function or feel physically well, then he or she is considered an alcoholic.

One of the first warning signs of alcoholism is tolerance. This is when you can drink considerable amounts without getting drunk or feeling “buzzed.” Tolerance is when a person requires more and more alcohol in order to feel the same effects. Another warning sign is withdrawal. This is when someone has certain symptoms when alcohol has not been in his or her system for a while, such as tremors, anxiety, or mood swings. In severe cases, withdrawal from alcohol causes hallucinations, seizures, nausea, vomiting, fever, and confusion.

Denial of Drinking Problems

Denial is the biggest obstacle when considering rehabilitation (rehab) for alcohol abuse or dependence. For many alcoholics, the desire to drink is so strong that it causes problems with rational thinking and the consequences are ignored. Denial also leads to serious problems with relationships, work, social life, and finances. A person who is dependent on alcohol will deny this by:

  • Downplaying the amount he or she drinks.
  • Avoiding accepting consequences that are related to drinking.
  • Complaining that friends and family members exaggerate regarding the problem.
  • Blaming the drinking on other people or things.

Illicit Drug Abuse

Illicit drug use and abuse often lead to severe consequences, as in jail time or a prison sentence. According to the National Institute on Drug Abuse (NIDA), 70 percent of prison entrants report using substances in the year prior to incarceration. Men are more likely than women to have used drugs before entering prison, also. Among young people aged 18 to 44, around 73 percent have used an illicit drug during the previous 12 months.

Illicit drug use and addiction is one of the worse types of addict problems. Illicit drugs are illegal to make, use, and/or sell, and include cocaine, methamphetamines, heroin, and various hallucinogens. Also, most of these substances are highly addictive and carry serious health consequences and risks, even when consumed in small or infrequent doses. While it begins as experimentation, illicit drug users often find themselves dealing with the mental and physical effects of the drug and withdrawal from the substance. A person can become addicted easily and endanger the safety and health of others. Researchers have found that addiction is a brain disease, which is characterized by chronic relapses and abnormalities in certain brain pathways.

Categories of Illicit Drugs

Illicit drug effects are dependent upon the substance. The main categories are opioids, stimulants, sedatives, and hallucinogens. These drugs are categorized based on their effects. These include:

  • Opioids – Painkillers and heroin that alter chemicals in the brain responsible for mood regulation, slow down the central nervous system, and decrease breathing effort.
  • Stimulants – Methamphetamines, and cocaine lead to increased heart rate, excessive brain activity, and a state of hyperactivity.
  • Sedatives – Drugs such as Xanax and Valium are sedatives, and these cause a slowing down effect, drowsiness, and confusion.
  • Hallucinogens – LSD, mushrooms, and marijuana can alter the perception of time, space, and reality.

The Signs of Illicit Drug Addiction

There are certain behaviors that indicate an addiction to an illicit drug. These include:

  • Aggressive behavior, violence, and/or mood swings
  • Unusual or sudden change of energy level
  • Preoccupation with obtaining and using a certain drug
  • Isolation from family and friends
  • Chronic mental and physical health problems
  • Inability to attend work or social activities
  • Legal consequences, such as loss of job or an arrest
  • Behavior that violates values and/or morals for the purpose of getting a drug

Treatment Options

  • Inpatient rehab program – This is best for individuals who suffer from severe illicit drug addiction. Doctors, therapists, and counselors monitor the addict to provide safety and a healthy environment for recovery.
  • Outpatient rehab program – These facilities work for the addict who wishes to maintain his or her job or for those who have families. The person attends group activities and classes at the facility but returns to home and daily activities.
  • 12-Step program – NA and AA are both good 12-step programs that offer support to people with addictions. These programs use the 12-step concept in order to help a person manage obsessions and compulsions of addiction.
  • Psychotherapy – Drug addiction often coexists with emotional and or mental health issues. This can lead to self-destructive patterns without appropriate psychotherapy.
References
Narcotics Anonymous
Drug Addicts Anonymous
National Institute on Drug Abuse
DrugFree.org
American Council for Drug Education
National Council on Alcoholism and Drug Dependence 

Techniques for Dealing with Mental Urges

Mental Urges - Heroin Drug RehabEvery person who is recovering from addiction will experience uncomfortable urges and cravings for his/her drug of choice. This is normal recovery behavior. Fortunately, these cravings usually pass with time. When you are first starting rehabilitation, these things are normal, so expect them. We offer some helpful techniques you can use to deal with mental urges.

