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Cracking Addiction

Recovery From Addiction
Cracking Addiction

What Everyone Gets Wrong About Recovery from Addiction

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What Everyone Gets Wrong About Recovery From Addiction

Misconceptions about recovery from addiction can lead to damaging misunderstandings that affect your journey. Many people believe that recovery is a linear process or a quick fix, but in reality, it often involves setbacks and considerable effort. It’s important to recognize that recovery is not just about stopping substance use; it encompasses emotional healing, acquiring new coping skills, and building a supportive community. By shedding these common myths, you can pave a more informed and constructive path toward your holistic healing.

Key Takeaways:

  • Recovery is a personal journey, and there is no one-size-fits-all approach; each individual may require a different method to find success.
  • Abstinence is just one aspect of recovery; addressing underlying mental health issues and emotional well-being is imperative for long-term healing.
  • Support systems play a vital role in recovery; building strong relationships with family, friends, or support groups can enhance the recovery process.
  • Relapse is often a part of the recovery journey and should not be viewed as a failure but rather as an opportunity for growth and reassessment.
  • Stigma surrounding addiction can hinder recovery efforts; fostering understanding and compassion is important for individuals seeking help.

Understanding Addiction

For many, understanding addiction is the first step in overcoming misconceptions and fostering a more supportive environment for those in recovery. Addiction is a complex condition that extends beyond mere willpower or personal choice. It involves intricate interactions between genetics, brain chemistry, environmental factors, and emotional health. By grasping the multifaceted nature of addiction, you can develop a greater empathy not only for yourself but also for others grappling with this challenge.

The Nature of Addiction

The reality of addiction lies in its ability to hijack the brain’s reward system, altering how you feel pleasure and desire. This neurological change can result from repeated exposure to addictive substances or behaviors, often leaving you with an overwhelming compulsion to seek them out, despite the negative consequences. It’s vital to understand that addiction is not simply about poor choices; it’s a chronic disease that can require ongoing management and support, much like other health conditions.

Common Misconceptions

Nature often leads people to inaccurately view addiction as a moral failure or a sign of weakness. This misconception can perpetuate stigma and shame, making it even harder for you to seek help or for your loved ones to support you. The truth is, addiction can affect anyone, regardless of background, socioeconomic status, or personal values. Understanding that addiction can result from numerous factors empowers you to approach the situation with compassion rather than judgment.

Plus, many believe that overcoming addiction is a straightforward process—the idea that you can simply “decide” to stop and that will be the end of it. However, this belief dismisses the incredibly complex nature of addiction and ignores the need for professional help, support systems, and often a multi-faceted treatment approach. Recovery typically involves addressing both the physical and emotional aspects of addiction, making it pertinent for you to look at this journey as a long-term commitment rather than a quick fix.

The Recovery Process

Clearly, the recovery process from addiction is not a one-size-fits-all journey. It involves various stages and levels of commitment that can vary greatly from one individual to another. Acknowledging that recovery is a non-linear path is crucial; it often entails ups and downs, making it paramount to be prepared for the challenges you may face along the way. Understanding that recovery requires time and effort is key to setting realistic expectations for yourself.

Stages of Recovery

Beside the common misconception that recovery is solely about abstaining from substance use, it’s crucial to grasp the distinct stages involved in this journey. These stages typically include precontemplation, contemplation, preparation, action, and maintenance. Each stage requires different levels of commitment and introspection, allowing you to understand where you stand and where you need to go. In precontemplation, you might not even recognize that you have a problem, while in action, you actively take steps to change your behavior.

Personalized Recovery Plans

Beside the stages of recovery, developing a personalized recovery plan is vital for your success. This plan should take into account your unique needs, triggers, and support systems. A one-size-fits-all program may not address the specific obstacles you face or the individual motivations that inspire you. Your recovery plan could include therapy, support groups, medication, or holistic approaches, tailored to ensure you have a strong foundation to build upon as you navigate through recovery.

Personalized recovery plans focus on your unique experiences and circumstances, emphasizing that there is no universal solution to addiction recovery. You’ll want to consider factors like your personal history, medical needs, and the specific triggers that led to your addiction in the first place. Involving professionals who can assist in crafting a plan that resonates with you can help you stay accountable and motivated. Your personalized plan should be adaptable; as you progress, revisiting and modifying it to reflect your changing needs ensures that you continually remain on the path toward a fulfilling, sober life.

Support Systems

Keep in mind that Recovery From Addiction is rarely a solo journey; instead, it often thrives on the foundation of a solid support system. You might assume that you can navigate this path alone, but that misconception can lead to setbacks and isolation. Surrounding yourself with individuals who genuinely care for your well-being, whether they are family members, friends, or fellow recovering addicts, can significantly enhance your chances of long-term success. It’s important to understand that these support networks provide not just emotional encouragement, but also practical advice and shared experiences that can guide you through the turbulent waters of recovery.

Role of Professional Help

Support systems are not solely composed of loved ones; integrating professional help into your recovery plan can be a game-changer. Engaging with trained therapists or counselors who specialize in addiction gives you access to valuable insights and coping mechanisms. These professionals can help you identify the underlying issues that may have contributed to your addiction and equip you with strategies to manage cravings and triggers. A structured treatment program often aligns your recovery with proven therapeutic models, offering a safe space to dive deeper into your recovery journey.

