Fighting the Drug Epidemic

Most communities across New Hampshire have been touched by the opioid crisis that’s taken the lives of more than 400 Granite Staters last year, a majority from heroin and fentanyl.21789-113979.jpg

But one place in the Lakes Region stands out not for its significantly high overdose numbers but rather how its community is responding

If you’re doing something illegal, the last person you’d willingly call is probably the police. Well that’s not always the case in Laconia – at least when it comes to using drugs.

“What do I do? My dealer is blowing up my phone, it’s driving me crazy. What do I do?,” said Police Officer Eric Adams, who was talking about one of the many calls he gets at all hours from those battling a drug addiction in the community. Read the entire article HERE. 

Medication And Addiction

Drug treatment providers in California and elsewhere have relied for decades on abstinence and therapy to treat addicts. In recent years, they’ve turned to medication.

Faced with a worsening opiate epidemic and rising numbers of overdose deaths, policymakers are ramping up medication-assisted treatment.

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President Barack Obama at the end of April 2016 said he’d allocate more money for states to expand access to the medications. He also proposed that physicians be able to prescribe one of the most effective anti-addiction drugs, buprenorphine, to more patients.

California already plans to expand access to medications as it launches an overhaul of the state’s substance abuse treatment system for low-income residents. The state recently embarked on a five-year demonstration project on the premise that addiction is a chronic disease and should be treated as such.

While medication is not for everyone, it can be critical for some people with severe addiction, said Marlies Perez, chief of the substance use disorder compliance division for the state Department of Health Care Services. The medications, she said, “have been proven as the gold standard for really helping people recover.”

The best-known medication, methadone, blocks the effect of certain drugs and lessens withdrawal symptoms. It is highly regulated and can only be prescribed by clinics that have government approval. Buprenorphine, which can be prescribed in doctors’ offices, produces mild opioid effects while also easing withdrawal symptoms. Another medication available by prescription, naltrexone, blocks the effect of opioids.

The medications are available across the country but must be prescribed by physicians with special training. There are only about 30,000 authorized doctors nationwide, and they can only prescribe to a limited number of patients.

Obama’s proposal would allow qualified doctors to prescribe buprenorphine to 200 patients, up from 100.

That could make a big difference in California, Perez said. The state is also trying to better link treatment centers with trained prescribing doctors so that physicians can consult with one another on treatment options for their patients. “Not all physicians, even in the substance use field, have that clinical knowledge,” she said.

The use of medication in treatment conflicts with the 12-step and Narcotics Anonymous philosophy of addiction recovery, which is based on abstinence, experts said. For many, experts said, simple abstinence doesn’t work.

“You would hope that just by talking to somebody, they could get rid of their problem with drugs,” said James Sorensen, a University of California, San Francisco professor and interim director of the substance abuse and addiction medicine program at Zuckerberg San Francisco General Hospital. “The reality is, that is simply not efficient, so we look for other tools.”

Medication is one of the most successful, evidence-based treatments available, and more access should have a big impact on those with substance abuse disorders, said John Connolly, deputy director for substance abuse prevention and control for the Los Angeles County Department of Public Health. But, he cautioned medication should be used alongside more traditional treatment methods.

“The medication has tremendous effect, but it is most impactful when it is prescribed with the necessary counseling and social supports,” he said.

Stephen Kaplan, director of behavioral health and recovery services for San Mateo County, said the county has increased its use of medication. About two years ago, the county began a pilot project to prescribe naltrexone to people with severe alcoholism who hadn’t been successful in traditional treatment.

The medication reduced people’s cravings and drinking, Kaplan said. The county recently began expanding the project to include people with opiate addictions.

Kaplan said he respects providers who believe that replacing one drug with another is not true recovery. But from a policy standpoint, Kaplan said, the medications are effective and should be more integrated into overall recovery for people with substance abuse disorders.

“We need to make available to them every possible option,” he said.

Perez of the state Department of Health Care Services said she believes that Obama’s focus on the opiate epidemic — and his recognition that it is a disease and not a moral failing — helps reduce the stigma.

“That makes a huge difference in folks coming forward and looking for treatment,” she said

Recovery Check list handout

  • Accept that you have an addiction.
  • Practice honesty in your life.
  • Learn to avoid high-risk situations.
  • Learn to ask for help.
  • The most difficult path of recovery is doing it alone.
  • Practice calling friends before you have cravings.
  • Become actively involved in self-help recovery groups.
  • Go to discussion meetings and begin to share. You are not alone.
  • Get a sponsor and do step work.
  • Get rid of using friends.
  • Make time for you and your recovery.
  • Celebrate your small victories.
  • Practice saying no.
  • Take better care of yourself.
  • Develop healthy eating and sleeping habits.
  • Learn how to relax and let go of stress.
  • Discover how to have fun clean and sober.
  • Make new recovery friends and bring them into your life.
  • Deal with cravings by “playing the tape forward”; consequences.
  • Find ways to distract yourself when you have cravings.
  • Physical activity helps many aspects of recovery.
  • Deal with post-acute withdrawal symptoms.
  • Develop strategies for social environments where people use.
  • Keep a gratitude list of your recovery, your life, and people.
  • Say goodbye to your addiction.
  • Develop tolerance and compassion for others and for yourself.
  • Begin to give back/help others once you have a solid recovery.
  • See yourself as a non-user.

thinking

I have been teaching anger management groups for a while using a combination of psycho-educational and process oriented techniques. For recovery groups anger is often listed in the top 5 reasons people report relapsing. One of the successful techniques of managing anger and other emotions is to identify you go to mode of thinking. Below is 1 hand out I often use. We go over the and out, and I ask folks to chose their one or two go to thinking styles and give examples in relation to anger. 1510499_10152095399702618_1945865276_n

 

All or nothing thinking

  • Be specific, focus on the behavior only and describe it with precision

Jumping to conclusions

  • Pay attention and catch yourself making the assumptions
  • Keep an open mind to other possibilities

Should statements

  • Describe what you want or would like. Then if it doesn’t happen you

can be frustrated/disappointed but less likely to feel righteous anger

Blaming

  • Forget the other person, they’re not going to do anything different

Labelling

  • Don’t make judgments about the other person

Overgeneralization

  • Make a conscious effort to look for exceptions

Magnification

  • How bad is it really? Look at the whole picture
  • Be very accurate & precise in your answermsclip-010.jpg

Rough Road/Path photos

I have been involved in facilitating groups for decades. One of the tools I use for groups of adults, teens, or children are photos. I use photos as a way for folks to become familiar and used to talking and sharing in a group. As a way to indirectly share something of themselves by talking about an image/photo. As a way to begin a conversation about larger issues or deeper issues.

One set of photos I use are Rough Road/Path photos with alcohol addicts and heroin addicts in the beginning of recovery. I spread the photos out on a table and ask the group (usually 10 to 15 men) to pick out one photo that represents their journey in the week or weeks before they came into rehab. Once everyone has chosen a photo I ask them to (one at a time) hold up the photo, describe the photo and why they chose it. The descriptions and stories they tell come from them, their experiences and begin the process of revealing a bit about their lives.

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