Leslie Glass's Blog, page 353

Change In Brain Cells Linked To Opiate Addiction, Narcolepsy

From Science Daily:

Two discoveries — one in the brains of people with heroin addiction and the other in the brains of sleepy mice — shed light on chemical messengers in the brain that regulate sleep and addiction, UCLA researchers say.

In 2000, UCLA researchers discovered that human narcolepsy is caused by a loss of roughly 90 percent of the 80,000 brain cells containing hypocretin, also called orexin, a chemical messenger, or neurotransmitter, important in the regulation of sleep. Narcolepsy causes excessive sleepiness, sleep paralysis (a feeling of being conscious but unable to move), hallucinations and episodes of cataplexy, a partial or total loss of muscle control that is often triggered by a strong emotion such as laughter.

Narcolepsy affects about one in 2,000 to 3,000 people but can go undiagnosed for years, according to the National Sleep Foundation. The sleep disorder usually has its onset in childhood or adolescence.

In a new study, these researchers discovered that people addicted to heroin have, on average, 54 percent more hypocretin-producing neurons than do people without addiction. They confirmed, in mice, that opiates cause this increase. The increase in hypocretin cells lasted for as long as four weeks after discontinuation of the morphine treatment, well after morphine had left the animals’ bodies.

The researchers hypothesized that morphine, the active ingredient in heroin, might restore the missing hypocretin-producing neurons in people with narcolepsy. To test this idea, researchers used mice that were made narcoleptic by the loss of hypocretin cells and gave them morphine. The researchers found that morphine increased the number of hypocretin producing cells and their narcoleptic symptoms disappeared.

The continued production of hypocretin in mice, after discontinuing morphine treatment, suggests that humans may continue producing hypocretin after they have stopped using heroin. The researchers hypothesize that this hypocretin increase may be a factor in opiate craving. In addition, raising the number of hypocretin cells to near normal levels could potentially reverse narcoleptic symptoms in humans. However, further work in mice is necessary before this can be recommended as a treatment for narcolepsy in people. Next, researchers would like to find out if reducing “excess” hypocretin cells — or blocking the action of the hypocretin peptide that they release — could make long-term withdrawal from opiates easier and prevent relapse.

 

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Drinking Changes Young Adults’ Metabolite Profile

From Science Daily:

Adolescent drinking is associated with changes in the metabolite profile, a new study from the University of Eastern Finland and Kuopio University Hospital shows. Some of these changes were found to correlate with reduced brain grey matter volume, especially in young women who are heavy drinkers. The findings shed new light on the biological implications of adolescent drinking, and could contribute to the development of new treatments.

“For instance, heavy-drinking adolescents showed increased concentrations of 1-methylhistamine, which, in turn, was associated with reduced brain grey matter volume,” Researcher Noora Heikkinen from the University of Eastern Finland explains.

1-methylhistamine is formed in the brain from histamine produced by immune responses.

“Our findings suggest that the production of histamine is increased in the brains of heavy-drinking adolescents. This observation can help in the development of methods that make it possible to detect adverse effects caused by alcohol at a very early stage. Possibly, it could also contribute to the development of new treatments to mitigate these adverse effects.”

The study was a 10-year follow-up study among adolescents living in eastern Finland. The researchers determined the metabolite profiles of heavy- and light-drinking young adults, and used MRI to measure their brain grey matter volumes. These two methods have not been used in combination before, although previous studies have shown an association between heavy drinking and metabolite profile changes.

“What is new and significant about our study is the fact that we observed metabolite profile changes even in young people who consumed alcohol at a level that is socially acceptable. Moreover, none of the study participants had a diagnosis of alcohol dependence.”

The findings indicate that even drinking that is not considered excessive has adverse effects on young people, both on their metabolism and brain grey matter volume, on the latter of which the research group has published findings already earlier.

“Although adolescent drinking is declining on average, we can see polarization: some adolescents are very heavy drinkers and they also use other substances,” Heikkinen adds.

The post Drinking Changes Young Adults’ Metabolite Profile appeared first on Reach Out Recovery.

Why Drugs And Alcohol Can Be So Hard To Quit

From Psychology Today:

Addiction treatment programs have an alarming failure rate often attributed to the powerful chemical effects of drugs and alcohol. And yet many users never become addicted–even after prolonged exposure. One reason some people relapse repeatedly is that, for them, being intoxicated allows them to express feelings that are out of awareness when they are sober—hidden “selves” emerge.

Intoxication sometimes allows hidden “selves” to emerge.

This compelling aspect of the intoxicated state is often overlooked in treatment programs: addicts not only miss being “high” when they struggle with sobriety, but also the way the substance facilitates the expression of disowned parts of the self.

What Are Disowned Parts of the Self?

As our identity develops, we tend to feel more comfortable in expressing certain parts of ourselves and less comfortable with others. Stereotypically, men in our culture grow up feeling more at ease conveying aggression as opposed to vulnerability. This doesn’t mean that men don’t feel vulnerable, but that this experience is not often in conscious awareness. Similarly, a person raised in a family in which aggression is frowned upon may have a tendency to deny feeling angry and behave as if nothing gets to them.

What happens to the feelings that we are reluctant to acknowledge? Well, they don’t just disappear; they stay out of awareness and often we really don’t know that they are there. These are the disowned parts of the self.

Intoxication Allows Expression of the Disowned Parts of Self

Drugs and alcohol can loosen our inhibitions allowing us to express the parts of ourselves we usually hide. Think of the cliché of the macho man who, after a night of drinking, gets teary-eyed, hugs his best bud and tells him how much he loves him. In this scenario, drinking allows the expression of vulnerable feelings that normally reside outside of awareness.

