By: Patricia Simpson, BS, MBA, HSM, HSM, MT

In today’s world those that “distribute” illegal drugs are constantly challenging those of us that that provide testing for drugs found in bodily fluids. One of the newest drugs, Gravel, is a combination of methamphetamine, crack cocaine and bath salts. All of which can be detected using today’s technology. Labs today need to be advanced enough to detect multiple synthetic drugs such as Bath Salts, Spice and Kratom. In recent times, these synthetic drugs have become popular especially due to their psychoactive properties and ability to evade detection via drug urinalysis testing systems.

We then have the distribution of “legal” drugs; drugs which are prescribed by physicians for pain relief (opiates) and anti–anxiety meds such as benzodiazepines. Many that become physically dependent on these “legal” prescription drugs will, at some point along the way, lose the ability to meet their need for the drugs on which they now have become dependent. Those working in the substance abuse and mental health fields have seen an increase in heroin and synthetic drug use. In the past, testing labs have had to test the population for prescription painkillers, benzodiazepines, heroin and alcohol, but today we also have to test for a variety of synthetic drugs. Laboratory reports with quantitative results are a tremendous clinical tool for medical staff and therapists. They can help clinical staff to evaluate if the form of treatment is working and if the person is remaining abstinent.

Substance abuse is not limited to teenagers and college students it effects ages 12 and older. From 1998 to 2008 admissions for pain pill abuse increased from 18,300 to 105,680. Studies have shown an increase in heroin use after 4 or 5 years of use and abuse of Non-Medical Pain Relievers (NMPR). The percentage of heroin use has increased 500% due to the misuse of NMPR’s. Increases in price of street OxyContin® sent many users towards Heroin which is cheaper and easier to obtain.

Heroin use from 2002 to 2011 went from 117,000 to 620,000. Since both NMPR’s and heroin act on the same receptors in the brain, studies have shown a direct link between past NMPR use and the introduction and continued use of Heroin. At New Beginnings Recovery Center (NBRC), we see this on a daily basis. Where many recovery patients have had a past of surgeries, injuries or pain and have been prescribed pain relievers a history of heroin use after the NMPR is frequently noted.

Drug testing is an important tool used by those in the treatment field. In clinical situations drug testing can aid in clinical and psychiatric analysis or detoxification of drugs or alcohol in addition to adding a high degree of accountability with the client. The priority is making sure that patients are taking their prescribed medications as prescribed and avoiding illegal and synthetic drugs.

Laboratory testing is the top of the line defense against these “new” drugs. Some labs now have available the ability to screen for drugs using instruments that are semi-quantitative and confirm those drugs using an instrument that will give us the exact drug and the quantity of it. Using both these defense mechanisms is important for the following reasons:

1. Quantification aids our medical staff when diagnosing, monitoring treatment progress of those in the in detoxification level of care.
2. It allows psychiatric and medical staff to make informed decisions when prescribing therapeutic medications.

The collection procedure consists of individual urinalysis collection that gives the medical staff an idea of drugs in the patient’s system. This can be a highly useful tool for monitoring patients enrolled in a detoxification program. This screening reinforces the cup results and also gives clinical staff a quantitative analysis.

Of all possible specimens available, urine is the easiest to tamper with or adulterate. By this we mean that either a patient has brought an outside negative urine sample or bought a substance that will interfere with or adulterate the testing of the specimen. Several preventative steps can be taken by lab staff to aid in detection of these practices. By making sure personal affects remain outside of the bathroom, and adding a bluing or coloring agent in the toilet water, you can decrease the chances of adulteration. At collection sites, the water should be turned off to the sink located in the bathroom where specimens are taken. In many cases a laboratory can test for creatinine, pH and specific gravity. These tests will let staff know if the urine is dilute or if a foreign substance has been added. An invalid test may not necessarily mean the test has been adulterated. It may, perhaps, indicate of the presence of dehydration, over hydration, other prescription medications or an illness that may alter the validity of the test.

