Healing

Dr. Marvin D. Seppala, Medical Director, CEO
Beyond Addictions

I recently gave a lecture to our outpatient program clients on the neurobiology of addiction. It was interesting, thought provoking and helped to explain, in scientific terms, why we do the crazy things we do during active addiction. Later that night several clients were graduating so I attended the celebration.

I heard people describe their struggle with addiction, their apprehension about treatment and their gratitude about staying sober. I heard them thank their peers and our staff, and they described the dramatic and wonderful changes taking place in their lives. I also heard family members describe their own journey into recovery, as well as the tempered excitement of having their loved ones abstinent and involved in their lives once again. They all spoke of the pain of addiction, the losses, as well as renewal and hope. They were beginning to experience the benefits of abstinence and were engaging in early recovery.

People expressed the raw emotions of addiction; both the tragedies of the disease and the gifts found in early recovery. Several new clients were there, still in the fog of detox, but buoyed up by the hope of change expressed by their predecessors.

As I took all this in I was struck by the juxtaposition exposed that evening. Neurobiology is essential to our fundamental understanding of this disease, and will lead to new medications and treatments that could make abstinence easier to attain. However, this is both a disease of the brain and a disease of the soul. Not one of the participants spoke of their neurotransmitters, or described the benefits of the brain sciences to their recovery. They spoke of the caring and love they have for each other, essential when one can no longer provide this for oneself. They exalted in hope and in the potential for change found in recovery from addiction. They expressed the joy of openly sharing themselves with other human beings. Their deep gratitude was exposed and readily expressed to one another. They were actively engaged in the process of emotional and psychological healing, perhaps even spiritual healing. Their strength was found in each other, and revealed to me once again how real healing takes place.

Opioids and Addiction

Dr. Marvin D. Seppala, Medical Director, CEO
Beyond Addictions

The use of oral opioids, pain medications, is escalating dramatically throughout the U.S. and we are seeing the end result in our treatment program. This class of drugs includes morphine, Vicodin, Oxycontin, methadone and heroin. These medications are extremely easy to obtain, whether from physicians, dealers or the internet. Prescriptions for oral opioids have increased since 1995 when it became apparent that pain was not being adequately treated, and when Oxycontin was released for use. Emergency room admissions for problems secondary to use of these drugs have escalated, in fact they doubled between 1997 and 2002. Treatment center admissions for opioid addiction doubled during the same period and continue to rise. With increased access to these drugs we have seen increased problems.

Often people start with legitimate use, but find that they like the effects for more than pain relief. Opioids provide a euphoric experience and numb psychological pain as well as physical pain. Oddly enough the opioids provide energy to most people who become addicted to them so when they run out or stop they not only experience terrible withdrawal symptoms, they have very little energy. The opioids are known for extreme withdrawal, and although it is miserable, it is not life threatening.

We have seen many young people seduced by the high associated with these drugs. Recently we met a 22-year-old who began to use these drugs during his days as a high school football player in one of Portland’s suburbs. He was given Vicodin for an injury. It was legitimate use of the medication, but he was already experimenting with other drugs and found he liked this one. He overused it and became very adept at convincing doctors that he needed more for various pains. Some of his friends on the team began to do the same thing and now several of them are in the midst of opioid addiction. The price of these drugs is high; Oxycontin costs between 50 cents and a dollar a milligram and comes in 40, 80 and 160 milligram tablets. Many of these people use as much as 240 milligrams per day, requiring either a good job or regular illegal activity. Unfortunately the cost is so high that heroin is less expensive, which results in many people switching over to save money. This can result in intravenous use adding to the danger.

Beyond Addictions provides outpatient detoxification and treatment for opioid addiction. We attempt to discern who could benefit from abstinence based treatment versus who would be better served by using buprenorphine for maintenance treatment of opioid addiction. We have equal numbers in our outpatient program. We require that those on maintenance buprenorphine enter into the outpatient addiction treatment program so that they are establishing recovery with multiple tools, not just relying on a medication.

Incredible Outcomes

Dr. Marvin D. Seppala, Medical Director, CEO
Beyond Addictions

12 Step programs are universally ignored and even derided by many mental health professionals who, like physicians, have little if any training in addiction. This lack of knowledge undermines the appropriate evaluation, treatment and referral of those people that come to them seeking their care. The professionals are left to their opinion, rather than their education, training and expertise, which is never a solid foundation for decision making. This sorry state of affairs brings us to an examination of the research about AA.