Importance of Community Support

Below the surface, community support plays a significant role in your recovery. Participating in group therapy sessions or local support groups not only offers moral support but also reinforces the belief that you are not alone in this fight. Listening to others share their stories and struggles can help you to recognize that recovery is a shared experience and that it is entirely normal to face challenges along the way. Sharing your own experiences allows you to process your journey, gains perspective, and may even inspire someone else.

Understanding the multifaceted nature of recovery means valuing the role played by community support systems. Engaging with others who have faced similar challenges can foster a sense of belonging and reduce feelings of shame and isolation. This shared experience enhances your ability to cope with stressors, as positive connections can bolster your resilience. Additionally, community support can serve as a powerful reminder that progress is possible and achievable, reinforcing your commitment to stay on the path of recovery and find strength through unity. Investing your time and energy in such connections can make all the difference in your journey towards a healthier, addiction-free life.

Relapse and Setbacks

Unlike what many may believe, relapse is not a failure but a common part of the recovery journey. Your path to sobriety can be fraught with challenges, and setbacks can occur, especially when facing triggers or stressful situations. Understanding that relapse can happen and does not mean you are weak or incapable is vital. In fact, many people in recovery experience multiple relapses before finding a lasting solution. What is important is how you respond to these moments and what you learn as you navigate your journey.

Understanding Relapse

Against the prevailing notion that a setback signals the end of your recovery, it is important to shift your perspective. A relapse can offer insights into vulnerabilities you may need to address or situations to avoid in the future. Contemplating the factors that led to your setback can provide valuable lessons that strengthen your long-term resilience. By dissecting the circumstances surrounding your relapse, you can develop a more robust preventive strategy for the future.

Strategies for Overcoming Setbacks

After experiencing a setback, it’s important to refocus your efforts and implement effective strategies that can guide you toward a successful recovery. Acknowledging your feelings and fearlessly exploring the emotions tied to your relapse can help you process the experience rather than bury it. Develop a well-rounded support system of peers, counselors, and family who can provide encouragement and accountability. Additionally, practicing mindfulness techniques, such as journaling or meditation, can help you regain clarity and stability in your recovery journey.

Understanding the importance of proactive coping mechanisms can reshape how you approach future challenges. Building a personal toolbox filled with resources like sober activities, relaxation techniques, and accountability partners can significantly aid in managing cravings and avoiding triggers. By being prepared and equipping yourself with positive strategies, you can face setbacks with greater confidence and resilience, ultimately paving the way for a stronger path to recovery.

Long-Term Recovery

Your journey towards long-term recovery from addiction involves more than just abstaining from substance use; it requires an intentional approach to building a healthy lifestyle. The process is deeply rooted in creating and maintaining healthy habits that support your mental, emotional, and physical well-being. These habits may include regular exercise, balanced nutrition, and sufficient sleep. Incorporating activities that promote self-care, such as mindfulness practices and hobbies, can also play a significant role in fostering resilience against triggers that may lead to relapse. The key is consistency—by embedding these healthy practices into your daily routine, you begin to reshape your life and environment in ways that nurture growth and stability.

Building Healthy Habits

By understanding that recovery is a long-term commitment, you will recognize the importance of building healthy habits that reinforce your sobriety. This includes not just the elimination of harmful substances, but also the adoption of positive behaviors that enhance your quality of life. For instance, establishing a routine can provide structure, while social connections can offer invaluable support. Engaging in physical activities or creative pursuits can act as effective outlets for stress and emotions that may arise during your recovery journey. Focus on setting small, achievable goals that allow you to celebrate your progress, further motivating you to continue on this healthy path.

Emphasizing Lifestyle Changes

Changes to your lifestyle play a significant role in maintaining recovery, as they help reshape your daily experiences and environments. This can mean distancing yourself from places and people that trigger cravings or revisiting certain social circles that prioritize sobriety. Surrounding yourself with a supportive community, whether through recovery groups or new friendships, involves a fundamental lifestyle shift that promotes accountability and emotional support. Lifestyle changes may also encompass daily rituals such as practicing gratitude, volunteering, or participating in community events—activities that deepen your connection with others and foster a sense of purpose.

Understanding how lifestyle changes affect your recovery enhances your ability to stay focused on your goals. It involves examining your daily routines and identifying areas where you can replace negative influences with constructive actions. Building a healthier social network, adopting stress-reduction techniques, and prioritizing self-care can all provide protective factors against relapse. Committing to these shifts not only supports your long-term sobriety but also enriches your overall quality of life, enabling you to thrive beyond addiction.

Myths vs. Facts

To effectively navigate the intricate path of recovery from addiction, it’s vital to separate fact from fiction. Misunderstandings abound, creating barriers that can hinder your progress and perpetuate stigma. Many individuals believe that recovery is simply about willpower or that it can be achieved within a fixed timeframe. These myths can lead to feelings of failure or inadequacy when, in reality, recovery is a unique journey that varies person to person. You need to recognize that while the process may seem overwhelming, acknowledging and addressing these myths can bolster your understanding and commitment to your recovery journey.

