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Thursday, September 18, 2014
Tuesday, September 16, 2014
September 16 Chp 143 v 3 TWELVE STEPPING WITH STRENGTH FROM THE PSALM
My enemy (addiction) has chased me . He has knocked me to the ground and forces me to live in darkness like those in the grave .
STEP 2 - Came to believe that God could restore us to sanity.
That explains addiction ! Once caught you will be imprisoned .If you try to get away you will be chased relentlessly . Like a corpse in a grave your addiction will allow no choices freedoms or light.You are under its spell and your mind and body begin to rot . Alone isolated and trapped is where you will be . Only God can dig you out once your buried in addiction.
When they cry out to the LORD because of their oppressors (addictions) He will send them a savior and defender (Jesus ), and He will rescue them. (Isaiah 19:20)
Are you up for a challenge? Please join In The Rooms for f.ree and send me a friend request (Barbara Theodosiou)
addictsmom on in the rooms. Also make sure to join the Addict's Mom group here is the link http://www.intherooms.com/
This Thursday 7:00pm EST on the Addict's Mom Live Video Chat Meetings on in the Rooms; We will be "Sharing Without Shame." Members will be reading poems, essays, letters, blogs written by those whose lives have been touched by addiction. We need 10 brave members to SHARE!!
Do you have a favorite story, letter, poem etc you wrote to your addict? yourself? your younger self? Or to anybody at all that you would like to share we would love your participation. To participate please join in the rooms, and the addicts mom group on in the rooms. Let me know you would like to share on Thursday September 18th by emailing me atbarbara@theaddictsmom.com. Please include your phone number and name on in the rooms.
Remember you can remain anonymous or not.
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Visit The Addict's Mom at: http://addictsmom.com/?xg_
Sunday, September 14, 2014
September 14 Chp 73 v 26 TWELVE STEPPING WITH STRENGTH FROM THE PSALMS
My health may fail ,and my spirit may grow weak , but GOD remains the strength of my heart ; He is mine forever .
STEP 2 - Came to believe that a Power greater than ourselves could restore us to sanity.
There is a Higher Power and his name is the GREAT " I AM " .Many twelve step programs tell you name your higher power whatever you want . My thinking is why cry out to a God of your understanding that does not excist because you created it. This universe and world in which we live was created by a God that is real and he loves you , and you are His greatest creation . He calls us Sons and Daughters and he understands our pains and hurts . God loved us so much that He gave His only begotten Son Jesus to die on a cross of reconciliation to bring us together with Him through Him and for Him. Your not getting clean or finding lasting joy or peace because you are praying too a God that does not excist ,stop listening too others and listen too God s voice coming from your heart. Be still and know that He is God.
Father's Love Letter
My Child ~
You may not know me, but I know everything about you ~ Psalm 139:1
I know when you sit down and when you rise up ~ Psalm 139:2
I am familiar with all your ways ~ Psalm 139:3
Even the very hairs on your head are numbered ~ Matthew 10:29-31
For you were made in my image ~ Genesis 1:27
In me you live and move and have your being ~ Acts 17:28
For you are my offspring ~ Acts 17:28
I knew you even before you were conceived ~ Jeremiah 1:4-5
I chose you when I planned creation ~ Ephesians 1:11-12
You were not a mistake, for all your days are written in my book ~ Psalm 139:15-16
I determined the exact time of your birth and where you would live ~ Acts 17:26
You are fearfully and wonderfully made ~ Psalm 139:14
I knit you together in your mother's womb ~ Psalm 139:13
And brought you forth on the day you were born ~ Psalm 71:6
I have been misrepresented by those who don't know me ~ John 8:41-44
I am not distant and angry, but am the complete expression of love ~ 1 John 4:16
And it is my desire to lavish my love on you ~ 1 John 3:1
Simply because you are my child and I am your father ~ 1 John 3:1
I offer you more than your earthly father ever could ~ Matthew 7:11
For I am the perfect father ~ Matthew 5:48
Every good gift that you receive comes from my hand ~ James 1:17
For I am your provider and I meet all your needs ~ Matthew 6:31-33
My plan for your future has always been filled with hope ~ Jeremiah 29:11
Because I love you with an everlasting love ~ Jeremiah 31:3
My thoughts toward you are countless as the sand on the seashore ~ Psalm 139:17-18
And I rejoice over you with singing ~ Zephaniah 3:17
I will never stop doing good to you ~ Jeremiah 32:40
For you are my treasured possession ~ Exodus 19:5
I desire to establish you with all my heart and all my soul ~ Jeremiah 32:41
And I want to show you great and marvelous things ~ Jeremiah 33:3
If you seek me with all your heart, you will find me ~ Deuteronomy 4:29
Delight in me and I will give you the desires of your heart ~ Psalm 37:4
For it is I who gave you those desires ~ Philippians 2:13
I am able to do more for you than you could possibly imagine ~ Ephesians 3:20
For I am your greatest encourager ~ 2 Thessalonians 2:16-17
I am also the Father who comforts you in all your troubles ~ 2 Corinthians 1:3-4
When you are brokenhearted, I am close to you ~ Psalm 34:18
As a shepherd carries a lamb, I have carried you close to my heart ~ Isaiah 40:11
One day I will wipe away every tear from your eyes ~ Revelation 21:3-4
And I'll take away all the pain you have suffered on this earth ~ Revelation 21:3-4
I am your Father, and I love you even as I love my son, Jesus ~ John 17:23
For in Jesus, my love for you is revealed ~ John 17:26
He is the exact representation of my being ~ Hebrews 1:3
He came to demonstrate that I am for you, not against you ~ Romans 8:31
And to tell you that I am not counting your sins ~ 2 Corinthians 5:18-19
Jesus died so that you and I could be reconciled ~ 2 Corinthians 5:18-19
His death was the ultimate expression of my love for you ~ 1 John 4:10
I gave up everything I loved that I might gain your love ~ Romans 8:31-32
If you receive the gift of my son Jesus, you receive me ~ 1 John 2:23
And nothing will ever separate you from my love again ~ Romans 8:38-39
Come home and I'll throw the biggest party heaven has ever seen ~ Luke 15:7
I have always been Father, and will always be Father ~ Ephesians 3:14-15
My question is ~ Will you be my child? ~ John 1:12-13
I am waiting for you ~ Luke 15:11-32
Love, Your Dad, Almighty God
Casey’s Law
Home » Casey’s Law
An involuntary treatment act for those who suffer from the disease of addiction.
