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Tuesday, May 19, 2020

The Myth of 'Rock Bottom' in Addiction Recovery


Often in the world of addiction and recovery, it is said that “you cannot make people change”. While this is true, there is a corresponding belief that therefore people must hit “rock bottom” before being ready to change and commit to treatment. 

Often this refers to extreme hardships as a result of drug use including eviction, loss of a job, strained relationships, even an overdose. While some have shared that an experience like this has brought a moment of clarity to realize they need help, many do not get that opportunity. 

Even more so, many others can and will seek some level of treatment before hitting their relative rock bottom. It is important for help to be made available for individuals wherever they are on their journey, to avoid rock bottom and still promote health, wellness, and recovery.

Do you have to hit rock bottom before entering treatment?

If we are to consider the disease model of addiction, then we must view recovery from it also as such. For other medical diseases, it would be dangerous to wait until “rock bottom” to start treatment. Instead, the medical model seeks to identify and treat illnesses at first detection and recommends preventative practices to avoid the continuation of the disease process. 

Even with chronic illness where a quick cure is not viable, there are still treatments to alleviate symptoms and slow down the progression of the disease. Similarly, substance use disorders are diseases that can increase in severity and cause harm to the individual, families, and communities. Therefore prevention efforts, or interventions that reduce the negative effects, are ideal from both a medical and public health perspective. This is known as the harm-reduction model.

Types of harm reduction treatment

The philosophy of the harm reduction model is to meet people where they stand in the progression of their addiction. This means treating those who struggle with addiction with respect, compassion, and attempt to limit the health, social, interpersonal, and economic consequences associated with drug use. 

This philosophy understands that regardless of efforts, some will continue to use substances, and rather than ignore or neglect these individuals, there are still beneficial interventions that can be put in place. 

This can be a therapeutic approach adopted by clinicians and treatment programs, or be the guiding principle for organizations and agencies. Harm-reduction strategies are not actually a novel idea. Both putting on sunscreen to avoid sunburn and having a designated driver or driving service available when drinking are also good examples of this philosophy at work. 

What does this look like in the community?

Some examples of programs and resources that embody the harm-reduction model are:
  • Medication-Assisted Treatment (MAT) - Also known as an opioid treatment program, these programs provide prescription medications to lower overall opioid use, overdose, and reduce cravings. These programs usually have group and individual counseling as well.
  • Safe injection sites - Facilities that provide medical supervision to prevent overdoses and provide education on safe injection practices, medical treatment, and therapy.
  • Needle exchange programs (NEP) - Community-based programs that offer sterile needles and syringes, and safe disposal. This reduces the risk of blood-borne pathogens and infections.
  • Harm reduction Abstinence Moderation Support (HAMS) Groups - A free, peer-led support group to discuss drinking habits and personal goals for lessening drinking.
  • Managed Alcohol Programs (MAPs) - Treatment facilities for people with chronic alcoholism experiencing homelessness. MAPs will offer small, regular doses of alcohol to prevent withdrawal, as well as provides housing, and seeks to lessen emergency room visits, hospital admissions, and potential lethal withdrawals

Other harm reduction efforts include administering medication to reduce cravings, aid withdrawals, and limit the effects of drugs if one uses.  

Advocacy and awareness efforts are also important, as some can hesitate to support or adopt this model for fear of encouraging use. However, studies show the harm reduction model is effective, safe, and does reduce multiple harmful consequences for individuals, communities, and families.

How you can help

If you have a loved one suffering from an addiction, there are ways you can help. Primarily, let them know you are there for them and seek ways to do so in a nonjudgmental and compassionate way

In keeping an open dialogue, it will be more likely that they can ask for help in the future if they are currently unwilling. Providing local resources can allow them to understand their options for safe use if they are not ready for treatment. 

While each relationship is different and sometimes boundaries and limits must be set, adopting a harm-reduction model can prevent rock bottom and limit negative consequences. It is always good to seek the advice of trained professionals who can address questions and concerns about substance use and explain the treatment options available. By treating those with addiction with respect and compassion, recovery is possible without the looming danger of rock bottom.

Recovery at The Haven

At The Haven, we ascribe to a harm-reduction philosophy. While we work to help our guests understand the costs of addiction, we place equal emphasis on understanding how their use of substances or addictive behaviors makes sense to them. Our goal is to help them see if anything else could make more sense.
Whether it’s seeking the support of our trained staff or seeking more information about the treatment options for your loved ones, give us a call today to learn more!

