addiction

Dual Diagnoses? There is a “chicken and egg” Phenomenon

January 2, 2018 // by Aton Center

Dual Diagnoses? There is a “chicken and egg” phenomenon that occurs in early recovery with regards to evaluating the effects of substance abuse vs. mental health issues.

Many people presenting for a detoxification from substances can show a variety of uncomfortable and clinically relevant symptoms. The substance misuse can complicate the diagnostic picture for any one. That being said, over time and with recovery, a person and their providers can get a clearer picture as to what underlying conditions, if any, may be driving the addiction.

Some people mistakenly believe that they have issues such as depression or anxiety that drive their addiction. Many of these people are happily surprised to see that once making it through the detoxification and post-detox process, their mood is actually relatively stable and balanced. There is relief in knowing that their emotional distress was driven by the roller coaster of chemicals manipulating their emotions. However, other times detox can reveal underlying mental health concerns that were either hidden or exasperated by the substances. This can be difficult to start to experience these problems when no longer numbed to them but once properly diagnosed the issues can the receive specific treatment.

Certainly the most controllable variable in the dilemma is helping a person become free from the substances. After that one can identify whatever needs are under the surface for which the substances were compensating. Once underlying issues are addressed there can be a relief that can never be found in the bottom of a bottle.

Chad K. Cox PsyD
AToN Center 888-535-1516

Opioid Addiction Treatment

November 16, 2017 // by Aton Center

Clinicians and counselors who work in the field of addiction treatment commonly refer to addictive disorders as a type of “disease.” The term, though, is often used in disparate ways. While a more traditional counselor will associate the disease of addiction to character deficits, others will use the term in connection to the neurobiological changes implicated in the addictive use of substances. The former focuses on symptoms of selfishness and shamelessness, the latter on neuroadaptations that shape an allostatic load and dysregulation in the executive areas of the brain. One views addiction as a moral failing, the other as the end result of neurochemical changes in the brain.

These perspectives on the “disease” of addiction greatly opposed each other. That opposition stokes often-heated debates on how to address the country’s drug epidemic. The use of Suboxone maintenance can serve as a flash point in such debates. The more traditional counselor will argue that Suboxone can be abused, that the medication can induce a low-grade euphoria that alters mood much as other drugs of abuse do. Simply substituting one drug for another, the traditionalist contends, defeats the idea of recovery. A more progressive clinician will counter that the subtle “high” of Suboxone pales in comparison to the euphoric state triggered by heroin and oxycodone, with many who are prescribed the maintenance medication reporting that the euphoric effect is short-lived after induction.

A more blunt point in the progressive argument is – who cares? Who cares if the script trips a cheap high in the first dose or two? The script saves lives. Approx 65,000 Americans will die by overdose this year, with two-thirds of those deaths attributable to opiates. Hundreds of thousands of Americans will die by opiate overdose in the next decade, a grim fact that underscores how both traditional and more contemporary treatment models generally fail to treat opiate addictions. On the other hand, a bounty of research exists that highlights how the use of Suboxone maintenance reduces the risk of relapse by more than half (see references), its effectiveness superior to both 12-Step and CBT-based interventions in preventing an initial slip.

Reducing the risk of an opiate relapse secondarily reduces the risk of overdose and death. The risk of overdose is exponentially higher after even a brief period of abstinence. That is, the risk of fatal overdose is much greater after someone completes time in treatment, especially residential care.

The first 3 months after residential treatment are a risky time. The brain of those in early abstinence struggles to use foresight, judgment, to manage stress, exercise impulse control, and so forth. A medication like Suboxone can help bridge the time needed for the addicted brain to reset itself, so someone can more fully engage the introspective process needed to sustain change maintenance, and to reestablish a sense of self-control.

Kevin Murphy, Psy.D.
Psychologist
AToN Center 888-535-1516

REFERENCES:
Sordo, L., Barrio, G.,Bravo, M.J. Indave, B., Degenhardt, L., Wiessing, L., Ferri, M., Pastor-Barriuso, R. (2017). Mortality risk during and after opioid substitution treatment: systematic review and meta-analysis of cohort studies, BMJ 2017;357:j1550

Pierce, M., Bird, S.M., Hickman, M., Marsden, J., Dunn, G., Jones, A. & Millar, T. (2015). Impact of treatment for opioid dependence on fatal drug-related poisoning: a national cohort study in England, Addiction, 111, 298–308

Potter, J.S., Dreifuss, J.A., Marino E.N. et al (2015). The multisite prescription opioid addiction treatment study: 18-month outcomes, Journal of Substance Abuse Treatment (48)1:62-69, 2015.
Weiss, R.D., Potter, J.S., Griffin, M.L. et al. (2015). Long-term outcomes from the National Drug Abuse Treatment Clinical Trials Network Prescription Opioid Addiction Treatment Study, Drug and Alcohol Dependence 150:112-119, 2015.

