Destin Recovery Blog

After Spring Break | Dealing with the Addiction

After Spring Break | Dealing with the Addiction

Dealing with the AddictionSpring Break has always been famous for fun and partying. It can also become a time of crisis for those who suffer drug and alcohol abuse and addictions and for those who love them. What is supposed to be a time to remember for a vacation can become the time for destruction to relationships.

Certain drugs that are offered as ‘recreational drugs’ can be extremely addictive and a trial or two of them at the spring break parties can lead to more use of the drug until the addiction is strong. You begin to realize that the one you care about, be they friend or family, has returned from Spring Break controlled by a substance.

Spring Break can also bring relationships that were fragile to a point of crises. Sometimes you will discover that the one you love is addicted when you are no longer in the safe environment of routine where you can easily deny their addiction, or they can more readily conceal their addiction.

Are you beginning to think about intervention?

Regardless of whether your plan for an intervention has been a long time coming, or it is a response to a new and real threat to the one you care about, don’t attempt an intervention without help. Strong evidence exists that unplanned interventions fail, while well planned and thought out interventions succeed. In fact, they have an 80% success rate. Knowing that if you do an intervention correctly that there is such a good chance of success should give you hope.  That is important for you to know. There is hope and also help for you and for the one you love.

It is also a good reason to refuse to react impulsively, but to act with intention and wisdom. Take all the steps you need to make that kind of intervention happen for the one you love. An intervention is simply an orchestrated attempt by one or many people – usually family and friends – to get someone to seek professional help with an addiction or some kind of trauma. You might have already attempted informal and solo interventions already. They may very well not have succeeded.

What is an Intervention?

Just as there comes a time when you ask the person with the addiction to admit they need professional help, there comes a time when you need to admit that you might need professional help with the intervention too. Start looking at the recovery centers that offer interventions as a service. Before choosing one, study their sites completely.  Make sure they have experience with the particular addiction that is controlling the person you care about.   Take the time to study what their philosophy is towards the treatment of addictions.  How they approach addictions and what methods they employ matter. Just as how they approach interventions and what they tell you to do will matter. You need to trust your councilor before you ever allow them to orchestrate an intervention for your loved one.

Some centers focus on the physical addiction and will lean towards treatments through medication and scientific findings. Some centers focus on the psychological addiction and will work more in the realm of personal and social behavior. Then there are centers that address both the physical addiction and the psychological addiction. Simply researching the different centers and how they approach addiction will begin a journey for you. A journey that you might need to take first, before you can ever help the one you love take their journey.

This spring break might have been the worst experience in your life. Facing addictions isn’t what Spring Break should be about. Yet if that is what your spring break was about, it’s time to think about getting help. Don’t write off your 2014 Spring Break as a loss. Make it an experience that leads you to take well planned actions that will change your life, and change the life of the one you love.

More on Dr. Reeves – Destin Florida

Dr. Reeves is the Medical director of Destin Recovery and South Walton Medical Center (Destin Florida)
Director of Addiction Medicine at Sacred Heart Hospital on the Emerald Coast; is a Member of the American Society of Addiction Medicine; a Fellow of the American College of Surgeons; and is Triple Board Certified in General Surgery, Vascular Surgery, and Addiction Medicine.

Relapse after Spring Break

Relapse after Spring Break – You thought you could handle it. You were going to have a fantastic spring break with your friends. You weren’t going to drink or do drugs too much. You promised yourself. Or you promised your loved one. Yet you did. Relapse! How and why can that happen? Why can addiction get the best of you no matter how determined you are, not to let it?

Addiction affects you on far more levels than you might first believe

Addiction doesn’t affect you just on the physical level. It affects you on the mental, emotional, and spiritual levels as well. Your relapse doesn’t mean your addiction is incurable. Nor does it mean that you simply don’t have enough willpower. What it can mean is that you have been attempting to deal with your addiction on one level or another, but you haven’t addressed the encompassing areas that your addiction has touched you at.  If you relapsed, take a serious look at getting help again. If you have been trying to break your addictions by yourself, consider getting professional help. Also, consider a long term program. A long term rehab program can last a few months and up to four months.

That long?

These programs are designed to take the time to address your addiction on all the levels. Not just on a behavioral level. Or on a physical level. Or on a social level.  It takes time to address you addiction on all the levels. There really is no such thing as a one-­size-­fits­-all rehab program. Each person faces completely different personal experiences because of their addiction, and those experiences will require attention. Each person’s physical makeup is unique and must be treated accordingly.  Medicine has made great advancements and it is important to find a center that employs those advancements.

Understanding the nature of addiction, and finding a personalized rehab program that will address your addiction on all its levels, rather than just one or the other, can help you finally be free from the addiction. So Spring Break caused you to relapse. It’s time to take the time to get rid of your addiction. Spring Break next year can be totally different…or you might be vacationing in a totally different place, because you are totally different.