There are 4 common adulterants which can be bought over the counter:

1. Gluteraldehyde known as “Clean X” interferes with immunoassay tests (screening results), has a very sweet smell.
2. Sodium or Potassium nitrite known as “Klear” or “Whizzies” will mask the detection of THC-COOH.
3. Pyridinium Chlorochromate “Urine Luck” can mask THC and many other drugs.
4. Peroxide/Peroxidase also known as “Stealth” effects the detection of THC-COOH and others. By running certain tests and confirmations the laboratory can detect and report the presence/absence of a drug  or report adulteration of the submitted specimen. Using anything that changes the result of the drug testing defeats the purpose of an individual’s recovery (SAMH p. 53, TAP 32).

The screening test which provides a semi-quantitative result is an immunoassay test. This test involves an antibody-antigen reaction. Thresholds (Cut-offs) are established according to state, federal or instrument detection standards.  Drug concentrations above these established thresholds are considered “Positive” for each particular drug. Below threshold would be reported as a “Negative”.

Confirmation testing looks for the molecule for a particular analyte (drug) using mathematical ratio equations which identify and quantitate that particular analyte (drug). Confirmation testing is a more specific type of testing for each specific drug which looks for the identified molecules and provides quantitative results. This is helpful when there is a need to evaluate the amount of substances in the patient’s system and how to evaluate plans for future treatment.

There are reasons why a lab may want to confirm “Positive” drug screens.  Many drugs have similar molecular structures which may lead to false Positive results. Amphetamine is a perfect example. Many over the counter medications such as diet pills or cold medications will produce a positive amphetamine screen but will not be positive upon confirmation. Screening for drugs helps detect “Negative” results but it does not always detect synthetic or therapeutic drugs such as Krokodil (a Heroin-like synthetic), Spice (synthetic Marijuana), Bath Salts or even the psychiatric drug Gabapentin.

As stated earlier, confirmations are done using human urine specimens. Since drug metabolites stay in the body longer, and urine contains the majority of drug metabolites, running confirmations on urine is the least invasive and the most reliable way to know beyond a shadow of doubt that a particular result is positive or negative. Cross-reactivity happens among many drug classes such as Amphetamines, Benzodiazepines and even Phencyclidine (PCP). Confirmations distinguish between these substances. For example a patient using “Unisom” with doxylamine may screen positive for Phencyclidine creating a false “positive” result. The report run through confirmation will state “Negative”. The importance of confirming a drug screen test can mean the difference between a “true” relapse and a false positive. Recidivism is a normal part of the recovery process. By reporting a “positive” result the clinical staff can decide whether the patient requires a higher level of care or if an alteration to the treatment plan is indicated.

Privacy considerations need to be understood. The Laboratory can only report results to the medical staff or therapists. HIPAA privacy regulations must be maintained at all times. Specimens are collected, labeled with a barcode label and brought to the laboratory for processing. The laboratory tests for specimen validity, screening and finally confirmation. All results are reviewed and reported should by a Board Certified Technologist. The results are compared between screening result and confirmation. Confirmations are reviewed for drug and/or metabolite, time it is identified and chromatogram peak. These are also reviewed by a qualified Board Certified Technologist.

Quality treatment providers should strive for quality and accuracy by providing medical staff with both screening and confirmation results. This will assist staff in identifying clients / patients that abuse drugs and thus make sure that prescribed medications are being taken responsibly.

Kronstrand, Robert, Roman, Markus, Anderson, Mikael and Eklund, Arne. “Toxicological Findings of Synthetic Cannabinoids in Recreational Users”- Journal of Analytical Toxicology, Vol. 37, No. 8, p. 534 – 541.

McDaniel, Glen, MS, MBA, MT, CLS, CLDIR. “Drugs of Abuse Testing: Old and New” – Advance for Administrators of the Laboratory, Vol. 23, No. 1, p. 24 – 27.