Tuesday, May 12, 2020

What Medications Are Used In Addiction Detox?


When an individual uses a large amount of substances over a long period of time, the brain and body can become addicted. To function again normally requires a period of detoxification.

The necessity of detox for individuals seeking treatment for substance misuse boils down to the concepts of tolerance and withdrawal.

Tolerance: The need to increase the dose of a substance ingested in order to achieve the same effect as previous doses. 
Withdrawal: Adverse effects experienced when the substance is no longer present in the system. 

Each of these concepts points to the body’s dependence on the substance in order to function normally. 

How does withdrawal work?

For those seeking recovery, when they begin to halt the use of these substances, they enter a ‘withdrawal period’ as the body is adjusting to the lack of the preferred substance effects. The absence of the numbing effects of the drug can make individuals feel extremely sick and can even be life-threatening. That is why often a medically managed detoxification is considered to be the safest and most effective treatment during withdrawals. 

Withdrawals vary based on the type of substance, therefore medically managed withdrawal should be tailored to each individual’s medical needs. This detox period can last anywhere from a few days to a few weeks and is best managed under a physician’s care in a medically supervised and secure environment.

What medications are used?

In a medically managed detox, multiple medications are used to combat the symptoms of withdrawal, prevent life-threatening symptoms, and maintain safety and comfortability. Medications vary based upon what substances the individual has been taking, and what medical risks are associated. 



Some medications used in the detoxification process are:

Drug of Addiction
Common Medications Used in Detox
Alcohol
Naltrexone, while an opioid antagonist that prevents the effects of opioids, also reduces the urge to drink or use. Gabapentin is used for pain relief.  Studies show using these in combination has improved withdrawal and abstinence outcomes. 
Propranolol is a beta-blocker that can also help with alcohol withdrawal. For severe withdrawals, benzodiazepines may be used short-term.
Opioids (heroin, prescription opiate pills)
Opioid antagonists like naltrexone can be used in pill form, or as an injection called Vivitrol. Another option is opioid agonists like Methodone. Methadone will stay in one’s system longer and can help relieve withdrawals and cravings. Methadone and Suboxone (buprenorphine and naloxone) can be used as a part of Medication-Assisted Treatment (MAT) as a way to taper off of opioids slowly or remain on a small dosage to deter using heroin. This is often done as part of the harm reduction model, as explained below.
Benzodiazepines 
Often medial detox requires a safe and structured tapering using benzodiazepines themselves. In adjunct, Barbiturates can be used for insomnia, anxiety, and as a preventative measure for seizures, and antipsychotics may be used for delirium.
Stimulants (cocaine, methamphetamine, prescription amphetamines) 
While there is no official medication protocol for detox from stimulants, some medications can be used to treat psychological symptoms associated with withdrawal. This includes Gabapentin for pain relief, Trazodone for insomnia, and antidepressants for depression and fatigue.

What is the harm-reduction model?

The harm-reduction model is both a philosophy of treatment and public health approach towards those who misuse substances. Under this model, we are encouraged to treat those who utilize drugs with respect and compassion rather than judgment and shame, with the goal of reducing negative consequences associated with drug use. 

Rather than subscribing to an abstinence-only model, harm-reduction acknowledges that there are multiple paths to recovery and it is important to meet people where they are at. 

Principles of the harm-reduction coalition

While avoiding minimizing the dangerous and harmful effects of drug use on individuals and communities is the backbone of our work, however...
  • Drug use is a part of our world, and rather than ignore it or condemn it, communities can take steps towards limiting the negative consequences associated with it.
  • Drug use severity is on a spectrum and that various ways of using are safer than others.
  • Providing services and resources is essential for those engaging in substance use and that those who use/used to misuse substances have a voice in the creation and implementation of these programs.
  • Empowering those who use drugs themselves to share information, and support each other can be incredibly powerful.

Programs that incorporate harm reduction models can include advocacy and outreach programs, needle exchanges to prevent the spread of bloodborne pathogens, supervised injection sites to prevent overdose and accidental death, take-home Narcan (or naloxone) kits to prevent overdose, and peer support services.

How is the harm-reduction model incorporated in addiction treatment?

In a treatment program, the harm-reduction model means to understand that addiction is a disease and that addictive behavior, and “relapse” or “slips” are possible, even for those who are well-intentioned in their pursuit of treatment. Rather than this being an automatic termination from treatment, the harm-reduction model seeks to meet people where they are on their journey, and instead offer more support and treatment to help them maintain long term recovery. 

