SUSTAINED RECOVERY IS POSSIBLE

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FREQUENTLY ASKED

QUESTIONS

ADDICTION: is “hiding that harms” (per Susie Wiet, MD). Any behavior that is compulsively repeated and harmful to self will eventually alter the biology of the reward system and become an addiction (e.g. the addiction pathway). This includes repeated use of addictive substances and stimulating behaviors (e.g. pornography, sex, gambling, self-mutilation, purging, anorexia, rage, etc.).  

Addiction IS:

  •   Avoidance of self and others (fear, guilt, and shame)

  •   Altered biology (receptors, neurochemistry, hormones, metabolism, and illness)

  •   Absence of a pause between stimulus and response (compulsive behavior, instant gratification, and damaging)

  •   An adolescent disorder

Addiction is NOT:

  •   What anyone seeks to create 

  •   Wanted or desired 

  •   An issue about morality

Addiction WILL cause damage:

  •   Health (physical and mental)

  •   Relationships

  •   Careers

 

ADDICTION SEVERITY: is based on criteria that determine mild, moderate, or severe addiction:

  1.   Taking larger amounts or for longer amounts of time.

  2.   Not able to cut down or stop using the substance.

  3.   A lot of time spent on getting, using, or recovering from use of the substance.

  4.   Cravings and urges to use the substance.

  5.   Not managing responsibilities.

  6.   Causing problems in relationships.

  7.   Giving up activities that were once enjoyable and important.

  8.   Putting yourself in danger.

  9.   Physical or psychological problems have been caused or made worse. 

  10.   Needing more for the effect.  

  11.   Withdrawal symptoms relieved by taking more of the substance.

DETOX: some addictive substances require medications and monitoring for a safe detox. This usually means that a medical provider is overseeing the patient during detox.

Alcohol

  • ​Detox: several days to 2 weeks

    • Typically: in a hospital or free-standing overnight medical facility​

    • Selectively: outpatient or in-home

  • Medications often prescribed for detox:

    • Benzodiazepines: lorazepam (Ativan), chlordiazepoxide (Librium), oxazepam (Serax)​

    • Anti-seizure medications: gabapentin (Neurontin), valproic acid (Depakote), carbamazepine (Tegretol), phenobarbital

  • Dangers of withdrawal:

    • Seizures (low risk but about 3% turn into status epilepticus (can't stop seizing), can lead to death)​

    • Hallucinations and delusions

    • Increased metabolism: high blood pressure, heart rate, temperature

  • Altered mental state: irritability, agitation, delirium tremens (most severe)

    • Nausea and vomiting: usually associated with very high blood alcohol level (BAL); can also be a precursor to alcohol poisoning​

  • Supplements that may be helpful to support recover and protect organs:

    • Brain and other nerve cells: B1 (thiamine), B9 (folate), B12 (cobalamine)​

    • Liver function: N-Acetyl-Cysteine, Milk thistle

    • Probiotics

  • Medications often prescribed for recovery (Medication Assisted Treatment, or MAT)

    • Craving control: naltrexone (Revia: oral, Vivitrol: injectable), acamprosate (Campral)​

    • Deterrent: disulfiram (Antabuse)

 

Opiates (including heroin, pain killers, and kratom)​​

  • Detox: 5-14 days

    • Typically: in a hospital or free-standing overnight medical facility​

    • Selectively: outpatient or in-home

  • Medications often prescribed for detox are prescribed to address severe cravings often experienced with opiate withdrawal, along with other unpleasant symptoms such as: sleep disturbance, anxiety, restlessness, bowel distress, etc.

    • Craving control: buprenorphine (Suboxone, Subutex, Zubsolv, Bunavail)​

    • Withdrawal symptoms: clonidine (Catapess), quetiapine (Seroquel), gabapentin (Neurontin), immodium, methocabarnol

  • Dangers of withdrawal: an easy way to think about it is that "everything oozes"

    • Electrolyte imbalances from diarrhea and vomiting can lead to seizures or heart rhythm problems (rare)​

    • Altered mental state: irritability, agitation, intense cravings

  • Supplements that may be helpful to support recovery and protect organs:

    • Brain and other nerve cells: B1 (thiamine), B9 (folate), B12 (cobalmine)​

    • Liver function: N-Acetyl-Cysteine, Milk thistle

    • Probiotics

  • Medications often prescribed for recovery (MAT)

    • Craving control: buprenorphine (Suboxone, Subutex, Zubsolv, Bunavail), methadone, naltrexone (Revia: oral, Vivitrol: injectable)