What is Casey’s Law?
The Matthew Casey Wethington Act for Substance Abuse Intervention is named for Matthew Casey Wethington, who died in 2002 from a heroin overdose at the age of 23. Casey was an energetic young man who enjoyed life until it was “taken” by drugs. Casey never intended to become addicted to drugs when he used the first time. What he did not realize was that his using would progress from abusing to dependence and then to the disease of addiction. Although his parents tried to get him help, there was no law that could force someone into treatment because he was an adult. After Casey’s death his parents lobbied for a change. “Casey’s Law” passed on April 9, 2004, and took effect July 13, 2004.
What does this law provide?
The act provides a means of intervening with someone who is unable to recognize his or her need for treatment due to their impairment. This law will allow parents, relatives and/or friends to petition the court for treatment on behalf of the substance abuse-impaired person.
Why is this law needed?
Denial and distorted thinking impedes a person’s ability to make a rational decision. The “bottom” for many is death. Addiction is a progressive, life-threatening disease. The best hope of survival for a person who is substance abuse impaired is intervention. Studies show that involuntary treatment can be just as successful as voluntary treatment. Most individuals who are substance abuse-impaired receive court-ordered treatment only after they have become arrested for a crime while under the influence of a substance. Drugs and crime often go hand-in-hand because people who are substance abuse impaired are forced by their disease to resort to any means necessary to procure their drug. Court-ordered treatment can be effective regardless of who initiates it. Not all people who are substance abuse impaired are arrested or, in the event that they are, may not receive the necessary treatment.
What is the process to use Casey’s Law?
The following steps must be taken in order to involuntarily commit someone to treatment:
Obtain a copy of the petition from the District Court clerk’s office by requesting Form 700A – the Verified Petition for Involuntary Treatment of Alcohol/Drug Abuse – or click here to download.
A spouse, relative, friend or guardian of the substance abuse-impaired person completes the petition and files it with the District Court clerk.
The court reviews the allegations in the petition and examines the petitioner under oath.
The court determines whether there is probable cause to order treatment for the person named in the petition (the respondent).
If probable cause is established a judge appoints an attorney to represent the respondent, order the respondent to be evaluated, and schedule a hearing within 14 days.
The respondent is notified of the date and purpose of the hearing.
The respondent is evaluated by two qualified health professionals, at least one of whom is a physician, to determine if the respondent could benefit from treatment.
If the judge finds the respondent should undergo treatment, the court shall order treatment from 60 days up to 360 days, depending upon the request in the petition and the result of the evaluation. Treatment options vary depending upon each individual’s circumstances and can range from detoxification to intensive treatment through recovery.
Who pays for treatment?
As the law is currently written the petitioner is obligated to pay all costs incurred in the process as well as for the court-ordered treatment. The petitioner must sign a guaranty for payment. Low-income individuals living within the Fifth Congressional District may qualify for a UNITE treatment voucher if they acknowledge that they have a problem. For information call the UNITE Treatment Referral Line – 1-866-908-6483.
What happens if the respondent fails to comply?
Failure to comply at anytime during the process may place the respondent in contempt of court.
What is UNITE’s role?
Operation UNITE is helping to raise awareness of this law’s existence by distributing pamphlets and educating court staff. It is UNITE’s opinion that those with a substance abuse problem often need treatment, but are unwilling to seek assistance. This law has the potential to save lives by enabling family and friends to look out for a person’s best interest.
Saving My Teenage Junkie
Haley doesn't understand her own mortality. She could be one careless combination of substances away from death. If she was home, I lived in a continuing state of fear. I realized she had to be in long term treatment, I couldn't allow her to destroy herself as well as the family.
