Can Opioid Maintenance Therapy Help Prevent Hepatitis C?
Monday, January 5, 2015
Opioid maintenance therapy is the term used to describe the ongoing use of an opioid-based medication as a treatment for people recovering from uncontrolled opioid addiction. While doctors often use a medication called methadone in this form of therapy, they can also use a generally safer medication called buprenorphine.
In a study published in October 2014 in the American Medical Association journal JAMA Internal Medicine, a team of American researchers assessed the potential role of opioid maintenance therapy in preventing the spread of hepatitis C infections among people who use injection drugs.
Opioid Maintenance Therapy
Opioid-based medications are commonly used to help people who enter treatment for an addiction to heroin, prescription opioids or other opioid substances. These medications are useful in two treatment contexts: opioid detoxification and opioid maintenance. During opioid detoxification, doctors temporarily use opioid-based medications to help people in treatment avoid the potentially severe, relapse-promoting effects of opioid withdrawal.
During opioid maintenance, doctors use controlled doses of an opioid-based medication as a longer-term, safer alternative to the uncontrolled substance intake that characterizes opioid addiction. Some people receive opioid maintenance therapy for a few months, while others receive the therapy on an ongoing basis.
The medication most associated with opioid maintenance therapy is methadone, a fairly powerful opioid substance only available in the U.S. in certain facilities licensed and monitored by the federal government. However, many programs now use buprenorphine, a weaker opioid substance legal for use in a much wider range of treatment settings.
Generally speaking, buprenorphine does not come with the same potential for abuse as methadone. In addition, while people who abuse methadone can easily experience an opioid overdose, buprenorphine overdoses are relatively rare. Also, people who abuse buprenorphine have much lower chances of developing medication dependence.
Hepatitis C is the name for a viral infection that produces significant and potentially dangerous inflammation inside the liver. The same name also applies to the virus (also known as HCV) responsible for causing this form of infection. Like all viral infections, hepatitis C is contagious. In America, people who use injection drugs are the most likely population group to experience exposure to HCV. Typically, such exposure occurs during the unsanitary use of needles and syringes or other types of paraphernalia associated with injecting drugs or medications into a vein, into a muscle or under the skin. Some people develop a limited form of hepatitis C known as acute hepatitis C.
However, others develop a much more serious, ongoing form of the infection known as chronic hepatitis C. People with the chronic form of the disease can experience severe or potentially fatal health issues that include permanent liver tissue scarring (i.e., liver cirrhosis) and certain types of malignant liver cancer. Unfortunately, most initially acute cases of hepatitis C turn chronic over time.
Can Opioid Maintenance Help Prevent Hepatitis C?
In the study published in JAMA Internal Medicine, researchers from Boston University, Boston Medical Center, the University of New Mexico and UC San Francisco used data gathered from a 13-year project to help determine if injection drug users who receive opioid maintenance therapy have a lowered chance of getting infected with the hepatitis C virus.
This project included 552 young adult users who were under the age of 30 and free from hepatitis C when their participation began. Some of these participants received opioid maintenance therapy as their primary form of treatment. Others received opioid detoxification or forms of drug treatment that did not involve opioid medications. In addition, some participants did not receive any drug treatment.
Over the course of the study period, 171 of the participants were infected with HCV. After analyzing the breakdown of affected individuals, the researchers concluded that the participants who received opioid maintenance therapy had a significantly smaller chance of getting hepatitis C than the participants who went through opioid detoxification or received a form of treatment not based on the use of an opioid medication.
The study’s authors concluded that members of the opioid maintenance therapy group had a lower rate of HCV infection because they had a lower rate of exposure to the risk factors that make such an infection more likely to occur. They believe that the use of opioid maintenance therapy may substantially limit the transmission of hepatitis C among young people who consume injection drugs.
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The Place For Alternative Medicine In Addiction
Thursday, August 7, 2014
Alternative medicine is gaining popularity as people begin to turn to natural practices in medicine, many of which have been used for centuries in cultures around the world. Some prefer to use alternative medicine, while others turn to practitioners when modern medicine has failed. Today, alternative medicine touches all areas of healing, including addiction. Many rehab facilities are beginning to incorporate some of these techniques.
