FRONT COVER
Morse Clinic of North Raleigh 3209 Gresham Lake Rd, Bldg 10, Ste 113 Raleigh, NC 27615 919-977-5993
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No matter where you are on your journey to recovery, our staff is committed to helping you succeed during treatment . www.morseclinics.com
CONTENTS To send a comment or question, write to: Morse Clinics 8300 Health Park, Ste 201, Raleigh, NC 27615 (919) 676-9699 Morse Clinics Magazine is published by theinfluence.org Copyright 2016 by AVA Consultants. No part of this publication may be reproduced in any form or by any means without the prior written permission of the publisher, excepting brief quotations in connection with reviews written specifically for inclusions in magazines or newspapers, or limited excerpts strictly for personal use. Printed in the United States of America. All rights reserved.
6830 West Villard Ave Milwaukee, WI 53218 FEATURES 08 THE RIGHTMEDICINE Dr. Morse explains the importance of treating addiction like a chronic illness 12 BRIDGING BRAIN AND BEHAVIOR COO brings two decades of neuropsychology experience 16 THE PRICE OF PAINKILLERS John Mattocks explains the complexity of opioid addiction 46 10 REASONSWHY I DONOT LIKE BENZODIAZEPINES By Dr. Eric Morse, MD 50 PROGRESS YOU CAN SEE CMO of Morse Clinics explains importance of medication-assistance for opioid users 54 HOWTOCHOOSE BETWEENMETHADONE AND BUPRENORPHINE Halfway house program supports lasting recovery 60 A HARMFULMISCONCEPTION Morse Clinics counselor shares the importance of using medication-assistance programs
IN THE NEWS 24 BEND BUT DON’T BREAK Yoga is being used to help people maintain recovery and avoid relapse 26 COPINGWITH DISCRIMINATION Discrimination remains largely ignored as a cause of substance abuse 28 FIGHTING FIREWITH FIRE Researchers look to combat addiction through repurposed pharmaceuticals 30 HIDDENDANGERS Alcohol poses whole host of health concerns 32 MORETHAN SKINDEEP Implant represents revolutionary approach to treating opioid addiction
34 UNDERSERVED AND UNDETERRED Overcoming the unique challenges LGBTQ individuals face with addiction 36 RELAPSETRACKERS Fitness trackers can help prevent relapses 38 PROLONGINGTHE PAIN Study suggests painkillers may be having the opposite effect in the long run 40 GROWING CONCERNOVER HEROIN USE New poll shows Americans are increasingly concerned with the dangers that heroin use poses to the country 44 BOOM, BUST, ANDDRUGS Study says economic downturn leads to increase in substance use disorders
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Dr. Morse explains the importance of treating addiction like a chronic illness Medicine The
When Dr. Eric Morse told his colleagues he was going to do an addiction fellowship, they didn’t understand his interest in that eld. In Dr. Morse’s experience, there’s a stigma attached to substance abuse services within the medical community. Some doctors believe addiction is a mental issue rather than a chronic illness. Dr. Morse, who now oversees four medication-assisted treatment clinics, says there is no evidence to support this belief. “It’s been proven that addiction is as much of a disease as diabetes is,” says Dr. Morse, a board-certi ed addiction psychiatrist. “If you have a disease, you want to go to a doctor for it.” INADEQUATE TREATMENT Dr. Morse graduated from Northwestern University’s Feinberg School of Medicine and completed his residency at the University of North Carolina at Chapel Hill. Starting his training in Maryland, where recovery services were more widespread and advanced, he led several methadone clinics before returning to North Carolina and opening the rst Morse Clinics center in 2006. That’s when it became clear to him that substance abuse was not being treated properly in North Carolina, naming a signi cant lack of resources and awareness as possible causes. His clients were reluctant to consider maintenance programs, only inquiring about them after years of failed attempts at recovery through non-medical practices. Viewing maintenance programs as a last resort is a misconception that Dr. Morse hopes to end. “We really need to be providing maintenance therapy rst. There’s only a 10% chance of recovery with programs like NA or AA alone. With medical treatment, the chance of recovering is 60%. Not recommending treatment that has been proven as more effective is close to malpractice,” says Dr. Morse. The disconnect between medicine and addiction is
“If you have a disease, you want to go to a doctor for it.” -Dr. Eric Morse, founder and CEO of Morse Clinics largely resulting from a lack of knowledge and understanding, according to Dr. Morse. North Carolina currently doesn’t offer training programs for any physicians in addictions. There is also an issue of countertransference, in which a medical analyst might have an emotional bias against their patient’s issue. That’s why Dr. Morse partners with the Governor's Institute to educate medical personnel and state of cials on addiction as a chronic illness, and the importance of treating it as one. A HEALTHY MINDSET When clients enter his clinics, they often experience high levels of guilt and shame. This can stem from believing their addiction is a personal fault or was a result of poor choices, rather than being a result of genetics and exposure like other medical conditions. Beginning to treat their illness with medication can help lift away some of this self-blame, empowering clients to get stabilized and begin dealing with underlying personal issues. While Dr. Morse believes counseling and 12-step
programs are effective processes for dealing with such issues, they need to be combined with medical treatment to create a holistic approach. This approach creates a healthier mindset so the patient can better handle the dif cult process of confronting their internal state. The process eventually leads to tapering off the medicine for most patients, though this could take several months or several years depending on the individual. Some patients may choose to stay on medication inde nitely, not wanting to risk their sobriety. “I encourage my patients to use the maintenance program for as long as they feel is right,” says Dr. Morse. “Some people think medicine is a crutch. Well if you break your leg, wouldn’t you want a crutch?”