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09/05/14
We stood outside the entrance doors. Three to six months at the minimum, I had been told. I was numb, emotionless, tired from this long crusade. This is her fourth rehab in nine months. I wanted to be on my way home, speeding down the NJ Turnpike, done with the dispassionate and tedious process of admitting my teenager to yet another rehab. Craving a morsel of fresh hope before I walked away, I told her,
"Haley, you have to go down this road alone. I can't come with you. Please get better this time, please,” I pleaded with her.
“I am by your side no matter what," I tell her.
She looked at me spaced out, distracted. Her dark brown eyes were glazed over and bloodshot.
"How much longer is this gonna take? I'm exhausted and crashed. I need my midday dose. I can't be late. The nurses in the hospital were right on time. I can't wait any longer."
I knew better. There’s no room in her mind right now for heartfelt sentiments. But I couldn't help myself.
It's the Ritalin she manipulated some doctor into prescribing that she is itching for. Smart. Feed the junkie drugs. But she had managed, as she always does.
Finally, a peppy twenty-something girl called us into a small, dark room to go over the paperwork. The process was very straightforward and impersonal.
“Sign here, sign there, here's your copy,” she instructed me, whizzing through the stack of paperwork like a well oiled machine.
I waited for the part where I could tell her about Haley’s history and my reasons for making her start treatment once again. It didn't happen.
It felt irresponsible to not have a conversation about her condition but she instructed me that the therapist would be in touch on Monday.
“She handles all that, I just do admissions,” she informed me.
After all, she was transported there in an ambulance straight from her two week detox stay at a local hospital. Haley was carted out of the ambulance with her Coach purse on her lap and looking like a space cadet. She had just thrown a fit as they were prepping her to leave the hospital. It was another panic attack. What a really solid attempt at gaining just one more dosage of Klonopin before the drought started.
After the paperwork, the admissions robot announced it was time for goodbyes. Detached, Haley gave me a weak, halfhearted hug.
Walking away from her, I felt a surge of guilt but I had to keep going. I forced myself to show no sign of hesitation. Despite wanting to look back, I didn’t. My daughter could smell weakness on me from a mile away. I focused on getting to the car. The blackout period had started now and I couldn't see her or talk to her for seven days. A much needed temporary reprieve.
Haley is a challenging case no matter where she goes. Her long, lean body, sharply intelligent mind and charming people skills make her a force to be reckoned with. She's a 17-year-old mini doctor, very well read on every kind of controlled substance and antidepressant and their effects on specific neurotransmitters in the brain. At times I've been embarrassed by the breadth of her knowledge. Sitting in her cave of a room drawing diagrams and making detailed lists, she devours any piece of scientific information on drugs and their interactions, side effects and symptoms needed to obtain them. She hides her knowledge disguised under the perfect recipe of symptoms to get the coveted blue piece of paper that meant her temporary mental freedom and ability to trade for other drugs.
Xanax is her drug of choice but it’s clear from reading her texts that she does not discriminate and will take anything that will give her a buzz or get her high. Cough medicine, alcohol, decongestants are all on deck if controlled substances aren't available immediately. She seems desperate, begging the druggies to please hook her up, she’s ready to sell her soul for one more pill.
Haley was expert at complaining incessantly about every kind of physical ailment that could aid her in obtaining a drug that could take her away from her inner pain. This was a hollow, dark anguish that manifested itself in uncontrollable moods, compulsive lying and nonstop manipulation of every person in her life. In a bizarre dichotomy, it was this wretched, unshakable teenage angst coupled with her motivation for success that made her the junkie she is.
The large high school in our town evidently supplied a buffet of every kind of illegal substance with an emphasis on prescription drugs. Benzos, opiates, stimulants, marijuana, it was all a connection or two, at the most, away. Even without actual friends, it was that easy to obtain the stuff. The high school was a booming black market for drugs despite police on duty at all times.
The sad fact is that my daughter had few real friends; she lived an endless cycle of brief acquaintances never lasting more than a few months.
Earlier this year Haley fell into lust with a short, twerpy boy (a dead ringer for Eminem), one grade below her. Apparently, Jason was well equipped with major drug hookups that compensated for his lack of charisma.
Andrew, Haley’s father, was mostly nonexistent in her world. He showed short, intermittent bursts of interest in her occasionally. That part of my daughter’s life was a continual heartbreak. It definitely played into the birth of her habit in a major way. Sadly, I had to take stock of my own failures and missteps, too. Like most parents, I have to shoulder some blame in the addiction. I won’t ever stop questioning myself and my responsibility in this nightmare that became her life.
Andrew and I had Haley at nineteen. Andrew was an immature, ambitionless kid who I briefly believed I could help and possibly change. At 20, my naive idealism was never so alive and kicking. Having had a disappointing childhood left me longing for a family of my own. I wanted to be the mom I always wanted.
