Here’s How to Support Someone Experiencing a Relapse

Headlines about Demi Lovato’s recent hospitalization have sparked a new public discussion about addiction, overdoses, and relapses. Unfortunately, some of that discussion has reinforced harmful stereotypes and misinformation about how to treat a loved one who struggles with addiction.

If you have someone in your life who is dealing with a relapse, don’t panic. There’s no need to cut that person off with “tough love,” or to max out your credit card shipping them off to a destination rehab. We talked to medical experts, plus people with lived experience of recovery, to get the facts on relapse and how to support someone through it.

First, understand what relapse is.

Here’s what happens medically when someone relapses—and why it can be so dangerous.

It has to do with tolerance, says Dr. Shawn Ryan, founder of BrightView Health and president of the Ohio chapter of the American Society of Addiction Medicine (ASAM). When a person stops using their drug of choice, “their tolerance drops and puts them at risk for more medical consequences if they relapse.” For example, “if a patient has stayed abstinent from opioids for a while (whether on medication-assisted treatment or not), their tolerance for fast-acting opioids such as heroin substantially declines; this is why patients are at such high risk of overdose if they go back to using their old dosages.”

Relapse is a part of addiction, and addiction is a medical illness.

“Once an individual becomes addicted, the brain rewires,” says Nikki Litvak, MA, LPCC-S, LICDC, the Associate Director of Counseling at BrightView. “Relapse is not a choice, but a potential part of the disorder.”

It’s really not about willpower.

“Most people wouldn’t yell at a loved one who forgot their inhaler at home, and then had an allergic reaction as a result of their medical condition,” Litvak continued. “So we shouldn’t do that when someone we’re close to experiences a relapse.”

As someone with addiction progresses toward recovery, relapse can happen—just as symptoms can flare up during treatment for any other chronic disease, like diabetes or hypertension. But a relapse doesn’t mean someone has failed, or didn’t try hard enough.

Next, learn how to best support someone experiencing a relapse.

Be there to offer “empathy, empathy, empathy.”

Laura Silverman, a Shatterproof ambassador and founder of the Sobriety Collective, has been in recovery for 11 years. Her advice for supporting a loved one through a relapse? “Empathy, empathy, empathy. Remove shame, don’t blame, and show love.”

It shouldn’t be that strange of a concept. “Do we shame someone with a recurrence of cancer?” Silverman asks. “No. Then why do we shame people with a recurrence of substance use?”

Litvak agrees with this approach. “There is no shame in connection and being a person,” she says. “We all need help sometimes and the best help anyone can get is genuine, compassionate and trustworthy connection from another person. The best thing to do is love them, support them, encourage treatment, and be understanding to their struggle.”

Remember to take care of yourself, too.

“Love can come with boundaries,” Silverman also says. “Caregivers or loved ones can show the person of concern that they care, that they’re there to support and love them—while still maintaining healthy boundaries and their own self-care.”

Be prepared for an emergency.

If your loved one is addicted to opioids, be sure to keep a naloxone kit on-hand at all times. This safe, FDA-approved, easy-to-use medication can reverse an opioid overdose in minutes. Naloxone is now available in pharmacies in most states without a prescription. Learn about how naloxone works, how you can get it, and how to use it.

Encourage high-quality treatment.

There’s so much misinformation surrounding what’s best to treat addiction. 12 steps? In-patient rehab? What about medications?

Two things matter most: Local resources and an individualized plan.

“The most effective treatment for someone suffering from substance use disorder is based on the individual’s needs. Each person suffering from substance use disorder should recognize their priorities which may include religious affiliation, insurance costs (or lack thereof), medication, privacy, and many other factors,” says Litvak. “You should begin looking for treatment within your insurance provider, primary care, and local recovery support systems.”

ASAM’s physician locator and the American Board of Preventative Medicine (ABPM)’s search tool are great places to find medical professionals in your area who are certified to provide addiction treatment.

Educate yourself on what good treatment looks like.