What Is Alternative Medicine?
Among the different terms referring to alternative medicine, a few stand out. Alternative refers to any practice outside mainstream, modern, Western medicine. Some prefer the term holistic medicine, which means treating the whole person instead of treating a disease or a set of symptoms alone. Holistic approaches use many alternative practices. Complementary medicine is another term commonly used. These are alternative medicine practices that are used in conjunction with traditional treatments.
What Kinds Of Alternative Therapies Are Used For Addiction Treatment?
Alternative medicine encompasses a variety of practices from ancient Chinese herbal remedies to modern biofeedback equipment. A few of these have found a place in addiction rehab and have helped some people in their battle to give up drugs or alcohol. Acupuncture, which comes from traditional Chinese medicine, is a practice that involves inserting thin needles into the skin. Acupuncture is believed by some to help reduce cravings and the urge to relapse.
Meditation and yoga are also often used as components of addiction treatment. Both come from ancient India and are great for relaxation and stress relief. Yoga is a type of exercise that involves using controlled movements. Research has proven that yoga helps people manage stress. When you can reduce stress in your life you can better resist the urge to abuse substances. Meditation has a similar effect; it helps focus the mind and control will. Turning to meditation when craving occurs can be a very powerful and effective tool.
Other types of alternative medicine may be used during addiction treatment, although research as to their effectiveness is limited. Some of these include art therapy, equine therapy (working with horses), massage therapy, herbal supplements, prayer or spiritual enrichment and hypnosis. Some rehab facilities may also use biofeedback and neurofeedback. These are techniques that use equipment to measure body and brain processes so that you can learn to control them. In neurofeedback, brain waves are retrained to a normal pattern to help reduce cravings.
Should I Use Alternative Medicine To Help Treat Addiction?
Whether alternative medicine practices can help you overcome addiction is uncertain. There is evidence for some of the more common practices like yoga and meditation, but others have received limited attention from researchers. For the most part, these practices are safe and it can’t hurt to try them. If they work for you and help you to stay sober and resist cravings, use them.
Only choose to participate in alternative medical care from experienced practitioners. If certain techniques are of interest, speak to your therapist, clinical team or doctor to get resources for practitioners who have worked with addicts. Most techniques are safe, but in the wrong hands there could be consequences or side effects. Also remember that alternative medicine should be used only in addition to primary addiction treatment. It is also necessary to keep up with therapy or support group sessions. The combination of traditional and alternative medicine, however, may prove to be just the right plan that works for you.
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Alternative Drug Treatment Programs
Thursday, January 30, 2014
There are many alternative drug treatment programs that use unique environments or experiences to enhance the treatment process. For example, experiential programs offer adventure, hiking, and related activities and tend to be popular among young adults. Wilderness drug treatment programs are conducted outside of a traditional treatment setting: in the woods, mountains, or desert. Ranch treatment programs offer a unique environment on working ranches; they often include equine therapy as an important component of the program.
Interesting and Unique Types of Alternative Drug Treatment Programs Include:
- Musical Behavioral Therapy
- Yoga Therapy
- Meditation Therapy
- Experiential Therapy
- Adventure Therapy
- Group Bonding Therapy
- Therapeutic Dietary Therapy
- Running Therapy
- Camping Therapy
- Survival Therapy
- Family Counseling Workshops
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Holistic Rehab Therapy is a Growing Trend
Thursday, February 16, 2012
Eliminating addictive behavior and not just the addiction is the key to holistic drug abuse therapy. More addicts are turning to holistic rehabilitation centers to treat their substance abuse problems, according to a recent news article.
Alternative Drug Rehabs
Sunday, June 5, 2011
Alternative drug rehabs often incorporate Eastern philosophies
Alternative drug rehab could refer to many types of rehabs, but often refers to the philosophical spirit of a drug rehab treatment program. An alternative drug rehab might combine Native American healing with group therapy and equine therapy for example. Often an alternative drug rehab will be in a natural or unique setting, such as on a ranch or in the wilderness.