Haley had spent two months at the third rehab in West Palm Beach. I was adamant that I had to have her in the best institution I could possibly find. Foolishly, I believed she should get well in a beautiful, sunny place to escape the nasty New Jersey winter and the environment she had corrupted herself in. I never wanted rehab to feel like jail time or a punishment. I only hoped that the right spot would be her turning point. I had been advised repeatedly to send her to a local institution, but none of them seemed nice enough. I borrowed every dollar I could to get her there. I was beside myself that I had to let her go. The facility was meeting her at the gate in Florida. I couldn't afford the plane ticket to go with her.
Much to my disappointment, Haley played me again. Full of relief and excitement, I had picked her up at the airport in Atlantic City. Though she looked healthier and had gained a few pounds, sadly, she seemed high. She had probably stolen some pills or shoplifted cough syrup from the airport gift shop.
Haley's drug crisis interfered with my shaky career despite my best attempts to go to work and close the door on my chaotic personal life. There was a constant stream of phone calls, therapists, doctors, nurses who all needed to talk to me now. I was nervous all the time, in a habitual state of sleepless adrenaline. I was drowning before I even brought my dire financial situation into the picture as well as my two younger children and husband.
Inside my heart, it was a struggle to love her. I couldn’t be resigned to the fact that my little girl was gone. There has to be a way for this to stick, for Haley to genuinely buy into the treatment, I keep telling myself. This had been the real roadblock all along. She faked her way through the last three rehabs, feeding doctors and therapists exactly what they needed to hear to send her on her way. Returning home, I would hear the same meaningless declarations that yes, she had learned her lesson. This time is so different than the last.
“Trust me, trust me, mommy. Please, I promise you.” She was so emphatic that this was it.
Within days of returning from her 62 day stay in Florida, she was texting her old hookups.
“Dude, I did my time. Ridiculous! I even learned how to get drugs in rehab,” she bragged.
Once again I found her barricading herself in her room telling me the same whiny sob story. She was just so worn out, not sleeping at all, just had to have some rest. I bought into it because I believed there was no way she still wanted to be a junkie after three rehabs and nonstop therapy. I wanted this horrendous gut wrenching chapter in our lives behind us with confidence. But it wasn't.
I had rummaged through her room, an unwanted duty I had to do. The broken Adderall capsules, the Xanax hidden in a mint tin, the empty baggies, the stench of alcohol in her trash, the empty bottle of Nyquil was evidence I couldn't ignore. She was worse than before Florida.
Haley doesn't understand her own mortality. She could easily be one careless combination of substances away from death. If she was home, I lived in a continuing state of fear. I realized she had to be in long term treatment, I couldn't allow her to destroy herself as well as the family. I had already been fired from my job for absences and poor performance. I badly needed the insurance for her treatment. My life was in shambles, I had lost control of it in my quest to keep her sober and finally fix the problem.
So there was no option. Haley had to go a fourth time. This time, I sent her to an institution an hour away, in a rural tucked away north Jersey town. There were no bells and whistles. It didn’t matter. There weren’t many choices left. Knowing that this was long term, I wanted to be able to see her as much as possible.
But, inevitably history has this wicked habit of repeating itself. I got the phone call from the therapist on her third day there.
“Haley isn't acclimating to the environment. She's not making friends and alienating herself with a bad attitude,” the therapist informed me.
She insisted Haley had to speak to me despite the blackout period.
"This place is an absolute nightmare, I cannot stay, Mommy. You would die if you could see how dirty it is and the gross, trashy people here. I have low blood sugar, they won't let me eat. I'm telling you, I gave it my best. I'm sorry, it makes the second rehab (a mental hospital that she was transferred to because of suicidal gestures) look like a country club. Get me out of here now," she sobbed.
I spoke calmly to her. I had grace unbeknownst to me, in that moment.
“I love you dearly but you are staying,” I told her. "We are out of options and you will die if you come home. That’s all there is to it, Haley.”
She said nothing, just threw the phone down.
I asked the therapist how long it usually takes for these challenging cases to finally concede.
“They're all different but usually they break,” she told me with ease.
It's the instinctual love I have for Haley that keeps me believing that she can and will get better. I tell her my love for her is unconditional. "I won’t give up on you. Love is when you don’t leave.”
Haley doesn’t understand this now. She will one day.
There is an awesome life ahead of her, full of dreams she hasn’t realized yet. College is a year away. Keeping her alive and safe long enough for her to see that and actually want it for herself is all that matters. I’m petrified of the alternative.
Today, I want her sobriety much more than she does, if she does at all. I’m buying time until the moment of clarity hits her. I have to believe with all my heart that the footprint of her life hasn't even taken shape yet. I pray.
Meredith O'Brien is a writer and runner living in New Jersey.
So You Thought You Could Get Off Suboxone?
Why is there no official medical protocol to detox addicts off of Suboxone? The Fix goes to the pharmaceutical companies for answers.
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By Dawn Roberts
09/04/14
Maybe the headline in the press release for Bunavailsays it all: First and Only FDA-Approved (Buccal Formulation) of Buprenorphine and Naloxone to compete in the $1.7 Billion and Growing U.S. Opioid Dependence Market.