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Not recommending treatment that has been proven as more
effective is close to malpractice. -Dr. Eric Morse
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Dr. Vicki Ittel has worked in the addiction Pennsylvania, Dr. Ittel received her PhD from SUNY Stony Brook, completed a Postdoctoral Fellowship at Boston University, and an MBA from New Hampshire College. Since divesting her previous addiction clinics, Dr. Ittel relocated to Raleigh to help address the need for increased treatment resources in eastern North Carolina and has partnered with Drs. Morse and Stanton as an owner PROVIDING ACCESS After attending a meeting in Washington D.C. to discuss substance abuse, Dr. Ittel was asked to expand Mountain Health Solutions, treatment centers for opioid addiction. At the time, North Wilkesboro, North Carolina had the highest death rate per capita, but no treatment resources. She and colleague Elizabeth Stanton opened another outpatient treatment center, which provided medication-assisted treatments such as suboxone and methadone to assist opioid recovery. Not long after the center opened, death rates in the area went down. “I’m proud of the work we did there,” Dr. Ittel says. “We provided a lot of people with the treatment they didn’t have access to before.” When it comes to the alarming drug-related death rates in North Wilkesboro, Dr. Ittel says it’s a common problem for small towns where the economy is dependent on physically challenging labor. “You tend to see more opioid addiction in places where the jobs are more dangerous,” Dr. Ittel says. “Workers start taking pain pills for an injury and it becomes an addiction.” Dr. Ittel believes our current opioid use epidemic impacts all ages, socioeconomic status, and
geographic areas. One of the contributors to the epidemic is that opioid use may begin for legitimate purposes and is prescribed by a physician. Though there are guidelines doctors must follow, Dr. Ittel says there’s a need for more training in regards to prescribing painkillers and monitoring the process with patients. Another distinction is an opioid’s ability to “hijack” your body, according to Dr. Ittel. Stopping use such as body aches, vomiting, diarrhea and pain sensitivity. With methadone-assisted treatment, methadone or buprenorphine attaches to opioid receptors in the brain to normalize brain chemistry, so patients can taper off their addiction slowly without the overwhelming physical symptoms.
COO OF MORSE CLINICS BRINGS TWO DECADES OF NEUROPSYCHOLOGY EXPERIENCE
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HOLISTIC TREATMENT At the beginning of her career, Dr. Ittel worked as an addiction counselor. Her interest is in understanding the interaction between the brain and behavior. In the case of addiction, brain chemistry and function are affected by behavior and vice versa. Dr. Ittel believes addiction is a symptom of root causes that must be addressed through counseling. Drug use has been linked with depression, anxiety and other mental health issues. To reduce the chances of relapse, treating underlying issues is as critical as stopping physical use. Medication assistance helps normalize the client and creates a quieted mindset, which helps them begin to explore the emotional and psychological causes.
“WORKERS START TAKING PAIN PILLS FOR AN INJURY AND IT BECOMES AN ADDICTION.” - Dr. Vicki Ittel, Chief Operating Officer, Morse Clinics
The staff of physicians and counselors at Morse Clinics collectively bring immense medical knowledge and counseling strategies, working to provide a holistic treatment option for clients. “We’ve formed a great team here,” Dr. Ittel says. “Everyone here has a lot of experience and a large network of resources. We bring together our different strengths to offer the best possible treatment for every client.”
“EVERYONE HERE HAS A LOT OF EXPERIENCE AND A LARGE NETWORK OF RESOURCES.” - Dr. Vicki Ittel 13
YOUR PATH TO RECOVERY STARTS TODAY
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JOHNSTON RECOVERY 1699 Old Highway 70 West Clayton, NC 27520 919-359-1699
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JOHN MATTOCKS EXPLAINS THE COMPLEXITY OF OPIOID ADDICTION
As program director at Morse Clinic’s Vance Recovery, John Mattocks ensures that the clinic is operating at its best daily. This includes everything from keeping the books to vacuuming oors, all to ensure that guests feel comfortable during their stay. He also helps resolve individual client problems and works to meet their speci c treatment needs. “We try very hard to make this a welcoming and comfortable environment for our guests,” Mattocks says. “Treatment is a long process that can’t happen unless they feel safe with us.” PRESCRIPTIONS GONE WRONG Morse Clinics provide maintenance therapy for opioid addiction recovery. Opioid addiction is generally different from other substance abuse because of the intensity of cravings and severe withdrawal symptoms, Mattocks explains. Addiction can result after being prescribed painkillers for an accident or sports injury. A person may respond pleasurably to the prescription medication, creating a need to maintain that state of euphoria. Medication-assisted treatment helps block the “high” caused by opioid use and lessens withdrawal pains. For many, this is the last hope for recovery. “No one comes to our clinic who isn’t ghting for their life,” Mattocks says. “They’re unable to meet basic survival needs. I’ve had clients who can’t function without drugs in their system. They’re not using to get high anymore. If they don’t have the drugs, they can’t get out of bed.” Medications such as methadone and buprenorphine suppress drug cravings to stabilize
clients and enable them to make informed decisions on starting their recovery. Given a clear and steady mindset, they can begin to work on other aspects of recovery such as lifestyle changes, primary care treatment and mental health counseling. REBUILDING FROM WITHIN A majority of Vance Recovery patients have experienced some sort of trauma or mental illness in their life. Mattocks believes it’s essential to combine medication with counseling and behavioral therapy in order to face these issues and form a holistic approach for treatment.
