Not everyone who enters drug treatment wants to be free of all substances. They may have a desire to cease the drug that is causing the most negative consequences.  Writer, Ross Fishman of THE FIX featured a father’s dilemma about Suboxone treatment and wrote his expert advice to the father.  In this podcast our members respond to the questions posed by the father who is concerned about his son who is opiate free but continues to abuse multiple other substances. Listen in to hear our group of recovering opiate addicts give their opinions and advice.

Discussion Guide:

Did you continue to abuse substances, other than your drug of choice,  on your path to recovery? (cross addiction)

How much control does the prescribing doctor have over cross addictions?

What is your advice to a father who asks “should my son stay on Suboxone if he is still using other drugs?

What are the pros and cons of stopping medication assisted treatment?

How much influence do family and friends have over an addict’s behavior?

Supplemental Reading:

Ross Fishman, Ask an Expert: Should My Son Stay On Suboxone If He Is Still Using Other (Non-Opioid) Drugs? https://www.thefix.com/ask-expert-my-sons-suboxone-treatment-working

The University of New Mexico, Center on Alcoholism, Substance Abuse, and Addictions (CASAA) Readiness Ruler, http://casaa.unm.edu/inst/Readiness%20Ruler.pdf

The properties of Medication Assisted Treatment are such that they stop withdrawal symptoms, decrease cravings and block the user from getting high if they use opiates. Because of this, MAT is a godsend to opiate addicts. But many hope to stop MAT at some point. Have you thought about tapering off your medication? What do you hope for and what do you fear about ceasing your medication? Listen to a group of opiate addicts discuss their hopes and fears.

Discussion Guide:

Do you intend to stop utilizing medication assisted treatment for your recovery?

How long do you believe one should engage in treatment before tapering off medication?

What are the pros and cons of stopping your medication?

Do you meet the criteria for ceasing medication assisted treatment?

What are your fears of ceasing MAT?

Supplemental Reading:

Centre for Addiction and Mental Health, Client Handbook, Chapter 8 How Long Will I Be On Methadone? http://www.camh.ca/en/hospital/health_information/a_z_mental_health_and_addiction_information/methadone/Documents/mmt_client_hndbk.pdf

In this week’s podcast, we turn to things in the news. “The Bridge” is a new device to help manage symptoms of withdrawal; the Federal Opioid Bill was passed; and synthetic marijuana sent 33 people to the hospital. Let’s check in with the opiate addicts themselves to get their opinion on these topics.

Discussion Guide:

The Bridge is designed to reduce the pain of withdrawal for a 4-5 day period.

What do you think the advantages and disadvantages of The Bridge are?

What’s the best use of The Bridge?

Do you think it could’ve helped you detox from opiates?

The Comprehensive Addiction and Recovery Act was passed this week to address the high number of deaths from opiate overdoses. It expands access to Buprenorphine, expands access to the opiate overdose reversal drug, expands access to prescription drug monitoring program, and expands prevention and education. However, the bill does not create new funding for these purposes.

Have you benefitted from Buprenorphine treatment? Do you think this will adequately address the range of opiate treatment?

Have you, or your contacts, benefitted from Naloxone, a.k.a. Narcan?

Have you been stopped from doctor shopping due to the prescription drug monitoring program?

In your opinion, what type of education would you recommend to decrease or prevent drug use among students or others?

Synthetic Marijuana aka K2, Spice

Have you used synthetic marijuana?

Do you know what it’s made from?

Did you suffer bad effects from it?

It was written that “emergency visits were mostly by males, with a median age of 37, who are disproportionately residents of shelters and individuals with a psychiatric illness.” Why do you think this is?

Supplemental Reading:

Danielle Lama, New Device Aims to Help Heroin Addicts Get Through Withdrawal http://www.wdrb.com/story/32329836/new-device-aims-to-help-heroin-addicts-get-through-withdrawal

Amanda Holpuch, More Than 30 People Fall Ill in Apparent Mass Drug Overdose in New York https://www.theguardian.com/us-news/2016/jul/13/more-than-30-people-fall-ill-in-apparent-mass-drug-overdose-in-new-york

Nicholas Rondinone, Five Things To Know About Recently Passed Federal Opioid Bill http://www.courant.com/health/heroin/hc-five-things-cara-passage-0714-20160714-story.html

Most people don’t achieve drug abstinence on their first try. Repeated relapses and treatment failure can be degrading and lower one’s motivation to try again. Author Jason M.S. wrote that failure is not final, but provides insight into the path of success. The more one fails, the greater their chances of success in the future. Listen to a group of people who were dependent on opiates talk about their failures and successes in recovery.

Discussion Guide:

Have you failed at recovery in the past?

How many times did you enter substance abuse treatment before you were able to achieve long term abstinence?

Would you say that you are now a success? Or, do you still feel like a failure?

What are the lessons you’ve learned with each failure?

What are your recovery successes?

 

Note:

Credit and appreciation is given to author, Jason M. S. for his article “Failure is Not Final.” However, his identification is withheld for purposes of confidentiality.

 

Writer Cathy Cassata wrote “If you witness something and have the ability to do something, you should, even if it’s reaching out to the family and saying ‘addiction is part of my family and I know how it goes. Please let me know if I can help in any way’.” She advocates for making it your business and intervening. There are ways you can help. Listen to a group of people who have been addicted to opiates talk about their experiences and opinions about possible interventions to help a child who is the victim of substance abuse.

Discussion Guide:

If you raised children, while you were actively engaged in an addiction, did someone reach out to them in order to help? If so, was it helpful?

If you learned that a child was suffering from a parent’s substance abuse, would you intervene?

If you chose to intervene, how would you do it?

What would you want this child to understand about their parent’s substance abuse?