$1.7 billion and growing, they got that part right. Heroin and prescription opiate addiction are massive, under treated and under reported conditions in the U.S. By2013 estimates there are over 669,000 opiate addicts in the United States. It's jarring to see a press release referring to opiate addiction as a high competition market for pharmaceutical companies. That, however, is the case, and the heart of the issue when it comes to understanding why Big Pharma enthusiastically went after the market in 2002. That's when the first buprenorphine/naloxone combination (Suboxone, from Reckitt-Benckiser Pharmaceuticals) received FDA approval.
During the time before Reckitt-Benckiser Pharmaceuticals received the green light to bring Suboxone to market, the company was one busy bee. They lobbied congress to create the Drug Addiction Treatment Act of 2002 (DATA) and worked with the National Institute on Drug Abuse (NIDA) and FDA to lay the groundwork for the successful introduction of their product into a needy marketplace. DATA's passing created a waiver for physicians with specific certification to provide schedule III, IV or V narcotics for detox and ongoing treatment. Buprenorphine (the powerhouse ingredient in Suboxone) was developed back in 1969 by Reckitt & Coleman (now known as RBP). They were attempting to develop an opiate derivative, harnessing pain-killing properties and sidestepping its potential for addiction. This required ten years and millions of dollars to cultivate the formula and an additional 13 years to bring Suboxone to market.
The emergence of the most recent opiate derivative can be framed in a historic context. Since the synthesis of opium in 3400 BC, mankind has danced with the devil, attempting to utilize the drug's benefits and avoid getting burned. Morphine was created in 1817, codeine in 1832, and in 1874, heroin. For a time each of these compounds was thought to be a less addicting substance. By 1914 heroin became available only by prescription, and in 1924 was classified as an illegal narcotic. The narrative of today's heroin addict moved in tandem with the activities of pharmaceutical companies. Oxycontin came to the US in 1996 and was aggressively marketed as (guess what) a less habituating alternative to morphine. By 2001 it was number one with a bullet, the highest selling narcotic pain reliever. In 2010 the formula was altered making it more difficult to crush, snort or inject. The combination of high street prices for Oxycontin and the lower cost of heroin moved some prescription drug abusers to jump the fence.
Vermont Pulls the Covers on Heroin Addiction
The Governor of Vermont dedicated his entire 2014 State of the State speech to heroin addiction. The syndrome has a chokehold on his state. In the bucolic home of Ben and Jerry's ice cream, maple syrup and same sex marriage, the Governor’s entire narrative goes to opiate dependence? You can be sure the problem has gone mainstream. Heroin addiction has swung from being an inner city to a suburban and rural crisis. The demographic shift from young, poor and brown-skinned to post-collegiate suburban and white continues to shock the media.
Globally there are an estimated 9.2 million heroin users. According to the World Health Organization this is triple the figures from 1985. One of the difficulties in quantifying the scope of opiate addiction is that reporting tends to come from treatment centers and other institutions.
In the United States accurate data is also hard to come by. WHO estimates the number of opiate addicts (including heroin) to be two million. Figures from The National Alliance of Advocates for Buprenorphine Treatment (NAABT) puts that figure at 5.5 million. We don't need charts, graphs and annual reports to tell us that opiate addiction is a disaster. Communities around the country once naive to the consequences of active addiction have been thrust into the squall. The Center For Disease Control (CDC) reports opioid analgesic consumption increased 300% between 1999 and 2010, and death rates for poisoning involving opioid analgesics more than tripled between 2000 and 2010. In 2014 the skyrocketing number of 911 calls and overdoses related to heroin and prescription drugs are traumatizing communities they never touched before, and the problem is not going away.
The Scope of the Buprenorphine Market
According to RBP's 2013 annual report, Suboxone had sales of $1.2 billion. It is ranked at #39 of the top 100 drugs prescribed in the U.S., placing it above Viagra, Adderall and (generic) hydrocodone. To give this sum context, Suboxone revenue is three times that of Super Bowl advertiser/provocateur Go Daddy, and dwarfs brands including Urban Outfitters and Ameritrade. In the U.S. more revenue was generated by Suboxone sales than the entire digital music download business. Other companies have arrived or plan to enter the market including Orexo (Zubsolv) and BioDelivery Sciences (Bunavail).
Getting Off Suboxone
RBP created and dominates the buprenorphine/naloxone market. Some patients who have been prescribed the drug decide they want to discontinue it. The reasons vary, ranging from financial pressures arising out of the cost of doctor visits and medication to side effects, potential future side effects and finally, the patient who wants to be 100% drug free.
Regardless of the reason one has for ending replacement therapy, making the choice presents a whole new set of challenges. Suboxone is a hard drug to kick. The medication's long half-life combined with its tight adhesion to opiate receptors makes tapering particularly difficult. From anecdotal reports, the least disruptive way to achieve a Suboxone-free life is to cut down the amount used very slowly week by week until titration is complete.
This scenario is complicated by two facts:
The lowest strength Suboxone comes in is 2 mg. (”Jumping” from a 2 mg dose can be a drawn out and debilitating process that takes months to recover from);
RBP warns against cutting Suboxone strips into smaller amounts, and maintains that the medication is not equally distributed in the preparation.