Debunking Common Myths

Debunking common myths surrounding addiction recovery allows you to grasp the reality of your situation. For instance, it is a widespread belief that addiction is a moral failing rather than a chronic disease. This misconception can instill a sense of shame, making it harder for you to seek help or ask for support. Additionally, many think that once you complete a treatment program, recovery is a one-time event, rather than an ongoing process that involves continuous growth and potential setbacks. The truth is, recognizing recovery as a lifelong commitment encourages you to embrace setbacks as part of your process rather than failures.

Evidence-Based Recovery Approaches

Facts about recovery emphasize the importance of utilizing evidence-based approaches, which are proven to be effective in promoting long-term success. These methods, such as cognitive-behavioral therapy (CBT) and motivational interviewing, are supported by scientific research and provide you with the necessary tools and strategies to address both the psychological and emotional aspects of substance use. When you engage in these evidence-based practices, you are not just relying on anecdotal experiences; you are participating in a system backed by substantial evidence, fostering a more informed recovery journey.

The integration of evidence-based recovery approaches into your journey underscores the significance of tailored treatment options. Programs that employ evidence-based methods boast higher success rates due to their focus on individualized needs and challenges. By participating in therapies that have been rigorously tested and shown to aid in recovery, you empower yourself with knowledge and techniques that can significantly enhance your chances of maintaining sobriety. This proactive approach not only boosts your skills in managing cravings and triggers but also equips you with a support system that is rooted in understanding and results.

Conclusion

Hence, understanding recovery from addiction requires a comprehensive perspective that goes beyond common misconceptions. You might be led to believe that recovery is a linear journey, marked by clear milestones and a straightforward path to sobriety. In reality, recovery encompasses a complex interplay of emotional, mental, and social factors, making it vital to accept that setbacks may occur and are a natural part of your journey. By recognizing the multifaceted nature of recovery, you empower yourself to navigate the challenges ahead with resilience and a more informed mindset.

Additionally, you may find that the societal stigma surrounding addiction can make your struggle feel isolating. It’s vital to acknowledge that addiction is a health issue rather than a personal failing, and seeking help is a strength, not a weakness. Embrace the idea that recovery is possible with the right support system, coping mechanisms, and treatment options. By breaking down the misconceptions you encounter, you pave the way for a more constructive and empathetic approach to your healing process, aligning your recovery goals with the reality of what it takes to achieve a healthier, fulfilling life.

Meducate has a great introductory webinar called What is Addiction and is free

Q: What is a common misconception about the timeline of recovery from addiction?

A: Many people believe that recovery from addiction follows a linear path and can be completed within a certain amount of time. In reality, recovery is a highly individual process that varies from person to person. Factors such as the severity of the addiction, personal circumstances, and individual mental health can all influence the length and trajectory of recovery. Some individuals may experience setbacks or relapses along the way, but these should not be seen as failures; they are often part of the complex journey towards sustained sobriety.

Q: Do people often underestimate the importance of ongoing support in the recovery process?

A: Yes, a prevalent misunderstanding is that once someone completes a treatment program, they are fully recovered and need no additional support. In truth, continuing support is vital for long-term recovery. This can include participation in support groups, therapy, and maintaining connections with sober friends and family. Ongoing support helps individuals cope with the challenges of everyday life, reinforces positive habits, and provides encouragement during difficult times.

Q: What role do co-occurring mental health issues play in recovery that people might overlook?

A: Many individuals do not recognize how common it is for addiction to co-exist with mental health disorders such as depression, anxiety, or PTSD. Ignoring these co-occurring issues can complicate the recovery process. Successful recovery often requires an integrated approach that addresses both addiction and mental health simultaneously. By treating both the substance use and any underlying mental health conditions, individuals are more likely to achieve lasting recovery.

Escape Addiction
Cracking Addiction

Can We Extricate Ourselves From The Thralldom Of Addiction?

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Escape Addiction

Thralldom from Addiction can feel overwhelming, often leaving you trapped in a cycle of dependency that impacts every aspect of your life. Understanding the challenges and triggers associated with your addiction is vital for your recovery journey. Fortunately, liberation is possible through effective strategies, support systems, and a strong commitment to change. This blog post explores the pathways you can take to reclaim your life and overcome the obstacles that may seem insurmountable. Embrace this journey towards a healthier, addiction-free existence.

Key Takeaways:

  • Addiction often stems from underlying emotional or psychological issues that must be addressed for successful recovery.
  • Support systems, such as therapy, support groups, and family, play a vital role in overcoming addiction.
  • Relapse is a common part of the recovery journey, emphasizing the need for resilience and continued self-reflection.
  • Developing healthier coping mechanisms can help individuals navigate stress and triggers without resorting to addictive behaviors.
  • Awareness and education about the nature of addiction are necessary to reduce stigma and encourage open discussions around treatment options.

can we escape the grip of addiction umg

Escape Addiction

A deep comprehension of addiction is important for overcoming it. Addiction is more than just a physical dependence; it involves complex interactions between biological, psychological, and social factors that can entrap you, making escape feel nearly impossible.