Pradip K. Muhuri, Joseph, C. G. Frocter, Christine Davis. SAMHSA CBHSQ  – “Data Review. Associations of Non-Medical Pain Reliever Use and Initiation of Heroin Use in the US”

SAMHSA, Clinical Drug Testing in Primary Care. Technical Assistance Publication

Series, TAP 32. www.samhsa.gov –Treatment Episode Data Set. The TEDS Report – “Characteristics of Substance Abuse Treatment Admissions Reporting Primary Abuse of Prescription Pain Relievers: 1998 and 2008″

Patricia Simpson, BS, MBA, HSM, MT is the Laboratory Director at New Beginnings Recovery Center in Palm Beach Gardens, Florida. Born in Buenos Aires, Argentina, Patty’s family came to this country in 1963. She was the first woman in her family to graduate from University. She graduated from C.W.Post University, with a Medical Biology degree. After that she moved to Florida, and has extensive laboratory experience ranging from hospital laboratory work to reference laboratories. The bulk of Patty’s experience is in forensic toxicology, managing a State of Florida drug free program and working as the responsible person for the federal SAMHSA drug free workplace program. Three years ago she graduated from Keiser University with an MBA in International Business and a Masters in Health Service Administration. Patty has 2 beautiful daughters.

Call now for more information at 888-840-5189.

By – Peter Gannon, ARNP, MSN, BC – VP Medical Services – Board Certified Psychiatric Nurse Practitioner

The presence and treatment of pain in an individual suffering from substance abuse disorder presents a difficult and challenging situation for both the patient and health care provider. Concerns regarding giving narcotic medications to such a person out of fear of triggering cravings and relapse have generally dictated decisions regarding patient care for the past several decades. The need to review and rethink our beliefs, as well as our own prejudices regarding addiction, is vital if we are to effectively treat the problem  while at the same time assure continued recovery for these individuals.

In recent years our understanding of addiction and its etiology has expanded significantly. The new DSM V diagnostic criteria reflect the concept that substance abuse occurs on a continuum ranging from mild to severe. We are beginning to realize that the idea of grouping all patients with substance abuse disorders (SAD) into the same category is generally unreasonable and ineffective. The use of narcotic medication is never without risk especially for someone with a history of a substance abuse disorder. There may be times however, when such medications are indicated. How then does this affect our concept of recovery and the treatment provided to the patient? If the patient requires certain medications for pain control does it necessarily mean that they have relapsed?

The impact of pain on the recovery process cannot be underestimated. Current research indicates that the presence of pain in individuals during the detoxification process is very common and is closely associated with continued long term substance abuse afterwards (Larson, et al, 2007). Pain affects the individual both physically and psychologically. A continuous low level stress response, as is associated with chronic pain, will have a negative effect on the body. Oftentimes, a decreased immune response and increased susceptibility to illness are are characteristic of  these patients. Fatigue, malaise and sleeplessness are also commonplace. Emotionally, depression and anxiety can occur as a result of continued pain. Research shows that the presence of these can lead to increased perception of pain which in turn increases the already elevated levels of anxiety and depression (Kotz, et al., 2012). It is generally accepted that significant feelings of anxiety and depression, left untreated, lay a foundation for relapse and continued substance abuse.

There are three primary categories of pain: acute, chronic and end of life. Acute pain is an isolated situation which is usually a result of injury or surgery and is usually time limited in nature. Experts agree that this should be treated in the same manner for both addicts and non-addicts. If narcotics are required, special precautions should be taken by the individual with a substance abuse disorder. First, doctors and other practitioners providing care need to be made aware of the patient’s abuse history. Second, the patient should have a significant other in place that is willing and available to dispense medication when needed. Third, there should be a stop date arranged between the physician and prescriber at which time narcotic the medication will be discontinued and non-narcotic analgesics will be utilized if needed. Lastly, detoxification may be necessary for a brief period of time should symptoms of opiate withdrawal occur or if cravings for the drug are significant.

Patients who present with chronic pain usually report a 6 month history of pain which is generally unrelieved by medication, treatments or surgeries. Many also report a significant inability to function well in their activities or daily living. These patients are also very prone to both anxiety and depression. It is estimated that approximately 35% of patients suffering from chronic pain are also experiencing an addictive disorder (Chelminski et al., 2005). The goal of treatment for this group is the same whether they suffer from a substance abuse disorder or not, that is, the least amount of narcotic and non-narcotic medication should be utilized to obtain the greatest pain relief with associated level of functioning (Prater, et al., 2002). This does not necessarily mean the individual will be pain free however. Pain may become a part of the person’s life, but hopefully not to the degree where it will significantly impact their ability to work and be productive.