Research on the medical use of various drugs such as Ketamine, LSD, and MDMA investigates how these drugs permit access to otherwise sequestered aspects of one’s personality. When these drugs are administered in a therapeutic setting they help people to understand and integrate otherwise disowned parts of self.

Sage

Take Sage, a successful medical professional who works long hours tending to the needs of her patients. At home, she is the go-to person for her extended family; whenever her relatives experience difficulties, she’s the one they turn to for advice. When sober, Sage is proud of her pivotal role in the family, even though she secretly wishes to be left alone with a good book.

When she drinks, Sage no longer assumes the role of the “strong one.” She often calls friends late into the night and keeps them on the phone for hours. She tells them how alone she feels and that there is no one looking out for her.

When drunk, Sage is able to express her longing and wish to be cared for. When she drinks, she can cry about her loneliness–she can feel sorry for how responsible she has had to be growing up the eldest of six children in a single-mother household. Sober, she has no access to these feelings.  When Sage is reminded of what she said during a drunken conversation, she has no memory of it.

Max

Max is a successful professional working at one of the most competitive companies in his business. He is in an on-again-off-again relationship with his girlfriend Mandy. When Max is sober he routinely expresses his love for and dependency on Mandy. He has a difficult time letting Mandy leave for work, often gently coaxing her to stay with him in bed just a little bit longer. Although he is aware of his dissatisfaction with Mandy’s relative lack of emotional openness, he doesn’t complain. Afraid of being abandoned, he avoids starting an argument. Discord in his childhood home eventually led to the dissolution of his parents’ marriage.

When Max is high, usually on a combination of alcohol and marijuana, he can easily express his discontent with Mandy. Often after a night of partying, he becomes enraged at her for seemingly small infractions. He has broken up with her numerous times because she was paying too much attention to another guy at a party: “You would rather talk to that guy than me.”

Max often tries to make up with Mandy the following day. He struggles to understand how he gets so out of control. Back in touch with his fear of losing Mandy, he disowns the angry and dissatisfied parts of himself. He is unable to express his legitimate concerns when he is sober, a time when he would be more capable of having a constructive discussion.

Where We Go from Here

Despite repeated attempts to stop using, Sage and Max frequently fall off the wagon. The work cut out for them in therapy is to learn to tolerate uncomfortable feelings. Instead of dismissing these parts of themselves as just “being messy,” they must realize that these feelings are legitimate—indeed, very important—aspects of who they are. If they can find a way to express the hidden and disowned parts of themselves when they are sober, they might more easily sustain sobriety.

The post Why Drugs And Alcohol Can Be So Hard To Quit appeared first on Reach Out Recovery.

Dogs Help Facilitate 12 Step Programs

From ABC News in Bakersfield, CA: A recently-implemented program at The Mission at Kern County is helping recovering addicts beat their addictions with the help of therapy dogs.

“What I’ve done is go through each of the twelve steps and put together themes,” said Liz Kover, director of the Miracle Mutts branch of Marley’s Mutts Dog Rescue. “Dog-related themes that kind of relate to the working of each step.”

The class, which Kover calls “Moving Forward with Dogs 12 Steps at a Time,” is now up and running at The Mission’s new women and children’s center in downtown Bakersfield. The program has already been used at the men’s center, but the current class is a first for the women.

The class, which takes place at the center on Thursday mornings, runs for twelve weeks. It involves discussion of the current step in the 12-step recovery addiction process in the first half of the class (this week’s involved turning your life over to God), and then interactive lessons using the dogs.

“They come from broken homes,” said Veronica Laughlin of the dogs used in the program, which are often rescued by Marley’s Mutts. “Being neglected and hurt.”

Laughlin is a recovering meth addict and Thursday represented her one-year anniversary of being taken off the street and placed at The Mission. She’s set to graduate from the recovery program this summer and then begin a post-program which will help with transitioning out of the rescue home.

“I’ve been restored inside and out. I’m not broken, I’m the happiest I’ve been in a long time.”

Women in the program spoke about how the dogs help relieve anxiety, an issue many said they faced when first entering the program. One woman even tracked her resting heart rate on her FitBit, saying it calms considerably when the dogs are in the room.

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10 Anxiety Hacks Therapists Swear By

From Fiona Tapp @ Huffington Post: The 40 million Americans who live with an anxiety disorder know how terrifying both the physical and mental symptoms can be. Issues like debilitating headaches, shortness of breath and persistent rumination make even the simplest daily tasks feel like impossible undertakings. For people without the disorder, acute instances of anxiety ― think job or financial stress ― can lead to the same symptoms and feelings.

However, there are ways to treat and manage the issue. We consulted experts on their go-to moves when it comes to mitigating anxiety, as well as their advice on when to seek professional help. Here are just a few anxiety tips experts swear by:

1. Put Your Anxiety On Ice

Sheri Heller, a New York City–based psychotherapist, suggested literally dousing your stress.

She recommended plunging your hands into ice water or splashing some on your face. “Sensorial stimulation with cold water can break through dissociative feelings that often accompany anxiety and offer immediate relief from heightened cortisol levels,” she explained.

2. Clench Your Fists

While exercise is great for alleviating anxiety, it’s not exactly realistic to go for a run when you’re in the middle of a panic attack. However, a few physical activities ― even ones as simple as clenching and releasing parts of your body ― can have a positive effect, said Nicole O-Pries, a therapist based in Richmond, Virginia.