Definition and Types

The definition of addiction encompasses a range of behaviors characterized by compulsive engagement despite negative consequences. Common types include:

  • Substance Addiction (drugs, alcohol)
  • Behavioral Addiction (gambling, internet)
  • Food Addiction (binge eating)
  • Sex Addiction (compulsive sexual behavior)
  • Work Addiction (workaholism)

This variety highlights the diverse ways in which addiction manifests in human behavior.

The Psychology Behind Addiction

Below the surface, addiction is driven by a combination of psychological factors. Understanding these elements is vital for breaking free from addictive patterns.

To effectively Escape Addiction, you must first explore your emotional triggers and mental processes linked to addictive behavior. It involves navigating feelings of stress, anxiety, or trauma, which can lead you to seek temporary relief in the form of substances or behaviors. Moreover, the brain undergoes neurological changes due to repeated exposure, reinforcing the cycle of addiction. Recognizing these dynamics allows you to develop a strategy for recovery, encouraging healthier habits and coping mechanisms that replace destructive patterns.

The Impact of Addiction

Now, addiction presents profound repercussions that extend far beyond the individual, affecting family, friends, and society at large. It can lead to a decline in quality of life, strained relationships, and loss of opportunities. Understanding the full scope of addiction’s impact is crucial for fostering awareness and motivating change.

Physical Health Consequences

An addiction can have dire implications for your physical health, manifesting as chronic illnesses, increased risk of infectious diseases, and severe organ damage. Dependence on substances may cause a significant deterioration in your overall wellness, making it vital to acknowledge these risks and seek help promptly.

Mental Health and Emotional Toll

Health issues often intertwine with addiction, leading to challenges in your mental wellbeing. The emotional ramifications can be overwhelming, resulting in heightened feelings of anxiety, depression, and social isolation. Your ability to manage daily stressors diminishes, creating a cycle that feeds the addiction itself.

Emotional instability stemming from addiction can lead to feelings of worthlessness or hopelessness, significantly impairing your ability to maintain healthy relationships and perform at work. The constant internal battle may make you feel as though you are in a dark tunnel with no escape, fostering a sense of despair that can complicate recovery. Understanding these emotional challenges is crucial to realizing the need for help and finding pathways toward healing. By acknowledging the emotional toll addiction takes, you can start taking steps to reclaim your life.

Pathways to Recovery

Unlike the misconception that recovery is a solitary journey, it often requires a multifaceted approach involving various pathways tailored to your specific needs. Engaging in a combination of treatments, knowledge, and community support can empower you to break free from the grip of addiction and build a healthier future.

Professional Treatment Options

One effective route to recovery involves seeking professional treatment options, which may include therapy, outpatient programs, or inpatient rehabilitation. These programs are designed to provide you with the tools and guidance necessary to navigate the challenges of addiction, equipping you with coping strategies for lasting change.

Support Systems and Community Resources

Pathways to recovery are significantly strengthened through supportive systems and community resources. You can lean on family, friends, and support groups to bolster your journey, reminding you that you are not alone in this struggle.

Indeed, establishing a robust support system is imperative for lasting recovery. Utilizing community resources such as 12-step programs, counseling services, and peer support groups can provide you with the emotional and psychological backing you need. Engaging with others who have shared experiences can offer you valuable insights and encouragement to help you navigate your recovery journey. Your willingness to connect and share will not only enhance your own healing but also foster a sense of belonging that is vital in overcoming addiction.

Strategies for Overcoming Addiction

Keep in mind that overcoming addiction is a journey filled with various strategies tailored to meet your individual needs. Developing a personalized plan can enhance your chances of success, whether it involves seeking professional help, engaging in support groups, or adopting healthier habits. Each step forward is a powerful move towards liberation from the grips of addiction.

Developing Coping Mechanisms

Around the challenges to addiction recovery, you can cultivate effective coping mechanisms that empower you to deal with cravings and triggers. Techniques such as mindfulness, journaling, and physical activities can significantly reduce stress and foster emotional resilience.

Building a Sustainable Lifestyle

Across different aspects of your life, creating a sustainable lifestyle can greatly support your recovery journey. This involves establishing routines that promote well-being, surrounding yourself with positive influences, and prioritizing self-care activities that nurture your physical, emotional, and mental health.

Addiction often thrives in chaotic environments and unhealthy habits. By fostering a sustainable lifestyle, you will not only combat the cravings associated with addiction but also build a strong foundation for long-term recovery. Focus on balanced nutrition, regular exercise, and adequate sleep as imperative components of your daily routine. Engaging socially with support networks and integrating hobbies that ignite your passion can also fortify your resilience against addictive behaviors. As you implement these changes, your ability to maintain a healthy, fulfilling life will significantly improve, enhancing your overall recovery journey.

The Role of Education and Awareness

Your understanding of addiction is vital in breaking free from its grip. Education provides insight into the mechanisms behind addictive behaviors, equipping you with the knowledge to recognize triggers and make informed choices. By fostering awareness in your community, you contribute to a supportive environment where discussions about addiction can take place without shame, ultimately paving the way for recovery and prevention.