To know what to look for in legitimate addiction treatment, read up on Shatterproof’s National Principles of Care. They’re a set of eight core concepts for addiction treatment, crafted by experts and backed by decades of research. These Principles remove some of that confusion from the addiction treatment process, and show the path toward sustained recovery for patients dealing with addiction.

Original article here written by Shatterproof.org.

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Video for Patients and Families With Questions About MAT

Dr. Hillary Kunins, a PCSS Clinical expert, dispels the notion that treating an addiction patient with medication is simply exchanging one drug with another. Learn how physical dependence is not the same as addiction. A good video to share with patients and their families who have questions about MAT.

Dr. Kunins is an Assistant Commissioner at the New York City Department of Health and Mental Hygiene where she leads the Department’s Bureau of Alcohol and Drug Use – Prevention, Care and Treatment.

Link to original video here.

View more videos at www.pcssNOW.org.

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Opioid Management Congress Aug 13-14 in Nashville

Join Dr. Shawn Ryan, president of OHSAM, who will be speaking at the Opioid Management Congress August 13-14 in Nashville, TN. This is the top destination for executives from hospitals, health plans, community health centers and treatment facilities to:

  • Implement strategies for prevention, monitoring, and treatment across the continuum
  • Network with like-minded executives from various health care sectors to better collaborate and respond to the opioid epidemic
  • Improve your day-to-day operations to target efforts toward pain management, stigma reduction, education, addiction treatment, and more

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Click on the image below to register.

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Click here for event home page.

New Clinician Screening Tool Available for Substance Use

The National Institute on Drug Abuse (NIDA) Clinical Trials Network has unveiled a new scientifically validated, online screening tool designed to assess a patient’s risk for substance misuse and substance use disorder, and assist the health care provider with prevention and treatment strategies. The Tobacco, Alcohol, Prescription medication, and other Substance use (TAPS) Tool is available on the NIDAMED Web Portal and consists of a comprehensive screening component followed by a brief assessment for those who screen positive. NIDAMED disseminates science-based resources to health professionals on the causes and consequences of drug use and addiction, and advances in pain management. NIDA is part of the National Institutes of Health.

The TAPS tool may either be self-administered by an adult patient (under medical supervision) or conducted as an interview by a health professional, but not intended to guide self-assessment or take the place of a health care provider’s clinical judgment. TAPS is one of several tools on the NIDAMED portal that can help providers quickly and easily introduce brief, evidence-based substance use screenings into their clinical practices. Clinicians can survey the tools available to determine which one best fits their practice.taps-image-web

For more information about the TAPS tool, go to: TAPS: Tobacco, Alcohol, prescription medication and other Substance Use Tool or https://www.drugabuse.gov/taps/#/.

For a more comprehensive list of evidence based screening tools, go to: Chart of Evidence-Based Screening Tools for Adults and Adolescents.

For more information on the NIDAMED initiative, go to: NIDAMED: Medical & Health Professionals

For more information, contact the NIDA press office at media@nida.nih.gov or 301-443-6245. Follow NIDA on Twitter and Facebook.

Medication Assisted Treatment – Debunk the Myths, Get the Facts

A common misconception associated with MAT is that it substitutes one drug for another.

But actually, these medications relieve the withdrawal symptoms and psychological cravings that cause chemical imbalances in the body.

Research has proven that this is the case when it comes to addiction to opioids. Medication-assisted treatments substantially improve the odds of successful recovery for people who misuse opioids, including heroin and prescription painkillers.

Addiction to opioids has reached epidemic proportions in the United States. In 2015, accidental drug overdoses surpassed car accidents as the leading cause of accidental death according to the Drug Enforcement Administration (DEA),and the American Society of Addiction Medicine says that more than two million individuals in the US are addicted to opioids.