“Place your hands on or beside your legs. Ball your fists like you are really mad and tighten your hands as much as you can. Take a deep breath and loosen your fists a little bit at the end of the out breath,” she said. “Continue to take deep breaths and loosen your fists until your hands are completely open. Then stretch your fingers outward as much as you can. Now notice your body again and the lessening of the anxiety points you felt earlier.”

3. Repeat A Calming Phrase

Carol Howe, a spiritual psychotherapist in Orlando, Florida, said that when the body is under stress, we need to address our physical discomfort before we can calm down.

“Breathe deeply at least three times, in through your nose and out through your mouth,” she said. “Assure yourself with this language: ‘I am safe, and I am loved.’” Repeat slowly three times, and you should begin to feel more at ease.

4. Allow Yourself To Feel Anxious

Yep, you read that correctly. Sometimes the more you fight it, the worse it gets, Howe said. Instead, acknowledge that you’re feeling anxiety and give yourself permission to feel uncomfortable.

“I know this sounds scary, but anxiety stays anchored into place when we resist its presence,” she said. “It can literally move through and beyond us the moment we decide to allow it.”

5. Let The Tears Flow

It can also be helpful to cry, Heller said. Research shows that crying can be therapeutic, and often it’s a sign that there are emotions that need to be released.

“Often anxiety is a response to trapped or repressed grief,” Heller explained. “In these cases, giving oneself conscious permission to cry can offer the catharsis needed to calm the nervous system.”

6. Shut Down Your Social Media Apps For A Bit

Those suffering from anxiety can often feel overwhelmed by external expectations, including cultivating the perfect image on social media. Lauren Rose, a psychotherapist in Rye, New York, suggested that people feeling anxiety based on their newsfeeds (FOMO, anyone?) take a timeout.

“Social media ― and the internet in general ― often heighten anxiety and fear, sometimes through encounters with inaccurate information or information not relevant to the particular situation,” she said. But the World Wide Web isn’t all awful. Online support groups can help anxiety sufferers feel less alone, she added.

7. Take Stock Of Your Surroundings

Not thinking about your symptoms entirely is frivolous advice. (How can you not think about feeling as if your world is crashing?) That said, distracting your mind by focusing on something concrete in front of you can help you to avoid spiraling out of control, said Julia Colangelo, a licensed clinical social worker based in New York City.

“Count different colors, numbers or items in a room. If you’re feeling panicked, this can be a way to ground yourself and manage distress and anxiety while also not checking out,” she said.

8. Jot Down Your Feelings

Putting your worries and triggers in writing can help you manage your symptoms and challenge negative self-talk that’s often associated with anxiety, said Karen Whitehead, a licensed counselor based in Atlanta.

“Write down two to three words or bullet points that describe your biggest worries at that moment. Take them one at a time and ask yourself if it is a fact or your opinion,” she said. “Often what feels 100 percent true in the moment is actually our opinion, and when we recognize it as such, we can diffuse its intensity.”

9. Face What’s Causing Your Anxiety In The First Place

It sounds counterintuitive, but it’s one of the most effective strategies. Robert Duff, a licensed psychologist and the author of Hardcore Self Help: F**k Anxiety, said it’s important to face specific fears you have and not practice avoidance tactics.

“Anxiety is fed by avoidance. When you feel anxious about a given scenario, one of the most common reactions is to avoid it,” he explained. “Even though logically there may be no real danger in these situations, anxiety makes you feel like you actually dodged a bullet by avoiding the potentially upsetting situation rather than pushing through. That just makes anxiety bigger.”

When you are in a possibly anxiety-inducing situation, try not to retreat. “Challenge yourself to stay in it for five minutes,” he said. “You can tolerate just about anything for five minutes. If you can handle it after five minutes, push it to 10, then 15, etc. Eventually, your body will regulate itself, and the anxious feelings that you have will become easier to tolerate.” Heads up, though: This approach is best undertaken with the support of a therapist, Duff said.

10. Seek Help From A Professional

Speaking of support from a therapist and talking things through with a mental health professional can be hugely beneficial and keep you safe from a progression to more dangerous anxious behaviors, said Heidi McBain, a licensed counselor based in Flower Mound, Texas.

“Seeing a therapist who specializes in anxiety can help people break the unhealthy patterns in their lives and learn new, healthier ways of coping with their anxiety,” she said.

Although experiencing anxiety isn’t always within your control, taking care of your mental and physical health can limit the chances that it will become overwhelming. Making sure that you eat well, exercise and get enough rest, along with watching the way you talk to yourself, helps ensure that you’re more resilient against negative feelings and thoughts.

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Rural Iowa Doctor Fights Opioid Addiction Her Way

From Abby Goodnough @ The New York Times: A newborn had arrived for his checkup, prompting Dr. Nicole Gastala to abandon her half-eaten lunch and brace for the afternoon crush. An older man with diabetes would follow, then a pregnant teenager, a possible case of pneumonia and someone with a rash.

There were also patients on her schedule with a problem most primary care doctors don’t treat: a former construction worker fighting an addiction to opioid painkillers, and a tattooed millennial who had been injecting heroin four times a day.

Opioid overdoses are killing so many Americans that demographers say they are likely behind a striking drop in life expectancy. Yet most of the more than two million people addicted to opioid painkillers, heroin and synthetic fentanyl get no treatment. Dr. Gastala, 33, is trying to help by folding addiction treatment into her everyday family medicine practice. She is one of a small cadre of primary care doctors who regularly prescribe buprenorphine, a medication that helps suppress the cravings and withdrawal symptoms that plague people addicted to opioids. If the country is really going to curb the opioid epidemic, many public health experts say, it will need a lot more Dr. Gastalas.

