Dr Manish Nair

specializing in addiction recovery

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3537 S Interstate 35 E Ste 320 Denton, TX 76210

940.243.8651

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Dr. Manish Nair MD

Contact Info 3537 S Interstate 35 E Ste 320 Denton, TX 76210

(940) 243-8651

mmnairmd@gmail.com

Education •University of Kentucky | Psychiatry Intership & Residency •International American University, College of Medicine •University of Texas at Dallas | Bachelor of Science in Business Administration •Southern Methodist University | Computer Engineering •Texas Academy of Mathematics and Science | Biology Specialties Psychiatry Certifications & Licensure

•TX State Medical License •KY State Medical License •American Board of Psychiatry and Neurology Psychiatry About

Manish Nair, MD is a board certified psychiatrist licensed in Texas and Kentucky. Dr. Nair completed his psychiatry residency at the University of Kentucky, where he served as Chief Resident. He went on to serve as Director for Consult Psychiatry for Albert Chandler Medical Center and Medical Director for Recovery Works, in inpatient rehab facility. Dr. Nair returned to Dallas, TX in hopes of serving his childhood community. He has practiced at Denton County MHMR, Veterans Administration in Bonham, and several other behavioral health hospitals in the area.

Dr. Nair currently lives in Frisco, TX with his wife and three young children. When not working, he enjoys spending time with his family and traveling.

WE WANT YOU TO LIVE LIFE TO ITS FULLEST

3537 S INTERSTATE 35 E STE 320 • DENTON, TX 76210 940.243.8651 CONTACT US TODAY

Talkin’ ‘Bout My Generation

NIDA Researchers Develop Screening Tool for Teen Substance Use This article is a condensed version of a piece that originally appeared on the National Institute on Drug Abuse (NIDA) website.

Teens’ use of addictive substances often goes undetected by health care providers. But NIDA-supported researchers have developed a Brief Screener for Tobacco, Alcohol and other Drugs (BSTAD), to help spot teens’ problematic habits. In a recent study, BSTAD developers Dr. Sharon Kelly and colleagues at the Friends Research Institute in Baltimore examined the frequencies of use likely to qualify a teen for a diagnosis of an alcohol use disorder (AUD), nicotine use disorder (NUD), or cannabis use disorder (CUD). The frequencies proved to be surprisingly low, according to the researchers.

Teen drug substance use revealed For the study, the BSTAD survey employed a few, simple questions about teens’ use of alcohol, tobacco or drugs within the past year.The teens’ BSTAD responses revealed that 22 percent had used alcohol in the past year, 16 percent had used marijuana, 10 percent had used tobacco, and 3 percent had used at least one illicit substance other

than marijuana. (Original article by Eric Sarlin, M.Ed., M.A., NIDA Notes Contributing Writer) 28

“ Health care providers should have a one-on-one discussion with teens who indicate any substance use to assess level of risk, provide brief advice, and, if necessary, recommend further assessment for a treatment intervention. “

-Dr. Sharon Kelly, Friends Research Institute

Analysis of the data showed that almost all teens who reported on the BSTAD that they had consumed an alcoholic beverage on two or more days during the past year had an AUD. Conversely, teens who reported drinking on fewer than two days were unlikely to have this disorder.The corresponding BSTAD cut point for an NUD was nicotine use on two or more days during the past year and for a CUD was marijuana use on two or more days. BSTAD enables early detection Using these cut points, the researchers found that the BSTAD was highly sensitive. Ninety-six percent of teens with an AUD, 95 percent with an NUD, and 80 percent with a CUD would be flagged as likely in need of further assessment for a brief intervention or referral to treatment. BSTAD’s specificity was also high: 85 percent of teens without an AUD, 97 percent without an NUD, and 93 percent without a CUD reported use below the cut points, and so would be correctly classified. “Very low substance use frequencies were found to be optimal in identifying these disorders,” Dr. Kelly comments. The BSTAD does not distinguish

