Runners have known it for years: Exercise helps curb the craving for addictive drugs. It’s no different for animals: Rats in cages with running wheels show less interest in amphetamine infusions than rats without exercise options. A recentVanderbilt Universitystudy published in the journal PLoS ONEshowed that heavy marijuana smokers (6 joints per day) with no interest in quitting reported less cannabis use after a modest two-week exercise regimen. In fact, the runner’s high and the cannabis high are more similar than anybody might have previously imagined. Compared to endorphins—the usual explanation for the runner’s high--the painkilling effect produced by the brain’s internal cannabis compounds is much more consistent with the demands of exercise. While high doses of marijuana tend to have a sedating effect, low doses induce activity or hyperactivity. Physical activity may promote cell growth in key areas of the brain involved in addiction, helping to calm the neural whirlwind of withdrawal and craving.
As with any and all issues, my general responses here do not replace individual support and should not be considered medical management for any individual or family. Any answers here are for informational purposes only. Personal treatment, interventions and case management are between you and your medical care providers.
That said, as a general rule, treatment is best considered as a family issue and not just rehabilitation for the child. Most programs include various aspects of family sessions, family training and psychological education, family support, and peer-to-peer counsel. This might include face-to-face forums, on-line chat and support forums.
Outside of programmatic support, personal support is helpful, including personal therapy, peer support, co-dependency support groups and groups such as NAMI (the National Alliance on Mental Illness), which supports families dealing with the co-occurring disorders of mental illness and substance abuse.
As your family begins its relationship with recovery, it is important to remember that each person and each family navigates recovery differently. The intention of residential treatment is to return positive control back to the client, teach behavioral and coping skills and create positive alternatives for stress management, addictive behaviors, as well as identify and address underlying emotional issues. It is helpful that family members use the time apart for their own healing, learning and recovery. Find restorative time and rest for yourself, carve out time for positive experiences with other family members, and obtain professional support for yourself if you have not already. Engage in your son’s program, learn about addiction, co-occurring disorders and cross addiction, and fight isolation by participating in peer to peer support.
It is hard to predict re-entry needs this early in your son’s recovery but, in general, moving from a residential program back home is a process that will require additional support. Lining up services for yourself and your child in anticipation of his return can provide a system-of-care safety net.
Residential treatment provides structure 24/7; returning to a less structured environment can be a challenge to all. Setting clear ground rules and expectations should be part of your son’s exit from rehab and of your re-entry protocols, and these should inform your dialogue with your child upon his return. Establishing a clear sense of routine and expectation is important. Some families utilize a step-down process where children return into an intensive outpatient program or a sober living environment before their full return back home. Typically, inpatient programs will provide guidance in these transitions.
Re-entry into the family and home environment can be a particularly triggering time so making sure services are in place for yourself, other family members and your son to cushion the stressors of return.
Doreen Maller, MFT, PhD, began her practice in community mental health with a specialty in high-risk children and their families, including numerous families coping with addiction issues. Dr. Maller is the series editor of the three-volume Praeger Handbook of Community Mental Health Practice. See www.doreenmaller.com
Amid Cape Cod’s coastal lighthouses, quaint hamlets and seafood shacks, lives a lost generation. Be it lack of opportunity or simple boredom, white and mostly middle-class twentysomethings—locals of so-called Cape Nod—are blotting out their conscious life with constant shots of heroin. But if you follow the headlines, this phenomenon is happening in towns all over the country. Heroin, it seems, is now as ordinary and American as apple pie.
Which is why I felt a sense of urgency watching Oscar winner Steven Okazaki’s latest documentary, Heroin: Cape Cod, USA. It is totally wracking, but necessary. At times it felt like watching gruesome surgery through a two-way mirror, or helplessly stumbling upon a brutal car accident. I simultaneously feared and desired to watch the eight millennial participants barbarically wrap white iPhone wires around their wrists, dig for veins, only to nod their supposed best days away in their childhood bedrooms.