    • Overdose reversal: Anyone can carry a Naloxone Rescue Kit and administer this medication, which can be life saving 

 

Sedatives (benzodiazepines, hypnotics, GHB, barbiturates)​​

  • Detox: 3-7 days, up to several months

    • Selectively: in a hospital or free0standing overnight medical facility to start reduction​

    • Typically: outpatient to continue tapering off

  • Medications often prescribed for detox:

    • Benzodiazepines: typically a slow tapering off of current sedative, or switch to a long-acting benzodiazepine​ with a slow tapering off

    • Anti-seizure medications: gabapentin (Neurontin), valproic acid (Depakote), carbamazepine (Tegretol), phenobarbital

  • Dangers of withdrawal (this includes a person who may be taking a sedative for a while, as prescribed, then abruptly stopping it):

    • Seizures (low risk, but about a 3% turn into status epilepticus (can't stop seizing), can lead to death)​

    • Sensory distortions, hallucinations, and delusions

    • Increased metabolism: high blood pressure, heart rate, palpitations, temperature

    • Altered mental state: irritability, agitation, panic, delirium tremens (most severe)

  • Supplements that may be helpful to support recovery and decrease anxiety:

    • Vitamin B-complex (some people may need methylfolate)​

    • Vitamin D

    • Pharmaceutical-grade lavender essential oil

  • Medications often prescribed for recovery:

    • Anxiety is very often an underlying problem; therefore, non-addictive medications that treat anxiety are often prescribed:​

      • Several antidepressants that are serotonin-based: SSRIs, some SNRIs, novel serotonin-receptor

      • Some anti-seizure medications: gabapentin (Neurontin), oxcarbazepine (Trileptal), other medications 

 

DUAL DIAGNOSIS:  assessing for the combination of addiction problems, psychiatric problems, and/or physical health issues​

  • ​Nearly 8 million adults battle both a mental health disorder and a substance use disorder - SAMSHA

  • The neurobiology of addiction is often interwoven with psychiatric disorders and can also cause physical health problems

  • Dual diagnosis is common, but can be challenging to tease out and treat effectively

 

 

GENETICS: we each are born with a genetic blueprint. Environmental influences (e.g. toxins, stress, trauma, nutrition, positivity) will either enhance or detract from how genes on the genetic blueprint are revealed. These influences will result in variations of good or poor health. This is similar to a blueprint for a home: not every part of a blueprint will necessarily be constructed and/or be the best design to withstand stress, but depending on how and with what materials a home is built, that home may vary in strength and durability.​​

  • Epigenome is the constantly-changing environmental influences that shape the genetic blueprint

  • The epigenetic effect is transferred to future generations

 

LEVELS of CARE

Addiction treatment has several levels of care:

Outpatient: regularly scheduled office visits with a health care provider 

  • Medical provider
  • ​Therapist

Intensive Outpatient Program (IOP): 9-15 hours over multiple days per week ​

  • ​​Group therapy
  • Individual therapy
  • Referral to a medical provider, as needed
  • IOP at Sovegna (for professionals)
    • Individualized care​
    • Thoughtful and detailed clinical assessments
    • Resiliency-focused
    • Trauma-aware
    • Innovative curriculum (based on effective principles of long-term recovery)
    • Team approach
      • Psychiatry
      • Internal medicine
      • Therapy
      • Nutrition
      • Yoga
      • Meditation
    • Discreet
      • HIPAA-compliant​
      • Personalized care
      • Limited group size
    • Transition into outpatient continuum of care
      • Maintain client-provider relationships
      • Recovery groups
      • Clinic for Recovery (C4R)
        • Medication As (or Assisted) Treatment (MAT)​
        • Addiction-Informed Primary Care (AIPC)
      • Psychiatry for dual diagnosis
      • Experiential therapy
      • Recovery-focused nutrition
      • Psychotherapy (trauma-informed, addiction-informed, resiliency-focused)

 

Day Treatment (Partial Hospitalization): 6-8 hours per day, 5 days per week​

  • ​Group therapy

  • Individual therapy

  • Family therapy

  • Medical provider

 

Residential Treatment Center (RTC): residing at a facility, typically 30-90 days​

  • ​Group therapy

  • Individual therapy

  • Family therapy

  • Medical provider

  • Psychiatrist

Hospitalization for detoxification: typically 3-5 days for uncomplicated medical detoxification; 5-14 days for complicated detoxification​

  • ​Alcohol

  • Benzodiazepines and other sedatives

  • Opiates

 

OVERDOSE KITS: overdose by opiates can be reversed with naloxone. Utah law now allows for any person to carry and administer naloxone as a rescue for an opiate overdose AND should call 911. These kits have been life-saving for many people. 