The federal government no longer funds studies examining whether AA works, it has been repeatedly proven to be effective in numerous studies. This is not a sexy research topic and doesn’t get a lot of attention because they are not examining new therapies developed by brilliant academics, nor can one make money by promoting 12 Step programs, as could occur with a newly defined therapy. So the dedicated researchers who take on the study of 12 Step programs are not highly honored or lining their pocketbooks, they are just proving that a program developed by a group of alcoholics in the 1930’s actually works better than anything else available for the treatment of addiction.

Approximately 20% of the US population will deal with addictive disease during their lifetime and more alcoholics will use AA than any other resource. Naturalistic studies have proven the effectiveness of AA, not just for abstinence from alcohol, but also in reduction of psychiatric symptoms and improved functioning. (1) AA attendance after formal addiction treatment doubled the rates of abstinence at one year and three years compared to those who did treatment alone. (2) Multiple studies have shown that involvement in AA, actually participating in specific aspects of a 12 Step program, result in better outcomes than merely attending and that those who attend more often per week have a higher likelihood of abstinence. Abstinence rates of close to 90% were shown at 8 years for those attending AA for more than 49 months. (3)

I tell people they will be twice as likely to be abstinent by attending AA after addiction treatment, and they often don’t believe me. The 90% abstinent rate data is often discarded because it is so remarkable. However, as a psychiatrist, this is the only disease I treat with the potential for such successful outcomes.

The research overwhelmingly supports the use of 12 Step programs for those with addiction. Unfortunately most mental health and medical professionals, as well as the public, are unaware of this information. As a result, they rely on their biases, and cannot make good decisions. Those of us that realize this data are responsible for letting others know and training our peers so that more people will be able to gain the benefits of an essentially free, incredibly successful, long term means for addressing alcohol and drug addiction. 1) Ouimette, Finney, Moos 1998 (2) Timko, Moos, Finney, Lesar 2000 (3) Moos & Moos 2006

Take Another Look at Relapse

Dr. Marvin D. Seppala, Medical Director, CEO
Beyond Addictions

I attended Beyond Addiction’s graduation ceremony over the Holidays and witnessed the beauty, gratitude and hope of new-found recovery from addiction. What struck me was that the graduates had each relapsed during their involvement in treatment, but continued to finish. They all spoke of the relapses and how they were afraid to discuss them, but found that our staff accepted their situation, developed new treatment plans, and helped them to move forward with more structure. The graduates repeated that they were ashamed and feared being kicked out of treatment, but found acceptance and caring, allowing them to quickly come to understand their addiction better and continue down the path of recovery.

Relapse happens with all chronic illness, not just addiction, and the rate of relapse is basically the same whether one has addiction, hypertension, asthma or diabetes; at least
40-60% in the first year. Most relapses occur in the first 12 to 18 months of initiation of abstinence from alcohol and drugs. If we take this information seriously and work to limit relapse while accepting it as inevitable in up to half of our clients, we can greatly inhibit the negative consequences of a return to drug or alcohol use.

People relapse for a lot of reasons, but addiction research tells us the three most common reasons are: increased stress, triggers of past drug or alcohol use, and use of a small amount of a drug or alcohol (the first drink). Many people will describe their relapses as related to a lack of recognition of the seriousness of addiction, basically related to denial of the power this disease has over them. 12 Step wisdom reveals that people relapse when they quit working a program and isolate themselves. People often think that their addiction is not that bad or they are somehow different and readily able to remain abstinent, only to find out it really is as difficult as they were told.

We know from research that completion of treatment, longer treatment and follow-through with treatment recommendations results in less relapse. Addressing other problematic life stresses and issues, like a failing marriage or an anxiety disorder, helps to eliminate relapse. The research on 12 Step programs also reveals that attending meetings regularly and getting involved in recovery activities eliminates relapse. There are new medications that can be used as pharmacological interventions and help improve the percent of people who stay sober and do not relapse.

Although we always treat people with the goal of abstinence, we must accept relapse as an integral aspect of any chronic illness and inherent to recovery from addiction. We cannot shame and berate people into recovery; they need our love, our support and our best efforts using every treatment approach available to them. Relapse goes with the territory, and we need to approach it as just another feature of addictive disease and its treatment.