Science says buprenorphine works: A substantial body of research has found that people who take it are less likely to die and more likely to stay in treatment. It is an opioid itself but relatively weak, activating the brain’s opioid receptors enough to ease cravings, yet not enough to provide a high in people accustomed to stronger drugs. But only about five percent of the nation’s doctors — 43,109 as of last week — are licensed to prescribe it. A new study found that even among people who had overdosed, only 30 percent were provided with buprenorphine or one of the other medications approved for treating opioid addiction, methadone and naltrexone, in the year that followed.

After a rocky start, the Trump administration has gotten on board with addiction medications, which also include methadone and naltrexone. The nation’s top health official, the Health and Human Services secretary, Alex Azar, said recently that trying to recover without them is “like trying to treat an infection without antibiotics.” Last year, Congress temporarily began allowing nurse practitioners and physician assistants to prescribe buprenorphine if they go through extra training, and more than 7,000 have gotten licensed; a bill that passed the House on Friday would let them prescribe it permanently. Still, half the counties in the United States don’t have a single buprenorphine prescriber.

Dr. Gastala has to follow strict federal requirements and live with the possibility that the Drug Enforcement Administration might inspect her office with no warning. Insurers require her to jump through constant hoops to get the medication approved for her patients.

She has found that addiction treatment is incredibly complex work, not least because the patients often have unaddressed mental health problems. She has been crushed when patients drop out of treatment, fearful of reading about one of their deaths in the newspaper and conflicted about whether and when to stop treating someone who continues to use drugs.

“This is not like a newborn exam or a diabetes check or strep,” said Dr. Gastala, who has kind eyes and an emphatic laugh. “It’s very complicated and takes a lot of time and effort, and can feel high risk.”

She added: “It definitely wasn’t comfortable at first.”

A Vital Partner

Early in her busy afternoon Dr. Gastala greeted a new patient: Fallon Steenhoek, who was trying to stop using heroin.

Ms. Steenhoek, 30, had started on Suboxone —the most common formulation of buprenorphine — a month earlier, while staying with her stepfather in Illinois. Now she was back at home and needed a way to keep getting the medication. She had already lost custody of her 10-year-old daughter, and didn’t want to lose her 1-year-old son.

Andrea Storjohann, a nurse case manager who is Dr. Gastala’s vital partner in treating addicted patients, was waiting for her in the exam room. Ms. Storjohann keeps the buprenorphine program running while the doctor multitasks. She gauges each patient’s progress, asking about their highs and lows since their last appointment. She also tests their urine to check for other drugs and that they’re not misusing or diverting the medication. And she makes sure they’re going to therapy, which the program requires. She’s a native of Marshalltown, gently sly and good at winning patients’ trust.

“In the last year, how many times have you used an illegal drug or prescription medicine for a nonmedical reason?” she asked Ms. Steenhoek.

“Like, 300,” came the reply. There was no trace of judgment on the nurse’s face.

The questions continued, a long checklist, including whether Ms. Steenhoek had been the victim of violence or abuse.

“I just know my main goal is to remain sober and recover all my relationships and have that sense of normalcy in my life,” Ms. Steenhoek said. “That’s what I want more than anything right now.”

Dr. Gastala increased her daily dose to 12 milligrams, from eight.

“If you feel it’s not enough, don’t wait until your next appointment,” she said. “Call us.”

An Unexpected Mission

Dr. Gastala had no interest in treating addiction until she arrived in rural Iowa, but she knew from a young age that she wanted to do work that others might shy away from. She was 6 when her mother, a secretary, died of Hodgkins lymphoma, and the doctors and nurses who cared for her left a profound mark. When she was in medical school in Chicago, her father, an engineer, died of brain cancer, and she decided to spend four months working at a rural clinic for the poor in Bolivia. The experience, she said, propelled her into family medicine.

She came to Marshalltown straight out of residency at the University of Iowa, as a participant in a federal program that would help pay off her medical school loans if she worked for three years in an underserved community. Marshalltown, a city of 27,000, appealed because of its diverse population — a mix of longtime, mostly white residents and Hispanics who started coming in the 1980s to work in the area’s meatpacking plants.

Dr. Gastala was eager to start the type of weight-loss and diabetes prevention programs here that she had organized as a resident in Iowa City. But after arriving in July 2015, she was struck by the number of patients dependent on opioids they’d been prescribed over the years — including at her new practice — for chronic pain.

Iowa is no Ohio or West Virginia in the breadth of its opioid problem; meth addiction remains more common here. Heroin and fentanyl, however, have started to grab hold. Iowa had 206 deaths involving opioids in 2017, according to provisional state data; fatal heroin overdoses more than doubled, to 34.

“Yeah, I definitely have a history with that,” she whispered

“Was it emotional, physical, sexual, financial?”

Ms. Steenhoek’s face crumpled. “All of it,” she said, starting to cry. “My daughter’s dad was pretty textbook.”

She said she’d been having intense cravings for heroin, and had taken more than her usual dose of Suboxone in desperation one recent night. She looked at the nurse uneasily.

“I’d rather you do that than go use heroin,” Ms. Storjohann reassured her. “How often are you feeling like you’re really on the edge and needing to reach for something else?”

“A couple times a week. I go to meetings and that only takes you so far. I do smoke a lot of cigarettes. I drink a lot of caffeine because that seems to help a lot, too. But you can only do so much.”