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“ NO ONE COMES TO OUR CLINIC WHO ISN ’ T FIGHTING FOR THEIR LIFE. ” -John Mattocks, program director at Vance Recovery
The center encourages every individual to participate in the variety of counseling programs available. Their art therapy group provides a unique way of handling the complex emotions that arise during treatment. The group meets once a week to work on different projects that usually re ect their internal struggles. One such project was building two masks—one for how the world sees the patient and another for how they perceive themselves. Mattocks thought this might help them deal with the stereotypes and generalizations about their disease made by the general public. He believes these projects give powerful and healing insight into their personal journey with addiction, an essential step towards healing.
To contact Vance Recovery give us a call: (252) 572-2625 We are located at: 510 Dabney Drive, Suite B Henderson, NC 27536
IT ’ S ALL THEM. THE MEDICINE JUST HELPS. ” -John Mattocks
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After working through these inner issues, clients begin restoring their external world. They grow stronger by learning life skills, emotion regulation skills and other methods for maintaining their sobriety when facing triggers. It’s a challenging process and something they will have to work hard to manage after leaving the center. According to Mattocks, those who recover successfully don’t receive enough merit for their recovery. “There’s a stigma for people who take medication to stop drug use,” Mattocks says. “My patients aren’t given enough credit. They work hard to rebuild their life. It’s all them. The medicine just helps.”
Does someone you care about need help treating their substance addiction?
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ASSISTING OUR PATIENTS IN ATTAINING A MATURE AND PRODUCTIVE LIFESTYLE, FREE OF SUBSTANCE ABUSE. www.morseclinics.com
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Bend But Don’t Break Yoga is being used to help people maintain recovery and avoid relapse
Yoga is no longer exercise your annoying, health-conscious friend won’t stop talking about.The ancient practice is now being used to help people recover from addiction. While scholars estimate yoga was developed sometime around 300 to 400 B.C., the practice hasn’t stopped changing over the last 2,000 years. A new wave of yogis are now helping people in recovery connect their spiritual and physical sides through yoga by combining the practice with more traditional 12-step elements. “It’s just a way of coming back to a sense of wholeness,” says Nikki Myers, a yoga therapist who helped develop the 12-step yoga system. “We use yoga as a process in order to bring that reintegration.”
Myers says she developed the system primarily as a means of relapse prevention. She says a typical 12-step yoga session would begin the same way most 12- step meetings do, with a focus on sharing and discussion of important recovery topics. Once the “meeting” portion of the session is over, the group will then move into a series of yoga poses designed to help participants focus on their physical recovery. “A focus needs to be on the body- based piece as well as the cognitive piece in order for wholeness to really be manifested,”Myers says. “Once you include those things, the whole idea is that these will begin to offer us a set of tools that we can use both on the mat in the yoga practice and off the mat when the triggers of life show up.”
“It’s just a way of coming back to a sense of wholeness.” - Nikki Myers, yoga therapist
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The right tools Myers says the idea that yoga can provide a set of tools is critical as the practice of yoga is much more than the poses themselves. She says there’s also a focus on breathing techniques, a meditation of sorts, and a connection to one’s physical reactions that can prove vital when faced with difficult circumstances. Myers recalls how one woman who participated in 12-step yoga later found herself in a very stressful situation at home with her kids misbehaving and everything going wrong. She said she could feel the negativity boiling up inside her. It was the kind of stress that had triggered her to drink in the past, but the woman said in that moment she was able to relax and calm herself by focusing on her breathing and remembering the feeling of tranquility she had experienced in class. “It had a way of creating a space, giving her tools to create a space between her reactions and instead take a different neural pathway,”Myers says. “These are the kind of tools that we’re looking to have people use.” “A focus needs to be on the body-based piece as well as the cognitive piece in order for wholeness to really be manifested.” - Nikki Myers
Not a replacement Myers is quick to point out that yoga is not a substitute for traditional 12-step support, but rather an additional measure that some people may find helpful. She says some people have pushed back against the practice, but others have been enthusiastic about its power, with classes spreading across the country and even internationally. Myers says she hopes that one day 12-step yoga will be as common as other treatment programs. But she says as long as people are maintaining sobriety and finding wholeness within themselves, she’ll be proud of the difference her system has made. “We’ll tell people, ‘Notice this in your body, what it really feels like,’” Myers says. “Healing only happens in safe space.”