Preventative Measures

Before facing the challenges of addiction, it is vital to implement preventative measures that empower you to build resilience. Engaging in open discussions about addiction with family and friends, promoting life skills, and encouraging positive coping strategies can significantly reduce the likelihood of developing harmful dependencies. Education plays a pivotal role in this, as it helps you identify at-risk behaviors early.

Reducing Stigma

About addiction, the stigma surrounding it can be a significant barrier to seeking help. The perception that those struggling with addiction are weak or morally deficient can prevent you or someone you care about from reaching out for support. By challenging these stereotypes and speaking openly about addiction, you foster an environment where honesty and vulnerability can emerge.

At its core, reducing stigma is about changing the narrative around addiction. By promoting understanding and compassion, you can help create a society where individuals feel safe to admit their struggles without fear of judgment. Sharing personal stories, supporting advocacy initiatives, and engaging in community education are all keys to dismantling the harmful perceptions attached to addiction. This shift not only aids those directly affected but also enriches your community by fostering connections based on empathy and support.

Personal Stories of Overcoming Addiction

Once again, the journey of overcoming addiction is a deeply personal saga filled with challenges and triumphs. Individuals from various walks of life have harnessed their inner strength to escape the grip of their dependencies, sharing their powerful narratives to inspire others. These stories remind you that recovery is not a linear path; it’s filled with ups and downs, requiring persistence and unwavering support from loved ones. By sharing these experiences, you might find the motivation to launch on your own path to liberation.

Inspiring Testimonials

An extraordinary array of testimonies illustrates the resilience of the human spirit. Many former addicts recount their darkest moments, followed by the spark of realization that they needed change. These transformations, often powered by therapy, community support, and personal dedication, showcase that you, too, can reclaim your life. Each story serves not just as a beacon of hope but also as a reminder that you are not alone in this struggle.

Lessons Learned

Stories of recovery often reveal valuable insights that can aid you on your journey. It is through every challenge that you discover your own strength and motivation. Many learn the significance of addressing underlying emotional issues rather than just the addiction itself. Finding a support network is regularly highlighted as a game changer in maintaining sobriety. Additionally, setting realistic goals and celebrating small victories can bolster your resolve, reminding you that change is possible, one step at a time.

Summing up

Presently, you have the power to Escape Addiction through commitment and informed choices. By acknowledging your challenges and seeking support, whether through therapy, community, or self-help resources, you can reclaim control over your life. Understand that recovery is a journey, often requiring perseverance and patience. Embrace each step forward, no matter how small, as a move towards a healthier, more fulfilling existence. With determination and the right tools, you can break free and forge a new path for yourself. Want to learn more? Watch our episode on MedHeads Addiction Facts Everyone Needs to Know

Q: What are the first steps to take when trying to overcome addiction?

A: Overcoming addiction starts with acknowledging the problem and seeking support. This often involves admitting the impact of the addiction on your life and considering professional help through therapy or support groups. Establishing a strong support network of family and friends can also provide encouragement and accountability during the recovery process. Additionally, identifying triggers and developing coping strategies can be beneficial in managing cravings.

Q: Can environmental changes help in breaking free from addiction?

A: Yes, making changes to your environment can significantly aid in overcoming addiction. This might include distancing yourself from places, people, or activities that encourage addictive behavior. Creating a positive environment that fosters healthy habits and includes supportive friends and activities can help reinforce a commitment to recovery. Surrounding yourself with influences that promote wellness and positivity plays an important role in maintaining long-term sobriety.

Q: Is it possible to relapse, and how can one handle it if it happens?

A: Relapse can be a part of the recovery process for many individuals. It’s important to understand that it does not mean failure and can serve as a learning experience. If a relapse occurs, it’s crucial to analyze what led to it and to seek support from a therapist or a support group immediately. Reinforcing coping mechanisms, revisiting treatment options, and recommitting to your recovery plan can help you regain your focus and move forward. Building resilience and developing strategies to cope with setbacks is a key aspect of maintaining long-term recovery.

Alcohol Anti-Craving Medications
Cracking Addiction, Global Awareness, Healthcare

Alcohol Anti-Craving Medications

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Alcohol Anti-Craving Medications

On Cracking Addiction 

The aim of anti-craving medications in alcohol use disorder is to prevent relapse or decrease cravings for alcohol. They are typically prescribed for relapse prevention once acute alcohol withdrawal is over and the best evidence favours the co-prescribing of anti-craving medications with behavioural modification therapies.

Naltrexone

Naltrexone is a mu opioid receptor antagonist which blocks the endorphin mediated pleasurable effects of alcohol which reduces the rate of heavy drinking and the craving for alcohol. Naltrexone is absorbed from the gastrointestinal tract and metabolised in the liver. The side effects include nausea, diarrhoea, fatigue and headaches. Naltrexone is contraindicated in pregnancy, when using opioid analgesia for pain, in opioid dependence and severe hepatic or renal impairment.

When opioid pain relief is required naltrexone must be discontinued 72 hours prior to opioid dosing. The Sinclair method involves taking Naltrexone one hour prior to drinking to decouple pleasurable stimuli with drinking ‘pharmacological extinction’.

The dose is usually 50mg daily (though it can be commenced on 25mg daily for first few days to reduce side effects) and the duration of treatment variable but can extend from 12 weeks to 12 months.