Treatment of pain issues should include a variety of medication and non-medication modalities. Therapies such as acupuncture, progressive muscle relaxation, guided visual imagery; meditation, etc. are all tools in the arsenal of pain relief available to the practitioner. Every effort should be made to focus on these complimentary techniques and less placed on medications which quickly stimulate the brain’s reward center. To a large degree, addiction is a learned response, especially in the patient experiencing acute or chronic pain. The positive reinforcement provided by opiate pain medications condition the patient to believe that pain relief cannot be achieved unless their brain feels the euphoric effects associated with the medication. This can be a very difficult obstacle for both the patient and practitioner to overcome. The health care worker must develop an environment of trust and caring before significant progress can be made in this area. With time and continued support, the patient will come to understand that their pain can be controlled, in many cases, without the use of narcotic medication.

For many practitioners, treatment decisions are influenced to a great degree by past personal experiences and exposure to addiction. Some may have been raised in an alcoholic family and have developed opinions and feelings regarding addiction based upon their years living in such a dysfunctional environment. Others may have been raised in a strong religious atmosphere where substance abuse is viewed as a personal and moral failing. The impact of past experiences and prejudices cannot be easily dismissed or overlooked when assessing and treating a patient with pain issues. Treatment for pain should never be withheld because of one’s personal beliefs or feelings regarding addiction or the addict. Treatment decisions need to be based on sound medical and scientific principles which focus primarily on the health and safety of the client. As our understanding of the disease of addiction grows, so should our willingness to treat it and all associated conditions in an ethical, humanistic fashion.

About the author:

Peter Gannon, ARNP, MSN, BC – VP Medical Services, New Beginnings Recovery Center/ Board Certified Psychiatric Nurse Practitioner. Peter oversee all medical services at NBRC.  You can reach him at 888-840-5189.  The NBRC website is www.newbeginningsrecoveryctr.com

By Robyn Wright, CHC – Integrative Program Coordinator and Nutritional Program Director at New Beginnings Recovery Center

At New Beginnings Recovery Center we are always looking at how we can improve an individual’s recovery.  We have been noticing that many substance dependant or addicted individuals coming into our addiction recovery center are not taking care of themselves nutritionally.  Many eat a diet high in sugar, refined carbohydrates, and fat.  Addiction or not that way of eating does not improve health.  At New Beginnings Recovery Center (NBRC) we start the physical healing at the source.  The food we eat directly impacts the ability for our bodies to function optimally and that is why we start by healing the gut.

To begin, we first need to understand the basic anatomy of the digestive system.   Digestion first starts in the mouth where enzymes are produced and begin to breakdown food.  From there, the food travels through pharynx and down the esophagus into the stomach, then food travels into the small intestine.  While traveling through the small intestine the liver, gallbladder, and pancreas all secrete enzymes in the small intestine to help breakdown food.  According to studies, 90% of all nutrients are absorbed in the small intestine.  At this point your food is broken down and waste is moved into large intestine where the end result is elimination.  The movement of food through the digestive system is carried out by a process called peristalsis, a series of wave-like muscle contractions that moves food to different processing stations in the digestive tract.

Where is the gut?  The gut: part of the alimentary canal that includes the intestines or stomach.  The human gut is commonly referred to as the second brain because of its high production of serotonin and other neurotransmitters.  Neurotransmitters play a huge role in addiction and in recovery. To help paint a picture of the complexity of the gut, the human genome codes for approximately 23,000 genes, whereas, the genomes for bacteria and viruses are thought to number 3.3 million genes!  These bacteria and viruses serve as a buffer and they interpreters of our environment.  With addiction the entire digestive system is affected.  The negative effects on the digestive system are due mainly to the deterioration of the mucous membrane lining that runs through the entire digestive tract.  The mucous membrane helps to break down food during peristalsis.  Substance use and abuse also leads to alterations in the patterns of intestinal bacteria called “gut flora”.  Gut flora refers collectively to the many microbes of bacteria in the gut.  This damage as well as the flora imbalances result in compromised intestinal lining and mucosal membranes that can lead to a vast array digestive issues.  Gut imbalances lead to neurochemical imbalances as well as the suppression of production of prostaglandins which leads to gut inflammation.   When the gut is not functioning properly disease will follow.  Your immunity is compromised because as much as 70% of immune system is in the gut.  One common result of compromised gut integrity is Leaky Gut Syndrome.  Leaky Gut Syndrome is also known as intestinal permeability.   The damaged lining allows substances that would normally be eliminated in the stool can be absorbed in the bloodstream.  This influx of toxins, undigested food, and microbes can lead to alterations in the brain chemistry and auto immune diseases.

