Sleep Problems in Addiction Recovery

by | 10. June 2015 08:20

Insomnia (difficulty initiating or maintaining sleep) is one of the most common issues tied to BOTH active substance abuse and the recovery process.  Lack of restful, productive sleep creates significant disruptions in day-to day functioning.  When someone is trying to re-establish stability in their job, relationships, health AND abstain from substances of abuse, sleeping problems represent a tremendous hurdle in reaching those goals.  SAMHSA addressed the sleep/insomnia issues in a Fall 2014 brief; they outlined several non-pharmacological interventions and several lifestyle tips for promoting healthy sleep.  These strategies are effective and minimize risk of relapse, the caveat is that they require vigilance, commitment and take time to produce results.  Patience, especially when not sleeping well, can be elusive for people in early recovery.  This process can open the door for relapse when (some) pharmacological remedies are recommended.  The ultimate challenge of recovery is to delay instant gratification & sleep medicines (mainly sedative-hypnotics and benzodiazepines) eliminate that delay.  Compounding that issue, often times, is the far too casual approach towards these medicines by prescribers and people in early recovery.  It can be easy to minimize or dismiss the risks associated with these medicines when they produce immediate results.  They are mistakenly perceived/presented as “low risk” or “not risky at all”.  The seeds for relapse are sewn far in advance of the actual event.  It is a poor decision to start planting these seeds by prescribing someone  with a substance abuse history these medicines that have documented abuse potential (even if they are not the person ‘drug of choice’).  It is equally risky (if you’re a person in recovery or loved one to someone in recovery) to start seeking these medicines for fast relief of insomnia.  A recent article published by NPR talks about the benefits of utilizing therapy to root out the underlying causes of insomnia.  This can help a person safely improve their sleep without the risks some medicines create.  A key statement from the NPR article quoting Dr. David Cunnington, director of the Melbourne Sleep Disorders Centre in Australia, explains the basic difference between lifestyle changes/therapy and sedatives to treat sleep problems: “A medication just puts a blanket over that anxiety and helps people get rest. But cognitive behavioral therapy addresses the core problems, challenging people’s thinking around sleep.  It can actually break the cycle of insomnia”.  SAMHSA, in the brief mentioned earlier in this commentary, cites Harvard Medical School, Division of Sleep Medicine and the National Sleep Foundation in their list of tips for Promoting Sleep Hygiene.  These tips include: 1) Go to bed and get up at the same times each day 2) Use natural light (that comes through a window) to remind yourself of when it’s time to be asleep & awake 3) EXERCISE regularly 4) If you take naps, keep them short and before 5pm 5) Don’t eat or drink too much when it is close to bedtime 6) Avoid caffeine and nicotine for several hours before bedtime 7) Wind down before going to bed (take a warm bath/shower, light reading or practice relaxation techniques). 8) Keep the bedroom a relaxing place – avoid paying bills or doing work from the bed 9) Sleep in a dark, quiet room that isn’t too hot or too cold & 10)Don’t lie in bed awake. If you can’t fall asleep within 20 minutes get up and do something relaxing.  To read more about sleep problems associated with addiction and recovery check out SAMHSA’s In Brief here.  To read more about hoe therapy & counseling can be helpful for sleep problems, check out NPR’s article here

Obstacles to Seeking Treatment

by | 02. June 2015 08:54

Funding and access to treatment is still a critical problem for many.  This topic, summarized in brief by NCADD from a USA Today article, identifies several factors that contribute to the biggest dilemma in addiction treatment. Check out NCADD’s summary here and the full USA Today article here

