Medication-Assisted Treatment

Medication Assisted Treatment

The medications traditionally used in harm reduction or medication-assisted treatment programs for opiod addiction are Suboxone, Subutex & Sublocade. Suboxone is really made up of two medications with the main med being Buprenorphine. It is a long-lasting opiate. Now why would you take someone off of opiates and put them on more opiates?  Well, Buprenorphine attaches to those opioid receptor sites in such a way that makes it very difficult to overdose. Consequently, it increases safety for anyone addicted to opioids or heroin. Another thing is, since suboxone has a tiny bit of naloxone, which is an opioid blocker, it adds a bit more of a safety net. Thus, adding protection for overdose and decreasing the ability for someone to abuse the medication.

Subutex is Suboxone without the Naloxone. That means it’s just the long-lasting opioid. You might ask yourself, ‘why would someone want to take it if doesn’t have the blocker?’ There are certain reasons why some people might want to do that. If someone is pregnant, if someone has a chronic pain issue, there are some specific medical reasons and there are some specific clinical reasons why a person might want to take Subutex versus Suboxone. One practical reason is it’s quite a bit less expensive because naloxone can be expensive. Suboxone is Buprenorphine + Naloxone. Subutex is pretty much just Buprenorphine.

There’s also something called Sublocade. Sublocade is Suboxone that is given in a once a month injection. Why would you want to ease off opioid addiction that way? Well, because it takes a lot of the addictive type behavior off the table, such as taking a medication every day or thinking, ‘maybe I’ll take a little extra today.’ It may help prevent someone from trying to take more when they’re having a rough day. It therefore also keeps people from running out of their prescription too early and several other types of things that can cause complications in the process.

So basically, you have three different ways of administering Buprenorphine, which is the main ingredient in all of these medications. If you’re considering this route, you may want to consider a couple things, like is medication-assisted treatment right for me in general? In order to make that decision you may want to consult with a treatment provider or someone who has successfully been treated for addiction in this manner and have a list of questions or concerns ready. If you do decide that medication-assisted treatment is the way to go, then you may also want to consider which one of these options might be the best choice for you. This is when you would want to talk specifically to an addiction treatment professional.

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Why Enabling An Addict Is A Bad Idea

Why Not Enable An Addict

Enabling is basically doing or arranging something for someone else so they don’t really have to feel the full consequences of their own actions. It is really common in families dealing with addiction. In particular what happens is, especially at the earlier stages of addiction, the family starts noticing problems that a family member is going through. Problems start to rise that are associated with their addiction, such as maybe they don’t have any money. Maybe they get some legal issues, relatively minor at first. Maybe they even lose their job. Stuff like this.

What happens is, the family members, especially if they don’t have a full understanding of addiction, feel like ‘OK If we can fix these problems, then the addicted family member will not want to use drugs or alcohol anymore’. Likewise, ‘Hey they’re having all these legal issues, so maybe if we get an attorney or bail them out, help them through this legal case, then they will feel better about themselves and also they’ll learn their lesson’ or if they have financial problems, same thing maybe ‘we’ll help them out financially, they’ll feel better about themself and they won’t have the need to do alcohol or drugs.’ Seems logical, right?

Unfortunately, addiction really isn’t logical. It’s a disease. Enabling an addict rarely works. It just doesn’t. What happens is that the family members keep doing whatever they’ve been doing. The reason it’s so dangerous is that what results, generally, is the addicted person never really feels the full consequences of their addiction. Therefore, it takes a lot longer to hit what is called ‘a bottom’. They never really get to feel that despair.

A family member may feel like they are helping but really what’s almost always happening is that they’re just kicking the can down the road before the inevitable happens. Because if an addict is not able, not allowed to feel the full consequences of their action, there may never be a sincere motivation or effort to change their behaviors before something serious or drastic takes place in their lives.

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Activating Events & Relapse

Activating Events & Relapse

An activating event can be big and it can be small. A small activating event might be stubbing your toe or getting a parking ticket. Big events might be losing a job, a break-up or a death in the family. These activating events are bound to happen in life and it’s the way that we deal with these activating events that can put us back into the cycle of addiction. Activating events will produce uncomfortable feelings, this could be sadness this can be anger, this can be any kind of adverse or negative emotional state. When negative feelings come up in response to an event, they may create a need to escape. How addicts usually cope with that need to escape is a maladaptive coping behavior

Maladaptive behavior is something that’s learned from childhood. These behaviors can look like anything from isolating, excessive use of video games, eating too much, etc. What they do is provide a temporary escape, however it is temporary, and it will eventually fail to negate bad feelings. So, if somebody has the disease of addiction, because the relief is temporary, it may eventually progress to actual drug use. This, in turn may lead to negative consequences.