With substance dependent individuals, the effects of drug use and abuse on the gut can arise even after an individual has stopped using substances.  Opiates in particular are hard on the digestive tract because the body has to re-learn how to produce endorphins which can cause digestive issues including stomach cramps.

As you can see the gut plays a large role in the health of the entire body.  It is with this knowledge and understanding of what a critical role a healthy gut plays, not only those in recovery, but also for the entire population. For these reasons, NBRC has a nutritional program with a focus on nourishing the gut as a part of the overall  addiction treatment program.

About the author:

Robyn Wright, CHC is a Certified Health Coach who holds a bachelor’s degree in Psychology from La Salle University.  She has been working in the integrative and functional medicine field in various capacities for the last 6 years.  Here at NBRC she is the Integrative Program Coordinator and Nutritional Program Director. The NBRC website is www.newbeginningsrecoveryctr.com or you can call at 888-840-5189.

By: Peter Gannon, ARNP, CARN, MSN, BC

For generations, there has always been great debate regarding the nature and cause of addiction. Many saw, and continue to see addiction as a moral failing or weakness of character. Theologians propose the ideas of demonic possession or that it is the result of living a sinful, immoral life style and that God has turned his back on the individual. Many still hold on to these beliefs despite evidence to the contrary. Research and experience has led most healthcare professionals to regard addiction as a disease of the brain. This disease concept of addiction has given science and medicine a foundation for the study and treatment of the illness. The result of this is that there is now hope for those thought to be hopeless.

Why should we believe that addiction is a disease? Disease, by its very definition is a disorder in humans, animals, or plants with recognizable signs and often having a known cause. Illnesses such as diabetes, high blood pressure, and asthma are common examples of a disease process. They all have very specific signs and symptoms which, when evaluated by a trained clinician, can lead to the appropriate diagnosis and treatment of the illness.

Like other illnesses, addiction brings with it its own set of signs and symptoms. The primary characteristic is that there is an on-going pattern of cognitive, psychological, physical, and behavioral problems brought about by the substance abuse. Equally important is the fact that the individual continues using the substance despite these negative consequences.[1] Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response.

A chronic condition is a human health condition or disease that is persistent or otherwise long-lasting in its effects.[2] Chronic illnesses are responsible for 70% of all deaths worldwide annually. These are conditions which can be controlled but never cured. One of the classic characteristics of a chronic illness is the presence of periods of remission followed by relapse. The chance of relapse is greatly reduced when the individual adheres to their prescribed treatment. Even with adherence however, relapse is always a possibility. Like other chronic diseases, addiction often involves periods of relapse and remission. Even if the individual remains abstinent from the substance, the disease process can progress, especially if there is no supportive treatment to help correct the medical and psycho-social damage that has been done.

Research shows us that while the abstinence rate of individuals completing inpatient drug and alcohol treatment remains relatively high for several months, there is a significant increase in the relapse rate thereafter. One study suggests that after two years following treatment, approximately 50% of those individuals had relapsed.[3] Other studies are even less optimistic showing relapse rates ranging from 40-90%. These results appear to be in line with relapse rates from other chronic illnesses.

What the research fails to indicate however are the length of the relapse and any co-morbid factors which could have contributed to it. There is a significant difference between a onetime “slip” and an all out relapse during which time the physical, psycho-social, relational, and spiritual consequences reappear. Experience shows us that many individuals who re-enter treatment do so with a very different outlook and level of motivation. Many have proven to themselves the chronic nature of their illness and are ready to do the work needed to control their symptoms.

