Wednesday, October 17, 2018

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Valentine’s Day Special Report: Where Has The Love Gone For Chronic Relapsers?

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How chronic relapsers are getting swept under the carpet and what they can do to find sustainable recovery!

Years ago a gentleman by the name of Todd (not his real name) enrolled in my program at the center I once owned in North Miami Beach. By all outward appearances Todd exhibited a normal middle-class, married guy image. He wore a suit to work every day and even owned a successful business. What you could never see or even imagine for that matter is that behind his smooth veneer Todd’s was a raging addict hooked on pharmaceutical painkillers.

Although Todd experimented with cocaine in his late teens, he was by no means addicted to it. In his early twenties Todd injured his knee in a pick-up basketball game. His doctor wrote a prescription for a commonly prescribed opiate painkiller, Percodan (Oxycodone). Todd got hooked. Soon he found himself taking prescription opiate painkillers not necessarily to get high, but rather to get normal.

The human body produces opiates naturally. When it becomes acclimated to opiates from external sources, the body ceases its own production. It also builds up a tolerance, constantly requiring more opiates each time to maintain levels and get the desired effect. The brain and body are being seriously damaged during this course. When the levels are not met, the addict’s body immediately goes into painful and debilitating withdrawal. Without opioids, Todd felt as though he was not able function.

This was the genesis of a twenty-year prescription opiate addiction. Todd was the most purest definition of a chronic relapser that I can ever imagine. He was in and out of twenty-three addiction rehabilitation programs before I’d met him and helped him find sustainable recovery.

I wish I could say that Todd’s experience is the exception, but it is not. According to the CDC in August 2017; “The supply of prescription opioids remains high in the U.S. An estimated 1 out of 5 patients with non-cancer pain or pain-related diagnoses are prescribed opioids in office-based settings.” Just like in Todd’s case, doctors continue to prescribe deadly opioids at an alarmingly dangerous rate.

Moreover, reliable scientific studies have shown that eight out of ten heroin addicts got their start with prescription opioids before transitioning to the less expensive and readily available heroin.

Todd once told me he found doctors to fall in one of two camps, being either naive or apathetic with very little in-between. “Some doctors just did not get it” Todd said. “They actually took the time to talk with me and try to get a handle on my phantom pain. Others simply didn’t care. They’d write a prescription as fast as they could and then it was off to the next patient. It was as if they had a daily quota to meet.”

With that being said, does anyone still question why we’re still deeply entrenched in the worst opioid epidemic known to man?

  • – According to a survey by the National Safety Council (NSC), 99 percent of doctors are prescribing highly addictive opioid medicines for longer than the recommended three-day period, and twenty-three percent prescribe at least a month’s worth of opioids,
  • – FDA approves Oxys for kids 11 – 16 years old (grooming the next generation of addicts?),
  • – Although the DEA has cut the aggregate production quotas for a variety of Schedule I and II drugs in recent years, current levels of lethal opioid painkillers being produced and brought into the U.S. market are still many times higher than pre-epidemic levels
  • – 1 out of 5 patients with non-cancer pain or pain-related diagnoses walk out of doctors’ offices with a prescription for opioids, –Opioid overdoses contributed to the declined of US life expectancy – the first time in decades

Dispite all of this Doctors still wrote 240 million prescriptions for opioids in 2016 – roughly equivalent to one bottle full of poisonous opioid painkillers for every American adult.

The U.S. government and our healthcare system’s answer for this deadly opioid epidemic is – believe it or not – more opioids. This is akin to put out a fire with a torch! In their infinite wisdom, the people in government charged with keeping us safe decided that the best treatment for an opioid addict is Suboxone, an FDA approved opioid whose research was financed by the U.S. government. If this wasn’t so serious it would be comical.

A sane, rational and slightly intuitive person might think that we as Americans might have been better served by investing that money into promising new cutting edge ‘non- opioid’ evidenced-based therapies that have been slow rolled because of lack of funding. After all, most of our addiction treatment programs are based in a therapy developed in the 1930s with little or no conformance to the more recent scientifically-proven effective therapies discovered since. By far, most of today’s 30 day model programs are simply not designed for a drug with the intensity of opioids.

Is there any wonder why more opioid addicts relapse than those who find recovery after treatment?!

The sad reality is that we have known for quite some time how to effectively treat opioid addiction. State medical boards began developing a program in the 60s exclusively for their doctors who had succumbed to addiction. Today, the Physicians Heath Program (PHP) has a 79% success rate among doctors, dentists, veterinarians and pharmacists – meaning that 79% of participants had no positive test for either alcohol or drugs over the 5-year period of intensive monitoring after treatment.