Researchers encourage regular screening Both the World Health Organization and the American Academy of Pediatrics recommend screening all adolescent patients for substance use since problems later in life often originate in adolescence. Still, many providers do not regularly screen their patients for substance abuse. “Providers are extremely busy and need a quick and valid screening measure for identifying teens who use substances,” says Dr. Kelly. She and colleagues developed the BSTAD in response to a NIDA call for new tools to fill this need. To create the BSTAD, Dr. Kelly and colleagues added the questions about tobacco and marijuana to the widely disseminated National Institute on Alcohol Abuse and Alcoholism screen for youth alcohol use. In the validation study, the FRI research team administered the BSTAD in person to half of the participants, and the rest of the participants self-administered the instrument on an iPad. The teens reported a strong preference for the iPad. The iPad version offers the potential extra convenience that results can be automatically transferred into a teen’s electronic medical record. 

the severities of the disorders, she notes, so when it flags a teen, providers need to follow up with questions to determine appropriate interventions or referrals to treatment. Furthermore, Dr. Kelly says, “Health care providers should have a one-on-one discussion with teens who indicate any substance use to assess level of risk, provide brief advice, and, if necessary, recommend further assessment for a treatment intervention.” Providers also should rescreen teens regularly, because onset of substance use can occur abruptly during adolescence. Pediatrics recommend screening all adolescent patients for substance use since problems later in life often originate in adolescence. Both the World Health Organization and the American Academy of

Working with families, and individuals in achieving health and balance in their lives. CONTACT US TODAY 3537 S INTERSTATE 35 E STE 320 • DENTON, TEXAS 76210

My primary goal is to help individuals and communities be as healthy and functional as possible by providing medically appropriate treatment and counseling.

SAMHSA PUBLISHES BEST PRACTICES ON MEDICATION-ASSISTED TREATMENT FOR OPIOID USE DISORDER Best Practices

Treatment Improvement Protocol 63, “Medications for Opioid Use Disorder,”

reviews the use of methadone, naltrexone, and

buprenorphine, the three FDA-approved medications to treat opioid use disorders.

Data indicate that OUD-treating medications are both cost effective and cost beneficial

The Substance Abuse and Mental Health Services Administration has published new guidance to help health care professionals better understand medications that can be used to treat Americans with opioid use disorder (OUD). Treatment Improvement Protocol (TIP) 63, “Medications for Opioid Use Disorder,” reviews the use of methadone, naltrexone, and buprenorphine, the three FDA-approved medications to treat opioid use disorders. TIP 63 provides guidance for health care professionals and addiction treatment providers on how to appropriately prescribe these medications and effectively support patients using these medications for OUD treatment. “We know that people can and do recover from opioid use disorders when they receive appropriate treatment, and medication-assisted treatment’s success in treating opioid use disorders is well documented,” said Dr. Elinore F. McCance-Katz, assistant secretary for Mental Health and Substance Use. “TIP 63 emphasizes that increasing access to medications to treat opioid use disorder will help more people recover, enabling them to improve their health, living full and productive lives.” TIP 63 is part of SAMHSA’s larger response to the opioid crisis. More access to treatment with OUD medications is critical to closing the gap between treatment need and treatment availability and an important public health strategy. Data indicate that OUD-treating medications are both cost effective and cost beneficial.

GET HELP TODAY 940.243.8651 3537 S Interstate 35 E Ste 320 Denton, TX 76210

Dead people don’t get into recovery

D. Waters Is Suboxone a Reasonable Treatment Option for Opioid Addicts? After twenty years of providing substance abuse treatment I can tell you that the ultimate goal of anyone battling an addiction is total abstinence. Every addict and alcoholic eventually figures out they can not control their usage, and moderation is unrealistic. Learning to live life on life’s terms is part of the process of learning to live abstinent. Self-help programs like Alcoholics Anonymous(AA) and Narcotics Anonymous(NA) do a great job of helping people understand their addiction, themselves, and effective solutions for coping with their disease. Dead people don’t get into recovery Opioid addicts are not terribly different from any other addict or alcoholic, except the risk of death by accidental overdose is huge. People are dying in droves from opioid overdose. The current heroin epidemic is even more dangerous than the pain killer epidemic it replaced. Relapse rates are tremendous. Unfortunately, it may take years before an individual addict is ready to give the 12-Step AA/NA

I’ve truly never seen anything work better, and when it works it’s a beautiful thing.

process the thorough try it requires to be effective. Therefore, Suboxone is a terrific option for chronic relapsers. You can’t generally get high from it, unless you haven’t used in awhile, or never used in the first place. You can’t overdose on it from use or abuse, and any other opioid you take while it’s in your system will be nullified and wasted.