Then it was Dr. Gastala’s turn to meet Ms Steenhoek, asking about her support system, how often she went to therapy and whether she had a job. She also wanted to know whether Ms. Steenhoek had been treated for the hepatitis C she had gotten from injecting drugs — not yet, the patient said — and whether she had a longterm goal.

Marshall County’s addiction treatment agency happened to be across the street from Dr. Gastala’s practice. When she mentioned the problem to the agency’s leaders, they asked her to consider prescribing buprenorphine. At that point, the closest prescribers were an hour’s drive away.

Dr. Gastala helped her practice, Primary Health Care, a community health center, get a federal grant to start a buprenorphine program. She took the eight hours of training required to prescribe it, along with an older colleague. They started in January 2016, and demand has grown steadily since then. Most of their addiction patients get individual or group therapy, or both, at the agency across the street, the Substance Abuse Treatment Unit of Central Iowa.

Dr. Gastala had learned almost nothing during her four years of medical school and three years of residency about addiction or how to treat it. She taught herself from articles and books; by talking to a Veterans Administration doctor in Iowa City who prescribes buprenorphine; and from monthly video conferences that a health center in Connecticut holds with primary care doctors around the country who are taking on addiction treatment.

Innately cautious, her instincts clashed with what the doctors leading the video sessions believed — that the overall goal of buprenorphine treatment was preventing deaths, even if it sometimes meant allowing patients to stay in treatment despite continuing to use illicit drugs.

“I thought the goal was zero inconsistent drug screens,” Dr. Gastala said during a 2016 session, sounding exasperated. “I don’t know what to do; I just don’t know.”

Dr. Marwan Haddad, who was leading the session that day from Middletown, Conn., reminded her that addiction was a chronic, relapsing disease.

“I don’t expect my patients, the moment I give them Suboxone, to say, ‘I got the miracle pill and my life is going to fall into place and I’ll stay off drugs completely,’ ” Dr. Haddad said. “If they are decreasing injection and use, you’ve moved them along to a safer place in many ways, even if it’s not completely gone.”

Dr. Gastala said she has undergone “a complete evolution” since then.

“I had to learn how to have a more open mind and just be O.K. with meeting patients where they’re at,” she said. “A lot of our nurses and staff have also grown and been more empathetic than in the very beginning, when it was more like, ‘Oh, you messed up? Then you’re done.’ ”

Another challenge is more logistical: How to fit addiction treatment into a busy primary care practice. Dr. Gastala does it by double-booking her buprenorphine patients; Ms. Storjohann, the nurse, conducts most of each appointment, with Dr. Gastala popping in at the end.

The appointments are not moneymakers; the modest income they bring in helps pay Ms. Storjohann’s salary. A separate grant provides initial doses of Suboxone for patients whose insurance (usually Medicaid) hasn’t approved it yet.

Those donated doses often have to last weeks. To get the required “prior authorization,” Ms. Storjohann has to provide insurers with proof that the patient is getting frequent urine tests and that nobody is prescribing narcotics or anti-anxiety drugs. Insurers sometimes limit daily doses and require reauthorization as often as every three months.

“You can write hydrocodone or Percocet and you have no hoops to jump through,” Dr. Gastala said. “With the Suboxone, there are still a lot of hoops.”

Lost to Treatment

Of the 60 patients Dr. Gastala’s practice has treated with Suboxone, 40 are “inactive” at this point, generally meaning they relapsed, found another treatment provider or tapered off the medication successfully, she said. Eleven of the 40 simply disappeared.

“We always try to reach out and call them,” Dr. Gastala said, “but sometimes they don’t call back and you don’t know why.”

In her experience, the patients who do best have strong family support, a permanent place to live and, often, a job. Melinda Karam is one of them; she started on Suboxone last September and has stuck with it but for one relapse around the holidays. The only cravings she has now are in dreams.

“Dreams about using are normal,” Ms. Storjohann reassured her during a recent visit.

That day, she also saw Tammie Mellies, 42, slouched and looking despondent.

Ms. Mellies had come to see her in early February about an addiction to hydrocodone, but disappeared afterward. It turned out a judge had sent her to an inpatient treatment center about an hour away. The center had started her on Suboxone, discharged her after three days and referred her back to Dr. Gastala.

Ms. Mellies was still struggling. The dose she was on, eight milligrams daily, hadn’t diminished her cravings enough.

“Addiction just sucks,” she said softly.

Dr. Gastala gave her a week’s prescription for the higher dose. “We’ll see you back in a week,” Ms. Storjohann said.

Ms. Mellies returned once but then disappeared again. When Ms. Storjohann called to check on her, she said she had decided to stop taking Suboxone. Her name went on the inactive list.

Fighting Stigma

Dr. Gastala initially planned to require patients to taper off Suboxone after two years at the most, believing that if patients’ lives had stabilized, they wouldn’t need it anymore. But she has softened her stance. Most of her patients are terrified of coming off the medication and having their cravings roar back, no matter how well they’re doing.

Andrea Steen, who started on Suboxone in 2016 after becoming addicted to Vicodin she stole from her disabled husband, is one who hopes to stay on it for the rest of her life.

“I would die with it if it was up to me,” she said during a visit with Ms. Storjohann.

Ms. Steen said she sometimes clashes with other recovering addicts who buy into the notion that buprenorphine is just another opioid, a crutch.

“In my 12-step program there’s one member, her and her husband say it’s just like taking heroin,” Ms. Steen said. “Well, do your research. I’ve done mine.”