Overdose Deaths in Bucks County: 2014

by | 27. May 2015 11:02

The Pennsylvania State Coroners Association has released their Report on Overdose Death Statistics 2014.  This report is broken down by overall totals for the entire Commonwealth of PA and also county-by-county. It provides the raw data and percentages as they pertain to each drug in addition to breakdowns by day of week, month and gender totals for incidents of overdose deaths.  They identify 2488 overdose deaths in Pennsylvania for the period covering January 2014 to December 2014.  It is also important to recognize that “a vast majority”  of the deaths involved the presence of more than one drug in toxicology results.  Bucks County alone endured 205 overdose deaths in 2014: 66% male to 34% female.  A slight majority (30%) of those deaths fell in the 31-40 age group, closely followed by the 41-50 age group (29%) and then the 20-30 age group (23%).  The remainder fell in age groups under age 20 or over age 50.  Opioids (oxycodone, hydrocodone, oxymorphone, hydromorphone, morphine etc.), Benzodiazepines (Klonopin, Xanax, Ativan, Valium) and non-legal drugs (heroin, cocaine, methamphetamine etc.) accounted for the highest occurrences in toxicology results.  These are just a few of the black & white facts.  More than that, this study represents the irreversible tragedy associated with drug addiction.  It is the culmination of too many worst case scenarios that parents, siblings, wives, husbands, partners, grandparents, aunts, uncles, cousins, co-workers, employers & countless friends are trying to process in their grief.  The report itself is not all data and graphs; they preface the statistics with a poem written by the mother of a young woman who died from an overdose this past year.  It is a heartbreaking example of the ultimate pain caused by drug addiction.  This battle cannot solely be measured by its casualties in sheer, raw numbers. There is also a definitive, almost tangible, qualitative price levied by it and all illnesses. Treatment, support  and advocacy are the platforms that give us the greatest chance at conquering this epidemic. Those platforms are bolstered by individual perseverance, resiliency and compassion.  When we combine those elements, we can make these staggering numbers dissipate. We can improve the quality of life for the afflicted and their loved ones. The time to act is NOW.  If you or someone you know is sufferance from drug abuse/dependence seek help as quickly as possible.  It is unacceptable to let these numbers continue to grow or remain steady.  Seek out help, tirelessly if need be. Treatment is effective!  To read the full report m click here

Naltrexone May Be Helpful in Treating Methamphetamine Addiction

by | 26. May 2015 11:38

This summary posted by NCADD describes a small sample experiment that yielded results indicating the potential for naltrexone’s effectiveness in treating methamphetamine addiction.  Check it out here

Generic Version of Narcotic was Most Prescribed Drug Under Medicare in 2013

by | 15. May 2015 09:26

Vicodin in generic version was the most widely prescribed drug under Medicare in 2013.  This article published in The Wall Street Journal and summarized by NCADD outlines a key contributing factor to narcotic addiction problem in the United States and the heroin problem, also.  Check out the NCADD summary here  and the full article from The Wall Street Journal here

Do I Have A Drug or Alcohol Problem?

by | 14. May 2015 11:18

The following self-assessment was published by the National Institute on Drug Abuse as part of the article “What To Do If You Have a Problem With Drugs” in June 2014.  It is a simple list of screening questions & it can help identify whether drug/alcohol use has become problematic.  It is a list of twelve “yes or no” questions.  Keep in mind, this list is not a diagnostic tool rather it can help someone to begin to identify the depth to which alcohol/drug use is effecting their life.  This is crucial to making the decision to seek help.  These are the 12 questions: 1) Do you think about drugs a lot? 2) Did you ever try to stop or cut down on your drug usage but couldn’t? 3) Have you ever thought you couldn’t fit it or have a good time without the use of drugs? 4) Do you ever use drugs because you are upset or angry at other people? 5) Have you ever used a drug without knowing what it was or what it would do to you? 6) Have you ever taken one drug to get over the effects of another? 7) Have you ever made mistakes at a job or at school because you were using drugs? 8) Does the thought of running out of drugs really scare you? 9) Have you ever stolen drugs or stolen to pay for drugs? 10) Have you ever been arrested or in the hospital because of your drug use? 11) Have you ever overdosed on drugs? 12) Has using drugs hurt your relationships with other people?  “Yes” answers to some or all of these questions indicates the need for professional assessment and possibly further treatment.  These can be difficult questions to answer in an honest fashion.  Beyond that (and a HUGE part of the recovery process) it can be exponentially MORE difficult to discuss those life consequences with another person.  A certified/licensed addiction professional provides a non-judgemental and compassionate environment to begin addressing these patterns without recrimination or shaming.  Physicians trained in addiction medicine (board certified by ABAM or board certified in Addiction Psychiatry) can discuss medication options that facilitate the recovery process.  A combination of medical and counseling services is the most effective treatment intervention.  Seeking a treatment professional in your area is the next step.  If you are in Bucks County, PA or the surrounding area contact BioCare Recovery at 267-392-5200 for more information about addiction recovery.    