Opioids and the brain

So what’s unique about opioid addiction? Opioids are so addictive—and so dangerous—because of the way in which they affect the brain’s pleasure center. These drugs work by attaching to the brain’s receptors and sending signals that block pain, slow breathing, and promote a feeling of calmness. They also flood the brain’s circuits with dopamine—that “feel-good” chemical that sends the brain feedback about rewards—creating a feeling of euphoria. For the sake of survival, our brains are naturally wired to repeat behaviors associated with pleasure or reward. So, when that reward system is over-stimulated by the effects of opioids, the brain remembers that behavior and records it as something that should be repeated without even thinking about it.

Due to the way opioids affect the brain, behavioral treatments alone, like therapy and 12-step programs, have been proven to be less effective. However, significant research has shown that the use of medication can be very effective in helping opioid users stay in recovery for years or decades.

MAT options

There are a few drugs that are commonly used in the maintenance of opioid use disorder: methadone, buprenorphine, and naltrexone. Methadone is available as an oral tablet, liquid, or wafer from licensed opioid treatment clinics only—and a person in recovery must visit the facility daily to receive treatment. Buprenorphine, which is usually combined with naloxone, is available as a tablet or film placed under the tongue or against the inside cheek or as an implant inserted in the patient’s arm by a physician. Doctors must be specifically credentialed to use buprenorphine to treat patients.

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MAT as part of recovery

Many doctors and other experts have come out in support of MAT as part of a recovery plan for substance use disorder. The American Medical Association (AMA), the American Academy of Addiction Psychiatry (AAAP) and the American Society of Addiction Medicine (ASAM) all support the use of medication-assisted treatments. Alcoholics Anonymous and Psychiatric Medication have also advocated for the use of MAT.

“The best way to overcome the myths about Medication Assisted Treatment is through information and education.”

Consider the following facts:

  • Science has proven that substance use disorder is a disease
  • Opioid use causes actual changes in the brain
  • Brain chemistry changes can be managed with medication
  • Many people with chronic conditions manage them with medication, including persons with diabetes and asthma
  • MAT is supported by the American Medical Association (AMA), the American Academy of Addiction Psychiatry(AAAP), and the American Society of Addiction Medicine (ASAM)
  • Research has shown MAT for opioids is effective
  • Persons in recovery who incorporate MAT can stay substance-free for decades

MATs have been proven very effective in avoiding relapse and fatal overdose, and staying in recovery.  Of course, every treatment plan should be tailored to the unique needs of the person in recovery, and medication may be used in combination with other therapies. Understanding all of your options and incorporating all of the treatments available will only improve your odds of success. Treatment decisions should be made in consultation with a trained physician.

Link to original article, including references and sources can be found here, originally posted on shatterproof.org.

For more information on Medication-Assisted Treatment please click the image below.

Medication-Assisted Treatment for Opioid Addiction: Facts for Fa

Podcast: Addressing Patient Resistance to Medication Assisted Treatment

Medication-assisted treatment is widely accepted treatment for patients with opioid use disorders. Still, patients have many reasons, spoken and unspoken, to be reluctant to start this potentially life-saving treatment.

On this podcast, Ashley Braun-Gabelman, PhD, discusses the importance of addressing this resistance and why it’s important to explore this barrier to treatment head on. The patient and family materials Dr. Braun-Gabelman mentions during the podcast are available for download here.

Dr. Braun- Gabelman is a clinical psychologist in Addiction Recovery Services at University Hospitals Cleveland Medical Center and an Assistant Professor in the Department of Psychiatry at Case Western Reserve University School of Medicine. She specializes in the treatment of substance use and co-occurring disorders including major depression, anxiety disorders, and PTSD. 

Please click the image below to listen to the podcast. 

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For other PCSS podcasts please click on this link.

US needs to invest ‘tens of billions or hundreds of billions’ to fight opioid epidemic

The goal of an opioid is to reduce pain, but the addictive drugs are creating pain for millions of families suffering through the crisis.

Deaths from opioid overdoses number at least 42,000 a year in the U.S., according to the Center for Disease Control.