We guarantee you will…

∙         Get the attention you deserve in an intimate, individually focused program with people just like you.
∙         Heal through an effective blend of integrated therapies at one of the world’s most beautiful beaches.
∙         Discover why this has happened to you and learn how to live free from you problem.

More on Dr. Reeves – Destin Florida

Dr. Reeves is the Medical director of Destin Recovery and South Walton Medical Center (Destin Florida)
Director of Addiction Medicine at Sacred Heart Hospital on the Emerald Coast; is a Member of the American Society of Addiction Medicine; a Fellow of the American College of Surgeons; and is Triple Board Certified in General Surgery, Vascular Surgery, and Addiction Medicine.

Posted in Recovery, Relapse

Balancing Act: Managing Your Recovery With Gratitude

Dr. Roland Reeves, MD, FACS, ABAM.

Dr. Roland Reeves, MD, FACS, ABAM.

While all recovering addicts know that the decision to get clean is the first step towards sobriety, managing your sobriety during the year can be a challenge. While rehab gives addicts and their families the tools to manage recovery, it is up to each person to actively manage his or her recovery daily. With the beginning of a new year, many recovering addicts will use the time to reflect on their personal growth since their decision to get sober and will set new goals for the days, weeks, and months, ahead. While recovery works best when it is managed “one day at a time”, addicts in recovery can begin to set some manageable and achievable goals as part of their personal inventory exercises.  By focusing on what you learned during your addiction and recovery, you can reflect on the past and continue your journey forward.

A good way to manage your goals for your sobriety is to start incorporating daily gratitude exercises into your routine. Whether this is a form of prayer, meditation, or an active engagement of thankfulness (through phone calls, emails, or written thank you notes), daily gratitude helps keep the world in perspective.

  • First, actively identify things and people for whom you are grateful or thankful. This may mean keeping a daily gratitude journal or notebook where you can jot notes about things that bring you pleasure, joy, or comfort.
  • Review your list daily. If you are prone to prayer, you may thank God for these things. If you prefer a more introspective approach, you can meditate on the things for which you are grateful. Beginning with “I give thanks for” or “I am grateful to” are good ways to start this exercise.
  • Demonstrate your gratitude. Actively seek out those deserving of your thanks and gratitude. Something as simple as an email or phone call not only acknowledges the things and people for whom you are grateful, it deepens your connection with them.

As you move through your recovery, it’s important to recognize that your sobriety is a daily challenge. After practicing gratitude mindfully, you can start identifying manageable and attainable daily goals. Marathon runners focus on specific benchmarks, and addicts in recovery should approach their sobriety the same way. By creating and then achieving goals, you will have the confidence to expand your reach.

Recognizing the impact your addiction and recovery has had on family and friends is important as well. While your family and friends can be an important support system, you must acknowledge and right any wrongs or mistakes you made while in the throes of addiction. Just as your addiction affected your family and friends, your recovery will impact them as well. As you continue to take and re-evaluate your personal inventory, you will find that your gratitude for the good things grows and your ability to soberly manage challenges and stresses increases as well.

More on Dr. Reeves – Destin Florida

Dr. Reeves is the Medical director of Destin Recovery and South Walton Medical Center (Destin Florida);
Director of Addiction Medicine at Sacred Heart Hospital on the Emerald Coast; is a Member of the American Society of Addiction Medicine; a Fellow of the American College of Surgeons; and is Triple Board Certified in General Surgery, Vascular Surgery, and Addiction Medicine. 

 

 

 

Panama City Beach / Safe Spring Break 2014

Welcome to Panama City Beach FL and a fantastic 2014 Spring Break. Fllipkey’s ranked Panama City Beach as #7 on Top Trending Destinations. It easily lives up to the title, with beautiful spring temperatures, fantastic beaches, and great entertainment.  This year 250,000 to 300,000 college students will come to Panama City Beach in March alone. Such numbers make Panama City Beach “Spring Break Capital of the World.”  (VisitPCFL.com)

Panama City Beach’s Police Chief, Drew Whitman,  has over 20 years of experience with the phenomenon  of  Spring  Break.  In  order  to  make  spring  break  as  safe  as  possible,  the  city employs dozens of additional law  enforcement staffers from outside  agencies to help with the throngs of college students. They even have mobile units to help with the underage drinking and various violations.

Policemen walk the beaches and strive to be both visible and approachable to help in any difficult situations that might arise. Panama City Beach Hotels, just as experienced in making sure that Spring Breakers enjoy their stay, also hire extra security, for the same purpose. Despite these added enforcements, casualties have already occurred.Rice University student Reny Jose went missing early March 3 after witnesses said he took LSD the previous evening at a beach house. Officials have been searching for him since. Another spring breaker died March 9 in a DUI­ related crash.