Alcohol & Marijuana: What are the Risks For Teens? How to Address Them?

by | 20. March 2015 11:09

In our January 16th 2015 blog, “Trends In Our Youth”, we discussed the  Monitoring the Future survey conducted annually by the Nat’l Institute on Drug Abuse.  Today’s article will look again to this data in addressing the hot button topic of risk; specifically how this risk applies to Alcohol & Marijuana use in teens.  CBS News addressed this topic in a recently broadcasted segment.  They posed the question “what is worse, alcohol or marijuana?”, leading them to the inverse notion about which drug is “safer”.  This is like asking “What would you rather have in your house, lead paint or asbestos?”.  I will go out on a limb that most of us would say neither.   A greater concern is that this question is being posited for debate in that fashion.  Dr. Aaron Carroll, a professor of Pediatrics at Indiana University School of Medicine, was interviewed for the CBS piece and his initial response to the question of which is safer,  is a home run.  He states, “The first answer always has to be neither.” when referring to teen safety for drinking alcohol or smoking marijuana. It is unrealistic to expect that all teens everywhere will abstain from experimenting with Alcohol or other substances.  The issue at present is how we present these developmentally common rites of passage to them.  We need to peel away some layers of this topic in order to understand it more clearly.  Experimenting with substances is a risk.  It is a disservice to our youth to present the argument solely in the form of pitting one substance versus another as measured by “danger”.  In this structure,  less attention is given to the third option: abstaining.  Adolescence is a tumultuous time in our development.  Famed psychologist Erik Erikson outlined the task of our teenage years as being characterized by developing identity versus role confusion. We have more freedom to shape our future, make decisions and examine the complexities of our personalities.  “Youth has a certain quality in a person’s life. . . Youth is a time of radical change – the great body changes accompanying puberty, the ability to search one’s own intentions & the intentions of others, the suddenly sharpened awareness of the roles society has offered for later life” (F.L. Gross 1987).  We become concerned with how we appear to others, especially peers. Teens care about how they are perceived by others.  In 2014’s Monitoring the Future survey, it showed that most 12th graders who used them obtained narcotic painkillers “for free from a friend or relative”: see the table here.  As all of these newly shaping parts of life coalesce, teens are faced with decisions that may determine important parts of their future.  It is our responsibility as informed adults to help them make these decisions with as much information as needed.  It is incumbent upon the adults to mitigate as much risk as possible.  “The problem of adolescence is one of role confusion. A reluctance to commit which may haunt a person into his mature years.  Given the right conditions. . . what may emerge is a sense of identity,  an emotional and deep awareness of who he or she is” (Richard Stevens 1983). The ‘right conditions’ speaks directly to idea of substance use.  When perceived risk is low, the likelihood to try something is higher.  Marijuana use in particular has seen a decrease in perceived risk for regular use amongst teens (check it out here MTF 2014) and has a downward trend since 1991.  Marijuana use amongst teens has increased over a five year period amongst 10th graders.   The opposite has been true for alcohol use amongst teens.   Parents play a critical role.  Talking with their teens and parenting them can help shepherd a teen through some of the more difficult aspects of adolescence.  It is important to have a measured approach; to help a teenager make informed decisions.  Fear mongering or, in the opposite case, dismissal of real risk presents a continuum wherein we try to find balance when educating teenagers.  There are lots of resources to continue finding information about how to address these (sometimes uncomfortable) topics.  For Bucks County residents and the surrounding greater Philadelphia region, your children’s schools will have educators dedicated specifically to this via their Student Assistance Programs.  Find out more through the Council of Southeast PA.  BioCare Recovery also takes an active role and offers free consultation for anyone seeking information about treatment options or addiction topics in general.

Defining & Measuring Alcohol Intake: High Risk Versus Low Risk Drinking

by | 26. February 2015 11:14

Alcohol is a legal drug.  It is marketed, sold and packaged in a fashion that emphasizes it’s useful qualities.  All alcohol advertisements add the phrase “please drink responsibly” at the end of their selling points.  What is “responsible drinking” though? This is a subjective phrase that depends on interpretation of the drinker, their social network/drinking companions and context of the environment where drinking occurs.  We tend be more socially accepting of heavier drinking in bars, at parties, during concert & sporting events, at weddings and on some holidays.  We are mostly indoctrinated with the notion that getting drunk alone is a red flag for problem drinking, but this is an extreme end of the alcohol use spectrum.  The damage cause by alcohol consumption is generally realized in less obvious circumstances.   There is a blurry line between less harmful social/recreational drinking & harmful ‘irresponsible’ drinking.  Determining whether alcohol is pathological problem in someone’s life can be a murky task.  With alcoholism, as with other substance use disorders, hindsight is 20/20.  The development of a pathological problems has sewn its seeds under camouflage of the aforementioned socially acceptable, heavier drinking scenarios.  In alcohol treatment, one of the more pragmatic measures is determining how much a person is drinking and how often.  This is a starting point.  A precursor to that is defining, recognizing and understanding what a defines a ‘standard drink’.  There is a scientifically accepted measure for that (What Is A Standard Drink?).  Oftentimes in the course of alcohol abuse, an individual’s personal interpretation of a standard drink begins to inflate and inversely they report having “less drinks” per day.  Self-assessment can be aided by clear parameters for measuring alcohol intake and what defines riskier drinking. The National Institute on Alcohol Abuse & Alcoholism (NIAAA) provides very clear explanations of alcohol intake.  Check out their information on Defining Levels Defined