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Discrimination, whether based on race, gender, or sexual orientation, has long been thought to be a contributor to substance abuse. Now a new study has confirmed the relationship between discrimination and addiction, but it’s also brought up many more questions that still need to be answered in order to improve treatment outcomes. Researchers at the University of Iowa recently completed a peer review study in which they looked at 97 previous studies on discrimination and alcohol use. Their goal was to summarize the collective knowledge researchers have uncovered throughout the years, and what they found confirmed in more detail what many had previously suspected.
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“Generally there is good scientific support, but the evidence is mixed for different groups
and for types of discrimination.” - Dr.Paul Gilbert, University of Iowa
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overtly racist or sexist to another person. But less research has been done on what are known as micro-aggressions, small everyday occurrences that can rub a person the wrong way. That research is improving, but there are other factors that need to be more fully explored. While studies have looked at historical trauma in the African-American population, the concept has not been fully investigated with regards to Hispanic and Asian populations. “This notion of historic trauma could be really relevant to other groups, but it hasn't received much attention at all,” Dr. Gilbert says. “This is something we should pay attention to.” All of this adds up to the fact that treatment providers may be missing a key piece of the substance abuse puzzle.
The team found that discrimination did indeed lead to an increase in drinking frequency, quantity of alcohol consumed, and in the risk for alcohol use disorders. Researchers say drinking can represent a coping mechanism in response to the stress caused by discrimination, and several studies showed clients acknowledging this direct link themselves. But when looking at specific populations and types of discrimination, the picture becomes less clear. “The story is that generally there is good scientific support, but the evidence is mixed for different groups and for types of discrimination,” says Dr. Paul Gilbert, the study’s lead author. “We don’t really know comparing one type or one level to another.” For example, much research has been done on interpersonal discrimination where someone is
But just because the intricacies of how discrimination affects drinking aren’t yet fully understood, that doesn’t mean our current knowledge base can’t be helpful. Dr. Gilbert says simply knowing that experiences with discrimination can drive drinking could inform the way treatment providers interact with clients, opening new areas of their lives to explore during treatment. “It can serve as sort of an early warning or indicator,” Dr. Gilbert says. “For treatment providers, it’s worth looking at: is there something that may be keeping folks from accessing services or affecting outcomes?”
Dr. Gilbert says treatment providers should continue to address discrimination as part of a holistic approach to recovery. He says it will be up to researchers to fill
in the gaps to find the precise ways that discrimination affects drinking behavior. “We’ve got good evidence on this level of interpersonal discrimination,” Dr. Gilbert says. “We’ve gotten the low-hanging fruit, now it’s time to start working on the stuff that’s a little further up the tree.”
“It can serve as sort of an early warning or indicator.”
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FIGHTING FIRE WITH FIRE FIGHTING FIRE
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ADJUSTING ALCOHOL CONSUMPTION Another team of researchers at the University of Queensland in Australia believe the FDA-approved drug pindolol could be used to stop alcohol abuse. Pindolol is an anti-hypertensive medication used to treat high blood pressure. But because of the way it interacts with neurotransmitters in the brain, they believe it could also be eective in treating alcohol use disorders (AUDs). To study the drug’s eect, the team used mice and exposed them to an alcohol consumption regimen similar to a binge drinking cycle common in humans. For mice also given pindolol, the team found they were able to reduce drinking in the long term (after at least 12 weeks).e team did not see as positive of results in the short term (only four weeks), but they say they’re still excited about its potential uses. “Although further mechanistic investigations are required, this study demonstrates the potential of pindolol as a new treatment option for AUDs that can be fast-tracked into human clinical studies,” the authors wrote.
espite years of stigma, medication-assisted treatment (MAT) is steadily gaining in popularity among treatment providers. Government groups like the U.S. Department of Health and Human Services are actively campaigning to get more providers to oer MAT as a potentially vital resource for patients. While such groups often promote well-known medications such as methadone and buprenorphine, drug researchers are looking for new medications that could be a lifeline to patients in need. But new medications can cost millions to research and take years to get on the market.at’s why some researchers are taking a closer look, and nding success, with drugs already approved by the FDA. CURBING COCAINE USE Researchers at the University of Pennsylvania say a drug already on the market for diabetes may be able to curb cocaine use.e FDA-approved drug Byetta, used to regulate blood sugar in diabetic patients, is derived from a natural hormone known as GLP-1.e research team looked at how the hormone functioned in rats and found that the same hormone that regulates food intake could be used to suppress cocaine consumption. “ese results are very provocative and suggest these compounds could be repurposed for drug addiction,” says Dr. Heath Schmidt, one of the lead researchers. “We have seen a reduction in cocaine consumption…but it doesn’t completely abolish it.” Currently, there is no FDA-approved drug for the treatment of cocaine abuse. But because Byetta and a similar drug have already gained federal approval, researchers say that leaves fewer hurdles before they could be used in treatment settings. Although still far from human trials, researchers say they’re optimistic, especially because their research suggests the hormone is not specic to cocaine and could be used in treatment of other substance abuse disorders. “I think this opens up a large world view with regards to this system in the brain,” Dr. Schmidt says. “ere’s really a lot to be explored here and I think it’s really an exciting time to be in the eld and exploring the GLP-1 system.”