Other than becoming aware of the police and hotel security staff and where they are located in Case you need them, there are common sense safety measures you can take. Always stick together with your friends. Keep an eye on your drinks and theirs to make sure that nobody slips anything in them.When partying and drinking, especially on the beaches where sun and exertion can lower your tolerance to alcohol or drugs, keep an eye out for your friends. The combination of different drinks with varying toxicity levels, or combining alcohol with drugs (be they over the counter or illegal) also can bring about critical alcohol poisoning or a drug overdose. Alcohol poisoning can also happen from taking in too much alcohol at one time.

What are the symptoms of alcohol poisoning? They are stupor, mental confusion, vomiting and seizures, and coma where a person cannot be roused. How can you know if your friend is merely passed out, or if they have fallen into a coma from alcohol poisoning? Check their breathing. If it is slowed with fewer breaths than eight per minute they can be in danger. Or if their breathing is irregular, where there is 10 seconds or more between their breaths.  Also check their skin color. If their skin is bluish in color and pale and clammy to the touch, they are suffering from hypothermia (or low body temperature). This is a dangerous effect from alcohol poisoning.  If your friend is experiencing these symptoms, call 911 immediately. Your friend could die otherwise. Do not concern yourself with the legality of their condition; make sure you get immediate help for them!  Continue to try and revive them. Turn them on their side. They will be less likely to choke on their vomit in this position. Many deaths have resulted simply from drunks choking on their own vomit. If they stop breathing, be ready to perform CPR on them. If you do not know how, try to find someone who does know how to do it.

Here are some Numbers for you to call for more information and advice for any situation that you might find yourself in that could potentially be dangerous to you or your friends.

For non­emergency situations:

Panama City
Police Department
1209 E. 15th St.
Panama City, Florida 32405 Phone: 850-­872-3100

http://www.panamacitypolice.com/

Panama City Beach Fire Rescue
110 South Arnold Road
Panama City Beach, FL 32413
General Inquiries:
(850) 233.5120

http://www.pcbfire.com/

Florida Drug Treatment
Phone 855-638-7258
www.destinrecovery.com

For immediate emergencies Always call 911!

More on Dr. Reeves – Destin Florida

Dr. Reeves is the Medical director of Destin Recovery and South Walton Medical Center (Destin Florida)
Director of Addiction Medicine at Sacred Heart Hospital on the Emerald Coast; is a Member of the American Society of Addiction Medicine; a Fellow of the American College of Surgeons; and is Triple Board Certified in General Surgery, Vascular Surgery, and Addiction Medicine.

 

 

Posted in Alcohol Abuse

The Marijuana Conundrum

The Marijuana Conundrum

Rarely a day goes by where we do not encounter political, legal or medical news and arguments asking or declaring how we should handle marijuana.  As an addiction medicine physician, I too encounter these questions almost daily.  My own research and attempt at crystallizing an opinion is frustrated by many paradoxes.  Several questions are really being asked about marijuana, but they are disguised or misrepresented as a single question:  “Yes or No” concerning marijuana?  This is an extreme oversimplification when asked this way, but it avoids and dodges potholes (sic).

Proponents for the use of marijuana for medical reasons cite growing evidence of proven medical benefits.  Legalization arguments are convincing too.  A purported failure of prohibition and the enormous economic and societal costs of attempts at enforcement burden us all.  Perhaps the loudest chorus for making marijuana legal and medically available comes from those whose real goal is recreational use with a cultural refrain written with Cheech and Chong asking “hey man, am I driving OK…I think we’re parked man…”

The argument of what to do with marijuana can and should be discussed as three separate issues, all related, but all with specific considerations.  1) medical use, 2) legalization, and 3) recreational use.  More often what we find in reported stories, quotes and political questions about marijuana is an argument covering only one of these issues, and it is used to answer all three questions.  This creates confusion and obfuscation inherent in finding “the answer” for marijuana.  We listen to Sanjay Gupta on CNN “doubling down” for the medical uses of marijuana.  Our Justice Department describes the inequities of prosecution leaving a disproportionate number of Blacks and Hispanics serving time for “minor marijuana offenses”.  Our own President in an interview in the New Yorker a few months ago has made statements supportive of marijuana comparing it to alcohol while the government he represents bans it.  He explicitly states that he tried marijuana when he was younger, while implicitly seeming to say “I turned out all right, how bad could it be”.  Each of these points of view are then used to support any and all use of marijuana by zealous proponents.  Some more specifics:

1)     Medical Issue- A growing body of evidence exists suggesting positive medical uses of marijuana for pain, epilepsy, multiple sclerosis, chemotherapy patients, diabetes, Crohn’s disease, and others.  Most of the evidence is anecdotal yet much is compelling.  Marijuana or its 480 ingredients and 66 various cannabinoids has undergone a relative paucity of the kind of research considered standard for potential pharmaceuticals.  Marijuana’s categorization as a Schedule I (one) drug says it is “dangerous and without known medical use” essentially placing a firewall between marijuana and medical research.  This firewall is bolstered and sealed by the holding of US Patent # 6,630,507 by the US Government for medical uses of marijuana.  It would be patent infringement for other pharmaceutical companies to develop medical uses for marijuana without express permission from the US government.  Our government states unequivocally at Whitehouse.gov on the Office of National Drug Control Policy page that “The Administration steadfastly opposes legalization of marijuana…it would pose significant health and safety risks to all Americans…”  Sitting atop the myriad obstacles to meaningful medical research on marijuana is our government, no matter how compelling the evidence for potential benefits. This conundrum has created a situation where five brothers in Colorado nicknamed “the chemical brothers” are at the forefront of developing medical uses for marijuana.  They have no medical background, yet opportunity and a vacuum places them on the cutting edge of standardizing extractions, potencies and components of medicinal marijuana.  The Stanley brothers are sincere and honest I believe, but for them to be the pioneers of medical discoveries in this country of vast medical infrastructure is a travesty.

 

2)     Legalization-   Our overburdened and costly prison system is partly so because of the 1.3 million drug arrests made yearly.  Of these arrests, Blacks are 6 times more likely to be imprisoned than whites, and Hispanics are 2.5 times more likely according to the Bureau of Justice in 2012.  Many of these involve small amounts of marijuana.  Although these statistics represent a problem with our justice system as a whole, they provide a pillar in the argument for legalization of marijuana.  Other arguments for legalization are economic and involve standardization and safety.  Pros and cons debate issues such as DUI’s, availability to minors, promotion vs control of use, marijuana as an addiction gateway, associated crime, and other issues.

3)     Recreational-   This is the category that astounds me as an addiction physician.  Proponents of recreational use uniformly compare it to alcohol and/or cigarettes.  It seems that the best argument for recreational use involves comparison to substances and products that kill hundreds of thousands every year.  As if there were some value to a “relative risk of dying” in the argument.  “Obesity and hang gliding can be fatal and they are not illegal, why is marijuana” goes the argument.  This can be debated concerning personal freedom to harm yourself, but our laws are also designed to protect others.  Most quoted studies evaluating driving and marijuana use are several years old, but the potency of marijuana increases every year.  In 2005 the journal Addiction stated that one joint was equivalent to a blood alcohol level of .05% concerning motor and executive function.  What is that level today?

 

We live in a country where New York outlaws Big Gulps, while Colorado enables marijuana use.  Tobacco smokers are exiles while marijuana smokers are cheered.  Regularly ignored in all of the above arguments except to be minimized is the addiction issue associated with marijuana.  It coopts our brain’s reward system just as any other addictive drug, leading to tolerance and the subsequent search for perceived reward with other substances.

Several paradoxes are described above.  Answers to the questions can be described as riddles- puzzles requiring creativity and ingenuity to answer.  I and others propose that marijuana be reclassified as a schedule II or even schedule III drug and treated as such medically and legally.  This would change the legal issues making it similar to having morphine or hydrocodone.  There are obviously problems with these drugs too, progress not perfection.  The goal is to make marijuana available for research, standardization, oversight as a controlled medication, and perhaps freeing billions of dollars currently wasted on failed prohibition to these endeavors.  Dispensing, oversight, and research would then all have already delineated pathways and mechanisms.  Simply making marijuana available and controlled like alcohol is an appealing argument for some, but as an addiction professional that encounters the ravages of alcohol and addiction daily, I can only hope that this approach is never taken.

“Conundrum” involves paradoxes and puzzles and unresolved questions.  Here is a doozy.

 

 

First Signs of Alcoholism

Dr. Roland Reeves, MD, FACS, ABAM.

Dr. Roland Reeves, MD, FACS, ABAM.

Are you concerned that you might have a problem with alcohol? Or perhaps you are worried about a family member that seems to be abusing alcohol.

Alcohol abuse is a pattern of drinking that result in harm to one’s health, interpersonal relationships, or ability to work.

A distinction is made between alcohol abuse and alcoholism itself. Alcoholism is a dependence on alcohol. While alcohol abusers still has some ability to set limits on their drinking. Their use of alcohol can still be self-destructive and hazardous. It may also develop into alcoholism if they do not receive help.

While some alcohol abusers do not become alcohol dependent or alcoholics, it remains a strong risk. Alcoholism can occur suddenly in response to a genetic predisposition from a family history of alcoholism or due to a stressful change, such as a breakup, retirement, or another loss.  Sometimes alcoholism can gradually evolve as you develop a tolerance to alcohol.

