Applegate Recovery

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Take the First Step Call us at 888.289.5906 or send an email to the program nearest you. We’ll complete a brief assessment over the phone and schedule your intake appointment if eligibility requirements are met. Intakes are done by appointment and can typically be scheduled within 24 – 48 hours of the initial call. To be eligible for a medication- assisted treatment program, patients must be 18 years of age or older, have valid photo identification and have a history of opiate use. Studies have shown that counseling, along with medication, is the most effective combination in treating opioid addiction

What to Expect The first appointment at AppleGate is typically 2 -3 hours and will include a review of program expectations and fees. Additionally you will meet with an intake counselor to complete:

Beginning Medication-Assisted Treatment

Your physician will complete a prescription for the recommended treatment medication during your intake appointment, which can be filled through the pharmacy of your choice. In addition, you should schedule your first counseling session during intake as well as a medication re-check appointment. It is important to be sure and follow all instructions and precautions when participating in a medication-assisted treatment program, and discuss any concerns with your physician. Ongoing Assessment As you progress through your medication-assisted treatment, re- check appointments with your physician will be scheduled based on your individual needs and the doctor’s recommendation. These appointments will include a medication check as well as a brief examination. Any concerns you have about your medication, dosage or side effects can be discussed with your physician at this time. Counseling Individual and group substance abuse counseling is offered at all AppleGate Recovery clinics and is incorporated into your personalized treatment plan. Studies have shown that counseling, along with medication, is the most effective combination in treating opioid addiction. Contact the clinic nearest you to learn more about how counseling is an integral part of a successful medication-assisted treatment program.

• Intake paperwork* • Social Assessment • Medical History • Required Lab Tests

Most importantly, your intake appointment provides an opportunity for you to speak with a physician about any questions or concerns you have regarding medication-assisted treatment. The physicians at AppleGate Recovery are all highly trained professionals who take your recovery, and the recovery of every single patient, very seriously. After a review of your history and a physical examination, you and your doctor can determine the treatment plan that is right for you. AppleGate utilizes multiple compounds of the generic medication buprenorphine, which include: Suboxone®, Zubsolv® and Bunavail®. Our physicians will work with each patient to determine the medication that will be most effective for them. * Please bring your identification and any insurance information to your appointment.

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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

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.”

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“Spending would likely be particularly effective during downturns since rates of substance use disorders are increasing when unemployment rates rise.” - Christopher Carpenter, Vanderbilt University

“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

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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We are dedicated to building a strong community through our commitment to providing cost- effective, high quality services, consistently and effectively to all those in need. 3303 N Central Expressway Suite 210 • Plano, TX 75023 WWW.APPLEGATERECOVERY.COM

Denial is a dangerous part of addiction

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AppleGate specializes in medication-assisted treatment, known to be the most effective treatment for opioid addiction.

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

Our doctors, counselors and

professional staff treat all patients with respect and compassion, just as you would expect if being treated for any life threatening disease.

Individualized treatment plans include counseling and medication,

providing patients the best opportunity for recovery.

3303 N Central Expressway Suite 210 • Plano, TX 75023 APPLEGATE RECOVERY

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

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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You gave me HOPE HEALING It’s about being ready to make a change, and knowing where to go to get the help you need. Visit Our Website! APPLEGATERECOVERY.COM

not just a bad habit It’s NOT JUSTA BAD HABIT not just a bad habit It’s T J STA 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 R cent r search and ialogue in the political sph r have brought long-sim ering questions about ad iction o the fore: Is addiction truly a disease? Do addicts eserv to b treated lik 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 disease that’s outside th ir contr l? While most re earchers agree with the so-called disease model of addiction, stereotypes and cultura bi s continue to stigmatize hose with addiction because they made n initial choi e to consume substances. However, Columbia University researchers point ou tha “choi e does not de ermine whether 34 While most r searchers agre wi the so-called isease model of ad iction, st r otypes and cultural bias co tinue to stigmatize those with ad iction because they made an initial choice to consume substances. How ver, Columbia University r s archers point out that “choice does not det rmine whether Recent r search and dialogue in the political sphere have brought long-simmering questions about addiction the fore ront: Is addiction truly a disease? Do addicts de erve to be trea ed like peo l who have