When I began my life in sobriety, I was ashamed and worried about what the people around me would think. Eventually, I became comfortable with my sobriety, and in turn I became more open about the fact that I was in recovery. I found that most, if not all, the people that I knew were supportive of my journey, and some were intrigued. Those that were intrigued began to ask questions, either for their own struggles, or for the struggles of a "friend". People would ask about my drug of choice, when or why I decided to seek help, and how did I actually come out of the abyss that is addiction. I am very open, maybe sometimes too open, about what it was like and what it is like now, and that I recovered in the rooms of Alcoholics Anonymous.
When I tell a person that thinks that they may be struggling with addiction or alcoholism how I got sober, they always seem to be surprised that it was through a 12-step program, rather than by some miracle of science. I tell of going through detox and then in-patient rehabilitation for months, all the while seeing counselors and case managers and therapists, and of course, going to meetings, obtaining a sponsor, and working the 12 steps. Some people literally scoff. "I've tried that, it's not for me." "I don't think my problem is that bad." "I just need to figure out how to control it." "Isn't that a cult?" "I don't believe in God, that program shoves God down your throat."
What is baffling to me about these reactions, is the fact that I'm in recovery, and living life as a happy, productive member of society, and the person on the other side of the conversation is actively using or drinking enough to think that they may need help, but they are unwilling to take certain steps to recover. Initially these responses are hard for me to take, and my first reaction is to say "Then why are you asking?". I have to remember that at one point in time, I too was unwilling to take direction.
When I went into rehab in August of 2013, I had no idea what was in store for me. All I knew at the time was that I was in desperate need of a life change, and my drinking and using were out of control. Had I been told I was going to have to put forth an immense amount of work not just to get sober, but to stay sober, I probably wouldn't have made the most important step of my life. Even after detox and rehab, I was still unwilling to let go of certain ideas, and 15 months after I worked so hard to kick all my habits, I relapsed.
Unfortunately, taking the path of least resistance is no longer suitable for me. As far back as I can remember, I did the bare minimum to get by in life. I did not want to work, and somehow I felt entitled, like the world owed me something. It was extremely hard, and it took a long time, years actually, for me to finally realize that my way does not work, and it may be time for me to take suggestion from others that have been more successful in their sobriety than I have been in my own.
Taking suggestion is hard. I know for me, I just want to do what I want to do, and I could be content in my own bubble, running on self-will. When I finally started listening instead of just hearing, my mind opened to many new ideas. I have to practice contrary action every day, other wise I'll walk down the wrong path again and again. It's a hard pill to swallow, realizing your way is the wrong way, but once you accept the fact that you don't know best, life becomes so simple
Being of service and helping others is one of the primary purposes of the program in which I found salvation. Helping those that are struggling in a way that I was struggling a very short time ago keeps me sober today. I still have problems with control, and just want those that ask for help to do exactly what I suggest they do, and that is a defect of my character that I will have to work on for a long time to come. If you are struggling with addiction or alcoholism, reach out and ask for help. No one can tell you what will work for you, but the key to success is just being willing to be willing.
If you or someone you love are struggling with addiction visit www.abetterliferecovery.com
Addiction is a selfish disease. Addiction is indiscriminate in its victims. Like a tidal wave it appears, often without warning or provocation, and destroys everything in its path, leaving its victims bewildered and never quite the same. This indiscriminate disease is also a selfish one. Important for us to remember as it is, the fact that ‘addiction is selfish’ is not as easy thing for anyone to accept. It may not be even be obvious, but it is true. It affects not only the user, but those around us. The selfishness of this disease leaves us incapable of caring for others while we are also incapable of caring for ourselves, or even being cared for at all.
The Oxford Dictionaries defines the word ‘selfish’ as follows:
“: lacking consideration for others; concerned chiefly with one’s own personal profit or pleasure.”
Webster’s Dictionary defines the word ‘selfish’ in another way:
“: having or showing concern only for yourself and not the needs of other people.”