While many treatment centers and 12-step support groups purport to embrace the concept of addiction as a disease, they seem to lack the understanding of its chronic nature. This is demonstrated, many times, by an attitude of intolerance and judgment of those individuals who may have experienced a relapse. Oftentimes it may be said that the individual wasn’t working a program of recovery when in fact they were doing everything suggested to them. This contributes to the individual’s existing shame and guilt and prevents him from seeking the help he needs.

As a nurse, I have worked with patients who have relapsed after having up to 20 years sober. These were people who had been working good programs of recovery, were mentally stable, and had achieved a level of social standing. Why does this happen? From my experience and observations, stress appears to be an underlying factor. The stressor may be an acute episode but can often be a long standing, low level stress which goes unnoticed by the individual. This is not the only reason for relapse of course. Fear of success, fear of failure, anxiety, co-morbid physical and psychiatric problems all factor in to the relapse process. The important issue here is that we are dealing with a chronic disease of the brain which we still do not fully understand. Our knowledge of addiction has increased significantly over the last two decades but out treatment methods and philosophy are still based upon recommendations established over 60 years ago.

The idea that addiction, as any chronic illness, can be treated successfully in 30 days is quickly becoming outmoded. Research is demonstrating that chronic illness, including addiction, requires treatment and attention throughout the lifespan. The goal is to help the individual learn to understand and detect the signs and symptoms of a relapse before the condition requires hospitalization. In the past, as in the present, the individual being discharged from treatment would simply be told to get a sponsor and go to 90 meetings in 90 days. While these suggestions are still pertinent and valuable, they are insufficient for sustained recovery.

Many support the idea that the substance abuse is simply the symptom of other underlying issues. While I support this idea I also believe that the substance abuse itself has changed the circuitry of the brain itself. These changes can take years to correct during which time feelings of emptiness, boredom, depression and hopelessness experienced by the individual can easily lead back to the substance abuse or even death.

Ongoing treatment addressing the medical, psychological, spiritual, and social needs of the person must be a priority. Nutritional services as well as case management services, which have been woefully neglected in our system, need to be incorporated into a comprehensive, team driven approach for recovery. Family involvement is of paramount importance and has been proven time and time again to be a primary factor in an individual’s recovery.

Those in the medical and social professions need to re-assess our definition of success regarding treatment for addiction. If, as the evidence supports, addiction is a chronic illness of the brain, should treatment be focusing on the idea that the individual can never use a mood altering substance again. On the other hand, however, we cannot be giving the message that relapse is an acceptable outcome.

We as healthcare professionals must start by examining our own feelings and prejudices regarding the chronic nature of addiction. We cannot allow ourselves to judge the patient who is coming into detox or treatment for the tenth time. There must be an attitude of understanding, compassion, and hope. Our treatment for the individual must be based upon the reality of the current evidence, not what we would wish it to be. Treatment should incorporate a comprehensive education of the neurologic basis of addiction and medical options available in healing it.

Lastly, the patient and healthcare professional need to understand that guilt and shame have absolutely no place in the recovery from relapse. These negative emotions indicate a moral failing on the part of the individual. Chronic illness is characterized by relapse and remission. Our goal needs to focus on utilizing incidences of relapse as a teaching tool for future recovery.

Peter Gannon is the VP of Medical Services at New Beginnings Recovery Center in Palm Beach Gardens, Florida.  He is an experienced and clinically competent Psychiatric Practitioner with proven accomplishments in the evaluation, assessment, diagnosis and treatment of psychiatric and substance abuse disorders in the adolescent and adult populations. Peter received his Masters of Science in Nursing at FIU in 2004., a Masters of Public Administration at Golden Gate University in 1988 and graduated cum laude with a BS in Science in Nursing at the University of Bridgeport in 1981. Peter’s many years of experience in the addiction and psychiatric field gives NBRC’s patients the advantage of having co-occurring disorders treated under a single roof. He is board certified by the ANCC, a member of the American Nurse Association, a member of the American Psychiatric Nurse Association and holds a U.S. Army Good Conduct Medal.    

www.NewBeginningsRecoveryCtr.com 888-840-5189

By: Peter Gannon, ARNP, MSN, BC – VP Medical Services – Board Certified Psychiatric Nurse Practitioner

What is a drug addict, who are they, and where do they come from? These questions have been the subject of research and debate for generations. We in the treatment community usually use the word addiction in relation to “a man or woman whose life is controlled by drugs and the finding of ways to get and use more.” We find a correlation between addiction and pathological behavior including lying, cheating, and stealing. In Narcotics Anonymous, the end results of addiction are believed to always be the same…jails, institutions, and death. Does everyone that is “addicted” to drugs fall into this terminal category.