Kevin Murphy, Psy.D., PSY23323
Psychologist
AToN Center

Isolation and Addiction

September 17, 2017 // by Aton Center

Isolation and loneliness have an overwhelming effect on drug addiction and alcoholism causing people to feel sad hopeless and abandoned.

When we are actively using drugs to cope with depression, anxiety and stressful situations, we are doing so to avoid our feelings and reality. As the disease of addiction progresses, we lose friends and damage relationship which just causes us to isolate even more. We also isolate to hide our drug use and to avoid judgment and confrontation from others.

The trouble with isolating ourselves when we are using drugs and drinking is we start to believe the lies that our addiction is telling us. Our addiction can carry a lot of stigma and shame. It may cause others to worry uncontrollably about us so we isolate more in the hopes that if we aren’t being seen then people will worry less.

Emotional isolation occurs when an individual avoids meaningful conversation and withholds their feelings.

Physical isolation is when a person removes themselves from the presence of other people. As the individual isolates more and more and the addiction progresses, changes in the brain start to occur causing them to become more consumed by their substance of abuse and prioritizing their drugs over everything else.

Rat Park

In 1978, Canadian psychologist Bruce K. Alexander conducted an experiment with the help of the Simon Fraser University called “Rat Park.”

One of the goals of Alexander’s experiment was to show that drugs alone do not cause addiction but that a person’s living environment can add to it. Alexander constructed” Rat Park” with food, wheels and balls to play with, plenty of space to move around in, and 16-20 rats of both sexes to mingling with. In this experiment, the social rats had the choice to drink fluids from one of two dispensers. One of the containers had just water in it and the other container had a morphine solution in it. The rats in “Rat Park” consistently resisted the morphine water over the plain water.

Alexander also conducted another experiment where the rats were isolated and starved for hours, and then hooked up to various intravenous needles implanted into their jugular veins. The rats would consistently press a lever to inject themselves with large doses of heroin, amphetamine and cocaine. What was interesting was the rats that were caged up for 57 days chose plain water over the other drugs when moved to “Rat Park” and voluntarily going through withdrawal.

Today, psychologists and substance abuse expert acknowledge the fact that drugs and alcohol addiction is mental as well as physical. Humans do not have to be physically isolated to become addicted to a substance. Emotional isolation can produce the same affects.

These experiments led treatment experts to advocate the need for a comprehensive recovery program that addresses the mental and emotional needs of recovering addicts, not just their physical needs.

For the best chance at beating addiction you need an environmental change, a holistic approach to address a person’s mental, social and spiritual needs as well as medical and physical care.

Johnina Noar, CADC-II
AToN Center 888-535-1516

Internal & External Triggers

August 13, 2017 // by Aton Center

Triggers can be feelings, experiences, people, places, and things that you associate with your drinking or drug use. There are different types of triggers: internal, external, and sensory triggers. All three usually work together to create a craving.

INTERNAL TRIGGERS are feelings that people have before or during drinking or using drugs. For instance, some people may feel insecure about sex and think they have to drink alcohol in order to relax before having sex. Other people may use drugs when they feel angry, lonely, depressed, sad, or bored – but any feeling can become an internal trigger.

EXTERNAL TRIGGERS are the people, places, and things associated with drinking or using drugs. For some people, external triggers might be: places where they bought or used drugs, certain bars and clubs they hung out at while they were drinking or high, people they drank or used drugs with, and even certain days and times, such as Friday nights and holidays.

SENSORY TRIGGERS are related to the senses of sight, sound, taste, and touch. They might include certain styles of music or specific songs, or the taste of a drug. For example, powdered sugar or artificial sweetener, which resembles powdered drugs, can be a powerful trigger for people who used cocaine, methamphetamines, or heroin.

The are many triggers in each category that were not mentioned, but once you have identified your triggers, use some tools like the thought records or talk to someone. If you are in a self-help program, ask for help in a meeting or with a confidant. You can overcome the power of these triggers with help and prevent a relapse of substance abuse.

Paul Aguirre, CADC – II
AToN Center 888-535-1516

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