Alternative Addiction Treatment Programs Offer Spiritual & Holistic Elements
Alternative addiction treatment is often a good choice for someone who feels alienated by traditional methods, or who has specific spiritual beliefs that they believe are important to their recovery. However, it is still important to embrace some traditional methods of treatment that are evidence-based and have been shown to be effective, such as traditional group therapy.
There are drug rehabs that are hybrids with a strong clinical program with evidence-based practices that also offer alternative therapies and treatments. These rehabs will offer the latest tools such as biofeedback and EMDR, but will also offer therapies that strengthen the body and spirit, such as yoga and acupuncture. They may also offer Native American rituals such as sweat lodges. Meditation has been shown to be highly effective in reducing stress and anxiety, so while this might be consider an “alternative” treatment, it is becoming quite common in drug rehabs.
Equine therapy is an effective alternative therapy
Alternative Treatment is Recommended if Traditional Treatment Wasn’t Effective
Equine-assisted psychotherapy is being offered by specialty drug rehabs, and has been shown to be particularly effective for people who are resistant to traditional talk therapy or those who have had multiple failed treatments in the past.
If you have a history of relapse or failed treatments, or if you have left treatment early in the past, you might consider researching alternative drug rehabs to see if you can find a program that will be more effective for you.
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Drug Courts Can No Longer Force Addicts Off Maintenance Programs
Monday, April 27, 2015
Any drug court that hopes to obtain federal funding will have to allow addicts access to drug replacement therapies for heroin and prescription opioid addiction, the U.S. government has ruled.
Treatment programs that practice abstinence-only therapies will still remain perfectly acceptable in most cases, but when doctors recommend drug maintenance as the best alternative for individual defendants, drug court judges will have to respect that opinion.
Changes In Addiction Rehab Policy
These changes in existing policy were announced in February by Michael Botticelli, director of the White House Office of National Drug Control Policy. Previously it had been left to the discretion of drug court judges to decide which types of rehabilitation and treatment were appropriate, and these institutions have a long history of rejecting drug replacement strategies. In Kentucky, there are signs posted outside drug courts instructing defendants in methadone or Suboxone maintenance programs to wean themselves off of these drugs before their court dates if they want to avoid being sent to prison.
Maintenance Programs More Effective Than Conventional Abstinence-Based Programs?
But the latest evidence strongly suggests drug maintenance programs, particularly those that rely on Suboxone as a replacement drug, are extremely useful and do an excellent job of helping opioid addicts stay away from the substances that endanger their lives. Abstinence-based treatments in general are more effective against alcoholism than against heroin and OxyContin addiction, which cause changes in the brain that can be incredibly difficult to overcome when relying on willpower alone.
Studies show more than 90 percent of heroin and opioid painkiller addicts will relapse back into drug use within a year of conventional rehabilitation, with the majority dropping out of treatment programs before reaching the end. In some cases, this may show a lack of commitment, but it is still data that treatment centers cannot afford to ignore.
Even outside structured treatment programs, Suboxone is extremely popular with opioid addicts, so much so that a thriving underground market for the drug exists among those looking to self-medicate themselves out of their drug habits. But only 2.5 percent of physicians across the United States have gone through the certification process necessary to prescribe this maintenance medication, helping to repress the availability of the drug.
Most physicians and treatment experts don’t recommend Suboxone or methadone maintenance therapy for opioid addicts, preferring to stick with what they see as the tried-and-true methods of abstinence and the drug-free lifestyle. Substitution drugs go against the grain, maintaining a state of addiction despite their abilities to decrease cravings and reduce the opioid high.
But plenty of studies have verified the relative safety of drug maintenance therapy. At the present time, prescription opioid painkillers plus heroin overdose take the lives of about 25,000 Americans each and every year, and the number of victims has increased exponentially over the last 10 to 15 years. Relapse following unsuccessful treatment is a common killer in these cases, because opioid addicts who go back to using after a period of abstinence have reduced tolerance for drugs and can overdose easily if they take the same dosages they did in the past.