Number 1:  Learn to Resist Cravings

For many individuals carvings and urges to use or drink will trigger automatic responses. These are unconscious thoughts and feelings. Learn to say no to these ingrained, intense desires. With the SMART Recovery Program, there is an easy to remember acronym DEADS. Each letter stands for one technique. These include:

D: Delay – Because mental activities associated with urges and cravings disappear over time, delay these thoughts and maintain your attention. With time, they will run their course and just go away. If you don’t feel they are gone in 15-30 minutes time, call someone in recovery or talk to a counselor. The best way to delay urges is to deny them and do something else.

E: Escape – Simply leave or go away from the urge or situation. Leave the bar, leave the market where wine is displayed, or turn off the television where you see something that triggers your urge to use again. Escaping the trigger gets your mind focused on something new. This, in turn, quickly lessens the urge to relapse.

A: Accept – You need to put your cravings and urges into perspective understanding they are normal with recovery, and will soon pass. When a recovering addict learns the process of addiction and accepts this discomfort, he/she can refrain from drug use. You understand that these feelings won’t kill you, and before you know it, they are gone.

D: Dispute – You now need to dispute these irrational mental urges. Keep telling yourself that you are in recovery and going to beat the addiction. Dispute these urges when they occur, and this will help them pass by more quickly.

S: Substitute – When you get a mental urge to use, substitute an activity or thought that is more fun or beneficial. This includes walking, hiking, and swimming, going to a movie, or taking a scenic drive. The possibilities for substitutions are endless, and these things lessen cravings. Before you know it, you won’t crave drugs at all.

Number 2:  Keep a Record of your Cravings and Urges

Many recovering addicts find it beneficial to write down the circumstances that led to the urges and cravings. Make a note of what you were doing when the urges hit, and what you were feeling and thinking. By documenting these things, you may see a pattern emerge. This way, in the future, you will know how to avoid this.  

Recording your cravings and urges may help you recognize the origins of your addiction, which is one of the first steps to identifying coping mechanisms. When an urge to drink alcohol or use drugs strikes, note the intensity of the urges and which coping behaviors helped you get over it. Before you know it, you will not only be able to bypass these cravings but will understand how to avoid them.

Number 3:  Make a Guideline to Use 

In a small notebook, use the following format to make a guideline for documenting your cravings and urges.

  • Date and time – While tedious and time-consuming, this will help you record any patterns that emerge.
  • Situation – Includes environment and situation. This way you have your feelings and thoughts associated with the actual situation.
  • Craving intensity – On a 1-10 scale, document how strong the cravings and urges were.
  • Coping behaviors – Note which strategies you used to help cope with the mental urges. If the strategy helps, note effectiveness.

Number 4:  Try Urge Surfing

Urge surfing is a technique many people in recovery use to cope with their mental urges. This involves gritting the teeth and letting the cravings pass. Some urges are overwhelmingly strong, particularly when you first go into your old using situation or environment. This technique is called urge surfing because the urges feel like ocean waves you must surf through.

Like ocean waves urges start small and then get larger, gathering momentum until they break or crash on the shore. With urge surfing, you simply tough it out and allow the cravings to pass by. The basis of this technique is similar to many martial arts techniques. You first overpower an opponent by going with the force of an attack. Then, you redirect your energy to your advantage.

The Relapse Prevention Plan

People who have a history of alcohol or drug addiction know that getting clean is tough, but staying sober tougher. Addiction affects 23 million Americans, and it costs society billions each year. Because returning to the addict way of life is a possibility, you should plan specific ways to prevent relapse. This involves understanding the challenges you face. Find out why the relapse prevention plan is one of the most crucial components of recovery.

When you make a relapse prevention plan, it is important that you recognize and respond to the early warning signs of relapse. Before things spin out of control, you can stop relapse quickly. Statistics show that two-thirds of people who finish rehab and attempt recovery will relapse. This does not mean that rehab has failed, however. When in recovery, you should address your problems and devise a plan. This way, you can better face the cravings and urges when they do occur.

How to Create a Plan

A relapse prevention plan is a vital part of addiction treatment, and it is also used in 12-step groups and support groups. Counselors and rehab workers will help you go through the planning process because others may see things you do not realize about yourself. Other people are a good source of support during addiction treatment. A written relapse prevention plan can act as an inspiration and guide as you go through addiction treatment. The plan can be shared with other recovering addicts and is a valuable tool when you feel like you are on the verge of relapse.