Acamprosate
Acamprosate modulates NMDA receptor transmission and GABA-A transmission and helps decrease the highly glutamatergic states associated with alcohol withdrawal. It isabsorbed from the gastrointestinal tract over four hours and has peak concentration 5-7 hours post ingestion and achieves a steady state after 7 days of usage.

Common side effects include diarrhoea, nausea, vomiting, skin rash and reduced libido. It is contraindicated in renal failure and Child Pugh C liver cirrhosis.
The common dose is 2 tablets tds if over 60kg or 2 tablets mane, 1 midi and 1 nocte if less than 60kg.

Disulfiram
Disulfiram irreversibly inhibits aldehydye dehydrogenase which is the enzyme that converts acetaldehyde to acetate and leads to an accumulation of acetaldehyde after drinking alcohol. Acetaldeyde causes an unpleasant reaction and acts as a psychological deterrent to drinking as an ‘aversive therapy’. The inhibition of enzyme activity occurs in 12 hours and lasts more than 5 days.

The symptoms that it invokes includes flushing, headache, palpitations, dyspnoea, hypotension, prostration and ECG changes. Symptom onset can start within 10 minutes, peaks at 20-30 minutes and lasts for 1-2 hours. Patients need to abstain from alcohol one days before taking medication and for one week after cessation of treatment.

Common side effects include drowsiness, tiredness, confusion, headache, neuropathies, gastric upset, garlic taste and optic neuritis. Disulfiram is contraindicated in psychosis, IHD, severe renal or hepatic disease, pregnancy, allergies to compounds in medication and cognitive issues.

Disulfiram also interacts with a lot of medications including metronidazole, isoniazid, phenytoin, benzodiazepines and anticoagulants.
The dose is 100mg daily for 1-2 weeks then 200mg daily for 6 weeks to 6 months though duration of treatment is variable and maximum dosage can be 300mg daily.

Baclofen
Baclofen is a GABA-B receptor antagonist that suppresses alcohol mediated dopamine release. It has limited hepatic metabolism and well tolerated in those with chronic liver disease. It can cause sedation, drowsiness, headache, rash and urinary difficulties. Baclofen needs to be weaned gradually to avoid withdrawal syndrome such as confusion, anxiety, seizures, delusions, hallucinations and delirium.

The dose of baclofen for alcohol use disorder is given three times per day initially at 15-30mg daily (5-10mg tds) and increased to a maximum daily dose of 150mg if required.

Topiramate
Topiramate reduces glutamatergic function and enhance GABA-A receptor activity or modulate impulsivity. Common side effects include sedation, unsteadiness, paraesthesia, headache, dizziness, depression, anxiety, cognitive impairment and glaucoma. It is contraindicated in pregnancy.
The dose starts at 25mg bd and can be up to 150mg bd.

We Don’t Want Druggies in our Surgery
Cracking Addiction, Global Awareness, Healthcare, MedHeads

We Don’t Want Druggies in our Surgery

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We Don’t Want Druggies in our Surgery

Yesterday I attended GPCE at Melbourne.
I had the opportunity of discussing buprenorphine based pharmacotherapy with a bunch of my GP colleagues. One GP came up and took a handful of sweets from the table at which I was sitting and then said to me, “I don’t want druggies at my surgery.” Before I could reply, he walked off. This is what I wanted to say to him.

Most patients with substance use disorder are grateful for the help that I give them. I would challenge anyone to spot the “druggy” sitting in my waiting room. My surgery has a zero tolerance policy towards violence and aggression. In the last twelve months I have “expelled” three people from my surgery for this kind of behaviour.

First was a woman who threatened me with legal action because I refused to agree to stop prescribing her mother diazepam to treat a new diagnosis of serotonin syndrome. Second was a woman who referred to my Vietnamese physiotherapy colleague as a “Monkey” Third was an elderly lady whom I had reported to Vic Roads.

She subsequently failed an occupational driving test and lost her licence. She came back to my clinic and berated me and accused me of deliberately lying on my original referral to Vic roads. She then threatened me with regulatory referrals.

None of these people were druggies.

The patients with substance use disorder that that I look after continue to to sit quietly in my waiting room and continue to express gratitude for the help that I am able to give them.

Opioid weaning
Cracking Addiction, Global Awareness, Healthcare

Opioid weaning

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Just as “No man is an island entire of itself” (John Donne), so too is no prescriber an island.

You’ve decided to start prescribing MATOD. You’ve decided to start prescribing either Suboxone or methadone. Great. Very soon you will develop a following of patients who will become dependent on your prescription, your signature and perhaps most importantly, you. If you get sick or go on holiday, and don’t manage your absence properly, the lives of your patients could be put into turmoil. Furthermore if you work in a group practice your practice colleagues will need to pick up the pieces in your absence.

What if they are not MATOD trained? What if they are “anti-druggies?” Not everyone is as enlightened as you are, not everyone wants to help the most vulnerable people in our society.

Because you cannot operate in isolation, because you cannot prescribe in isolation it behoves you to establish good working relationships with your colleagues so that in the event of any absence, planned for unplanned, then at least some form of agreement can be made in principle regarding the management of your patients.