Not the solution, but maybe a good step forward Suboxone is not the solution, but in many cases it’s better than nothing, and a good response for chronic relapsers who are risking death from overdose. At least the addict is getting some exposure to treatment which is more likely to lead to recovery in the long run. Suboxone buys people time and keeps them alive. There are quite a few people who’s funerals I’ve attended that I wish had gotten on Suboxone. You can’t treat the dead.

The Subs knock down the monster cravings almost completely, and people don’t go through the nasty withdrawal that’s so painful. Once dysfunctional people who couldn’t hold a job, or were constantly on the obsessive hunt for the next fix suddenly become much more functional, and the addiction looks like it’s in remission. They can work consistently, they stop chasing the drugs, they have more money and can care for themselves and their families, and their addiction doesn’t seem to be ruling their lives. It seems like magic! Very few people actually wean off Suboxone successfully Suboxone users often wrongly think they’re cured because they look and feel more functional. Then they think all they have to do now is wean down, or taper off the medication, which is what the clinic doctors help them manage over a number of months to years. The problem is they’ve done nothing about the underlying addiction and all the addictive thinking and coping that go along with it that drive the addiction from within. They haven’t developed any social support, or learned anything about themselves and their disease. We like to say that using, or putting some chemical into the body, is only a symptom of the underlying disease. Abusing substances is not the actual disease—just a symptom. As soon as they stop using the Subs the addiction is still there and ready to start expressing itself all over again through the many painful ways it does. Chemically addicted people cope with life stressors with chemicals—that is, unless they make some fairly significant changes. Suboxone changes nothing in the end. Suboxone changes nothing A combination of Suboxone treatment coupled with AA/NA (with Sponsor and Step work) is a great thing. At Crossroads Counseling we require anyone with a substance abuse issue

to attend AA/NA, obtain a Sponsor, and work the 12-steps. If they don’t we won’t sign-off on their program. Most Suboxone clinics require their participants to attend at least one counseling meeting a month. Unfortunately, this is almost completely useless unless the individual engages in a personal program of recovery that addresses not only the biological issues, but the social, psychological, and spiritual issues related to the disease, as well.

There are times in which extra support is needed whether that support is in the form of therapy, medications, and or health management strategies; I am here to help you on your journey.

3537 S INTERSTATE 35 E STE 320 • DENTON, TX 76210 PH: (940)243-8651

We provide real treatment that produce real results.

CALL US! (940)243-8651 3537 S Interstate 35 E Ste 320 Denton, TX 76210

The Centers for Disease Control and Prevention reports that overdoses from prescription opioids drive the 15-year increase in opioid overdose deaths. Opioids are drugs that are extremely powerful and lead to uncontrollable addiction, even in good, honest people. If you’re a resident of Alpharetta, Roswell, John’s Creek, Milton, or located anywhere in the metropolitan Atlanta, Georgia area, who’s ready to be free of your addiction, contact the trusted staff at Detox with Dignity, an affiliate of W.I.S.E. Medical Centers. Call the office to make an appointment, or use the online booking agent.

SUBSTANCE ABUSE Q & A

How do I know if I have an unhealthy addiction? Not all addicts are recreational abusers. You may question your use of the drugs if you’re unable to stop using the drug after the cause of the pain has resolved. If you have a past or a family history of substance abuse, your risk of addiction to opioids is great, even when a doctor prescribes pain medications for a valid condition. Do you use medications to help with withdrawal symptoms while detoxing from opioids? There is no single correct way to detox off of opioids. Sometimes sedatives, anti- nausea, anti-depressants, and blood pressure medications are helpful in different stages of the rehabilitation process. Some patients must taper off the opioids gradually before starting any detox medications. One of the most successful medications for detox is called Suboxone—containing the active ingredient buprenorphine. You start on Suboxone® once withdrawal has begun. Dr. Locke may also recommend naltrexone, sold under the brand name Vivitrol®, after all opioids are out of your system. Vivitrol discourages the resumption of opioid use.