We put our addiction above all else. We may take care of our personal obligations, but these obligations are only fulfilled after our primary goal has been reached. Ironically, addicts have very few goals, and often, just one: to use. Before we can do anything else, we must use. Using takes up all of our time. We may need to use in order to feel ‘normal’ enough to complete our obligations. We may need to meet up with someone to whom we owe money. We may need to work an extra shift to make up for money we spent. We may be sick, and waiting for relief, and therefore we are late for our obligations. Before we are concerned with anything else, we handle our desire and our need to use. This is the way addiction works. However it presents itself, addiction comes first. For many of us, it has taken up many precious moments of our lives.
Something takes us away from our families, our friends, our jobs, our schools, our entire lives. Something requires our time and attention. Something takes away our free time. We become unavailable to the people who love us, the people who need us. This is selfish. The irony of the selfishness of addiction is that we are not concerned with ourselves; we are concerned with feeding our need. In sobriety, I take care of myself far more than I ever did when I was using. Ironically, I am a far less selfish person. This is the irony of the selfishness of addiction. When using, I selfishly focused on my own desire and need: the desire, and the need, to use. Even when I didn’t want to use, I had to use, and I took care of that before anything else. Before I looked in the mirror, before I took care of my own real basic needs: food, shelter, income, love; before I took care of myself, I took care of my addiction. Those who love me could not understand how I could be so selfish, and I did not understand how they couldn’t see that I was the farthest thing from my mind. It was the drug, only the drug, always the drug. That was my only concern. I had no hobbies, I had no free time; my hobby was using, and my free time was spent the same.
While using, we may not give our attention to friends, loved ones, a job, school, or other venues. We are busy caring for our own wants and needs: using. When we are addicted, using is our only true want or need. We need to pay our rent. We need a new coat for winter. We need food in the pantry. We need to spend time with our loved ones. We need to clean our house. We need to bathe, do laundry, feed ourselves. But none of this is taken care of until we get our fix, and in this way, we are selfish. Those who love us want us to be ourselves, be the person they know. Those who love us want us around and want us to be the person they love, but addiction robs us of everything, especially of ourselves.
For the addict who has found a new way to live, rebuilding relationships is a difficult task. Many who love us feel we have not been present in their lives for so long, other than when we have caused pain and disappointment. Some may have resentments and feel bitter towards us for our selfishness. Recovery has provided an opportunity for many addicts to care for themselves in ways we have never known. When we care for ourselves, we are more capable of caring for others. The watermark of addiction may still be visible in our lives. It is the point where the tidal wave crested, and then flowed back to sea. Let this be a reminder of where we never have to go again, and how things never have to be.
We still don’t get it right when it comes to understanding addiction. The most recent example of our failure to appreciate what makes addictive behavior so compelling is the burgeoning widespread addiction to the synthetic opiate oxycodone—with all of its tragic consequences. We keep reacting as if the problem is the potency of the drug itself that leads to the escalation of use and, unfortunately, sometimes progression to the more deadly intravenous use of heroin. The examples that are most frequently encountered are the instances where oxycodone was initially prescribed for some medical or surgical problem, but then the person becomes “hooked.” As the psychoanalyst Sandor Rado instructed at the turn of the 20th century, it is not the drug but the urge to use it that causes addiction. Similarly, Norman Zinberg pointed out that it is the drug interacting with the person and their surroundings—i.e., drug, set, and setting—that leads to addiction. I offer another example that has recently caught my attention as yet another mischaracterization and misunderstanding of what addiction is about. This one has to do with recent clinician warnings that addicted individuals on the street and in correctional settings are seeking out Seroquel, a powerful antipsychotic drug, to “get high.” This is just one more pejorative and stigmatizing misinterpretation of addiction.
The generic name for Seroquel is quetiapine, thus the use of the street term “Q Ball.” While the street name of the drug draws a parallel to street use of “speedball” injections—an intravenous admixture of opiate and cocaine—the presumed intentions behind the misuse of the two drugs couldn’t be more different. You don’t get “high” on Seroquel—you get tranquilized, you get relief from something so disturbing that it makes you go to great lengths to shut it off.