“A lot of people say Narcotics Anonymous has saved their life,” she added. “In a meeting, I said, ‘I love Narcotics Anonymous but it’s the Suboxone that’s saved my life.’ And it’s the truth.”

It was Thursday, and as usual, Dr. Gastala was the last to leave the office, around 8 p.m. She climbed into her Subaru and set out for Iowa City, where her husband, a radiologist, is completing a fellowship.

After he finishes his training this summer, they are moving home to Chicago. She has accepted a job at another community health center, and will continue treating addiction.

By then, two nurse practitioners at the Marshalltown clinic will be licensed to prescribe buprenorphine, taking over her caseload and, she hopes, allowing it to grow. Primary Health Care, which already offered buprenorphine at a clinic in Des Moines, now also offers it at a clinic in Ames. And doctors from Sioux City, Iowa City, the Quad Cities and Cedar Rapids have sought Dr. Gastala’s advice on starting buprenorphine programs.

Fallon Steenhoek, the patient who was struggling to stop using heroin, remains in Newton, a 45-minute drive from Marshalltown, keeping a video log of her recovery and hoping the expansion of buprenorphine prescribers will reach her there. She relapsed one afternoon in April after finding an old bag of heroin in her garage, but being on Suboxone, she felt sick, not high.

She called Dr. Gastala’s office a few hours later to report what happened.

Ms. Storjohann, the nurse, told her, “‘Fallon, the important part is you came back from it,’” Ms. Steenhoek recalled. Until she has a closer option, she plans to continue driving to Marshalltown.

The post Rural Iowa Doctor Fights Opioid Addiction Her Way appeared first on Reach Out Recovery.

Police In Houma LA Seize Enough Fentanyl To Kill 14,000

From WGNO @ ABC: An investigation into several overdoses in Houma Tuesday evening led police to a home with enough fentanyl to kill 14,000 people, according to the Houma Police Department.

Houma Police said officers responded to several calls of overdoses within a 10-15 minute span about 6 p.m. Tuesday (June 26).

Officers were first dispatched to the 100 block of Chateau Road, where two victims appeared to be overdosing on drugs. Both of the people were revived with Narcan, and officers learned that a gold-colored sedan occupied by two females dropped the two victims off and left the scene.

A few minutes later, officers responded to an accident at the intersection of Grand Calliou Road and Tunnel Boulevard involving a gold-colored sedan and a pickup truck. Police learned that the sedan involved in the crash was the same vehicle that dropped off the first two overdose victims. The two female occupants in the gold-colored sedan were also found unresponsive and displaying signs of overdoses.

Officers revived both women with Narcan, and both women were taken to a local hospital for treatment.

While police investigated the first four overdoses, concerned residents told officers that there was an unresponsive man in a vehicle in the Walgreens parking lot at Grand Calliou Road and Tunnel Boulevard. The man appeared to have overdosed and was revived with Narcan.

Investigators learned that each of the victims had taken fentanyl, a synthetic opioid and powerful anesthetic that’s 30-50 times more potent than heroin.

The investigation led to an apartment at Renata Lakes, where police found more than 28 grams of fentanyl in the presence of an 8-year-old and a 4-year-old. Police also recovered about $1,000 in cash. The street value of the fentanyl bust is about $5,600, police said, enough fentanyl to kill about 14,000 people.

Terrell Walker, 39, was arrested and booked into the Terrebonne Parish Jail on the following charges: Distribution of CDS I, Possession with Intent to Distribute CDS I, Possession of Drug Paraphernalia and two counts of Illegal Use of a CDS in the Presence of Persons Under 17 years old.

This investigation is ongoing. Police are considering charging the woman involved in the crash with Operating a Vehicle While Under the Influence of Certain Drugs.

Anyone with information can submit a tip anonymously through Crime Stoppers Bayou Region by phone at 1-800-743-7433 or online.Tipsters could be eligible for a reward of up to $1,000 in cash if the information leads to an arrest.

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Netflix Documents What Happens After Opioid Addiction

From Amanda Holpuch @ The Guardian: Sitting on leather couches at a West Virginia farm, a father of two reckons with terrible news about his three-year-old daughter, who he just learned had been molested while in foster care.

“I don’t know what to do,” says Jeff, who was at the farm to treat his opioid addiction.

The silence lingers until addiction counselor Craig Cohen carefully asks the four men, each a portrait of masculinity in camouflage caps and tattoos: “Are we just talking shit every day? Are we just having fun?”

Then, something quietly revolutionary occurs: the men consider Jeff’s options, his feelings, and share their own experiences with sexual assault and losing custody of their children. They are not swapping war stories but working through their own experiences and emotions to process an unfortunate reality without the help of drugs or alcohol.

It is one of several scenes in the new Netflix documentary Recovery Boys that depicts four men who could easily be classified as “tough guys” processing their emotions at the Jacob’s Ladder rehabilitation program.

They are there to treat their addiction to opioids such as heroin and prescription painkillers, which have been misused at such a high rate in the US that 115 people died each day in 2016 from opioid-related drug overdoses, according to the US health department.

Opioid abuse skyrocketed in the past 10 years, especially in the Appalachian region, which engulfs West Virginia. Its widespread abuse has led to a barrage of devastating news coverage and the Trump administration declared a federal public health emergency in response to the crisis.

Set in the middle of this crisis, the film provides an exploration of male emotions will be refreshing to anyone who has grown accustomed to staid representations within popular culture, as will the film’s focus on people in recovery instead of people suffering from addiction.