What are the differences between tolerance, physical dependence, and addiction? Tolerance refers to a drug’s becoming less effective over time. Physical dependence describes a situation in which a person develops symptoms and signs of withdrawal, including sweating, nausea, diarrhea, anxiety, and rapid heart rate, when they cease taking the drug or lower the dosage. Addiction is a condition in which a person has lost control over the use of the drug. They continue to use it even when the drug harms themselves and their relationships with others. People who are addicted may obtain pain medications from non-medical sources, alter oral formulations of prescription medications, or snort or inject medications.

What are opioids? Opioids are drugs that affect the body in the same way that opium does. Examples of opioids include:

Oxycodone Hydrocodone

Fetanyl Heroin

They’re often prescribed for chronic pain or to help you recover from surgery. You may know them from their brand names, such as Vicodin®, Percocet®, and OxyContin®. For people with pain, opioids are very effective, and most patients don’t become addicted to them. However, in some people, opioid dependence becomes an unexpected side effect of well-intentioned pain treatment.

We offer a variety of treatment options to meet your needs.

DR MANISH NAIR, MD WE CAN HELP YOU. VISIT US TODAY 3537 S INTERSTATE 35 E STE 320 DENTON, TX 76210 Contact us at (940)243-8651

not just a bad habit It’s NOT JUSTA BAD HABIT

Recent research and dialogue in the political sphere have brought long-simmering questions about addiction to the forefront: Is addiction truly a disease? Do addicts deserve to be treated like people who have a Recent res arch and ialogue in the political spher have brought long-sim ering questions about ad iction to the fore: Is addiction truly a disease? Do addicts deserve to b tr ated like people who hav a dise s that’s outside their control? disease that’s outside their control? While most researchers agree with the so-called disease model of addiction, stereotypes and cultural bias continue to stigmatize those with addiction because they made an initial choice to consume substances. However, Columbia University researchers point out that “choice does not determine whether 34 While most res archers agre with the so-called isease model of ad iction, ster otypes and cultural bias continue to stigmatize those with ad iction because they made an initial choice to consume substances. However, Columbia University res archers point out that “choice does not det rmine whether

something is a disease. Heart disease, diabetes and some forms of cancer involve personal choices like diet, exercise, sun exposure, etc. A disease is what happens in the body as a result of those choices.” Experts say that applying the distinction of choice to addiction creates biases that justify inadequate treatment. It begs the question New Jersey Gov. Chris Christie asked during a 2015 town hall meeting in New Hampshire. When Christie’s mother was diagnosed something is a disease. Heart disease, diabet s and some forms of cancer involve personal choices like diet, exercise, sun exposure, etc. A disease is what hap ens in the body as a result of those choices.” Experts ay that ap lying the distinction of choice to ad iction creates biases that justify inadequate treatment. It begs the question New Jersey Gov. Chris Christie asked uring a 2015 town hall me ting in New Hampshire. When Christie’s mother was diagnosed with lung cancer at 71 as a result of addiction to tobacco, he noted that with lung cancer at 71 as a result of ad iction to tobacco, he noted that

no one suggested that she should not be treated because she was “getting what she deserved,” he said. “Yet somehow, if it’s heroin or cocaine or alcohol, we say, ‘Ahh, they decided that, they’re getting what they deserve,’” Christie remarked. HOW ADDICTION WORKS After satisfying basic human needs like food, water, sleep and safety, people feel pleasure. That pleasure is brought by chemical releases in the brain. This is according to Columbia researchers, who note that the disease of addiction causes the brain to release high levels of those pleasure chemicals. Over time, brain functions of reward, motivation and memory are altered. After these brain systems are compromised, those with addiction can experience intense cravings for substance use, even in the face of harmful consequences. These changes can stay in the brain long after substance use desists. The changes may leave those struggling with addiction to be vulnerable to “physical and environmental cues they associate with substance use, also known as triggers, which can increase their risk of relapse,” write Columbia researchers.

not just a bad habit treatment and continued monitoring and support or recovery.

THE COLUMBIA RESEARCHERS DO HAVE SOME GOOD NEWS: Even the most severe, chronic form of the disorder can be manageable and reversible, usually with long term

3537 S Interstate 35 e ste 320 • denton, tx 76210 | 940.243.8651

The highest level of Quality, Customer Service and continuous compliance are always met.