As my colleagues and I have written in the past, I believe that substance addiction “functions as a compensatory means to modulate distressful affects and self-soothe from unmanageable psychological states” and that substance misusers are unsuccessful in managing negative emotional states on their own, without the use of substances. Instead, “substance abusers use drug actions, both physiological and psychological effects, to regulate distressful emotions and achieve an emotional stability.” I view substance addiction and misuse as an interplay between the properties of the drug of choice and the “inner states of psychological suffering and personality organization” of the user.
For example, opiates (e.g., heroin, codeine, and oxycodone), which are used medically for pain management, may similarly be used by persons who have difficulty managing their rage and aggression, which I posit are “often linked back to earlier traumatic exposure to violence and aggression.” In this manner, “opiate abuse functions as a temporarily adaptive response that mutes and attenuates the rage and aggression.”
As another example, the drug effects of cocaine use may include elevated mood, improved confidence and an enhancement of feelings of self-esteem. There is evidence to suggest that “low-energy individuals use cocaine because they do not possess an adequate degree of psychological capacity to relieve themselves from the feelings of boredom, emptiness, and fatigue state, whereas high-energy individuals use cocaine because of their magnified need for elated sensations. Cocaine users' need to regulate inner emptiness, boredom, and depressive states or to maintain restlessness draw them to the powerful, energizing effects of cocaine.”
Finally, alcohol misusers frequently present with “rigidly overcontained, constricted emotions. To avoid distressful affects, emotions are isolated and “cut off” from abusers’ awareness through the use of rigid defenses, leaving the feelings of emptiness and isolation.” Alcohol, a depressant with sedating and relaxing qualities, softens these rigid defenses and provides relief from these constricted emotions.
So I argue that simplified explanations for the seductiveness of drugs are insufficient explanations for the development of addiction, whether it is alcohol, cocaine, marijuana, oxycodone or Seroquel. The use, misuse and sometimes dependence on these substances are driven by a meaningful and purposeful connection between the inner state of the individual and the effects of the person’s drug of choice. As psychoanalystDebra Rothschild has pointed out, in addiction theory and practice “the object of study should be the individual rather than the substance." Here, in what follows I offer a perspective on some of the psychodynamic determinants that make addiction so compelling.
With respect to Seroquel, it could be argued that since it is sedating, individuals are drawn to it to help them sleep. More often, what is not sufficiently appreciated in these cases is why individuals seek these drugs out so persistently. Indeed, if it is for sleep, we do not often enough ask what keeps people from sleep. And in the case of inmates who seek it out for reasons beyond sleep, what could its appeal be? Is it possible that Seroquel does for them what is does for the more seriously mentally ill?
The term “sedative” does not do justice to the effects of medications like Seroquel. Medications in this category are powerful agents to quell states of agitation, intense fear and uncontrollable rage and violent feelings. Recent reports, for example, indicate that quetiapine is effective in treating patients who suffer with borderline personality, a condition in which the aforementioned intense painful emotions predominate. Opiate pain medications have similar actions. As a returning combat veteran suffering with all the violent feelings of rage and anger associated with his PTSD put it, “I don’t use the heroin to get high; I use it to feel normal.” These feeling states can keep us awake and tossing, or can cause a person such discomfort as to want to “zone out.” Pharmaceuticals such as Seroquel are powerful calming agents, which in good part explains their appeal. Yet unlike addictive drugs, Seroquel does not cause tolerance (the need to use more to get the same effect) or dramatic withdrawal symptoms when the drug is discontinued.
Despite the fact that individuals who experience extreme physical trauma (e.g., painful burn conditions), and are treated with opiate pain killers, in the largest majority of instances do not become addicted. What more likely happens is a vulnerable person discovers that such drugs counter more than the feelings of physical pain. Rather, the drugs grab ahold of susceptible individuals because knowingly or unknowingly they suffer with co-existing psychiatric conditions and painful psychological feelings and states. A recovering alcoholic physician, a reserved and reticent man, described himself as a “born-again” isolationist, and in exquisite and colorful language, described in group therapy the preparation of a gin martini—the scent of the bitters, the crackling of the ice, etc. Then he exuberantly exclaimed, “I could feel free, be one of the guys, I could join the human race!”