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Most people are aware that excessive alcohol consumption is bad for your liver. But newresearch shows it can also be harmful toother parts of your body and put you at risk for a number of diseases previously thought to be unrelated toalcohol use.
Trouble breathing A research team from Loyola
Cancer nightmare
Cardiovascular concerns Heart disease is the number one killer of people worldwide, and medical experts everywhere have been trying to gure out how to reduce the risks associated with cardiovascular conditions. New research suggests they should take a closer look at alcohol. While some studies have suggested that low levels of alcohol consumption can improve heart health, a team of researchers from the University of California - San Francisco found that to be a bit of a mixed bag. In studying health dierences between people living in “dry” (alcohol sales prohibited) and “wet” (alcohol sold more freely) counties in Texas, they found varying results. “Greater access to alcohol was associated with more atrial brillation and less myocardial infarction and congestive heart failure,” the authors wrote. “Although an increased risk of congestive heart failure was seen shortly after alcohol sales were liberalized.” So while they did see a dip in some cardiovascular conditions, the results also show a clear link between alcohol access and various health problems. Researchers said policy makers should use this information when establishing laws to protect public health. “We believe that our results have broadly applicable health implications relevant to people with and at risk for various types of cardiovascular disease,” the authors wrote.
When people think about substances that can cause cancer, they often think of cigarettes or other tobacco products. But a new study shows alcohol may also be a major contributing factor to no fewer than seven types of cancer. A researcher from the University of Otago in New Zealand, Dr. Jennie Connor, looked at a number of studies dealing with cancer and alcohol and found strong evidence that excessive drinking can cause cancer in seven parts of the body. Connor identi ed those areas as the “oropharynx, larynx, oesophagus, liver, colon, rectum and breast.” She wrote that while there are always limitations to determining exactly what caused a speci c disease, the evidence is overwhelming. “Current estimates suggest that alcohol-attributable cancers at these sites make up 5.8 percent of all cancer deaths worldwide,” Connor wrote. “Con rmation of speci c biological mechanisms by which alcohol increases the incidence of each type of cancer is not required to infer that alcohol is a cause.”
University in Chicago recently found that excessive drinking could also cause problems in the respiratory system.e team looked at levels of nitric oxide in the exhaled breath of over 12,000 people. Nitric oxide protects against a number of respiratory diseases and can even be used in medical settings as a treatment for sick infants. e researchers found that excessive drinkers had less nitric oxide in their breath, meaning they were more susceptible to respiratory infection and disease. Although more research is still needed to determine the full extent of the relationship between alcohol and nitric oxide, the authors of the study said the results are troubling. “Alcohol use impacts several lung diseases, and heavy consumption has been associated with poor clinical outcomes,” the authors wrote. “e fractional excretion of exhaled nitric oxide (Feno) has clinical implications in multiple airways diseases.”
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Sign of the times Experts say the newly approved implant also provides a big boost to the concept of medication-assisted treatment (MAT) in general. For years, the idea that someone could achieve recovery through the use of drugs like methadone and buprenorphine was rejected by many professionals in the eld who saw complete abstinence as the only true sobriety. Many still hold that belief, but attitudes appear to be changing. Top government ocials say they want to increase the amount of MAT taking place at the country’s treatment centers. Several states as well as the federal government have enacted laws making it easier for physicians to prescribe medications like buprenorphine, but they say too few patients receive the medication they need. National Institute on Drug Abuse, in a statement. “is product will expand the treatment alternatives available to people suering from an opioid use disorder.” ] [ "Opioid abuse and addiction have taken a devastating toll on American families.” - Dr. Robert M. Cali , FDA Commissioner “Scientic evidence suggests that maintenance treatment with these medications in the context of behavioral treatment and recovery support are more eective in the treatment of opioid use disorder than short-term detoxication programs aimed at abstinence,” said Dr. Nora Volkow, director of the
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edication-assisted treatment is growing in popularity and acceptance among addiction recovery professionals. And now it’s taken a revolutionary step forward that could oer renewed hope to thousands of people struggling with an addiction to opioids. is summer, the U.S. Food and Drug Administration approved a new buprenorphine implant to treat opioid dependence. Buprenorphine had previously been available only as a pill or a dissolvable lm placed under the tongue. But the new implant, known as Probuphine, can administer a six-month dose of the drug to keep those dependent on opioids from using by reducing cravings and withdrawal symptoms. "Opioid abuse and addiction have taken a devastating toll on American families,” FDA Commissioner Dr. Robert M. Cali said in a statement. “We must do everything we can to make new, innovative treatment options available that can help patients regain control over their lives.” e implant comes in the form of four one-inch rods that are placed under the skin on the upper arm.e implant must be administered surgically and comes with the possibility of certain side eects, but experts say it could be more convenient and more eective for patients.ey say by eliminating the need to take pills, ll prescriptions and generally manage their medication, it makes it easier for people to focus on the other areas of their recovery while making it less likely someone will lapse in their treatment plan.