Benefits Of Drug Maintenance Therapies
The reliance of drug courts on abstinence-based rehabilitation is understandable, given the fact that drug maintenance therapy does replace one type of opioid addiction with another. But having one addiction kill the other can play a constructive healing role for desperate individuals who lack the capacity to beat their drug dependencies without extra help.
Willpower is an important part of any addiction recovery regime, and all addicts who plan to get better must make a determined effort to overcome the brain disease that plagues them. Opioid addicts undergo significant neurological changes that won’t go away overnight, however, and that is why drug maintenance can help bridge the gap between dependency and recovery.
Ideally, addicts who use methadone or Suboxone will eventually be able to wean themselves off of these substances under medical supervision. But until they do, these drugs can keep them alive, still in a position to win a battle against addiction that can so easily end in tragedy if intervention is unsuccessful.
Drug courts can provide a route to recovery for addicts only if they remain open to all possibilities, including those that may seem a bit outside the box. The new federal government policy may force their hand to a certain extent, but is will also help raise the consciousness of drug court judges who have a responsibility to keep up with the times.
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What, You’re An Atheist? You’ll Never Get Sober!
Thursday, July 10, 2014
Atheists in AA may get the impression that they’re going to have it tough. All the talk of a higher power might be abhorrent to you, and like The Fix writer Bill Manville, you might be told that “Booze is too tough to beat all alone without the help of Jesus and His Infinite Mercy.” But is this really true? If you’re an atheist, is AA just a waste of time because it requires you to accept something you can’t fathom? Bill wondered this himself, but he attended anyway and—aside from one short relapse—has been sober for 20 years. So how did he do it? Esprit de corps, or in English: group cohesion.
Lyrics Without The Music: Drawing Parallels With Addiction Recovery
Manville asks if you’ve ever read the lyrics to a popular song without the music pumping along to back it up. If you have, you’ll have undoubtedly noticed that without the thumping beat, the power of the words is diminished. It’s only when those lines are spoken with the incorporeal addition of the feel and strength of the music itself that they take on an almost mystical sense of meaning and importance.
He draws the analogy between this and addiction treatment. When you attend lectures on addiction, learn about the consequences, causes and anything you can about your problem, it’s like reading the lyrics without the music. You understand the meaning in a flat, emotionless sense (and the message that you should stop abusing drugs) but you don’t have thumping, powerful drive underpinning it all that motivates you to action. It’s missing the music.
The Therapeutic Community And AA
The rehab Manville eventually attended called itself a “therapeutic community,” with a counselor commenting that, “it’s the existential experience of going through the process with a bunch of other addicts and drunks—all of whom want to stop too—that changes the self.” Despite his initial skepticism, he found himself beginning to understand the importance of this community aspect.
He likens it to the Army, where the tough experience of basic training builds a group morale that gives the otherwise uninspired the motivation to rush into enemy territory to complete the mission at hand. The fact that you’re part of a larger group that shares your mission and has experienced the same sort of problems you have gives you that same type of motivation. You aren’t just one person being asked to tackle addiction alone. You’re part of a larger, stronger group and that in itself gives you the motivation to fight.
Getting Sober Without God
In AA, the “higher power” doesn’t have to be a deity, to the relief of any addicted atheist. Manville found his higher power in a different place: the esprit de corps and the desire to socially fit in with the new group did it for him. That was where the music came from. His theory is explained perfectly in his attitude to the Lord’s Prayer as an atheist. He writes, “When I join hands with fellow members at the end, I feel so buoyed by this merging of self into the greater whole that I find myself reciting the Lord’s Prayer aloud just like rest, and if there is indeed a God listening above, I hope my over 20 years sobriety will make Her smile.”
Becoming Empowered Without Religion
The feeling of being part of a larger group gave Manville his power to overcome addiction, but the important lesson for atheists in AA isn’t that you need to embrace the group or you won’t get sober. Embracing and connecting with the group is important for many other reasons, but the thing that spurs you on personally (the “music” for you, if you will) can be anything that works for you.