Happy Holidays

Dr. Marvin D. Seppala, Medical Director, CEO
Beyond Addictions

The Holidays are a wonderful time to be in recovery and they can be a very difficult time. It’s a time of great joy and a common time for problems and relapse. It’s a time that a lot of people get sober, but also a time for partying and excess use of alcohol and drugs. This newsletter has articles that will help you enjoy the Holidays with tips for a sober and joyous Holiday Season, advice for families, and recovery events occurring in the Portland area over the Holidays.

The first time people in recovery go through the Holidays can be trouble. The Holidays are known for mixed emotions under the best of circumstances. For those in early recovery these emotions often include a generous helping of shame and guilt. Memories of celebrations gone awry and the damage that occurred during active use of drugs and alcohol can undermine the best of intentions. Some people have memories of horrifying experiences from their own childhood that can limit any attempts to get into the spirit of the Holidays. It can be a very lonely time, even among friends and family. Some people have burned all those bridges and may no longer have anyone to rejoice with. It’s dangerous to spend the Holidays alone. It’s important to increase recovery activities and learn how to celebrate in recovery.

The Holidays offer many opportunities to get outside of ourselves and focus on service and expression of love. Most cultures emphasize giving this time of year, and how better than to give of ourselves? There are ample opportunities for service within 12 Step programs, and plenty of other people who could benefit from your friendship. Many organizations need volunteers over the Holidays. Giving to others will always take the focus off our own problems.

The end of the year is a time for reflection and gratitude. It’s an important time to gauge one’s growth, and to honor the changes that have occurred. Take a good look at how far you’ve come, and how you’ve changed. Determine what changes you want to bring with you into the New Year and those you still need to work on. It is also a good time to put the year behind and move on. Examine your hopes and dreams for the New Year as you acknowledge the lessons of the old year. Make a list of those things you are grateful for that occurred in 2007. Tell someone else about your gratitude list. Contact those people that played a role in your recovery during the past year and thank them. Gather together with family and friends and celebrate what was right and good in 2007. We have a lot to celebrate!

Is a Spiritual Solution Necessary?

Dr. Marvin Seppala, Medical Director, CEO
Beyond Addictions

Dramatic advances in the brain sciences have resulted in an increased acceptance of addiction as a disease. New psychotherapies are being promoted for addiction treatment. We know the areas of the brain involved in addiction, the neurotransmitters (especially dopamine) that carry the information from one brain cell to another, and we know the receptor sites that exist for all addicting substances. Pharmaceutical companies are devoting money and resources to finding medications that could help people stay sober. Where does all this new information leave the use of spirituality in addiction treatment?

Throughout his sobriety, Bill Wilson, one of the founders of AA, tried to find new means to help others get into recovery, and it is a necessary pursuit. Neurobiology research has shown that addiction alters the reward center and associated areas of the brain. Current theory suggests that drug or alcohol use becomes the most important drive, limiting the priority given to other human needs, like food, sleep, friendship and family. It is as if addiction alters one’s memory to establish a sort of super-memory of the “high” that can preclude, at end- stage addiction, other human needs. This helps to explain some of the bizarre behaviors that define addiction: lying, cheating, stealing, ignoring family, losing jobs and risking lives. Since the drive to continue to use drugs and alcohol supersedes other rewarding activities, how can people think themselves out of it? Cognitive attempts to address addiction are inadequate if our sub-conscious reward system drives addiction.

The scientists have established that addiction is a brain disease and I believe that it is also a disease of the soul. Life itself is in the balance, and due to the power of addiction our own brain convinces us to risk it all, and compromise everything that is important. It is here that the role of spirituality makes tremendous sense in response to the new information about addiction as a brain disease. We need something even more powerful than the drug in order to successfully address addiction. The AA textbook states, “The spiritual life is not a theory. We have to live it.” If a new medication resulted in sudden abstinence it would not change the necessity of recovery using a spiritual program. Abstinence is not recovery. Healing, life change and personal growth would still have to occur for the individual to move on and lead a life they can enjoy and be proud of, and I do not know of a more effective and powerful way for this to occur than using a 12 Step program. The 12 Steps are based on spiritual principles that, combined with the fellowship of a 12 Step program, promote healing and establish a new way of life.

Neurobiology and the social sciences support what people in 12 Step recovery have known all along. The spirituality of 12 Step programs provides the opportunity for the individual to look outside themselves, recognize limitations, admit they have a disease, and turn to a power greater than themselves for a solution. We need spirituality in addiction treatment; it can be the foundation of long-term recovery and establishes the ability to change, not just remain abstinent, using the 12 Steps.