If you ask the doctor who has been prescribing you the drug for months or years, you may find him/her woefully lacking in experience or a plan for tapering. Some physicians continue to murmur the mantra of RBP, that a majority (95%) of patients who go off the remedy will return to active addiction. The overall statistics on recovery from addiction reflect this same figure. The fact is that a high percentage of people who try to get clean fail. Some fail many times before achieving freedom, and some die. Confusing the rhetoric of a pharmaceutical company with studies on the outcome of addiction treatment is a mistake.
This perception is changing. Four doctors I spoke to while researching this article told me they have successfully tapered patients formerly on replacement therapy. A successful taper requires adopting a combination of daily cardio exercise and mindful nutrition to repair and rebuild body and brain. For some a spiritual program is central.
While there are lower strength formulations of buprenorphine on the market (that would make tapering a more simple and accurate process) they are created for pain management and are illegal to prescribe to recovering addicts. Physicians routinely prescribe medications for "off label" use, but there are many laws directed towards prescribers of buprenorphine and they have serious repercussions. A doctor could lose his/her license for prescribing a Butrans patch to help taper a patient off of Suboxone.
Getting certified to prescribe buprenorphine is remarkably easy. It requires completion of one eight hour online course. The amount of time in the course agenda dedicated to taking patients off off the drug is nil. No doctor I spoke with recalled the topic of withdrawal from Suboxone being mentioned during the certification process.
Many doctors have found that prescribing Suboxone is akin to installing an ATM in their waiting rooms. It’s the perfect storm. Patients are desperate when they come in, willing to pay significant sums of cash for services, and rarely shop around for the perfect fit between patient and practitioner. In many cities there is a waiting list to get in to see a doctor able to prescribe. No background in addiction medicine is required to take the course. This creates a wide berth for physicians who may be opportunists to cash in on the vast and growing population of opiate addicts frantic for a solution.
Wrestling with Big Pharma
The difficulty of compelling a pharmaceutical company to take suggestions from the public is directly related to the power Big Pharma wields in the United States. Pharmaceutical companies spent almost three billion dollars lobbying the U.S. Government in the last five years. Pharma is thelargest of all 121 lobbying entities and donated over $90 million dollars to federal candidates and political parties.
Advocates for an exit strategy from Suboxone have the weight and effect of a single fly in the chardonnay of Big Pharma. There are some lobbying groups working on issues of addiction treatment, and the numbers of these groups are growing. New York, Florida and Pennsylvania have advocacy groups, but their efforts tend to be focused on broader stroke issues. With an entire health care system in transition, obtaining any treatment for addicts is the fight these groups are concentrated on.
Big Pharma's Inconvenient Truth
Pharmaceutical companies gross massive annual earnings; a whopping $950 billion dollarsglobally. It is an industry of Goliath momentum and political reach. Relying upon recipients of lobbying influence to look their gift horse in the mouth? In the battle of ethics and commerce, conscience rarely rears its inconvenient head. Like Jesse from Breaking Bad, we might ask “What about science, bitches"? Where are the impartial and sovereign scientists? The reality of scientific investigation means taking marching orders from drug companies. For more on this topic read Jacky Law’s examination in her book, Big Pharma - Exposing The Global Healthcare Agenda.
Knee Deep in the Muck
With these facts in mind, I reached out to RBP, Orexo, and BioScience Delivery International. My outreach to RBP is particularly pertinent, since they are both the creator of Suboxone and the market leader. It’s key to understand that the first company to bring a pharmaceutical product to market jumps through extra hoops in order to obtain first entrant advantage. The company had to work closely with the FDA and NIH to first prove that there was a need for the drug. They also worked together to establish dosage protocol, and in the case of Suboxone, on establishment of a certification program so that physicians could legally prescribe the drug (using a narcotic to treat narcotic addicts was against the law until DATA was created in 2002). The intimate relationship between RBP, the NIH, NIDA and the FDA raised a red flag in my mind.
The initial safety and dosage protocol studies created to bring Suboxone to market have not been revisited since 2002. Since the drug has been in the market for 12 years, it seems prudent to have a look at how people on long-term maintenance are faring.
There are no FDA regulations requiring re-evaluation of a drug and its side effects over time. In the past new studies were prompted by negative outcomes not identified during clinical trials. Post-marketing investigation uses a number of methods to check on the safety of drugs: reporting databases, prescription monitoring, electronic health records, patient registries, and linking records between databases. In the U.S. post-marketing surveillance is overseen by the FDA through MedWatch where doctors or the public can report adverse reactions to drugs.
Gambling in High Places
Addiction to gambling is not exactly the same as an addiction to a substance, but the compulsion it inspires and the wreckage it creates are on the same level.