“This is an epidemic that’s been getting worse over 10 to 20 years,” Caleb Alexander, co-director of Johns Hopkins Center for Drug Safety, told CNBC’s “On The Money” in a recent interview.

“I think it’s important that we have realistic expectations about the amount of work that it will take and the amount of coordination to turn this steamship around,” Alexander added.

President Donald Trump declared the opioid epidemic a public health emergency last fall, and he announced an initiative in March to confront the national health crisis.

“No doubt there’s a lot of efforts underway at every level to address the epidemic,” Alexander explained.

“There’s a flurry of legislation right now working its way through Congress and these legislative efforts address everything from safer packaging to better use of information to try to address the diversion of prescription opioids.”

Opioids include not just prescription drugs, like OxyContin, codeine, and morphine, but also heroin and synthetic drugs like fentanyl.

But Alexander says some progress has been made in reducing the overprescribing of the prescription painkillers, “this was one of the primary drivers of the epidemic in the first place.”

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“There’s been modest declines in prescription opioid sales over the past 5 to 7 years. But we’re still way beyond the volume of opioids prescribed compared with every other country in the world. We have a long way to go before we get to the levels of opioid prescribing that we were at in the late 1990’s before this epidemic began.”

Alexander says his research is focused on identifying clinical and policy solutions to the opioid epidemic.

Beyond reducing opioid prescriptions, he sees another step as crucial in addressing the epidemic.

“We need to better identify and treat people with opioid addiction. This is a treatable condition, just like diabetes or high cholesterol and yet the vast majority of people with opioid use disorder are not enrolled and seeking care.”

Alexander added: “The statistics are stunning. More than 2.1 million Americans have an opioid use disorder or opioid addiction” and he says the country needs to “invest tens of billions or hundreds of billions of dollars” to shore up the treatment system.

He said patients should be able to access medications that “we know work to help reduce the cravings for further opioids.”

With treatment, Alexander said “they can return to normal healthy productive lives in recovery.”

Original article here on CNBC.com.

Medication-Assisted Treatment Needs Community Support

Communities like Portsmouth, Ohio, regularly make national news for waves of overdoses. On any given day, nearly 100 people across the country die due to opioid overdose. The problem always feels like an uphill battle, and often a losing one for social workers and drug counselors who hope to get clients on the path to sobriety.

Evidence shows that one method, medication assisted treatment (MAT), works; however, for MAT to be truly effective, it takes an entire community.

What Is Medication Assisted Treatment?

Medication assisted treatment is an evidence-based recovery process that combines traditional therapies and detox programs with the use of medication. Medication helps patients manage cravings and provides relief from detoxification symptoms. MAT is useful for people who are addicted to opioids or alcohol.

Addiction Spelled Out in Scrabble Pieces

These are some of the most common medications used to treat in MAT.

  • Buprenorphine: A partial opioid agonist, buprenorphine is used for the treatment of patients who are addicted to prescription painkillers. This medication is the first opioid treatment not required to be administered in a clinic.
  • Probuphine: Approved by the FDA in 2016, the probuphine implant requires four rods to be inserted into the upper arm. The rods provide a continuous dose of buprenorphine for six months to alleviate cravings and withdrawal symptoms.
  • Methadone: Methadone is known as a full opioid agonist, which means that it provides many of the same effects of other opioids. The effects are usually milder and do not impact the patient’s ability to function as much, though.
  • Naloxone: An opioid antagonist, naloxone can reverse or prevent life-threatening overdoses by blocking opioid activity at receptor sites. Police officers and medical workers typically carry these injections and administer as necessary. Sometimes, users also carry them in case of an emergency.
  • Naltrexone: Available as an injectable or in pill form, naltrexone is available as a monthly or daily dose and lacks the potential for abuse.
  • Acamprosate: Sometimes referred to as Campral, acamprosate is used to prevent relapse in alcoholics by lessening the post-acute withdrawal symptoms that often lead to relapse.

Along with medication, patients in an MAT program are required to participate in therapy or counseling.