First Signs of Alcohol Abuse

Neglecting Responsibilities: Drinking causes a person to repeatedly neglect their responsibilities at home, work, or in school. You may neglect children, perform poorly at work, or skip out of work or school or social obligations to drink or because you are hung over.

Drinking in Dangerous Situations: If you drink in situations that you know can be physically dangerous to you like drinking while you drive, drinking when you are in a dangerous neighborhood, mixing alcohol with prescription drugs against your doctor’s advice

Creating Legal Problems: You face legal problems from things you do while drinking, like being arrested for fighting, for drunk and disorderly conduct, for domestic disputes or DUI’s

Constant Relationship Problems: You continue drinking despite the fact that it is causing fights and problems with your family and friends. An example would be that you fight with them because they do not like your behavior when you drink. Or your marriage is strained because you are always out drinking with your buddies.

Using alcohol to de-stress: You use alcohol to relieve your stress. Alcohol acts as a sedative drug. Over the course of time, you build up a tolerance to it. You will need more alcohol to relieve stress. An example would be if you use alcohol to decompress after a hard day at work. After repetitive use, you start becoming drunk to relieve the stress from a hard day at work. Another example would be you get a drink because you have had an argument with your boss, spouse or friend.

Symptoms of the Disease of Alcoholism

Alcoholism will involve the above signs of alcohol abuse, with one more factor added to it: a physical dependence to alcohol as well as a physical tolerance and withdrawal to alcohol.  It’s important to note at this point that the person in question has a chronic disease that will only get worse if left untreated.

Tolerance: Tolerance means that you need more and more alcohol to achieve the desired effect. Are you drinking more than others without showing the typical signs of intoxication?

Withdrawal: Once the effects of alcohol wears off, do you become anxious, jumpy, stressed? These are signs that you are experiencing withdrawal from alcohol. You might even experience withdrawal symptoms of shakiness or trembling; sweating, nausea and vomiting, headaches insomnia, fatigue, depression, irritability, or loss of appetite. Do you need a drink in the morning to simply steady your nerves? Drinking to relieve or avoid withdrawal symptoms is a sign of alcoholism and addiction.

No Control: Do you drink more than you planned to drink, longer than you intended, and despite the fact that you had determined not to do so?

You Can’t Stop: You want to stop drinking, yet despite your best efforts, you continue to drink

Loss of Other Pursuits: You have given up activities and pursuits you use to care about or enjoy because of alcohol. Spending time with friends, favorite hobbies and interests are some examples.

Alcohol takes up all your focus: Your time is dedicated, whether you like it or not, to drinking, thinking about drinking, or recovering from the effects of drinking.  Almost all your interests and social or community involvements revolve around the use of alcohol.

Negative Consequences: You continue drinking regardless of the negative consequences from it. You might see that your drinking is destroying your marriage and family relationships, it is causing you to fail at your job, or you are developing health problems from it, but you can’t stop and you continue to drink.

 

TREATMENT
Alcoholism is a chronic disease.   It needs to be treated with same rigorous methodology as you would treat diabetes, heart disease or depression. Treatment must involves the latest science that combines medical therapy and private, one-on-one counseling.

Alcoholism is a complex disease that involves changes in the structure and function of the brain. Treatment needs to involve  not only therapists and peer groups, but the ongoing involvement of a physician.

 

More on Dr. Reeves

Dr. Reeves is the Medical director of Destin Recovery and South Walton Medical Center; Director of Addiction Medicine at Sacred Heart Hospital on the Emerald Coast; is a Member of the American Society of Addiction Medicine; a Fellow of the American College of Surgeons; and is Triple Board Certified in General Surgery, Vascular Surgery, and Addiction Medicine.

Alcohol Affects Everyone in the Family

Dr. Roland Reeves, MD, FACS, ABAM. Medical director of Destin Recovery and South Walton Medical Center; Director of Addiction Medicine at Sacred Heart Hospital on the Emerald Coast; Member of the American Society of Addiction Medicine; Fellow of the American College of Surgeons; Triple Board Certified in General Surgery, Vascular Surgery, and Addiction Medicine.

Dr. Roland Reeves, MD, FACS, ABAM.

Alcoholism and drug dependence is the United States #1 health problem.  The disease of alcoholism doesn’t affect just one person. It affects all the people who are in relationship with the person who suffers the addiction.  NCADD and their National Network of Affiliates possess decades of research that shows the disease of addiction affects not only the individual, but millions of family members as well.

The family members who suffer the most from the effects of alcohol and drug abuse are young children and adolescents.

How Alcohol Abuse Affects the Family

A family member’s addiction will often create interpersonal problems for all the members within the family. Some interpersonal problems created by alcoholism are:

1) Jealousy: You become jealous of your partner, friends, and other family members. Your partner may in return grow resentful or jealous of you.