In my 34 years as a nurse, I have seen and treated hundreds of individuals with substance abuse disorders. The degree of use, drug of abuse, and demographics of these individual patients vary from patient to patient. There seems to be very little rhyme or reason behind the cause or course of the individual’s illness. In an effort to provide care for these individuals, certain standards of treatment have been established. In most cases, the 12-Step model of treatment has been adopted. The fundamental issue with this model is the acceptance by the individual that they are an “addict”. Many patients have difficulty with this term because of the negative connotations associated with it. Denial also plays a major role in their unwillingness to accept the fact of who and what they are.

More and more, however, we are beginning to see a new type of addict for whom this term may be inappropriate. These individuals include those who are taking addictive medications as prescribed by their physicians, usually for pain or anxiety, but who have become chemically dependent upon these medications. These patients take the proper dose of the medication at the proper time and for the right reason. Narcotic medication being what it is, however, higher doses are eventually required to obtain a therapeutic result. Because of this, doses are usually increased to meet the demands of the presenting symptoms. As the dosage increases, so does the degree of dependency on the medication.

Chemical dependency shares several characteristics with true addiction. The development of tolerance (needing more of the drug to get the same effect) and withdrawal (a syndrome of distressing symptoms which occur when the drug is quickly tapered or abruptly discontinued) are the primary similarities between those with addiction and those who are chemically dependent. In most cases however, this is where the similarity ends. The psychosocial, economic, physical, and spiritual consequences usually manifested in true addiction are often absent in cases of chemical dependency.

Knowing this, however, treatment programs continue to categorize everyone as an “addict” and require the individual’s acceptance of this concept if they are to progress in their recovery. Is this thinking realistic or has it become obsolete? Why with our advanced understanding of substance abuse do we tend to cling onto old thoughts and ways of doing things? Are we actually helping and treating the individual in the way most appropriate for him or her?

I recently treated an older gentleman who had been taking large amounts of opiates for many years due to a true chronic pain condition of the cervical spine. Although his dosage of pain medication increased over the years, his compliance with regimen was always consistent and adherent. When he entered the detoxification program, he did so willingly and was very open minded . He also attended outpatient group therapy to help him explore his “addiction”. Although he found some of the group process beneficial, as it helped him to deal with other issues he had experienced in his life, he was totally unable to identify himself as an addict. Was this resistance or denial on his part? After much conferencing, staff came to the consensus that this individual’s condition was different and perhaps not as unique as we had first thought. As a result, it was decided that group therapy requiring an admission on the individual’s part, that they are an addict, was inappropriate for this man. A treatment of individual therapy focusing on other, more pertinent, psychosocial issues was provided to assist him in dealing with the stress, anxiety, and anger which aggregated his chronic pain. It was also determined that his degree of chronic was such that he was referred to a physician for very low dose Suboxone maintenance (2-4mg). This was a vast improvement over the 100 plus milligrams of Morphine Sulfate he was taking on a daily basis.

In order to treat the disease, we must treat the individual. No two people are the same nor are their conditions. The DSM-5 has now recognized this and the diagnosis of “addiction” has been replaced with that of Substance Use Disorder (SUD). This indicates that substance use occurs on a spectrum ranging from very mild to very severe. We in the Recovery field must recognize that our approach to the treatment of Substance Use Disorder must truly become individualized and accept the fact that chemical dependency is a separate entity which much be addressed with special sensitivity and measures for success.