Healthcare Providers and Community Members Can Erase Stigma

Even though MAT has proven to be an effective form of treatment, there’s still a stigma associated with it, as many believe that it’s about replacing one drug with another. What can be done so that members of behavioral healthcare can recommend this treatment?

Change in Mindset

Addiction is complex. It is a brain disease. Simply viewing addiction as a disease rather than a moral or criminal problem can help make addiction treatment programs, including MAT, more accessible. Despite inclusion in the Diagnostic and Statistical Manual (DSM) and research that states addiction is a disease, many community members and medical professionals do not view addiction in this way. If behavioral healthcare professionals don’t understand addiction as a disease, MAT will continue to be underutilized.

Education

Addiction professionals have a responsibility to educate others on MAT and its effectiveness. There are still misconceptions about what the treatment actually entails.

Social workers, counselors, and others must understand MAT and the evidence that supports this type of program. This also means that healthcare organizations need to mandate ongoing education for staff. Education enables counselors to make appropriate recommendations as to when individuals need abstinence-based treatment or MAT. Both types of treatment can be effective, but which is appropriate for the patients they are treating?

Law enforcement officials should also receive education and training on MAT. This includes promoting MAT as a treatment method for incarcerated addicts. A lack of MAT in prisons means many addicts end up relapsing, and even dying of an overdose because they didn’t receive proper treatment.

Access to Naloxone

Reducing stigma associated with MAT means that access to medication should go beyond the treatment setting. First responders should be trained to carry and administer naloxone. As mentioned earlier in this article, it can be a life-saving step in reducing overdose fatalities. Many states already passed legislation to allow access to naloxone. Healthcare professionals can share research and evidence with community officials to allow access to naloxone or increase supply in cities that already have it.

A holistic solution that involves the whole community is necessary to combat the opioid epidemic, reduce fatalities, and direct people to the appropriate treatment option, whether it’s MAT or not. Community officials and healthcare providers should also look to treatment centers as resources. What can they learn from the individuals who are working with these patients? In order to make MAT effective, it takes community involvement before, during, and after treatment.

Original article here posted on psychcentral.com

Annals of Emergency Medicine

Identification, Management, and Transition of Care for Patients With Opioid Use Disorder in the Emergency Department

Herbert C. Duber, MD, MPHIsabel A. Barata, MD, MBAEric Cioè-Peña, MD, MPHStephen Y. Liang, MD, MPHSEric Ketcham, MD, MBAWendy Macias-Konstantopoulos, MD, MPHShawn A. Ryan, MD, MBAMark Stavros, MDLauren K. Whiteside, MD, MS

Because of a soaring number of opioid-related deaths during the past decade, opioid use disorder has become a prominent issue in both the scientific literature and lay press. Although most of the focus within the emergency medicine community has been on opioid prescribing—specifically, on reducing the incidence of opioid prescribing and examining alternative pain treatment—interest is heightening in identifying and managing patients with opioid use disorder in an effective and evidence-based manner. In this clinical review article, we examine current strategies for identifying patients with opioid use disorder, the treatment of patients with acute opioid withdrawal syndrome, approaches to medication-assisted therapy, and the transition of patients with opioid use disorder from the emergency department to outpatient services.

See full article here.

What is Opioid Use Disorder in the New DSM-5?

Opioid Use Disorder is a diagnosis introduced in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, DSM-5. It combines two disorders from the previous edition of the Diagnostic and Statistical Manual, the DSM-IV-TR, known as Opioid Dependence and Opioid Abuse, and incorporates a wide range of illicit and prescribed drugs of the opioid class.

Probably the most well-known and notorious type of Opioid Use Disorder is Heroin Use Disorder, yet less than 10% of people aged 12-17 years old in the United States with Opioid Use Disorder take heroin.

 Most people with Opioid Use Disorder use analgesic opioids, or painkillers whether they are prescribed for themselves of for someone else, or obtained some other way.