 

SIGNS and SYMPTOMS: a person may cover up substance use for a long while before seeking help, or when someone else recognizes a pattern of addiction. Some clues may include: 

  • Seeking to spend alone or in isolation (i.e. multiple excuses to miss out on activities with others)
  • Not being able to limit use (e.g. can't stop after 1-2 drinks
  • ​Compulsive and deceitful behaviors (i.e. half-truths, lying, elaborate explanations)

  • Sleep problems (insomnia or excessive amounts)

  • Drop in productivity or activity (work, home, school, interests)

  • Change in social group

  • Intense mood swings, abrupt personality changes, or anxiety that is otherwise inexplicable

  • Unexplained falls, bruises, weight loss, skin changes (sagging, gray, red, picking)

  • Black outs or loss of time

  • States of confusion or hallucinations

  • Poor health (e.g. unusual infections, malnutrition)

  • Unhealthy liver, heart, kidneys, or gut

 

TRAUMA: is an emotionally painful event or series of experiences that is overwhelming, and causes a disconnect to one’s emotions and understanding of emotions. Trauma is often linked to addiction.

  •  
  • ​​Unresolved traumatic experiences will create toxic stress in the emotional part of the brain (limbic system). This toxicity will impact both physical health and the reward center of the brain
  • Toxic trauma is associated with poor health and addiction across its lifespan
    • The effect of traumatic experiences can be resolved, which can dramatically improve health and long-term recovery for the individual and future generations
  • Addiction is often used to avoid painful emotions (numbing or pushing away emotions)
  • Addiction-related behaviors can become a source of additional trauma
  • Sobriety can result in an increased recall or re-experiencing of traumatic memories; this may increase cravings to use an addictive substance to suppress intense emotions

 

TREATMENT (Cornerstones for Recovery)

  • Medication: an important tool for recovery especially when combined with group therapy and community self-help meetings. Medication can be life-saving and is used for:

    • Detox

    • Maintenance of recovery

    • Relapse prevention

    • Medical and psychiatric conditions co-occuring with addiction 

  • Therapy: identifying core issues and developing healthy coping skills through discussion. There are specific techniques that are very helpful for sustained recovery, including trauma-resolution therapies. Types of therapy audiences include:

    • Individual​

    • Group

    • Couples

    • Family

  • Community support and meetings: the cornerstone of recovery is making connections and building relationships that are based on integrity, responsibility, and accountability to yourself and others. Meetings are subdivided into AA (alcohol), CA (cocaine), CMA (crystal meth), GA (gambling), NA (narcotics), and SA (sex addiction)

    • 12-Step: AA was the original model for social recovery that has saved the lives of millions of people. Regular participation encourages making sober and supportive connection with others in recovery.​

      • First goal of recovery: "90 in 90" (90 meetings during the first 90 days of recovery) while starting to work through the 12-steps of recovery and establishing a 12-step peer sponsor​

    • Experiential:

      • Addict to Athlete: groups are open to anyone touched by addiction (e.g. in recovery or affected by someone in recovery) who seek to establish and maintain sobriety through fitness (free)​

      • Fit-2-Recover: recovery based on 4 principles: fitness, nutrition, community service, and creative arts (membership fee)

      • Full Circle Yoga: offers yoga, community meetings, and some therapy services

    • Professionals Helping Professionals (PHP): several professional groups (e.g. physicians, attorneys, therapists, etc.) support professional peers through discipline-specific challenges of recovery. The meeting schedules are not publicized.

    • Refuge Recovery: supports recovery through regular meetings that are based on Buddhist principles, which includes meditation during each meeting.

    • USARA (Utah Support Advocates for Recovery Awareness): a unique resource for all people active in the recovery process. They recognize that recovery takes on as many paths as there are individuals.

  • Health: balancing health is very important for sustained recovery. Health can be influence in many different ways and include:

    • Psychiatric: assess, treat, and stabilize mental and emotional problems that have resulted from or contributed to addiction​

    • Internal medicine: assess and treat physical health problems related to addiction

    • Nutrition: assess and provide instruction to balance metabolism, optimize health, and recovery through food

    • Yoga and meditation: develop awareness of self, connection to others, and deeper meaning of life

    • Sleep: addiction can cause problems with getting restful sleep. When sleep is a problem, it is more difficult to maintain health