Addictive drugs, as powerfully compelling as they can be, are not universally appealing. Whether in non-medical experimentation or legitimate medical use, most individuals exposed to these drugs do not become addicted. We still tend to explain the appeal of addictive drugs on the basis of reward and pleasure (“the high”) that can be obtained from these drugs. Such explanations derive from old and new theories about addiction. Freud and his early followers emphasized pleasure drives (and to some extent destructive drives), and modern neuroscientists, examining where the drugs act in the brain explain that addictive drugs “hijack” the pleasure and reward centers of the brain.
Then if it is not pleasure or physical pain that causes addiction, why are some of us more vulnerable than others to addiction? My colleagues and I at Cambridge Hospital have collectively spent more than six decades trying to explore, understand, and explain the powerfully compelling nature of addiction. Beyond biological addictive mechanisms of tolerance and withdrawal, and genetic predispositions, we have had enough extensive clinical evidence backed by empirical studies to conclude that addictive disorders are related to the powerful effects addictive drugs have on a range of painful feeling states, thus giving them their appeal. For example, there is data indicating that there is a far disproportionately high co-occurrence of addictive disorders in conditions such as post-traumatic stress disorder, bipolar disorder, attention deficit disorder, and schizophrenia, conditions which have unimaginable emotional pain associated with them, which we understand makes such people self-medicate. And one need not suffer with a painful psychiatric condition, however, to find addictive drugs appealing. Those who endure excessive painful or intolerable emotions are also more likely to find inordinate relief and comfort in addictive drugs. If there is “reward” associated with addictions, it is less the reward of pleasure, but more the reward of relief from intense psychological suffering.
Dr. Khantzian is Professor of Psychiatry, part time, Harvard Medical School in Boston, and President and Chairman, Board of Directors, Physician Health Services of the Massachusetts Medical Society in Waltham, Mass. He is in private practice and specializes in addiction psychiatry.
For original article visit: https://www.thefix.com/why-some-people-more-vulnerable-addiction
At A Better Life Recovery, we believe that the gifts and skills of modern science can contribute significantly to the 12-step process of spiritual transformation.
Recently there have been some Tweets and other opinions from folks out there on the Internet who believe that traditional addiction treatment is ineffective. They often point to high relapse rates, high costs, etc. Some even advance the notion that “disease concept” of addiction is hogwash and it remains largely a moral, ethical, and criminal symptom of weak character and self-control.
The same people also often suggest that all that is needed instead of traditional treatment is some kind of injection or magic pill that will keep addicts (including alcoholics) from using. In short many people believe that a technological or scientific “cure” is the ultimate solution.
Unfortunately addiction is a disease that displays an array of physical, mental, emotional and other symptoms. Moreover the vast majority of those that have recovered since the birth of AA in 1935 would no doubt agree that at its core addiction is fundamentally a spiritual malady.
There is no way around the central need for a spiritual solution.
To paraphrase from the book Alcoholics Anonymous, “We hope one day science finds a cure for addiction, but it hasn’t done so yet.” However, this same book also speaks to the important role of science and health care professionals in contributing to the battle against addiction.
To paraphrase from the book Alcoholics Anonymous, “We hope one day science finds a cure for addiction, but it hasn’t done so yet.”
However, the “Big Book” also speaks to the important role of science and health care professionals in contributing to the battle against addiction:
“But this does not mean that we disregard human health measures. God has abundantly supplied this world with fine doctors, psychologists, and practitioners of various kinds. Do not hesitate to take your health problems to such persons. Most of them give freely of themselves, that their fellows may enjoy sound minds and bodies. Try to remember that though God has wrought miracles among us, we should never belittle a good doctor or psychiatrist. Their services are often indispensable in treating a newcomer and in following his case after.”
- Alcoholics Anonymous, p. 133
The idea that some new found chemical molecule can cure addiction is analogous to the notion that putting criminals in prison will cause a psychic change in criminal thinking and behavior.