At the very least any doctor who has access to your patient record can act as your Locum and can theoretically continue a pharmacotherapy prescription – even without training. Of course Ideally, any Locum you engage or any other doctor in your practice who is prepared to manage your patients when you are away, should be trained in pharmacotherapy.

So just as you have a duty to engage with your colleagues in order to arrange Locum cover, so too should your colleagues acknowledge your expertise skills and attitudes to your patients. I have heard too often stories of GPs who have undergone special training to prescribe pharmacotherapy, who have gone back to their surgeries and told everyone the good news that they want to engage in this line of work, only to be told by the “Senior Partner” or the practice manager, that the surgery doesn’t do drug addicts.

Please, I urge all surgeries and colleagues to facilitate and encourage any doctor who wants to prescribe pharmacotherapy. By nurturing this skill, your surgery will be better able to meet the combined challenges of prescription opioid dependence and real time prescription monitoring.

Whether you like it or not the tide is coming in, these issues will affect us all, and it is better to have a pharmacotherapy prescriber on your team: imagine having to cope with these challenges without such talent batting on your team.

Question
Cracking Addiction, Global Awareness, Healthcare

Prescription Opioid Crisis

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Prescription Opioid Crisis

I have just started using SafeScript. This is the Victorian Department of Health’s response to the current prescription opioid crisis.

I think it is fabulous. Even though it is not yet mandatory in my area, I am nonetheless able to access the service online. It has thrown up some interesting challenges.

For instance I have a female patient with a relatively new diagnosis of seronegative arthritis. She is embarking upon her journey into biological therapies. She also loves her endone. I have been a bit uneasy in dishing it out, but I have rationalised that she has a proven arthritis syndrome, she is already under the care of pain specialists who have recommended clonidine which she takes. So what the harm?

That is until now. I have just seen her SafeScript record. We have all been doing it, my other colleagues and I. We have all been feeling sorry for her and we have all been giving her endone scripts. It has mounted up.

Thanks to SafeScript I can now see that she is getting the equivalent of 50 mg daily of endone. The information was there all along had I chosen to look carefully at it, however now with SafeScript it has been presented to me in an easily digestible format with red alarms all over it. I now have to do something about it.

I have a difficult conversation ahead of me, but at least I now know the facts.

I Just Need a Script
Cracking Addiction, Global Awareness, Healthcare, MedHeads

I Just Need a Script

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I just need a script

She breezed in saying those words I dread, “I just need a script”.

I had never seen her before.

I looked at her prescription record. She was on mirtazapine 15 mg nocte and sertraline 100 mg mane. That’s ok, I thought. Then I saw the Panadeine Forte.

So I printed off the antidepressants and smiled sweetly at her.

“Is everything going well?”

“yes, she said, apart from my dental pain. I have just been told I need dental surgery, and the waiting list is nine months. So I need my Panadeine Forte as well.”

My heart sank.

“It’s the only thing that works for me, I have tried everything else, and Dr… always gives me some.”

“Have you tried anti-inflammatories in combination with regular Panadol?”

“Yes, of course, I have. Nothing else works for my pain except Panadeine Forte, I have tried Nurofen, and that upsets my tummy.”

What started as a “quick script” consult turned into a twenty-minute discussion during which I told her the following.

The efficacy of codeine is dependent on its conversion to morphine.

The RACGP does not recommend the use of codeine for non-traumatic dental pain.

Opioids, including codeine, have no evidence of benefit beyond three months.

Opioids, including codeine, have plenty of evidence of harms in the long term, including dependency.

Her history of depression and her personal circumstances were risk factors for aberrant behaviour and ware relative contra-indications to long-term opioid use.

If an upset stomach was the only thing preventing her from using anti-inflammatories, then concomitant use of Nexium would protect her stomach and facilitate the use of an NSAID.

I ended the consultation by suggesting that she might benefit from a powerful NSAID. I suggested meloxicam; I told her that the vet had given my dog meloxicam for her post-operative hysterectomy pain. It had worked for Millicent; perhaps it might work for chronic dental pain in humans.

She left clutching her scripts for antidepressants and a new script for meloxicam 15 mg daily and Nexium 20 mg daily.

I wonder if she will see Dr… soon for a refill of her Panadeine Forte. It will be interesting to see what will happen when Safescript becomes mandatory in my area.

A Difficult Conversation
Cracking Addiction, Global Awareness, Healthcare, MedHeads

A Difficult Conversation

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A Difficult Conversation

I hate seeing other doctors regular patients. They have expectations of clinical behaviour of which I am totally ignorant. This lady was no different. I had never met her before. She was middle aged. She ran her own cleaning company.

She breezed in and said to me that phrase that I dread.

“I normally see Dr…This will be quick, I just need a prescription.”

So the conversation went something like this.

“Hello, my Name is Dr Armstrong. How can I help you.”

“Well, I just told you, I just need my usual script.”

“What usual script.”

“I just need my usual Panadeine Forte.”

“may I ask why you need Panadeine Forte?”

“I take it two to three times a week when I cannot sleep. I don’t abuse it. Dr… always gives me some.”