Supplemental Reading:  Cathy Cassata, How to Help Children of Alcoholics https://www.mitadone.com/blogs/news/how-to-help-children-of-alcoholics

 

Writer, Maia Szalavitz, states “Addictions are harder to kick when you’re poor”. She makes the point that there is a socio-economic dimension to addiction. Addiction correlates with high unemployment and  lower income. For example, Szalavitz states heroin addiction is more than three times as common in people making less than $20,000 per year compared to those who make $50,000 or more. Higher levels of education are linked with lower rates of addiction. The addiction rate among the unemployed is around twice as high among people who have jobs. She also makes the point that most addiction ends by the age of 30, if they reach certain milestones such as working, getting married and having children. While this may be true of most drugs of abuse, is it different for opiate addictions? Listen to a group of people who were addicted to opiates discuss their opinions of  the socio-economic dimensions to heroin and pain killer addiction.

Discussion Guide:

Do you believe that addiction is influenced by income, education and employment?

Is your addiction influenced by these factors? If so, in what way?

Is opiate addiction different than other substances in terms of being socio-economically influenced?

Do you agree that most people “age out” of addiction by the age of 30?

Are people in late stage addiction to heroin or pain killers as likely to age out of addiction?

Do you find that the national economy directly impacts whether addicts are able to access treatment?

Supplemental Reading:

Szalavtiz, Maia  https://www.theguardian.com/commentisfree/2016/jun/01/drug-addiction-income-inequality-impacts-recovery

Conventional wisdom holds that it is important to avoid people, places and things associated with drug use in order to achieve and maintain drug abstinence. During recovery, people are fragile. They are exposed and vulnerable as they create a new lifestyle without the drug. If you don’t put a distance between you and the drug, you are likely to relapse. Listen to a group of people who were addicted to opiates discuss the importance of a clean break.

Discussion Guide:

Are you ready to make a clean break, or are you simply interested in managing your drug use?

Is making a clean break from your drug using lifestyle important for recovery?

Do you have loose ends that need to be tied up before you can commit to recovery?

What attempts are you making to avoid the drug environment?

What’s the hardest aspect of avoiding people, places and things for you?

Note:

Credit and appreciation is given to author, Jason M. S. for his article “The Importance of a Clean Break”. However, his identification is withheld for purposes of confidentiality.

 

 

Members who attended our group entitled “Harm Reduction” were asked to set two personal goals after rating what behaviors they would like to change. The first goal was directly related to their substance use. The second goal was related to wellness. Listen to the group members discuss their values, goals and their process of working toward them. Additionally, they were posed several questions that are designed to clarify what is most important to them, and assist in formulating goals.

Discussion Guide:

Have you set action goals toward recovery? Have you been successful in attaining your goals?

The following questions are designed to clarify your goals:

*  What are 5 things you value the most in life, that you would sacrifice for?

* What would you do if you won one million dollars, tax free?

* What would you do and how would you spend your time if you knew that you had only six months to live?

* What have you always wanted to do but were afraid to attempt?

* In looking back over all the things you’ve done in your life, what type of activities gives you your greatest feeling of importance?

* Imagine that you received one magic wish. What one great thing would you dare to dream if you knew it could not fail?

Supplemental Reading:

The Beginner’s Guide to Goal Setting, Michael Hyatt, http://michaelhyatt.com/goal-setting.html

65% of jail inmates have a drug or alcohol problem. Many people believe that drugs should be legalized, and that non-violent offenses should not be subject to jail time. This would decrease the number of inmates in an overcrowded system. But criminal behaviors have to be accounted for. Drug Courts offer an alternative to incarceration for people who have been convicted of a drug related crime. Listen in to a discussion about Drug Courts by people who have been dependent on opiates, and some of whom have participated in a Drug Court.

Discussion Guide:

Do you have a drug related criminal charge? Were you offered the possibility of participating in a Drug Court? If you were offered a diversion program, did you do so?

What do you perceive to be the pros and cons of a diversion program?

Do you think that a highly monitored court program could help you achieve drug abstinence?

Does your local court system allow people to continue medication assisted treatment in the jail?

Would you recommend that someone participate in Drug Court rather than serve jail time and have a criminal charge on their record?

Supplemental Reading:

Elaine Pawlowski, Drug Court Solutions Mislead the Public, https://www.thefix.com/drug-court-solutions-mislead-public

Sara Berman, Diversion Programs, http://www.nolo.com/legal-encyclopedia/diversion-programs.html

Drug Addiction Treatment in the Criminal Justice System, author unknown, https://www.drugabuse.gov/related-topics/criminal-justice/drug-addiction-treatment-in-criminal-justice-system

 

People have different levels of motivation and not everyone wants total drug abstinence. Harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use. Examples include a needle exchange program and Narcan, the overdose reversal medication.  Listen to a group of people who were dependent on opiates discuss harm reduction.

Discussion Guide:

Are you fully motivated to refrain from all substances of abuse, including cigarettes, marijuana and alcohol?

Do you believe you are safe when you use opiates? What could make your drug use safer?

Which substances are you interested in reducing or eliminating?

Which substances do you want to continue? Why?

Set two goals for yourself.  One goal is directly related to your substance abuse such as decreasing your use, or having a day of abstinence. And a second goal that is focused on wellness. It might be to add exercise, or  it could be about finding alternative activities to drug use.

Supplemental Reading:

Cynthia Hoffman, Harm Reduction Therapy Groups for Substance Misuse, https://www.thefix.com/harm-reduction-therapy-groups-substance-misuse

The University of New Mexico, Center on Alcoholism, Substance Abuse, and Addictions (CASAA) Readiness Ruler, http://casaa.unm.edu/inst/Readiness%20Ruler.pdf