Albert Einstein, perhaps the greatest scientific mind in history, found deeper meaning in his theories of special and general relativity. The precision and elegance of his mathematical equations led Einstein to conclude that an intelligent force behind the creation and continuation of all matter and energy. Simply put his scientific vision led him to become a deeply spiritual person.
At A Better Life Recovery we believe that science and faith are not opposing concepts, but harmonious allies in the fight against addiction. We believe that modern science, technology, and medicine have important contributions to make in
Some Useful Scientific Tools
Here are some of the tools of modern science and medicine used by A Better Life Recovery. Note that we do not utilize and are philosophically opposed to the use of synthetic opiate substitutes for heroin such as Methadone and Suboxone.
Vivitrol: Vivitrol is a slow release injection form of Naltrexone, an opiate and alcohol receptor blocking medication. A single Vivitrol injection essential “locks” receptor cells in the brain from feeling the effects of opiates and/or alcohol. In short, a recovering addict who has had a Vivitrol injection simply can’t get high for the next 30 days or so.
A Better Life Recovery endorses the selective use of Vivitrol when appropriate as a component of an overall treatment regimen. The value of such medical tools is in their ability to assist in reaching a true, long-term solution. They do so by giving clients some temporary relief and breathing room while they begin a journey of lasting spiritual progress.
Vivitrol does not solve the core desire among addicts to use and get high; it just temporarily deprives them of the result of using. If an addict does not undergo profound spiritual, psychological and emotional change, he/she will often simply stop taking Vivitrol, or switch to a substance not blocked by Vivitrol, so that they can once again get loaded.
Here are some specific reasons why Vivitrol is a useful tool especially in the early stages of addiction treatment:
· By preventing an addict from getting high if he uses, Vivitrol may help prevent the addict from suffering some the additional serious consequences that result from behavior and choices made while high.
· Vivitrol possesses a psychological deterrent in that an addict who has had injection consciously is informed and aware that he simply can’t get high, so why bother.
· Studies have shown that Vivitrol actually reduces the craving sensations common to addicts during early detoxification and treatment.
Once study on Vivitrol is particularly worthy of mention (article 1 below). The study concluded that the rate of continuous abstinence at end of study was 32% for patients on Vivitrol versus 11% for a control group. It should be noted that all the patients received counseling during the study; this implies that Vivitrol can indeed be a helpful tool in support of traditional addiction counseling.
Please see the following publications and scientific articles for more information on Vivitrol.
1. The Journal of Clinical Psychopharmacology, October 2007 edition, “Efficacy of Extended-Release Naltrexone in Alcohol-Dependent Patients Who Are Abstinent Before Treatment.”
2. The Lancet, April 28, 2011, “Injectable extended-release naltrexone for opioid dependence: a double-blind, placebo-controlled, multicenter randomized trial.”
3. SAMSHA Advisory, Winter 2012, Volume 11, Issue 1, “An Introduction to Extended-Release Injectable Naltrexone for the Treatment of People with Opioid Dependence.”
On the downside, like any medication Vivitrol does have some side effects. Another negative is that in rare cases alcoholics and addicts have been known to ingest large amounts of substances in the hope of overwhelming the blocking effects of Vivitrol, leading to overdoses.
Other Slow Release Injections: Patients on certain psych medications such as Haldol and Depakote often struggle with taking daily pills as prescribed, and thereby never obtain the desired relief and mood stability these medications are intended to provide. At A Better Life Recovery, some of our clients have experienced substantial benefits by receiving monthly, slow-release injections of these psych meds.
Anti-Depressants: Addicts often present with co-occurring issues such as depression and anxiety. Careful prescription of appropriate anti-depressants by a licensed psychiatrist can often give clients much needed relief and “breathing room” so they can focus on their addiction counseling program. A Better Life Recovery works closely with a Psychiatrist who specializes in addiction issues; all of our clients receive an initial consultation and follow-up visits as needed to determine if anti-depressants are warranted and to calibrate them as needed.