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Although the implant is certainly a new alternative, it has yet to show any increased success in keeping people from relapsing compared to the pill or lm tablet. In a study of the implant’s eectiveness, they found that 63 percent of people given the implant were free of illicit drugs at six months, compared to 64 percent of people who took buprenorphine by pill. Still, those rates are much higher than the success rates of people who follow abstinence-only treatment plans. And ocials hope the new implant will lead more people to get MAT, increasing the number of successful recoveries across the country.
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U n d e r s e r v e d And Undeterred Overcoming the unique challenges LGBTQ individuals face with addiction A s more and more addiction treatment centers are looking for ways to tailor programs to address the individual needs of clients, one section of the population is being largely overlooked. Advocates say treatment providers need to be more aware of the unique issues and barriers facing the LGBTQ community. Numbers don’t lie program. Advocates say 46 percent of homosexual men and women have had a homophobic therapist, and 34 percent felt their sexuality was seen as irrelevant. While putting sexuality aside to address addiction glance, advocates say recognizing those recovery. Need for understanding Understanding a person’s sexuality and gender identity can be as important as understanding their race or ethnic background in that it can uncover potentially hidden sources of stress or trauma that may contribute to substance use. Just as counselors should consider the social experiences of African-Americans, so too should they consider the unique circumstances faced by members of the LGBTQ community. “In order to not continue to create trauma towards the LGBTQ community, the more culturally competent a person or work/recovery environment is, the better,” says Molly Gilbert, director of business development for the PRIDE Institute in Minnesota. LGBTQ individuals at much higher rates than they do the heterosexual population. Some estimates show an addiction rate between 30 and 40 percent, compared to around 10 percent of the population in general. While statistics also show that LGBTQ individuals enter into treatment more readily than the rest of the country, they also face
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e PRIDE Institute specializes in addiction treatment for the LGBTQ community, and Gilbert says a lack of understanding or awareness by treatment providers can create barriers for people seeking treatment. Even for organizations that seek to become “inclusive” communities, they may not set up a program that accurately addresses LGBTQ concerns, or providers may not realize how they are doing harm to LGBTQ individuals, transgressions known as micro-aggressions. “Micro-aggressions occur daily towards the community and educating heterosexual colleagues, supporters and the rest of society is key in helping to diminish these daily slights and harm,” Gilbert says. Education first To improve treatment outcomes and the experiences of LGBTQ people in general, advocates say it’s vital that treatment providers, physicians, and social service
employees educate themselves on some of these unique challenges and barriers. But they also say LGBTQ people need to educate themselves as well. “Educating the LGBTQ
community on the dangers of abuse of alcohol and drugs, and the fact that the
community is actually being targeted by
institutions such as big tobacco, alcohol companies and drug manufacturers is key,” Gilbert says. With very few LGBTQ-specic treatment centers across the country, advocates know many
LGBTQ individuals will end up in heteronormative treatment facilities. And while that can present problems, Gilbert says with the right education and the right system in place, recovery is attainable. “With the right therapy coexisting with a mainstream treatment center, we believe it is doable.”
“There’s a lot of information that can be gained from when somebody relapses.”
- Dr. Stephanie Carreiro, University of Massachusetts
Fitness trackers could help prevent relapses
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Dr. Carreiro says wearable biosensors can detect a relapse event for some substances (like heroin and cocaine) by sensing a change in heart rate or other physical conditions. The treatment provider can then use the tness tracker’s other information, like the time and location of the relapse event, to develop a pro le about the conditions that prompt a patient to use. “It gives us very speci c contextual information and serves as that reminder to the patient that someone could potentially know right away when they relapse,” Dr. Carreiro says.
Fitness trackers, or wearable biosensors, like Fitbit and Jawbone are the latest tness trend to gain widespread popularity. But some believe they could be used to treat addiction as well. New research suggests the devices can be used to reliably detect relapses, which could then give treatment providers the information they need to prevent relapses in the future. “There’s a lot of information that can be gained from when somebody relapses,” says Dr. Stephanie Carreiro, a researcher from the University of Massachusetts.
ACCOUNTABILITY MATTERS That accountability to someone who could see the relapse is an important step in moving past simple self-reporting and drug testing. People can lie during self-reports and drug testing will only show that drugs were used, but not information like how much was used, when it was used, and where. Because the sensors can be easily removed, the system will only work for patients who are truly motivated to stay sober. Dr. Carreiro says rather than a big brother scenario with treatment providers tracking a patient’s movements, the devices simply connect a patient to their support network.