Shutterstock
Shutterstock
09/03/14
Death of a GamblerWhen the parishioners of St. Mary’s and St. Mark’s, two small western New York Roman Catholic churches, dropped their dollar-filled envelopes into the collection plate each Sunday, they entrusted Sister Mary Ann Rapp with their donations. After all, the gray-haired nun had devoted 50 years to serving others. So the unquestioning donated, and the nun pilfered, diverting nearly $130,000 into slot machines at various western NY casinos. Sister Mary Ann Rapp was sentenced last year to 90 days in jail, five years of probation, 100 hours of community service, and restitution of stolen funds.
In a similar scenario, Monsignor Kevin McAuliffe, referred to as Father Kevin by his parishioners at St. Elizabeth Ann Seton, a parish in the Las Vegas Roman Catholic Diocese, tapped $650,000 from votive candle offerings and gift shop funds to finance a video poker and casino gambling obsession. Father Kevin was sentenced in 2012 to three years and one month in prison, plus three years of supervised release and $650,000 in restitution.
And what about Maureen O’Connor, the former San Diego mayor who devoted years to serving the city? A political phenom, O’Connor secured a city council seat just three years out of college and later a two-term run as the first female mayor of California’s second-largest city. But her swift and honored ascent collided with a nine-year gambling obsession which she described in a CBS-interview as heroin-like.
Her wagers at San Diego, Las Vegas and Atlantic City casinos burgeoned along with her video poker obsession and daily losses easily topped $100,000. As O’Connor’s debts grew, she initially liquidated her inherited $50 million personal fortune. But like Father Kevin and Sister Mary Ann Rapp, O’Connor eventually plundered reserves allocated for those less fortunate, bankrupting the charitable foundation of her late husband—Robert Peterson, Jack-in-the-Box founder—the R.P. Foundation.
But unlike the nun and the priest, O’Connor was able to make a deal with the court to avoid prison time if she is able to repay the foundation in two years; something she says she always intended doing.
“I think they may rationalize that they are borrowing the money,” says Carole Lieberman, MD, a Beverly Hills psychiatrist who treats gambling addicts. “But it rarely gets paid back.”
It is not uncommon for public officials to also be compulsive gamblers, because for both types, the aphrodisiac is power. It is essentially a gamble for someone to run for public office, investing a lot of money and time on the chance that they might win. Then, once elected, their access to public coffers makes it very tempting to steal, in order to feel another powerful high by gambling at the usual games of chance.
Addiction to Gambling differs from alcohol or other drugs
Differences
Gambling connected to fantasy
Gamblers favor suicide, alcoholics helpless and hopeless
Fully functional until hitting bottom
Money seen as drug and power
Gambling disease model harder to accept
Cannot measure gambling through blood, urine, or hair
Gambling sponsored by religion and government
Bailout or big win temporarily can stop self-destructive cycle
Gambling win seen as solution to problems
Gamblers tend to do it alone
More difficult to define gambling
No saturation point for gamblers
Gambling recovery often requires significant financial restitution
No hangover
No preventative medication
Often overlooked by professionals until late stages
What makes one person become a gambling addict and another a politician? “Both may come from the same place, past traumatic or painful experience. The child who grows up with nothing may compensate for that as an adult by going into public service so that s/he is never at the bottom again,” says Constance Scharff, PhD, senior addiction research fellow and Director of Addiction Research, Cliffside Malibu. “S/he may bring others up at the same time as a fighter for social justice. Another person may respond to the same situation by trying to make fast money; one way is through gambling. In other words, the same past can drive different behaviors.”
Experts suggest a prevalent belief that they will not get caught. “I would imagine that this comes from a sense of entitlement and feeling above the rules, as some leaders can feel, or even be,” says Scharff. “As far as gambling away the public coffers, people with gambling addiction gamble any money they can get their hands on – from public coffers, private corporations, charities, family members – you name it, if they can gamble with it, they will. That is the peculiarity of the gambler. The gambler, like the politician, always believes s/he’s going to win, even if the odds are against you.”
In recent years scientists have debated the origins of gambling addiction, with some pointing to neurological pathways and others linking it to a behavior addiction. Johns Hopkins’ neuroscientist David Linden, PhD, says that neural signals regulate how and why we feel pleasure, calling it the pleasure path. In Linden’s book, The Compass of Pleasure: How Our Brains Make Fatty Foods, Orgasm, Exercise, Marijuana, Generosity, Vodka, Learning, and Gambling Feel So Good, he says that the dark side of pleasure is addiction. “It is now becoming clear that addiction is associated with long-lasting changes in the electrical, morphological, and biochemical functions of neurons and synaptic connections within the medial forebrain pleasure circuit,” he says. “Perhaps, most important, analysis of the molecular basis of enduring changes in the brain's pleasure circuitry holds great promise for developing drugs and other therapies to help people break free of addictions of many sorts, to both substances and experiences.”
Conversely, others look to certain behaviors. According to a study published in the Canadian Journal of Psychiatry, researchers from the Ontario Problem Gaming Centre studied 1,171 pathological slot machine gamblers identifying four gambling subtypes.
Type I pathological gamblers had poor impulse control, were uncooperative, and held mystical or spiritual beliefs. This group had the most severe gambling behavior, the highest level of other psychological disorders, and the highest level of substance abuse.