About the author:

Peter Gannon, ARNP, MSN, BC – VP Medical Services, New Beginnings Recovery Center/ Board Certified Psychiatric Nurse Practitioner. Peter oversee all medical services at NBRC.  You can reach him at 888-840-5189.  The NBRC website is www.newbeginningsrecoveryctr.com

By: Lisa Petrilli, RN, BSN, CLNC

Recently I had a close friend pass away.  He was 58 years old.  When he died he was in liver failure and we all wondered how this could have happened so quickly. Actually it ended up that it wasn’t that quickly.  I spoke with one of his brothers who is a Pathologist in CA.  He told me that approximately 6 years ago his brother had some lab work done and that it showed liver problems. His brother chose to ignore the results because he didn’t believe the blood work was correct.  He denied having any liver problems. Here we are six years later now with my friend gone.  All of his friends began talking and I realized that not that many people are educated about liver disease, Hepatitis C and or liver cancer.

Hepatitis C results from the infection with the Hepatitis C virus (HCV), which is spread primarily through contact with the blood of an infected person. Hepatitis means inflammation of the liver.  Toxins, certain drugs, some diseases, heavy alcohol use and bacterial and viral infections can all cause Hepatitis.

What is Hepatitis?

Hepatitis C is a contagious liver disease that ranges in severity from a mild illness lasting a few weeks to a serious lifelong illness that attacks the liver.  It results from infection with the Hepatitis C virus, which is spread primarily through contact with an infected person.  Hepatitis C can either be “acute” or “chronic”. Acute Hepatitis C infection is a short term illness that occurs within the first six months after someone is exposed to the Hepatitis C virus.  For most people, acute infection leads to chronic infection.

Chronic Hepatitis C infection is a long term illness that occurs when the Hepatitis C virus remains in a person’s body.  Hepatitis C can last a lifetime and lead to serious liver problems, including cirrhosis (scarring of the liver) or liver cancer. Approximately 75-80% of people who become infected with the Hepatitis C virus develop chronic infection. An estimated 3.2 million people in the United States have chronic Hepatitis C virus infection.

How is Hepatitis C spread?

Hepatitis C is usually spread when blood from an infected person with Hepatitis C virus enters the body of someone who is not infected.

How does this occur?

Sharing needles, syringes, or other equipment to inject drugs are a common cause. Needle stick injuries in healthcare settings can also be a cause. Lastly, those born to a mother with Hepatitis C can can infect the newborn child.

Lesser common causes would be sharing personal items that may have come in contact with another person’s blood such as razors or toothbrushes, sexual contact with a person infected with the Hepatitis C virus.

The Hepatitis C virus can survive outside the body at room temperature, on surfaces, for at least 16 hours but no longer than 4 days. Approximately 70-80% of people with acute Hepatitis C do not have any symptoms.  Others can have mild to severe symptoms soon after infection such as fever, fatigue, nausea, vomiting, and loss of appetite to name a few. In persons without symptoms, Hepatitis C is often detected during routine blood tests to measure liver function and liver enzyme level. Hepatitis C is a serious disease that can result in long term health problems, including liver damage, liver failure, liver cancer, or even death. Approximately 15,000 people die every year from Hepatitis C related liver disease.

Acute Hepatitis C can be treated.  When diagnosed, treatment does not reduce the risk that acute Hepatitis C will become a chronic infection.  Acute hepatitis C is treated with the same medications used to treat chronic hepatitis C. In the treatment for Chronic Hepatitis C there are several medications available to treat chronic hepatitis C.  The FDA maintains a complete list of approved treatments for Hepatitis C.

In conclusion, Hepatitis C is a serious illness and should not be taken lightly.  A Physician consult with the appropriate lab tests should be completed.  Once the results are back there should be a conversation between the doctor and patient discussing the treatment options.

Sadly with my personal friend, he chose to disbelieve the lab results and deny his liver issues.  Please do not follow in his footsteps.  Life is precious.  There is treatment and it is lifesaving.

www.NewBeginningsRecoveryCtr.com 888-840-5189

Lisa Petrilli is a Registered Nurse (RN) with 34 years of professional medical experience. She works at New Beginnings Recovery Center (NBRC) in Palm Beach Gardens, Florida.  Her specialty is infusion therapy and administers the Restore Neurotransmitter Restoration Program at NBRC. Lisa graduated from Villanova University in 1979 and began her career at Boston Children’s Medical Center treating patients with Cystic Fibrosis using Infusion Therapy. . Lisa’s significant experience and relaxed attitude really helps our Restore Program patients feel comfortable and truly enjoy their treatment.