“We could potentially trigger an interaction with a patient just seeing if they’re okay and need some help,” Dr. Carreiro says.
“It definitely served as a reminder that there was something motivating them to stay sober.”
- Dr. Stephanie Carreiro
SIMPLE REMINDER In a study of 15 patients, nearly everyone kept wearing the devices even when relapsing. Dr. Carreiro says that’s because many people are already used to wearing tness trackers, and the treatment plan simply ts into the daily routines they’ve already established. Researchers also say just having a physical object on a patient’s wrist to remind them about their dedication to sobriety can be enough to prevent a relapse. “Multiple people looked at it and thought of going back to jail or being there for their children,” Dr. Carreiro says. “It de nitely served as a reminder that there was something motivating them to stay sober.”
WHAT ABOUT PREVENTION? The ultimate goal is to prevent relapses and keep patients on the path to sobriety. While the technology is advancing quickly, researchers say the collective knowledge base simply isn’t there yet to predict a relapse event. But as they conduct more studies and develop better algorithms with the information gained, they should be able to tailor interventions to a speci c patient and hopefully keep them from relapsing. “We need to continue to de ne different pro les so that we can get a more complete understanding of what’s happening,” Dr. Carreiro says. “That’s when it will be the most powerful.”
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“We were surprised that morphine was able to induce these really long-lasting changes,” says Dr. Peter Grace, the study’s lead author. Dr. Grace says the cause of the chronic pain increase has to do with cells that form part of the immune system. He says if those areas could be isolated or their eects reduced, the resulting pain may not be as great. “If it does turn out to be a relevant issue to patients, then what our study suggests is that targeting the immune system may be the key to avoiding these kinds of eects,” Dr. Grace says. “Opioids could essentially work better if we could shut down the immune system in the spinal cord.” e team’s research only looked at spinal cord injuries and morphine, and did not study other opioids that are commonly prescribed to patients experiencing pain. But he said it’s likely drugs like Vicodin or OxyContin could aect other parts of the body in a similar way. “While we haven't actually tested other opioids in this particular paradigm, we predict that we would see similar eects,” Dr. Grace says.
ain relievers are supposed to relieve pain. It sounds simple enough, but new research suggests a common pain medication may actually be prolonging chronic pain. Morphine is an opioid painkiller commonly prescribed in hospitals and clinics, and while it is eective in the short term, doctors don’t always consider the potential consequences for pain down the road.at’s why a team of researchers based out of the University of Colorado - Boulder set out to study how morphine treatment aects chronic pain, and found some troubling results. e team, which used mice with spinal cord injuries, found that in mice not given morphine, their pain thresholds went back to normal about four to ve weeks after the injury. But mice who were given morphine didn’t see their pain levels return to normal until around 10 to 11 weeks, meaning the use of morphine eectively doubled the length of their chronic pain. P
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Chronic problem Chronic pain can be debilitating for many people facing serious health problems, and it can also be a key factor in substance abuse. Many people report developing a dependence on opioids after having them prescribed for an injury. But new research suggests the number of people who develop dependency issues because of chronic pain may be far higher than people realize. A study from researchers at Boston University looked at a group of nearly 600 people who had either used illicit substances or misused prescription drugs.
ey found that 87 percent reported suering from chronic
pain, with 50 percent of those people rating their pain as severe.ey also found that 51 percent of people who had used illicit drugs like marijuana, cocaine and heroin had done so to treat their pain. While many prevention eorts focus on recreational users, the numbers suggest that chronic pain plays just as prominent a role in substance abuse. “Many patients using illicit drugs, misusing prescription drugs and using alcohol reported doing so in order to self-medicate their pain,” the authors of the study wrote. “Pain needs to be addressed when patients are counseled about their substance use.”
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CONCERN OVER HEROIN USE GROWING
New Poll Shows Americans Are Increasingly ConcernedWith
45 percent of Americans think heroin use is a bigger problem in their communities than shows they’re not wrong. According to the Centers for Disease Control, heroin-related overdose deaths nearly quadrupled from 2002 to 2013. Experts fear the numbers will continue to rise, with recent data showing roughly 156,000 Americans began using heroin in 2012 alone. Political Discourse a time when lawmakers and treatment providers are struggling to combat the rise in heroin overdoses. Several states have passed legislation making it legal to purchase Naloxone, a drug that works as an antidote for opiates, and Congress is considering several bills that would change the way federal authorities handle drug issues.
ore and more Americans are feeling the dangers of heroin, with nearly half of adults describing heroin abuse as a very serious problem,
according to a recent poll.