Prescription Sleep Medications: People in the early stages of sobriety and recovery are often faced with serious sleep deprivation issues. Carefully prescribed non-narcotic, non-addictive sleep medication can often help clients get much needed sleep so their minds and bodies can properly function as they begin their journey of recovery.
These are just a few of the many tools modern science has made available in the fight against addiction. A Better Life Recovery will continue to seek the input of our colleagues in medicine and science regarding any and all new means supplementing and improving our treatment program with cutting-edge innovations. Addiction is a formidable and resilient foe; the fight against it will continue to require the full attention of the brightest minds and most dedicated people on the planet.
- Paul Stackhouse, December 2015
(Mr. Stackhouse is one of the founders of A Better Life Recovery. He holds an A.B. degree in Economics from Harvard University and an MBA degree from the University of Chicago. He currently serves as Director of Finance and Administration.)
Through trial and error, I've learned how to apply ACOA to the two most primary triggers.
It’s a common refrain every year during the holidays: Dealing with your family, particularly parents, can be a real nightmare. There’s the usual concerns. Will they talk to you like you’re still 12? How long until your weird uncle says something racist? But for anyone from an alcoholic family, the concern gets piled upon: How long til someone triggers one of those character defects from no-longer-useful childhood survival skills? What if one of those parents is still drinking? How long til we’re screaming at each other?
Coming up as an angst-filled teen in the late ‘90s, grunge and alternative rock were a regular staple in my musical diet. I remember being around 11 years old when I discovered Nirvana and fell in love with the voice of Kurt Cobain, a man who would be my introduction to musical loss. At 12 years old, I mourned for Kurt as much as I could. When I saw older kids in school weeping and congregating to memorialize the fallen rock star, I got it, but I didn’t get it. Until now.
In three days, I’ll be 33 years old, but for tonight, I am 17 again and the death of singer/musician Scott Weiland has left me gutted and vacillating in a thick fog of nostalgia, sorrow and anger.
“…Vivitrol is a valuable addition to the recovery toolbox, along with methadone and buprenorphine…medical research unequivocally shows that most individuals addicted to opiates require some form of medication to recover from their addiction, a chronic brain disease…Vivitrol, like any other medication for opioid dependence, must be accompanied by a firm commitment to recovery, including substance abuse counseling, outpatient programs and support systems.
–Dr. Mark Publicker, President, Northeast Society of Addiction Medicine as reported by the Bangor Daily News August 27, 2014 in article “Once-a-month shot that blocks high from opiates making inroads in Maine.”
Most people are unfamiliar with the injectable medication Vivitrol and how it used in the treatment of opiate addiction. While there is no generic available for Vivitrol, there are oral medications that contain the same ingredient. The oral version is available as the generic naltrexone and may also be known as ReVia.
The following questions and answers are provided to educate, dispel myths and familiarize people with Vivitrol and its use in opiate treatment. As always, if you have any additional questions or would like to share your comments you can always contact Center for Behavioral Health or any of our individual Treatment Locations.
What is opioid dependence?
Opioids, such as some prescription pain medications or heroin, attach to the opioid receptors in the brain, which stimulate the release of dopamine and produce pleasurable feelings. When the opioid eventually detaches from the receptors, people experience withdrawal and cravings and have a strong desire to repeat the experience. The need to satisfy cravings or avoid withdrawal can be so intense that people who want to stop taking opioids find this difficult to do. Or, they may find themselves doing things they would not ordinarily do in order to obtain more of the drug they crave. For this reason, even though opioid dependence is a medical condition and not a moral failing, it can drive behavior.
Drug use often begins as a choice, but frequent use can cause the brain cells to change the way they work. The brain is re-set to think that the drug is necessary for survival. Researchers have discovered that many drugs, including opioids, cause long-term changes in the brain. These changes can cause people to have cravings years after they stop taking drugs. Research has shown that addiction is a chronic, relapsing brain disease, but treatment can help achieve recovery.
What is Vivitrol?