Symptoms of Opioid Use Disorder

The diagnosis of Opioid Use Disorder can be applied to someone who uses opioid drugs and has at least two of the following symptoms within a 12 month period:

  • Taking more opioid drugs than intended.
  • Wanting or trying to control opioid drug use without success.
  • Spending a lot of time obtaining, taking, or recovering from the effects of opioid drugs.
  • Cravings opioids.
  • Failing to carry out important roles at home, work or school because of opioid use.
  • Continuing to use opioids, despite use of the drug causing relationship or social problems.
  • Giving up or reducing other activities because of opioid use.
  • Using opioids even when it is physically unsafe.
  • Knowing that opioid use is causing a physical or psychological problem, but continuing to take the drug anyway
  • Tolerance for opioids.
  • Withdrawal symptoms when opioids are not taken.

Does Anyone on Opioids Have Opioid Use Disorder?

No. Many people are prescribed opioids for pain, for long and short periods, and do not develop an opioid use disorder. And while it is often the case that people will develop physical tolerance to prescribed opioids, and experience physical withdrawal symptoms if they do not take the drug, DSM-5 explicitly states that these are not applicable if the individual is experiencing these symptoms under appropriate medical supervision. Why? Because addictive disorders are primarily psychological in nature, and although someone can develop normal physical responses to prolonged drug exposure, that in itself does not constitute a disorder, if they have no cravings for the drug, no difficulty using appropriate dosages, and no lifestyle problems as a result of taking the drug (although someone in pain may have reduced activity as a result of their pain, that is not the same as reduced activity because they are seeking out opioid drugs.) This is a major step forward in the understanding of substance use disorders.

While many problematic heroin users claim their use is non-problematic, typically heroin use causes more significant and long lasting problems for users than use of other drugs. The exact numbers of problematic and non-problematic heroin users is unknown, and because of the secrecy surrounding heroin use, so it is difficult to compare problematic and non-problematic users. It does appear that those who develop Heroin Use Disorder have very significant psychological problems even before they start using the drug. In contrast, those who are able to control and manage their use tend to be more psychologically healthy and socially advantaged prior to use. The same may be true of those who do or do not become addicted to pain medication, but much more research is needed to understand exactly why some people become addicted when they take opioids, while others do not.

Screening

There are several screening tools available that have been developed by experts in addiction, and published so that others can use them. These screening tools can be used to determine whether someone is may need to be assessed for opioid use disorder. One very commonly use, simple tool that is used to screen for substance use disorders is the CAGE questionnaire, which is easy to remember using the acronym CAGE as key letters in four revealing questions. If someone answers yes to any of these questions, they would benefit from a more complete assessment.

C – stands for “cut down” – “Have you tried to cut down on your drinking or drug use, but couldn’t?”

A – stands for “annoyed” – “Are family and friends annoyed about your drinking or drug use?”

G – stands for “guilty” –  “Do you ever feel guilty about your drinking or drug use?”

E – stands for “eye opener” – “Do you have a drink or use drugs as an ‘eye-opener” in the morning?

A more complex screening tool is the Opioid Risk Tool, which calculates the factors that place individuals at greater risk of having a substance use disorder. These factors include past family and personal history of substance use, a history of childhood sexual abuse, age, and history of past or present psychological disorders, including depression and schizophrenia.

Sources

  • American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, fifth edition, DSM-5TM. American Psychiatric Association. 2013.
  • Hser, Y., Evans, E., Huang, D., Brecht, M. and Li, L. “Comparing the dynamic course of heroin, cocaine, and methamphetamine use over 10 years.” Addict Behav 33:1581-1598. 2008.
  • Powell, D. “A pilot study of occasional heroin users.” Arch Gen Psychiatry 28 (4), pp. 586-94. 1973.
  • Sanchez, J., Chitwood, D. and Koo, D. “Risk Factors Associated with the Transition from Heroin Sniffing to Heroin Injection: A Street Addict Role Perspective.” Journal of Urban Health 83:896-910. 2006.

Original article here on verywellmind.com