Negative consequences can consist of relationship issues, it can be losing a job, it can be financial issues, it can be legal issues. Negative consequences are native to what happens when an addict puts drugs or alcohol into their bodies. This then produces shame and guilt which is directly connected to the negative consequences. In an addict, shame & guilt are their own activating events which bring them full cycle, round and round.

At this point, only an intervention or moment of extreme clarity will help this individual to pull themselves out of the activating event and into some kind of treatment center or recovery program. Once there, they’ll be able to learn about activating events and be able to own the feelings associated with those activating events. Developing and learning about new, healthy coping mechanisms or utilizing a support network before things progress to active addiction.

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EMDR in Addiction Treatment

EMDR Addiction Treatment

We know for sure that trauma occurs in well over 90% of people who seek mental health or addiction treatment. When a trauma occurs, it is outside of the normal range of human experience. When the experience happens and it enters into the brain, the brain doesn’t know how to process it, metabolize it for lack of a better word. Consequently, it gets frozen and isn’t processed like every other experience. If it’s frozen in time, the person consciously or unconsciously is still hanging on to the remnants of that experience and that can last for many, many years.

We certainly don’t want blame any person or event as the cause of an addiction. However, can a person or event have led someone who experienced trauma to seek comfort, solace, a sense of peace, or escape what they’ve gone through, with drug use? Absolutely that can happen, and that can happen with first use. They escaped the pain of the experience and that becomes its own reward. People may go back to that for the same reward. What can happen then is addiction, because it becomes its own separate issue and it is a disease. A fatal disease if it is not treated.

EMDR stands for eye movement desensitization and reprocessing. It is considered a very effective treatment for trauma. It’s also effective with other conditions including anxiety, depression and obsessive-compulsive disorder. EMDR uses bilateral stimulation to actually help the brain process though the experience. So that the memory is still there but it does not have the emotional stronghold that it once had. The memory doesn’t leave, but it doesn’t have a grip on the person any longer.

The brain tends to cluster similar experiences, including traumas. When a therapist and the client decide on the traumatic event that they want to work on, by clearing that one trauma, the other ones seem to have much less impact on their lives, and thus clear much more quickly. Thereby negating the necessity of having to do EMDR on everything they’ve ever gone through. The therapists at Oceanside Malibu are trained to set-up a treatment plan so that emotions and experiences are not overwhelming, they are manageable. Facing trauma may be upsetting at the beginning, but it is not overwhelming and it is not more upsetting than the original event itself. No more upsetting than continuing to try to resist negative feelings by drinking and drugging.

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Binge Eating

Binge Eating Treatment

When you think about an eating disorder, you might think about restricting food, like in anorexia, or purging food, like in bulimia. But the most common eating disorder has nothing to do with either of those. It’s called binge eating. These days when we hear the word ‘binge,’ we mostly think of watching like 6 episodes of the Netflix show in one day. And If you’re less TV-inclined, maybe you think of binging on food. Say, on Thanksgiving. But what if you found yourself overeating like that multiple times a week?  What if it felt like a cycle and it got really difficult to control?

This is what it’s like for people with a certain type of eating disorder. Even though it’s easily the most common eating disorder, chances are you’ve never heard of it. Binge Eating Disorder, or B.E.D., has as a primary symptom of frequent, seemingly uncontrollable food binges that create feelings of distress or guilt. If you’re thinking, “Yeah, I’ve gotten that extra-large pizza all for myself before, and I felt pretty terrible after,” you’re thinking more of over-indulgence than binging. Those with B.E.D. often eat even when they’re not hungry — even when continuing to eat is upsetting.

During a binge, they’ll eat a lot of food, super-fast, until it’s physically uncomfortable to eat any more. Binges are often planned in advance, with ‘special’ food purchases. Sufferers often try to hide their atypical eating by eating alone or hiding food they’ve purchased specifically for binging. But while the binges may be planned, when people are actually in the middle of a binging episode, it’s not uncommon for them to just zone out, then struggle to stop or even remember everything they’ve consumed. And even though it’s less likely to be on your radar than anorexia and bulimia, studies have shown that B.E.D. is over three times more common than anorexia and bulimia combined.

In one study, researchers asked nearly ten thousand Americans about their experiences with various mental health conditions. And they found that 3.5% of women and 2% of men had B.E.D. at some point in their lives. That’s a pretty massive number, and it doesn’t just make binge eating the most common eating disorder. It makes it more common than breast cancer, HIV, and schizophrenia. So, it’s something worth paying attention to. It was only officially recognized as a stand-alone eating disorder in 2013, so at this point, we don’t know everything about what causes B.E.D. But research seems to show that it has some genetic basis.