Vivitrol is one of the newest medications available and can treat both opiate and alcohol addiction. It blocks other opioids from acting on the receptors in the brain and can also help ease drug cravings. By blocking the effects of other opioids it takes away the pleasurable effect, which can help with preventing relapse. Although it is not fully understood as to why an opioid antagonist works in treating alcoholism, it is believed that Vivitrol blocks the pleasurable effects of alcohol by blocking the release of endorphins caused by alcohol. This treatment can help you stop misusing opioids and alcohol and, when combined with counseling, can help you rebuild your life.
What is an opioid antagonist?
An antagonist is a non-opioid that binds to opioid receptors in the brain. The way different opioids work can be explained using a lock and key example. Receptors are like a lock to a door. Only the right key will fit the lock, and only opioid-like drugs fit opioid receptors. With a full opioid agonist such as oxycodone, hydrocodone, morphine, or heroin, the key fits the lock, opens the door wide, and produces full opioid effects (the feeling of euphoria, or being high, as well as the side effects). With an antagonist, such as Vivitrol, the key fits the lock but does not open the door at all, it simply blocks other keys from fitting the lock.
How effective is Vivitrol treatment?
Studies have shown that opioid-dependent patients who received counseling and Vivitrol had significantly more days of complete abstinence, stayed in treatment longer, reported less craving, and were less likely to relapse to physical dependence. Complete abstinence was defined as having a negative urine drug test for opioids and no self-reported opioid use. Craving was measured by self-reported “need for opioids”.
In a study of alcohol-dependent patients participating in counseling plus Vivitrol, patients had significantly fewer heavy drinking days (defined as a self-report of 5 or more drinks on a given day for males and 4 or more drinks for females). A small group of alcohol-dependent patients who completely stopped drinking one week prior to their first dose of Vivitrol and had counseling had significantly fewer drinking days and more success maintaining complete abstinence.
How does Vivitrol work?
Vivitrol is an opiate antagonist with a series of actions that make it possible to block cravings and the pleasurable effects of opioids and alcohol. Vivitrol binds to the opioid receptors in the brain, produces no opioid effects, and does not allow other opioids to enter. Because Vivitrol is an antagonist it will cause withdrawal if you still have any opiates in your system when you take the medication. For this reason, you will need to have gone through detoxification prior to starting the medicine and have ideally not taken any opiates for 7 to 14 days before your first Vivitrol injection. While it is not required for you to stop drinking prior to your first injection, research has shown that patients have a better response to the medication if they stop drinking at least one week prior to their first Vivitrol injection.
Once you have received an injection of Vivitrol, the medication acts on the receptors in the brain causing the blocking effect. This effect will slowly decrease over time, allowing you to only have to receive the medication once per month.
Is Vivitrol addictive?
Because Vivitrol is a non-opioid, an antagonist, it is not addictive nor does dependence on the medication develop.
How long does treatment take?
You and your treatment team decide what will be an appropriate length of treatment to ensure the best outcome for you. Although short-term treatment may be an effective option for some people, it may not allow others enough time to address the psychological and behavioral components of their disease. Since physical dependence is only part of opioid dependence, the chances of relapsing can be higher with short-term treatment because patients have less time to learn the skills necessary to maintain an opioid-free lifestyle. There is no risk of withdrawal when Vivitrol is stopped; however, you are still encouraged to talk with your treatment team about any plans to discontinue treatment so they may assist you with your relapse prevention plan. Treatment with Vivitrol for as long as you need, combined with counseling and support, can often increase the level of treatment success.
What will Vivitrol treatment be like?
Please call our individual treatment locations to speak with a professional counselor that specializes in opioid addiction to book an appointment with our treatment team. On your first visit, the treatment providers; including a doctor, a nurse and a counselor will ask questions about use in order to provide the best treatment. If it is determined that Vivitrol is appropriate for you, the treatment team will take the necessary steps to get the medication and a nurse will give you the Vivitrol injection. You may be asked to wait for a period of time so staff can monitor you for any adverse effects. While there are some side effects to Vivitrol, they are usually mild and go away fairly quickly.