The film changes the narrative from destitute people injecting drugs in a run-down apartment block or crumbling rural shack and instead nestles recovering drug users among frolicking pigs and chickens, providing a much-needed antidote to the barrage of depressing stories about the country’s opioid crisis.

“Now that you’re not high, you come out and listen to all the birds,” Jeff says one morning at the farm. “When you’re high, you don’t focus on shit like that.”

For 18 months, the film follows men through treatment, as they grapple with feelings of not being loved, supported or in control.

Months after the shoot ended, 35-year-old Ryan spoke to the Guardian about the positive results the program had on his life.

Ryan, who was raised in North Virginia, said he grew up with people who used but did not embrace rehabilitation programs. But he was attracted to Jacob’s Ladder because it had non-traditional treatment offerings, such as eastern philosophy, meditation and yoga.

“I went through overdoses and car wrecks, and I was jailed a couple times but I didn’t want to give up,” Ryan said. “I had to find something. And it turned out it was Jacob’s Ladder.”

Jacob’s Ladder was founded by Dr Kevin Blankenship after the retired emergency room doctor was unable to find a long-term recovery program for his son, who is now clean and makes a brief appearance in the film.

Blankenship’s holistic, long-term residential facility incorporates meditation, music and art programming and farm work into the healing process.

Ryan said he is now part of what he described as the “huge community of recovery” in Morgantown, West Virginia. Opioid addiction and overdoses have wreaked havoc on the state, but the resilience and strength of people in recovery is fighting to get attention amid a barrage of depressing news stories.

Sharing this side of the story was a concerted decision by director Elaine McMillion Sheldon, who is from West Virginia. “I make this film not to victimize, pity or make excuses for individuals, but to uplift the stories of people who are actively trying to make change, no matter how big or small,” Sheldon said in a statement.

In telling the story of recovery, the film-makers also had to show that the glimmers of hope in recovery don’t come easily either.

Rush, 26, had been to rehabilitation facilities nine times without success before arriving at Jacob’s Ladder.

He said that at those facilities, even though he wanted to be sober, he would just try to get out as quickly as possible. “I know what people want to hear so it is really easy for me to skate through a program undetected,” he explains in the film.

But the Florida native saw something different at Jacob’s Ladder and tried harder than ever to interrupt patterns in his life and finally put an end to his drug use.

Rush said he was uncomfortable at first with the cameras, but that the film-makers quickly became a “part of the family” by doing yoga and eating meals with the men.

He said that he hoped that by participating in the film, he could send a message of hope and recovery to others suffering from addiction, and a message of understanding to those that don’t.

“My hope for this documentary is that it destigmatized the addict,” Rush said. “Everybody thinks of the guy under the bridge with the tattoos, the beard. We’re not just all bad people. We are good people inside.”

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6 Steps to Stop People Pleasing

From Scienceofpeople.com: Some people can’t help to want everyone around them to like them. Sometimes, at the sacrifice of their own wants, needs and desires.

The only person I want you to please is you. 

Okay to say ‘No’?!

According to Dr. Susan Newman, people pleasers want everyone around them to be happy. And they will do whatever it takes to keep them that way. They put everyone else before themselves. Dr. Newman said, “for some, saying ‘yes’ is a habit.” For others it’s almost an addiction, it makes them feel like they need to be needed. This makes them feel important and like they are contributing to someone else’s life. So here is what you can do to start saying “no” to others and say “yes” to yourself:

6 Ways to Stop Pleasing
1 Internal Validation

Most people pleasers are desperate for validation and appreciation. They want to feel needed, so they become over-the-top helpful and say “yes” to everyone. This makes their confidence purely based on on external forces. The approval of others and not internal forces. I want you to rely on internal validation, not external.

The best way to fight people pleasing is to build up what makes you feel good. If you feel good, you don’t need others to make you feel good. Do activities that make you feel like a ‘baller’. Hang around people who make you feel awesome without having to do anything for them. Remind yourself that you already have a lot going for you.

2 Start With Small No’s

It’s hard to go cold turkey on pleasing people so start with small no’s. For example, if you really don’t want to go to a party, but you feel guilty, say you’ll go but you will be a little late. You don’t have to stay the whole night. Or, if someone wants to grab dinner, do a shorter coffee date instead. Start with small no’s to practice for the bigger ones.

3 Give Yourself Time

It is extremely hard to say no to someone else’s personal request; it’s even harder when you are a people pleaser. So when a friend asks you to help her find a new outfit, you default to “sure”. Or when a colleague asks you to be a part of their project, you’ll say “okay,” but then immediately you regret it. Then you are angry at them and at yourself for saying yes. That is why I always tell people pleasers not to give an answer immediately. Make a rule that if someone asks you for something, your default answer is, “Let me get back to you.” You can say that you have to check your schedule, your to-do list or your spouse. Do whatever you need to do to buy yourself some time, then you will have some space to think about it and respond on e-mail or text with a polite “no”. This is so much easier than doing it in person and gives you time to make the right choice. Remember: the right answer, “Let me get back to you” is always best.

4 Know Your Goals

It’s much easier to say no to other people’s lives when you know what you are saying yes to in your life. Once a week I sit down and re-evaluate my long-term goals and short-term goals for the week. I want to know what I am doing this week that gets me closer to where I want to be in 5 years. When I have this clear in my head, it’s much easier to say no to a request because I have to make time for my goals right now.

So my questions for you are:

Where do you want to be in 5 years time?
What are you doing right now to get yourself there?

These answers will make it easier for you to focus on you.