One of the core principles and key drivers of the PHP’s success is a minimum requirement of 90 days residential treatment – that can often lead to 180 days – and comprehensive long term outpatient programs. This makes perfect sense to anyone who has been even remotely involved in ‘hands on’ addiction treatment – the 30 day treatment model is simply inefficient in treating the powerful effects of opioids.

This is why comprehensive after treatment programs are now more important to recovery than ever in the past. We know that opioid addiction requires longer treatment. It’s no secret. Any reputable addiction specialist will tell you the same. The barrier to effective treatment is cost. The vast majority of insurance policies that include addiction treatment only cover up to 30 days of treatment – and even that can be iffy. It is far more profitable to just hand an opioid addict a month’s supply Suboxone and sweep him or her under the cover of ‘treatment’.

Even with all of these unnecessary obstacles opioid addicts are finding their way to sustainable recovery. For anyone with the financial wherewithal to afford aftercare recovery programs I strongly encourage you to pursue it. I’m confident you’ll find they can significantly improve your recovery process. Below you’ll find seven tips that can help anyone trying to find sustainable recovery.

  1. Make The Commitment – As with everything in life, it starts with you. Nothing will ever come to fruition without someone committed to making it happen. You are the captain of your own ship. Others have done this before you, many are doing it now and will do it after you. There is every reason in the world you should believe you can succeed if you put in the same amount of energy you put into your addiction into achieving recovery.
  2. Find A Strong And Supportive Sponsor – This is an important decision. Your sponsor is going to be your guiding light to recovery. You want to find someone who has the experience working the 12 steps and the ability to keep you on the right track – someone you feel you can trust and be open with. It’s important that your sponsor has a sponsor and has been clean for at least three years.
  3. Locate A Reputable Doctor Of Integrative Medicine – This is essential. Certainly opioids destroy the body and brain in ways no other poisonous toxin can. However our changing environment also presents a broad spectrum of challenges that we are simply not physically capable of meeting. A physician with Integrative Medicine bona fides can help you navigate this treacherous terrain and help your body and brain find its natural state of homeostasis.
  4. Diet And Supplements – You are what you eat. We’ve become conditioned to consume what taste good rather than what is good for us. Everyone is unique and require there own individual nutritional plan. Furthermore, we can no longer get our minimum daily requirements of nutrition from the food we eat. Integrative Medicine Physicians can develop a diet/supplement plan tailored to your biological needs.
  5. Exercise – This is perhaps my biggest pet peeve. I cannot impress upon you just how important exercise is – regardless if you are an addict or not – for both your physical and mental health. Take a thirty to forty-five minute walk; go for a bike ride or a long swim. You will notice a change immediately. You’ll sleep better, feel lighter on your feet and be clearer minded. Additionally, exercise reduces stress, depression, anxiety and improves cognitive function. It forces the body's physiological systems — all of which are involved in the stress response — to communicate much more closely than usual. Exercise aids in the functioning of your brain's ‘happy chemicals’ like endorphins and dopamine. Physical activity will improve your health and sense of well-being from the second you start.
  6. Work Your Plan – A plan is just that unless you put some wheels under it and push it down the street. You have to go to meetings, you have to talk with therapists and you have to eat right and learn to take better care of your self. Each step you take brings you closer to happy and meaningful recovery. You’ll get out of it what you put into it. The sooner you get started the better off you’ll be!

I haven’t spoken with Todd in a while but last time I did he was high on life. One of the things Todd mentioned in our last conversation was that he felt that the holistic or all encompassing approach we used that also treats the underlying or co-contributing factors of addiction helped him the most in finding recovery. I’ve helped thousands of people like Todd using this approach and know it works if you let it. I strongly encourage you to take a look at holistic and consider it for your plan for recovery.

John Giordano, Doctor of Humane Letters, MAC, CAP, is the founder of ‘Life Enhancement Aftercare Recovery Center,’ an Addiction Treatment Consultant, President and Founder of the National Institute for Holistic Addiction Studies, Chaplain of the North Miami Police Department and is the Second Vice President of the Greater North Miami Beach Chamber of Commerce. He is on the editorial board of the highly respected scientific Journal of Reward Deficiency Syndrome (JRDS) and has contributed to over 65 papers published in peer-reviewed scientific and medical journals.

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