I checked safe script. She was right. Dr … was regularly prescribing it. There were no red flags against her safe script record. It appeared that Dr…was prescribing only small quantities of the drug and no alarms had been triggered in the SafeScript software.

I then asked her, “So you use it to help you sleep, is that right?”

“Yes, I’ve just told you, now please give me the prescription. I am in a hurry.”

She then looked at her watch meaningfully.

I explained to her that I felt that it was my role to manage her appropriately and safely. I explained that I felt that her use of codeine was inappropriate and that it could lead to dependency. I offered to help her deal with her insomnia in a more holistic way.

She then said, “Look Doc. You are being difficult. Are you, or are you not going to prescribe Panadeine Forte for me. Or do I have to go to Dr…?”

I replied, “No I am not.”

“Well you’re a useless waste of space then aren’t you!”

She walked out. An hour later she saw the other doctor. At least he came to me to let me know that he had prescribed for her, on the grounds that her use was not excessive and that a year ago she could have bought it over the counter.

What is a Partial Agonist
Cracking Addiction, Global Awareness, Healthcare

What is a Partial Agonist?

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What is a Partial Agonist?

A partial agonist is a drug that, when bound to a receptor, only partially activates that receptor.

This is in contra-distinction to full agonists which, when bound to a receptor, fully activate the receptor. If you look at a dose response curve, in the case of full agonists, as the dose increases so too does the clinical effect. In the case of partial agonists, they behave differently.

22 292 pbBlocks1171560905696

At low to moderate doses they behave as functional agonists in that as the dose increases then so too does the clinical effect, albeit at a lower rate when compared with the full agonist curve.

However at high doses they behave as antagonists in that any further dose increase results in no additional clinical effect. Therefore in the case of partial agonists a ceiling effect occurs wherein beyond a certain dose no further effect is seen.

Now, what is this all about? Why am I bothering to write about this?

Well the answer is prescription opioid abuse.

More people died last year from prescription drug misuse than did on the roads in Victoria.

We as doctors are killing our patients with our prescriptions. Prescription opioids play a big part in this mortality. Most clinically used opioids are full mu opioid receptor agonists. Therefore as the dose goes up so too does the risk of respiratory depression and death.

Imagine if there was a drug which was a great pain killer, just like the commonly used opioids, but which was much less likely to cause respiratory depression and death. Wouldn’t you want to use that drug? Wouldn’t you want to at least know more about it?

Well, there is an opioid that is a partial agonist at the mu opioid receptor. Because it is a partial agonist it has a ceiling effect which occurs below the threshold for respiratory depression in most healthy adults. Therefore it is much less likely to cause respiratory depression and death.

Just think about how much safer this drug would be as compared to all the other full mu opioid receptor agonists that are commonly prescribed, including morphine and oxycodone.

I cannot understand why we as doctors are not prescribing more of this safer drug when faced with the horrifying statistics of mortality associated with prescription opioid misuse.

Want to know what this drug is?

It’s called buprenorphine. It comes as a “Norspan” patch, a “Temgesic” sublingual pill, and a “Suboxone” sublingual film.

We Agree to disagree
Cracking Addiction, Global Awareness, Healthcare

We Agree to disagree

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A patient who normally saw Dr…came to me. She needed more of her fentanyl patch.

She needed high dose opioids for her right elbow pain. These drugs were the only thing that kept the pain away, and she worked as a hairdresser, so she needed these patches and her other meds to stay in work.

According to the clinical record, she was on the following interesting medications.

Fentanyl 50 mcg/hr patch
Tramadol 50 mg prn
Temazepam 10 mg nocte

I looked up Safescript.

Her record was full of red alarm bells suggesting that she was at a higher risk of death, not only because of her high dose of opioids but also because of her concomitant use of benzodiazepines.

I told her that I was unable to sanction her use of these medications.

The summary points were as follows:

Her OME was > 100 mg of morphine (fentanyl 25 = OME 100) This alone put her at an increased risk of death

Her use of additional short-acting tramadol was inappropriate and possibly indicated a dependency syndrome.

Her use of temazepam at night put her at an even higher risk of death.

The RACGP explicitly states that there is no role for Fentanyl for chronic non-cancer pain in GP-land.

She had non-cancer pain, probably osteoarthritis of the right elbow, which needed a proper assessment and a decent management plan.

I had no choice but to deny her current prescription request. I told her to stop the tramadol and immediately and I advised her to wean off the high dose fentanyl.

The next step was a 25 patch and a 12 patch in combination. This would be a step forward towards the goal of weaning her off fentanyl completely.

She was somewhat shocked and angry at this but seemed to accept what I said finally.

We agreed on a review in a fortnight.

In a fortnight she cancelled her appointment to see me. Instead, she saw Dr…, her regular doctor.

I looked at his medical record for the consultation. He had restarted her on fentanyl 50 mcg patches. I spoke to him later in the evening to ask his opinion of what was going on with the patient.

He told me that she was in severe pain and could not work because of her left elbow and that I had contributed to her increased suffering. She could not afford to buy two patches at the same time, so he had advised her to use a full 50 mcg patch again.

I asked him if he had read her safe script record. He said he had. We agreed to disagree.

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