2) Conflict: You have increasing arguments with your partner or get/give the “silent treatment.” You grow apart as you are forced to put your addiction first.  Conflict between you and your children increases, and they begin to either disregard your authority or they become frightened of you.

3) Money Problems: You are struggling economically from losing your job, needing to take time off from your job, making ill-advised and ill-considered financial decisions, or simply using all your money to support your addiction.

4) Emotional Trauma: You may create emotional hardships for your partner and/or your children by yelling, talking down, insulting or manipulating them.

5) Violence: You lose control and are violent towards your family members.

6) Patterns: Your life style will influence your partner and your children. Your children have a high chance of becoming alcoholics and drug addicts because you have set the pattern and cycle within them.

7) Health Risks: When you are under the influence of drugs and alcohol your judgment is impaired. This can lead to neglect or harm to your family and others.

Help that is available when Alcoholism is destroying your family

Weather you have been living with alcoholism for some time, or living with a family member who is an alcoholic for some time, learning the facts about alcohol and drug addiction is the first step. You cannot rely on just your experience. You need to learn all the facts about alcoholism and how it affects the family.

Then seek help and support for yourself.  Even if you are not the family member suffering from Alcoholism, you need help. Education is available to help you find healthy ways to overcome the negative effects of the disease.  Education and counseling helps you realize that you are not alone, nor are you responsible for another person’s abuse of alcohol and drugs. You can receive help for yourself, no matter if the other family member chooses to seek help for their addiction or not.

Treatment programs, counseling, mutual aid/support groups are all options for getting help.  While the simple fact is that only the person abusing alcohol or drugs can make the decision to get help for themselves, you can assist in creating the conditions that might make that decision more attractive to them.  Once you have sought help and support for yourself, they may be encouraged to seek treatment or self-help.

Family Intervention

If the family member who is abusing alcohol or drugs refuses to seek help, you might consider a family intervention. This intervention should be planned and professionally directed.  With the guidance and support of an experienced interventionist, an intervention can be a powerful tool in causing the family to gain council that will keep the focus on getting the addicted person to accept treatment.

Family Therapy

Family therapy can be a very good process for recovery for family members with drug and alcohol addictions. It can strengthen your family’s resources to help you find new and rewarding ways of living without alcohol or drugs. Your family will discover ways to be able to handle the impact of detoxification, while your body is being cleansed from an addiction.

Your family may start becoming aware of their own needs and may feel that it is safe enough to express them. The next generation in your family will be less likely to carry on your addiction.

If you have lost custody of your children, family therapy can be a way to help you to recover your relationship with them.

More on Dr. Reeves – Destin Florida

Dr. Reeves is the Medical director of Destin Recovery and South Walton Medical Center (Destin Florida)
Director of Addiction Medicine at Sacred Heart Hospital on the Emerald Coast; is a Member of the American Society of Addiction Medicine; a Fellow of the American College of Surgeons; and is Triple Board Certified in General Surgery, Vascular Surgery, and Addiction Medicine.

 

Physicians are a Problem, part 2.

How Do Docs Help and Not Hinder?

Dr. Roland Reeves, MD, FACS, ABAM

Dr. Roland Reeves, MD, FACS, ABAM

My last blog pointed out many of the shortcomings of our current system of outpatient treatment for opiate dependence using Buprenorphine.  There are positive aspects as well for the availability of Buprenorphine in the outpatient setting.  Buprenorphine provides an option that can be widely available, and great success

is possible for this devastating epidemic, but only if the medication is provided with all needed components.   There must be concrete accountability and a real program of recovery.  Most of the problems I pointed out are not due to unethical Docs trying to make a buck although there are too many of these.  Most of the Docs prescribing Buprenorphine are very sincere in their desire to appropriately offer treatment for a bad disease.  Unfortunately, the system that was set up for them gives a false impression that what they are doing is adequate.  A piece of the puzzle missing is referral in every patient treated with Buprenorphine to an addiction professional specializing in addiction treatment. This might be a counselor or an addiction physician, but it would facilitate complete evaluation and integration of the needs for a fatal disease that is totally unforgiving of any missing pieces.