5 Get Rid of Toxic People

As you have been reading this article, is there one specific person you have been thinking of? You might have a toxic person in your life who is constantly asking you for things that you are sucked into. If you have a toxic person, please get them out! Check out my post on the 7 Types of Toxic People.

6 Stop Apologizing

When you say no, say it with meaning. Don’t apologize because you have to prioritize. Don’t feel bad that you have something to take care of. You are standing up for you; and remember, if you don’t stand up for you, no one else will.

I know you can do it! It’s time to stop people pleasing and start doing what is right for you!

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7 Ways Parents Can Nip Narcissism In The Bud

From Sarah Hamaker @ The Washington Post: Have you heard? There’s a new study creating quite a buzz, probably among your friends too: It found parents have a key role in whether their children become little despots.

The findings, published in the Proceedings of the National Academy of Sciences, found that parents who “overvalue” their kids between the ages of 7 and 11 raised children who scored higher on tests of narcissism. In other words, parents who described their offspring as “more special than other children” and as deserving “something extra in life” had kids who think they’re God’s gift to the world.

“Children believe it when their parents tell them that they are more special than others,” said Brad Bushman, co-author of the study and professor of communication and psychology at The Ohio State University. “That may not be good for them or for society.”

It comes as no surprise that having children who think they are better than everyone else at anything they do isn’t a good thing—for the kids themselves and for society at large. And kids can attest, parents are some of the worst when it comes to bragging about their kids’ achievements.

What struck me the most about the study was that in helping our children develop a healthy self-esteem, we can so easily slip into overvaluing their performances, which can lead to a narcissistic attitude. As Eddie Brummelman, lead author of the study and a postdoctoral researcher at the University of Amsterdam put it, “Rather than raising self-esteem, overvaluing practices may inadvertently raise levels of narcissism.”

Parents should read the findings as a warning  that labeling their kids as “extra special” may not be the self-esteem booster previously thought. “When I first started doing this research in the 1990s, I used to think my children should be treated like they were extra-special,” said Brummelman. “I’m careful not to do that now.”

Here are seven ways we as parents can keep narcissism at bay in our kids and avoid overusing praise:

1. Love Your Kids, Warts And All

The more we view our children as flawed (like we ourselves are), the more we will be able to love them in their imperfect state. None of us are perfect, and when we can accept that our children are not all geniuses or the next great sports star—that they are, in fact, wonderfully ordinary and average—we will be able to relax and enjoy them for who they are right now. The ability to recognize failings and to still love and accept them is one of the greatest gifts we can give our children.

2. Stick To The Point With Your Praise

Think about how you feel when someone says, “Good job!” as opposed to “You really nailed that presentation by including those questions at the end. Gave us something to think about going forward with this project.” General praise is much less meaningful than a compliment on a certain achievement. Our children are no different. When we are as precise as possible in our compliments, we tell them that we truly appreciate—and recognize—their effort.

3. Praise The Present

When we talk in terms of “always” or “never,” we negate the effort right in front of us. We also mar the satisfaction in a job well done if that job is lumped in with the past and future. This means we shouldn’t tell our kids, “You always do such a nice job” when referring to their room cleaning. What we should say is something like, “You did a good job on your room today.” That anchors the praise in the present and shows the child it’s his current effort that’s being complimented, not his general achievement.

4. Be Sparing, But Not A Miser, With Your Praise

Kids don’t need a lot of praise to build their self-esteem. The more you praise, the more the child craves compliments. When your child has had an overload of praise, she will start to crave it by asking you to compliment every effort she makes. Over-praising can also lead to a child viewing your compliments as meaningless and not special. Striking a good balance between too much and too little praise can be difficult but well worth the effort on our part.

5. Praise What Is Worthy Of Complimenting

More often than not, we tend to not think about what we’re praising for our children. I’m as apt to toss off a generic, “Oh, great job, dear,” as I am to truly think about why I’m complimenting my son’s effort. If we praise everything a child does, the praise loses its effectiveness. If we praise nothing a child does, their self-esteem can suffer. Again, the middle ground is our friend in terms of praise-worthy actions and efforts. For example, rather than praising every good grade on a test in a subject that’s easy for your child, praise the effort it took to finish a particularly difficult math worksheet. By using our praise judiciously, we help our children see that hard work pays off, that they are not special above all others, and that they have faults just like everyone else.

6. Teach The Golden Rule

The concept of treating others as you would like to be treated has taken a beating in today’s all-about-me culture, but it’s, ahem, golden in helping kids not think too highly of themselves. Have your kids memorize “Do unto others as you would have them do unto you,” and use it to check motivations, actions and attitudes in their lives. This can be prescriptive against letting narcissism take root in their lives. When we think of others in terms of ourselves, we naturally are not putting ourselves on a higher plane above them and their needs. The Golden Rule helps to ground our children in a life of thinking of others.

7. Walk In Their Shoes

Along with the Golden Rule is the ability to empathize with others—the flip side of narcissism. The more we can guide our children in thinking about how the situation looks from the other person’s point of view, the less likely they will develop an attitude of superiority. By pointing out how the other person might feel or why the other person might have acted a certain way, we help our kids think through situations with compassion rather than a “what’s-in-it-for-me” outlook.

These are just some of the ways we can work with our children to have a healthy, open-handed approach to life, one that will embrace others as worthy of empathy and compassion. The more we can help our children see their limitations, embrace their abilities, and view others as worthy companions in their lives, the more we will help our kids become happy, productive members of society.

Sarah Hamaker is a certified leadership parenting coach.

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