The true lesson from Manville’s story is that atheists in AA need to understand that you don’t need God to get sober, just something—anything—that takes the intellectual lessons you’ve learned and provides the underlying vigor you need to turn them into reality. Becoming part of the group is just one potential solution. You need to find the one that works for you.
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Are Better Prizes Keeping Cocaine Addicts In Contingency Management Clean?
Tuesday, June 10, 2014
Contingency management is a form of behavioral psychotherapy known to help people recover from an addiction to the stimulant drug cocaine. This therapy uses vouchers or cash prizes to encourage recovering addicts to stay active in the treatment process and meet their program goals.
In a study published in June 2014 in the journal Drug and Alcohol Dependence, a team of researchers from Wayne State University investigated the question of whether the value of the reward offered during contingency management has an impact on the therapy’s chances of producing beneficial outcomes.
Cocaine Addiction Treatment
People addicted to cocaine have a chemical dependence stemming from the lasting changes that the drug makes inside their brains, as well as symptoms that indicate a loss of control over use of the drug and/or a clearly damaging pattern of behavior centered on drug use. When doctors treat certain forms of substance addiction, they can rely on medications proven to increase the odds that a client/patient will halt substance use and establish long-term abstinence.
However, although a number of medications show promise as potential treatments for cocaine addiction, doctors addressing this type of addiction do not currently have a reliable medication available for their use. This means that treatment programs for people addicted to the drug must use some form of counseling or psychotherapy to provide the needed assistance.
The form of psychotherapy most commonly employed for this purpose is behavioral therapy, a term that describes any therapeutic approach designed to modify and/or replace harmful behaviors that support continued involvement in substance use.
Contingency management (CM) is one of the most frequently used forms of behavioral therapy. One approach to the therapy, called voucher-based reinforcement, provides clients/patients with valuable vouchers as rewards for doing such things as producing drug-free urine tests, regularly attending treatment program activities and otherwise taking the steps required to establish drug abstinence and maintain that abstinence.
Within limits, people enrolled in voucher-based programs can choose how to redeem their vouchers.
Another approach to CM, called prize incentives contingency management, substitutes cash prizes for vouchers. When a client or patient participating in this type of contingency management reaches a program objective, he or she earns the chance to enter a drawing and win varying amounts of cash.
As a rule, the rewards in both types of contingency management go up when a program participant consistently meets his or her treatment goals.
Does The Value Of The CM Reward Matter To Addicts?
The Wayne University researchers assessed the impact of the value of the reward offered on the odds that a recovering cocaine addict will comply with his or her program objectives and avoid cocaine use.
During the study, 15 cocaine addicts participated in 10 sessions that required them to choose between drug use and taking the steps required to receive a financial reward for program compliance. During some of these sessions, the reward offered was $1; other sessions offered a reward of $3 for avoidance of cocaine use. In addition, during some of the sessions, the participants had a chance of winning $6, $12 or $24.
The conditions of the first two types of sessions mimicked the terms of voucher-based contingency management, while the conditions of the third type of session mimicked the terms of prize incentives CM. Prior to the main phase of the study, the researchers made sure that the enrolled participants still viewed cocaine use as an attractive and tempting option.
After completing their testing, the researchers concluded that, during the contingency management sessions that offered a fixed $3 reward for not using cocaine, the study participants were substantially more likely to avoid taking the drug than they were during the contingency management sessions that offered a $1 reward.
They also found that the same results held true when the study participants had to choose between using cocaine and taking a chance at winning $6, $12 or $24.
Are Both Alternative Addiction Treatment Programs Effective?
The results of the study generally confirmed the effectiveness of both voucher-based CM and prize incentives CM as methods for helping recovering cocaine addicts remain drug-abstinent.
The study’s authors also concluded that the chances that both of these approaches to contingency management will produce the desired benefits go up when the amount of the reward for avoiding drug use is relatively high.
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