by | 13. February 2015 11:18

Addiction treatment is evolving.  This is a difficult process; older methods & interventions have been effective for millions of people.  This creates a dilemma.  For some, older “tried and true” methods can been seen as “the only way” or “the best way” to conquer addiction.  It creates skepticism, doubt and ignorance of newer methods for treating the disease.  Why does this happen?  That is for a longer and more open discussion.  Getting right to the point, there ARE numerous pathways to recovery.  It is cannibalistic for one effective paradigm to dismiss another simply on bias or because it is different from older ways. In EVERY OTHER area of health care we EMBRACE forward leaps & innovation.  Medication assisted treatment and counseling are firmly on the scene for substance abuse treatment.  They have a definitively valuable place on the “Mount Rushmore” of the battle against addiction.  Integration of effective resources is part of the solution; this means pooling the strengths from various different modalities rather than puffing out our chests and proclaiming that each of our respective approaches, program or ideologies is superior.  There is no skeleton key for opening up recovery to a person. Collaboration is key.  The Delaware Valley is a hotbed for addiction treatment.  There are many options available @ all levels of care in Bucks, Montgomery, Delaware, Chester & Philadelphia counties.  Check out some of the options available in this press release from NCADD, here

A Family Disease

by | 06. February 2015 11:20

“However bad life may seem there is always something you can do and succeed at. While there’s life, there is hope” — Stephen Hawking 2006. Addiction is a family disease.  The affliction alters reasoning, judgement, emotional stability & decision-making —- for loved ones.  Countless time is spent researching the effects of addiction on drug users yet, perhaps, not enough consistent attention to the family’s needs.  The landscape is not completely barren.  There is plenty of support and information out there.   Most families have been introduced to Al-Anon/Nar-Anon in some way or other support resources.  In my experiences as a counselor,  I have (subjectively) observed a parallel process: substance abusers difficulty seeking peer support and family members resistance to seeking consistent external support.  It is difficult to ask for help, for anyone.  The consequences of addiction are draining, crippling.  These consequences make us vulnerable and a loved one may find themselves making decisions based on immediate emotional reactions (anger, disgust, fear).  Just as a person in a active addiction may act on the desperation to sustain/protect their drug use so will a family member (parent, sibling, grandparent, spouse, significant other etc) defer to self-protective instincts.  There is continuum of support: on one end of the extreme is “Neglect” and at the other end is “Overprotect”.  When we “wash our hands of someone”, it is indicative of the ‘neglect’ end of the spectrum.  When we “helicopter” over someone’s recovery, we are leaning towards the ‘overprotect’ part of the spectrum.  Balance & self-care are paramount.  Seeing a loved one succumb to addiction obliterates attention towards self-care and balance. It can be like navigating a minefield trying to find that balance, knowing when to maintain self-care and not martyr oneself in an effort to ‘save’ the substance using person.  Families need support, sometimes counseling and guidance AS MUCH as their loved one.  The addicted person may seek treatment; often overlooked is that the closest loved ones need to engage in THEIR OWN program/network of support on a consistent basis.  If we are truly supportive, it is incumbent upon us to learn as much as we can.  There are better outcomes with an open mind.  Learn from science and the experiences of others. Recovery is not an addicted person “fixing” their own self-contained problem; such a philosophy undermines the complexity of the disease.  The following article from is a beautifully told slice-of-life presenting one mother’s struggle to maintain the balance of support and self care.  This mother’s plight is easily relatable to many parents out there who have feeling like they are losing, have lost (tragically) or are fighting alongside their addicted sons/daughters.  The story has the added benefit of being in our own backyard, a situation empathized with by parents throughout the 5-County area (Philadelphia, Bucks, Chester, Montgomery & Delaware counties) Check out the story here