When outpatient Buprenorphine is used for the treatment of opiate addiction, it can provide treatment for many that otherwise never could or would be able to participate in a more intensive treatment setting such as Rehab or residential treatment.  A typical patient I might see as an outpatient is a twenty-thirty-something person without insurance, a new baby is at home cared for by a neighbor or relative while at work, and they have no healthy relationships.  This might be a single parent, or both parents are working minimum paying jobs and barely making ends meet.  This potential patient would end up losing their child, their job, and eventually their life before they could ever have the means or ability to go to residential or full time program. Addicts usually have a heartfelt desire to change. I have yet to meet the honest addict that desired to continue what they were doing.   It is too often almost impossible for them because of a lack of resources or other support.  There is no one for the child if they go to treatment.  They have no financial support if work stops for treatment.  These patients become hopeless, lose their child and job, and when they finally die, it is a relief.  There are dozens of scenarios that make the hurdle of starting treatment perceived to be just too high.  This does not have to happen.  If this patient can be treated as an outpatient allowing them to continue to work, it just might happen.  A local Doc that provides an affordable real alternative can provide non-threatening access.  This can be the oasis they see as they feebly crawl over one more dune across an endless desert.  Hope.

Simply exchanging an opiate for Buprenorphine bought from a primary care physician too often does not lead to successful treatment though.  The initial promise fades as reality continues to show up.  Appropriate management of this patient must address the biological, behavioral and spiritual components of this disease.  Otherwise, the denial, compulsion and craving that are the pillars of this malady soon reemerge.  “Go to meetings” is instructed as the Rx is handed to them and this is woefully lacking.  Buprenorphine then is diverted for financial gain, used in between other drugs to prevent withdrawal, and otherwise enables disease progression rather than recovery.  All of this takes place while faithfully returning to the well-intentioned but ill equipped “Suboxone Doctor.”   There must be an end-point.  “Maintenance” becomes perpetuation.  There must be steady progress propelled by accountability and leveraged with the need to regularly return to the physician.  Yes, the same dependence we are treating becomes power in compelling the patients to put up and show up.  All of this is easily and often wasted, but it does offer real drive if used as it can be.  Buprenorphine can actually be a life-saving tool achieving the relationships first with a physician, then with life and love and eventually Peace.  This is the real answer.  It cannot be stumbled upon.

More on Dr. Reeves – Destin Florida

Dr. Reeves is the Medical director of Destin Recovery and South Walton Medical Center (Destin Florida)
Director of Addiction Medicine at Sacred Heart Hospital on the Emerald Coast; is a Member of the American Society of Addiction Medicine; a Fellow of the American College of Surgeons; and is Triple Board Certified in General Surgery, Vascular Surgery, and Addiction Medicine.

 

Physicians Are a Problem

Dr. Roland Reeves, MD, FACS, ABAM

Dr. Roland Reeves, MD, FACS, ABAM

Data published by the Center for Disease Control that prescription pain medicine is the largest cause of accidental deaths in this country is widely reported. The corollary very strongly states that doctors are the number-one cause of accidental deaths in this country, but I have yet to hear this indictment made. Sure, much of the prescription pain medicine causing all of these deaths is stolen, diverted, bought illicitly or otherwise obtained, but it is still prescription medicine from physicians who overprescribe without oversight or accountability, leading to three of every four opioid overdose deaths. More than double the number of U.S. deaths in the entire Vietnam conflict died of opiate overdose in the last decade in this country. This epidemic led to the embrace by federal officials of the use of Suboxone (which contains buprenorphine) as a safer, less-stigmatized alternative to methadone for the treatment of opiate addiction. The group contributing greatly to this epidemic—physicians—would now be tasked with treating it using Suboxone. Instead of getting the fox out of the henhouse, rabbits were added to the henhouse, giving the fox another choice! At least this is the reality that has emerged. Buprenorphine is now experiencing the exact same problem that opiate over-prescribing fuels. Many physicians who have no experience in addiction treatment are indiscriminately prescribing it. The law describing who could prescribe Suboxone requires an eight-hour online course, then “Presto!” an addiction expert is created. In my own experience, a pharm rep came to my office and basically told me how to answer the questions, and it took 45 minutes. This is the norm, according to the Suboxone docs in many areas of the country I have polled. There are addiction specialists prescribing Suboxone, but the same federal law making it available limited the number of patients a single doctor could treat to one hundred at any given time. The reasoning for this is baffling and unclear, but there has been great resistance among lawmakers to change it. The law requires regular UDS testing, counseling, groups and other provisions. There is basically no enforcement.

Patients often pay cash for the doctor visit and the med. One hundred patients added to a practice at prices ranging from 200 to 600 dollars per month each for the visit in many non-addiction specialist offices attracts many for profit motives in this day of declining reimbursements for everything. If addiction treatment is not addressed, these patients can be seen in less than five minutes. 

Buprenorphine can be abused. It is. It is also illicitly bought and sold. Addicts want buprenorphine around to keep from withdrawing, even if not used to get high, so it is sought on the street. 

Addicts showing up for treatment at the office of a Suboxone doctor often abuse many different substances, and they often have co-occurring disorders. The non-addiction specialist providing the med more often than not has no experience or training to address these issues. Being a Suboxone “expert” tells me nothing about detoxing someone with an anxiety disorder from benzos.