1,000 U.S. adults about heroin abuse, with 49 percent saying they thought it was a very serious problem, and another 38 percent saying they thought it was somewhat serious. heroin epidemic is hitting, with one-third of respondents saying they personally know someone who has become addicted to heroin or another opiate. Numbers Don’t Lie Public perception of heroin use has changed quickly over the last few years. A Rasmussen Reports survey in November of 2015 found
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groups to increase understanding of addiction as a disease, 28 percent said those who use heroin are most to blame. Still, the poll showed public opinion remains somewhat balanced, with 48 percent of people saying all groups are equally to blame. A Universal Issue races. Although black and Hispanic Americans were more likely than white respondents to cite heroin as a very serious problem, all three groups had similar views on nearly every other question. across almost every demographic over the past decade, and poll numbers show perception and reality are more in line than most would like to admit.
commander-in-chief have also paid closer attention to the heroin epidemic, with the issue playing a more prominent role in this year’s presidential campaign than it has in
past election cycles. Who’s To Blame?
voters are paying close attention to the problem may come as no surprise considering how much blame the public puts on them. Of those surveyed, 5 percent said the U.S. government and those who decide how heroin users are treated are most to blame for the current heroin problems. In comparison, drug dealers themselves were singled out by only 11 percent of “49 percent of U.S. adults think heroin abuse is a very serious problem, and 38 percent say it’s somewhat serious.” -
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Boom, Bust, and Drugs Study says economic downturn leads to increase in substance use disorders When the economy tanks, drug abuse goes up.That’s the finding of a new study which shows the state of the economy is closely linked with substance abuse disorder rates for a variety of substances. The study, conducted by researchers from Vanderbilt University, the University of Colorado and the Substance Abuse and Mental Health Services Administration (SAMHSA), found the use of substances like ecstasy becomes more prevalent during economic downturns. Researchers also found that other drugs like LSD and PCP see increased use only when the economy is strong. But for overall substance use disorders, the findings were clear.
“Problematic use (i.e., substance use disorder) goes up significantly when the economy weakens,” says Christopher Carpenter, one of the lead researchers. “Our results are more limited in telling us why this happens.” Researchers say it’s possible that people turn to substance use as a means of coping with a job loss or other major life changes caused by economic pressures, but their particular study did not pinpoint an exact cause and effect. Not all drugs are equal The study showed that a downward shift in the economy has the biggest impact on painkillers and hallucinogens. Rates of substance abuse disorders were significantly higher for those two categories than any other class of drug.
Researchers also found the change in disorder rates was highest for white adult males, a group which was one of the hardest hit during the Great Recession.They say more research is needed to determine exactly how the economy and drug use are related, but they say the study highlighted some key groups for prevention and treatment workers to target during future economic downturns.
“Problematic use (i.e., substance use disorder) goes up significantly when the economy weakens.” - Christopher Carpenter, Vanderbilt University
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Slippery slope Despite some lingering questions, researchers were able to show the significance of the economy’s role in problematic substance use.The study showed that even a small change in the unemployment rate can have a tremendous impact on the risks for substance abuse disorders. “For each percentage point increase in the state unemployment rate, these estimates represent about a 6 percent increase in the likelihood of having a disorder involving analgesics and an 11 percent increase in the likelihood of having a disorder involving hallucinogens,” the authors write. Previous studies have focused on the economy’s link to marijuana and alcohol, with many looking at young people in particular.This study is one of the first to highlight illicit drugs, which given the current opioid epidemic, holds important lessons for those working to curb problematic drug use.
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When it’s needed most The study bears significant weight for treatment facilities and public policy makers in particular. During economic downturns, government agencies typically look to cut spending on treatment programs as a way to save money, something researchers say may be more costly in the end. “Our results suggest that this is unwise,” Carpenter says. “Such spending would likely be particularly effective during downturns since rates of substance use disorders are increasing when unemployment rates rise, at least for disorders involving prescription painkillers and hallucinogens.”
“Spending would likely be particularly effective during downturns since rates of substance use disorders are increasing when unemployment rates rise.” - Christopher Carpenter, Vanderbilt University
10
Reasons Why I Do Not Like
Benzodiazepines
By Dr. Eric Morse, MD
Benzos kill people in combination with methadone and buprenorphine by suppressing breathing. At the Morse Clinics, we limit doses of methadone or buprenorphine to minimize this risk as part of our Benzo Policy. I believe that is why we have a much lower death rate than the national average.
Benzos are addictive, especially in folks who already suffer with an addiction. They lead to relapse.
Benzos cause dementia. September 2014’s British Medical Journal published a study that showed just 91 days of taking Benzos in your lifetime increased your risk of developing dementia by over 40%.
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Benzos disinhibit. I have seen many patients not acting like their usual self while on Benzos.
Overdoses – in North Carolina, Benzos have overtaken opioids as the leading cause of unintentional poisoning deaths.
Impaired reaction time in driving.
Benzos are often used to treat dif cult emotions. No new coping mechanisms can be developed. Folks use Benzos to change their feelings, not living life on life’s terms.
Benzos are not considered 1st, 2nd or 3rd line recommended treatment by the American Psychiatric Association’s treatment guidelines for any anxiety disorder (other than the rst 2 weeks of treating Panic Disorder whilst a serotonin medication is being titrated up).
There is no medical evidence that shows Benzos need to be used for more than a few weeks. Benzos have been shown not to be effective long-term to treat any anxiety disorder.
Benzos are like whiskey in the form of pills. They act similar to alcohol on the brain via GABA. They can easily cause intoxication.
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