Type II pathological gamblers were characterized by materialistic, controlled, avoidant behavior and aloofness. They had the highest level of alcohol abuse.
Type III pathological gamblers started gambling as teens, sought high sensations, and were impulsive and overspending. This group was highly sensitive to reward and tended to persist on tasks. They showed no other psychological issues.
Type IV pathological gamblers were considered high-functioning. They began gambling later in life, showed low levels of impulsiveness and sensation seeking, and they had responsible and goal-directed behavior. Few had other psychological and substance use disorders.Some may recall the 2003 film, Owning Mahowny, starring Philip Seymour Hoffman as the true life Canadian banker, Brian Molony, a self-admitted compulsive gambler who embezzled millions from the Canadian Imperial Bank of Commerce. Molony was arrested in 1982, the day after he lost $1 million at Caesars Atlantic City Hotel and Casino. Interestingly, Molony placed his first bet at the race track when he was 10 and acted as a bookie for friends in school.
In the film, Hoffman offers an excellent portrayal of the intensity of purpose, power and a sense of oneness with the cards. According to Scharff, the question is really about what gives some people drive that is far above and beyond the average person.
“Think about what it takes to become a state governor or President of the USA. It’s more than ambition. It’s almost a type of quest. On a path like that, you’ve got to be a risk taker. You’ve got to be bold and empowered and think a great deal of yourself. You have to believe in yourself despite the odds,” she says. “We’re talking about people who desire power. These are all traits you’ll find in a problem gambler. Again, I don’t want to draw a link; there is no data at this point to suggest that politicians are more likely to become gambling addicts than anyone else, but you can see the parallels between the personality types. I think gamblers would understand politicians very well, and vice versa.”
The nun, the priest, the mayor and the banker are not alone in their gambling crimes:
A Dallas-based firm, Affiliated Computer Services, hired Thomas H. Koch in 2001 to pursue medical insurance cases for the company’s clients. But the Wisconsin attorney, over several years, duped the firm out of $2.5 million to fund his slot machine wagers at Potawatomi Bingo Casino in Milwaukee. According to court records, the judge sentenced Koch to two years in prison, followed by four years of extended supervision. Koch must continue with Gamblers Anonymous and psychiatric treatment. He has been banned from entering any kind of gambling establishment anywhere and prohibited from gambling online. Koch must pay $2,421,768.57 in restitution, even though Assistant District Attorney Kurt Benkley said Koch has no assets and likely will never pay the money back.
Keith Soderquist, mayor of Lake Station, Indiana, was indicted on three counts this spring, following an extensive FBI, IRS and ISP investigation. According to the U.S. Department of Justice release, Soderquist, 44, and his wife, Deborah Soderquist, 55, who was employed as the administrative assistant to the mayor allegedly used funds from the Lake Station Food Pantry account to finance gambling at casinos in Indiana and Michigan, among other charges. Their trial is slated for October. United States Attorney David Capp said, “These indictments are part of this office’s ongoing public corruption investigation.”
Casino surveillance footage shows former Braddock, PA Manager Ella Jones withdrawing more than $40,000 stolen from taxpayers to feed her gambling addiction. Braddock fired Jones from her $45,000-a-year job after she pleaded guilty to stealing $178,000 from 2008 to 2009 from taxpayer-fed accounts. A judge this month sentenced her to nine years of probation, and she must pay restitution.
Anne Elizabeth Dalton, 65, manager at the Family and Youth Services in Australia was found guilty of 271 counts of deception. She stole $100,000 from emergency funds applications for bogus victims of domestic violence, supposedly to help them find alternative accommodation. She was sentenced to five and a half years in prison and must pay restitution.
Cheri A. Logue, 42, Claysville, PA received a 22-month federal prison sentence for embezzling $90,000 in government money provided to the Southwestern Pennsylvania Legal Services Corp. She used an ATM card registered to the corporation to withdraw more than $12,000 at or near casinos on 56 occasions, investigators said.
Nancy J. Brown, 62, is awaiting trial on charges of stealing nearly $389,000 from payroll accounts in Springfield Township, PA where she worked as township secretary. Her lawyer said she lost most of the money at Presque Isle Downs & Casino near Erie and other casinos.Treatment for these high-powered addicts can be a challenge, according to recent research. “Yes, our experience shows that 'smarter' people are harder to treat. All addicts try to work the system at one point or another,” says Scharff. “Those who are smarter can work the system better, and this works to their disadvantage when it comes to getting healthy. “
“Research shows all addicts (substance abuse or process disorders – like gambling) need highly individualized, evidence-based care,” Scharff added. “The residential phase of treatment generally lasts 90-120 days with the remainder of a year being spent in intensive, non-residential aftercare. Twelve- step programs, while certainly a good adjunct to treatment or prong of an after-care plan, are not treatment. They are support groups and while they have definite advantages, they cannot take the place of quality, evidence-based care. “
Kathleen Phalen Tomaselli has written for the Washington Post, the LA Times, USA Today and American Medical News, among other publications. She last wrote about the state of addiction funding research.
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