OPIATE PROGRAM BREAKING THE CYCLE

Why are we non-12-step? We’d like to state at the outset that this does not mean that we are Anti-AA. (See “An Open Letter to Our Friends at AA.”) We believe in anything that works, and we believe that individuals should have a variety of choices from which to choose.

Since 1995, here at Assisted Recovery, we have seen our

approach work even when the 12- step approach had previously failed.

Most people are already familiar with AA’s primarily spiritual program of recovery (turning your will and your life over to a Higher Power). AA offers many social support resources, in the form of self-help group meetings that are available nearly everywhere… plus dances, pot-luck suppers, retreats and conventions where members can meet other sober people. AA also offers some limited psychological tools, mostly in the form of simple slogans such as “One Day at a Time,” which are easy to understand and remember. Finally Evidence- Based Treatment for Opiates that will empower you to quit using and make positive changes in your life. As a recognized leader in the non-12-Step recovery movement, Assisted Recovery’s founder and Director Lloyd Vacovsky was interviewed for the Penn and Teller Show on the Showtime Cable TV network. The episode about AA, entitled “12 Stepping”, which began airing in September 2004. In this episode, Penn and Teller were particularly critical of AA, and of government-mandated attendance to what is essentially a religious program. (Note: Suggested only for mature audiences and those who are not offended by foul language.)

Assisted Recovery is a leader in providing state of the art treatment for opiate dependence. ARCA addresses the biological, psychological and social components of the recovery process. This program fully integrates medications with psychosocial support. This type of integrated program is an example of the Pennsylvania Model of Recovery. The model is so named in recognition of the work of the University of Pennsylvania and in particular Dr. Joseph Volpicelli, MD, PhD (author of Recovery Options) Assisted Recovery is a fully licensed behavioral health agency, Arizona BH 2620. We recognize that most individuals whom become dependent upon drugs and or alcohol have core psychological issues which they self-medicate for. Stopping drug use does not stop the cravings and the thought processes that lead an individual to relapse. ARCA provides effective individual and group cognitive behavioral therapy. Treatment is provided in an Out Patient professional setting. With Suboxone®, we can safely and effectively detox an individual from opiate dependence comfortably in an Out Patient environment. Cognitive Behavioral Therapy is provided and is an integral component of the Assisted Recovery Pennsylvania Model program. It fully meets the counseling requirement that is mandated by the Food & Drug Administration for individuals taking Suboxone®. ARCA recognizes the anxiety and depression associated with detoxing from opiates. Further that benzodiazapine’s are not an appropriate response. ARCA utilizes ondansetron as a safe and effective alternative to a benzodiazapine. As soon as a client is detoxed, ARCA strongly reccomends the use of Vivitrol(r) which is injectible naltrexone. Vivitrol(r) blocks the ability to use any type of opiate for 30 days. Vivitrol(r) is an escential tool that clearly is often the differance between success and failure. ARCA works closely with Vivitrol’s manufacturer Alkermes Pharmaceuticals to facilitate the delivery of Vivitrol(r) to the client. Vivitrol(r) provides the assurance that an individual cannot use an opiate for 30 days. The Assisted Recovery Program fully integrates medications with psychosocial support. This type of integrated program is an example of the Pennsylvania Model of Recovery. The model is so named in recognition of the work of the University of Pennsylvania and in particular Dr. Joseph Volpicelli, MD, PhD (author of Recovery Options) The Psychological component is addressed primarily with the use of Cognitive Behavioral Therapy as developed by Dr. Albert Ellis, PhD of the Albert Ellis Institute of New York City. Suboxone® protocols offer opiate dependent individuals a safe, effective and reasonable path to abstinance and recovery.

Since 1995, here at Assisted Recovery, we have seen our approach work even when the 12-step approach had previously failed

3537 S Interstate 35 E Ste 320 • Denton, TX 76210

GET WELL WITH US TODAY 940.243.8651

Our ultimate goal is to improve your quality of life.

(940)243-8651

3537 S INTERSTATE 35 E STE 320 • DENTON, TX 76210

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