Addicts seeking treatment, and even referring doctors, know nothing of these issues. They are duped. I hear in my office regularly the question “why did the doctor do that?” when talking about either the large number of opiates and alprazolam they were prescribed or the large amount of buprenorphine they were regularly prescribed with no other real addiction treatment.

At this pint let me say, there are many well intentioned and ethical Suboxone providers that have been placed in a position of caring for a disease that is far more complex than what is taught in the online certification course. However, too many doctors are using it only as a profit center.

These problems and others have led to a general “bad rap” for buprenorphine in general. Evidence-based medicine practices strongly demonstrate the benefits of buprenorphine in the appropriate setting. This setting must include professional addiction counseling, treatment of co-occurring disorders, and strict accountability measures by the prescribing physician. 

Addiction societies and others have been lobbying strongly to rectify these problems. It may be a while. In the meantime, we must do our best to make sure patients with addictions are appropriately treated by addiction specialists. Medicine-assisted treatment of addiction is proven to save lives. We must not judge the use of medicines for this brain disease because they are misapplied.

Primum non nocere.  First, do no harm. 

Terrance R Reeves, MD, FACS, ABAM

Hello Molly!

Dr. Roland Reeves, MD, FACS, ABAM

Dr. Roland Reeves, MD, FACS, ABAM

The Effects of Molly

Who is Molly? Or what is Molly? That’s a question that is coming up far more often. Of course, the name itself makes you think of a fun and sweet kind of kid.

What Molly is, is actually a drug that is luring the pop and electronic community. The drug has been mentioned and sang about by idols like Madonna, Miley Cyrus and Kayne West. Molly is considered some kind of girl and some kind of drug!

Molly, in fact, is the street name for MDMA, but considered to be the “pure” powder or crystal form of MDMA. MDMA is the main chemical in the banned substance of ecstasy. So in a way, Molly isn’t new and she’s been around the block once or twice.

The marketing of Molly presents Molly as a purer “molecular” version of ecstasy. In fact, Molly is thought to be the nickname for “Molecule”.

Whereas ecstasy was unpredictable and cut with everything from caffeine to diverse amphetamines, Molly is presented as safe and reliable, without possible unknown additions. However, according to NIDA, an assortment of other chemicals or substances ranging from caffeine, dextromethorphan that is found in certain cough syrups, amphetamines, PCP, and cocaine are often added to — or substituted for — MDMA in Molly as well.

“Anybody who propagates the idea that this is purer than anything else— it’s ridiculous,” says Dr. Julie Holland, a psychiatrist in private practice and the editor of Ecstasy:  The Complete Guide, “It’s a white powder. What could be more of a question mark? At least in a tablet someone put some time into putting it together.  But [the name molly] sounds so innocent, like a girl in freckles and pigtails. It’s good marketing.”

Not So Nice Molly

While Molly delivers the same effects as Ecstasy-creating euphoria, boundless energy and a confident and strong feeling of intimacy, “Molly, in any form, is just as dangerous,” reports the National Institute on Drug Abuse (NIDA), a component of the National Institutes of Health (NIH).

The DEA labels it a Schedule 1 controlled substance, which means, it ranks as a drug with a high potential for abuse while having no accepted use in medical treatment. In the same category as marijuana and heroin, it is illegal.

Once inhaled, eaten or parachuted (wrapped in a tissue and swallowed) molly brings euphoria because it floods the brain with neurotransmitters serotonin, norepinephrine and dopamine.  Acting on the brain chemical serotonin-which involves the perception of mood-it also seems to affect the “love hormone” oxytocin, which effects bonding.

MDMA acts as a stimulant and possesses the same side effects as other stimulants like cocaine. It can cause and increase in heart rate and blood pressure. It decreases the body’s ability to regulate temperature. It also has the affects of a psychedelic. It can produce distortion of thought processes. These effects can cause users to ignore their body’s rising body temperature or their failing stamina as they continue to party. When combined with alcohol and other drugs, MDMA causes even more serious side effects.

The more severe side effects can include hyperthermia, seizures, electrolyte abnormalities, cardiac episodes and comas. The drug also leads to a decreased mood a day or two later and has been known to trigger long-term depression. Overdose symptoms can include rapid heartbeat, overheating, excessive sweating, shivering and involuntary twitching.

Molly is now coming into the spotlight because of the deaths it is causing. Drugs sold under the name Molly have flooded the market according to Rusty Payne, who is a spokesman with the Drug Enforcement Administration.  The Drug Abuse Warning Network reports that the number of emergency room visits with MDMA involved has jumped 123% since 2004. There were 22,498 such visits in 2011. In some states, there has been a 100-fold increase – the combined number of arrests, seizures, emergency room mentions and overdoses – between 2009 and 2012, according to DEA figures.