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. H art disease, diabetes and some forms of cancer involve personal choi es like diet, exercis , sun exposure, etc. A disease is what happens in the body as a result of those choi es.” Experts say that applying the distinction of choi e to addiction creates bia es that jus ify inadequate treatment. It begs the question New Jersey Gov. Chris Christie asked during a 2015 town hall meeting in New Hampshire. When Christie’ mother was di gnosed something is a disease. Heart disease, diab tes and some forms of cancer involve personal choices like diet, xercise, sun exposur , etc. A disease is what happens in the body s a result of those choices.” Experts ay th t ap lying the distinction of choice to ad iction creates biases that justify inadequate treatmen . It begs the question New J rsey Gov. Chris Christie aske 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 s a result of ad iction t tobacco, he noted that with lung cancer at 71 as a result of addiction tobacco, he noted hat

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

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Too Much? From the Office of Dr. Study cites concern over doctors' prescribing habits

Family physicians are the largest prescribers of opioid pain medications, even outpacing pain specialists, according to a recent study published in the journal JAMA Internal Medicine. The findings reinforce the need for prevention efforts that focus on prescribing behaviors of physicians as well as patients who are at risk of overdosing, the researchers say. “Overprescribing is a national concern, and mitigation efforts should not be oversimplified or targeted to a select few prescribers, or to regions of the country, or to patient populations or communities,” says Victoria Richards, associate professor of medical sciences at Quinnipiac University School of Medicine, in a HealthDay article on the study. According to the advocacy group Physicians for Responsible Opioid Prescribing, many prescribers underestimate the risks associated with opioids – especially the risk of addiction – and overestimate their effectiveness.

Prescription rates vary

painkiller prescriptions per person as those in the lowest prescribing state. Yet, health conditions that cause people pain do not vary much from place to place and do not explain this variability in prescriptions issued. These latest findings add fuel to those who advocate for stricter oversight of narcotic pain medication. Approximately

44 people die each day from prescription opioids, and opioid- related deaths have tripled since the 1990s. More than 80 percent of these deaths are accidental or unintentional, according to the CDC, which estimates that up to 60 percent of opioid overdose deaths occur in people without a prior history of substance abuse.

Another indicator of the need for more scrutiny of prescribing practices is that prescribing rates for opioids vary widely among states, says the Centers for Disease Control and Prevention (CDC). In 2012, health care providers in the highest-prescribing state wrote almost three times as many opioid

Who is prescribing painkillers? In 2013, 15.3 million family practice physicians and 12.8 million internal medicine physicians wrote prescriptions for narcotic pain medication, researchers found in studying Medicare Part D drug coverage claims.The study also found that nurse practitioners wrote 4.1 million prescriptions for narcotic painkillers while physician assistants ordered up 3.1 million.The research, led by Dr. Jonathan Chen of Stanford University, focused on prescriptions for narcotic painkillers containing hydrocodone (drugs such as Vicodin), oxycodone (Oxycontin and Percocet), codeine and others in the opioid class. In studying prescriptions written by 808,020 American doctors in 2013, the researchers found that pain management specialists and anesthesiologists wrote the most prescriptions for opioids. On average, individual pain doctors ordered 900 to 1,100 prescriptions for painkillers in 2013, and anesthesiologists wrote nearly 500. By comparison, each family physician wrote an average of about 160 prescriptions. Because there are many more family doctors than specialists, as a group, their number of painkiller prescriptions was higher than for any other provider category—more than 15 million prescriptions collectively, followed by internal medicine physicians at just under 13 million. In total, these two groups wrote more than half of all opioid prescriptions in the country. Pain specialists, including those involved in the more invasive sub-specialty of interventional pain management, accounted for about 3.3 million prescriptions.

CDC issues draft guidelines In the wake of growing concern over the excessive use of prescription opioids, the CDC recently issued a draft Guideline for Prescribing Opioids for Chronic Pain.The document provides recommendations regarding when and how these drugs are used for chronic pain: selection, dosage, duration, follow- up, and discontinuation; and assessment of risk and addressing harms of opioid use. However, the Guideline is not a federal regulation; adherence to it will be voluntary, the CDC notes. 

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

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We understand that addiction is a disease, and treat it as such, in an environment of compassionate, respectful care.

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