As one’s DNA doesn’t determine everything about mental health, genetics isn’t the only factor here. Stress may play a role, too. Some evidence for this comes from a study published in the journal Psychiatry Research. It compared 162 black and white American women with B.E.D. to the same number of women without it who matched their demographics. After interviewing these women, the study found that, across the board, those with B. E. D. had a lot more stressful events in the year before their symptoms began.

These triggering events could be anything from a passing comment about their body shape or weight, to work or school stress, abusive relationships, or major life changes. Outside of this study, research has also found that other psychological factors can contribute to binge eating too, such as anxiety, low self-esteem, obsessiveness, and perfectionism. But people can also be born with differences in their brains that make them more likely to develop B.E.D

For example, a systematic review analyzed 51 articles on binge eating and found that when compared to obese people without B.E.D., people with the disorder had stronger responses to food rewards, meaning food likely had more influence over them. They were also more impulsive, and many of the studies showed evidence that those with the disorder were more likely to act spontaneously, or even recklessly, in their day-to-day lives.

Brain imaging studies have also backed up these findings. For example, another study used brain scans to show that people with B.E.D. had less activity in the part of the brain that handles inhibitions. But really, that’s just one piece of the puzzle. There appear to be other things happening in the brains of those with binge eating disorder, and honestly, scientists haven’t quite gotten to the bottom of it yet. That doesn’t mean they don’t know how to treat this condition, though.

People seeking treatment are often prescribed a course of cognitive behavioral therapy, or CBT. This type of therapy aims to make people aware of how their behaviors are connected to harmful beliefs. And that awareness can help minimize behaviors like binge-eating. This approach is often effective, but those who need a little extra may be offered antidepressants to alleviate symptoms related to binge eating, like depression and anxiety — which can make therapy more effective. Like many other psychological conditions, B.E.D. is complex and there’s no silver bullet to treat it. But the more we learn about it, the faster we can get working on finding new and improved ways to recover.

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Ketamine to Treat Depression?

Ketamine Treatment

There’s a new drug called Esketamine for treatment-resistant depression. This is a type of depression where people basically do not respond to any of the conventional treatments. In the United States alone, there’s just over sixteen million people with depression. That’s just over 6 percent of the entire population of the country, and a third of those people do not respond to any of the treatments offered to them. These individuals are classified as having treatment resistant depression and it’s one of the most horrible things to comprehend. To know that you are depressed, you have a diagnosis of depression, but your psychiatrist just turns around and says, ‘sorry there’s nothing else I can do, you’ve tried everything.’ That is just like staring into the abyss.

Hopefully esketamine will prove a tremendous option, a real godsend for people with this type of a depression. If you have been diagnosed with depression and you’ve tried at least two different drugs, you maxed out the dose of those drugs & you’ve tried them for long enough, then you are defined as having treatment resistant depression. Ketamine is said to work in as little as one day. Realistically it might be a week, or maybe five days, but even that is incredible because the current treatments like SSRI’s and other common treatments for depression, take weeks to work. You have to wait four to six weeks for the treatment to fully kick in, this is amazing news for people with depression who want to get better as soon as possible.

Esketamine is incredibly restricted, so the supply of this is only through clinics and a psychiatrist. When a patient enrolls to take this medication, they are administered it in the psychiatrist’s office, as they have to be monitored for at least two hours afterwards, so there’s incredible restriction on the use and possession of this drug. This drug is based on ketamine, which was a huge party drug, particularly back in the 80’s & 90’s. It’s a hallucinogenic which people took to feel euphoric & creates an out of body feeling. Ketamine was really a popular recreational drug and esketamine is essentially pharmaceutically pure ketamine.

One of the ways ketamine has been traditionally used is as an anesthetic, a horse tranquilizer, and the side effects can be incredibly deadly if not used properly. If you overdose on ketamine, you are pretty much finished because it basically just shuts you down and you lose consciousness. While esketamine is administered via nasal spray at low to moderate doses, it still has a pain killing effect, an antidepressant effect, a little bit of euphoria, and it will impair your motor skills. When you take this, you won’t be able to drive a car, you are pretty much out of action, so this drug has to be used incredibly carefully. There is a concern that esketamine may yet reveal a potential for abuse.

The cost of this treatment is also high, around nine hundred dollars for one treatment cycle. Another concern with esketamine is that the drug was rushed through the FDA process, it did not go through all the trials that a normal drug goes through before being marketed and given a license. The decision to bring it to market quickly was based on the reasoning that it was necessary due to lack of other treatment options. Consequently, little is known about long-term side effects.

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