Here are the steps to creating the relapse prevention plan:

  • Examine your use history and previous relapses – Once you are sober and stabilized, start the relapse prevention plan by looking at every stage of your life. Examine patterns of using alcohol and drugs, examine your compulsive behaviors, and consider consequences. It helps to identify why you relapsed, so you can feel more in control of your recovery.
  • Know warning signs and ways to manage them – The warning signs of relapse are red flags to you. These are signs and symptoms that occur right before actual physical relapse. These include anxiety, moodiness, fantasizing about drug use, loneliness, feelings of hopelessness, sadness, not going to meetings, avoiding clean friends, seeking out using friends, and planning your drug use. It often starts with subtle warning signs, but then, full-blown drug use occurs.
  • Have a support network – If you don’t have supportive people in your life, get some. Build a team of people you can depend on, vent to, and discuss your problems. These could be family, friends, counselors, therapists, support group members, or clergymen. It is important that you remove yourself from people that trigger drug use.
  • Have an emergency relapse plan – This involves a detailed plan for yourself when you feel like using drugs and/or alcohol. Strategies include authorizing someone to step forward and place you into treatment should you relapse. This could include daily 12-step meetings, talking with counselors, or starting outpatient therapy.
  • Prioritize your overall well-being – Make yourself a priority. Plan lifestyle changes that will improve your mental and physical health. Start exercising, learn to prepare healthy meals, and add yoga or meditation to your daily routine. These things help to control stress and combat boredom. Many mental health problems often co-occur with substance use, so see a therapist to work through your problems.

Buprenorphine and Opioid-Dependency Treatment

Opioid-AddictionBuprenorphine is a partial opioid-receptor agonist used in high dosages to treat the opioid-dependence disorder. This semi-synthetic opioid derivative of thebaine/paramorphine (an opiate alkaloid) is popularly used in Medication-assisted Treatment (MAT) or opiate-drug detoxification process, which helps reduce or completely cease chronic addiction to heroin, morphine and other opiates. Short or long-term opioid replacement therapy using buprenorphine is more effective when practiced through a ‘whole-patient approach’ with behavioral interventional therapies and psychological support, given through one-to-one guidance counseling.

 

 

Methadone SolutionComparison with Methadone

Buprenorphine, also a partial opioid agonist, is just as effective as methadone, having a similar mechanism of action. These drugs negate the potential of any life-threatening respiratory depression or stress known to occur in heroin abuse. Buprenorphine also has fewer side-effects when compared to alpha-2 agonists, since withdrawal symptoms resolve quickly in shorter duration than methadone or clonidine. Buprenorphine’s long-acting opioid effects increase on regular administration until they level off at a certain dosage; thereafter, drug-effects would not escalate even if the dosage is increased. This is called the ‘ceiling effect’, which helps reduce the chances of drug misuse or dependency and helps control other side effects of the drug.

One of the major advantages of buprenorphine is that it does not require a highly sophisticated clinic setting for treatment, like in the case of Methadone. Buprenorphine is the first medication, which can be dispensed directly to the patient through a physician’s prescription. This ease of treatment methodology has increased access to the drug, which can be prescribed in any setting, be it a doctor’s office, private health clinic, community hospital or public health department. Though therapeutic efficiency of buprenorphine is identical to methadone, it is not the commonly preferred treatment of choice for patients with high level of physical dependence on opiates. Common side effects of buprenorphine use are fever, fatigue, muscle cramps, insomnia, nausea, vomiting, stress, and irritability.

Phases of Buprenorphine treatment

  1. Induction is the primary administration of buprenorphine to an opioid-dependent addict. One important condition to start this drug treatment is abstinence from opiate-consumption for at least 12 – 24 hours before buprenorphine ingestion. If the patient is not in the early stages of withdrawal and still has opioids circulating in their bloodstream, severe withdrawal symptoms may set in, upsetting the treatment course.
  2. Stabilization phase is when the patient has ceased or greatly reduced their opioid abuse habit and do not experience cravings or side effects. Buprenorphine dosage may be reduced from daily to an alternate-day regimen, due to the long-acting nature of the drug.
  3. The maintenance phase is when the patient is showing steady recovery while on continuous buprenorphine treatment. The length of maintenance on the drug is customized according to every patient’s needs and could also go on indefinitely. Medically-supervised withdrawal or tapering the dosage helps in making the transition to a drug-free state smoother. To prevent chances of relapse back to the old addiction, the patient is recommended to continue rehabilitation through psychiatric guidance and counseling.

Buprenorphine Misuse Potential

Mild opioid effects of buprenorphine’s intake are usually misused by many, especially by those who have no opioid dependency. To forestall diversion from treatment course and prevent the likelihood of drug-misuse, Naloxone is added along with buprenorphine as it blocks opioid withdrawal symptoms.