Another example is by offering Medication-Assisted Treatment (MAT) for those using opioids. This substitution program allows individuals to have fewer withdrawals, cravings, risk of relapse and ultimately leads to improved health and recovery outcomes. Individuals can utilize MAT to taper off of opioids or continue daily dosages for years. 

The harm reduction model is an evidence-based and holistic approach to improving substance misuse and related consequences for individuals, families, and communities.

Recovery Support at The Haven

At The Haven, we recognize that medically-assisted withdrawal management is only the first stage of addiction treatment and without effective treatment, does little to change long-term addictive drug use. After detoxification at The Pines, we strongly urge you to consider continuing your journey with us, through residential treatment and beyond. Call today to get started.

Tuesday, May 5, 2020

Does The Brain Have an Impact on Addiction?



There is a cultural myth that addiction is a choice. While it may be a choice to first use a substance, continuous use can have a dramatic impact on the brain and lead to a substance use disorder. 

According to Dr. George Koob, director of NIH’s National Institute on Alcohol Abuse and Alcoholism, “the brain actually changes with addiction, and it takes a good deal of work to get it back to its normal state. The more drugs or alcohol you’ve taken, the more disruptive it is to the brain.” 

A quick lesson in brain chemistry

The brain is made up of millions of cells called neurons. Neurons are responsible for sending signals throughout different parts of the brain, as well as to and from the body. When a neuron needs to send a signal, it releases a neurotransmitter to connect from one neuron to another. This process creates a neural network, where neurons can signal back and forth in a circuit. This can be a message from our brain to jump, smile, or curl our toes and the returning sensory information about the feel of the sand under our feet, or the breathtaking scenery we’re viewing. 

How do substances affect this process?

When drugs or alcohol are introduced, it interferes with neurotransmitters and therefore affects how the neurons send and receive signals. 

Different substances affect the brain in different ways. For example, depressants (like opioids or benzodiazepines) mimic neurotransmitters and activate neurons, causing abnormal signals to be sent throughout the brain. Stimulants (like cocaine or amphetamines) cause the brain to release abnormal amounts of neurotransmitters and can cause a euphoric high.

When someone uses substances and feels pleasurable effects, this is due specifically to the effects of a particularly reinforcing chemical called dopamine. Because dopamine allows the user to experience pleasure as they would after a really good meal, caring for loved ones, or having sex, they’re highly motivated to continue drug-seeking and using behavior. 

Not only does this exist on a somewhat-conscious level, this additionally changes the brain’s neural networks, creating physiological cravings, and making it easier for substance use to become a habit. 

How does this lead to addiction?

Over time and continued use, because you are providing an external source, the brain will severely decrease producing neurotransmitters on its own. This means that individuals now rely on ingesting substances to have normal levels of dopamine, or pleasure. Without them, they may feel unmotivated, helpless, and depressed. 

This rewiring of the brain causes drugs to become the priority for survival. The brain perceives drugs as more important than connection to others, success, money, even food, water, and shelter. The brain becomes physically, emotionally, and biologically dependent on the substance, and the individual becomes addicted.

What does recovery do to the brain?

While addiction can cause significant and sometimes long-term effects on the brain, it is possible to recover. 

Oftentimes when an individual stops taking a substance, they experience withdrawals as the body and brain detox from the substance. The withdrawal period depends on the substance, how long it was used for, and how often. Withdrawals can last days to sometimes months, and so it is often helpful to detox in a safe and structured environment

However, with continued abstinence and the right supports, the brain will remarkably heal itself. Not only will improvements in memory, executive functioning, and cognitive processes improve, but also the brain’s ability to find pleasure and enjoyment in activities and life again. 
Priorities are able to shift away from substances and align to the individual’s needs, wants, and values. Over time and with the right treatment, recovery from addiction is attainable and the brain’s ability to heal is possible.

Recovery at The Haven at Pismo

As a fully-equipped treatment center, we are capable of meeting you where you’re at on your journey towards recovery and provide you with the right support all along the way. As a part of our “phase program”, we can lead you right from our beautiful detox residence, The Pines, into residential care and follow that with our Partial Hospitalization or Outpatient programs. 

At The Haven, we understand how addiction has impacted, and in many ways “hijacked”, the brains of the guests who come to us to heal. Not only can we offer a plan to help the brain detox and heal from harmful substances; we also understand that through holistic healing in mind, body, and soul, you’ll have your best chance to truly experience long term recovery. 

Contact us today, no matter where you fall in the journey to recovery to experience real and lasting life change!