- Video: By Ted Salins
- Interview Part 2: Dr. Peter Coleman on Addiction MAT and Recovery
Anne Moss Rogers of Emotionally Naked interviews Dr. Peter Coleman, National Medical Director of The Coleman Institute and a person in long-term recovery. Although he obviously runs a business, I trust Dr. Coleman and his knowledge of addiction detox and recovery which he has been doing since 1984. He has true compassion for those with Substance Use Disorder.
So while I don’t “endorse” here on Emotionally Naked, I will choose article writers and interview candidates that are more knowledgeable than I am to help you find answers when you are wondering what to do for your son, your daughter or other loved one. I specifically reached out to Dr. Coleman to help all of us find answers so you can make a more informed decision on what to do for your child or loved one.
I found the part about MAT, Medically Assisted Treatment, for those under 21 to be especially enlightening. That’s what we should have done for Charles. But it’s unlikely I was to come up with that solution on my last phone call in 2015.
AM= Anne Moss, DC= Dr. Coleman, MAT=Medically Assisted Treatment, VIVITROL®= naltrexone (generic name)
AM– – Hi, I’m Anne Moss Rogers from Emotionally Naked and today I am talking to Dr. Coleman of the Coleman Institute.
AM-Coleman could you tell us a little about yourself and how the institute works?
PC– Well thanks Anne Moss. So I’m Dr. Peter Coleman and I’m the National Medical Director here at the Coleman Institute and for about twenty years now we’ve been specializing in helping people who have opiate problems. You know, back in the late nineties, heroin started to become a pretty big problem and it’s just gotten worse and worse and worse. And we’re in the midst of a crisis now where there’s over 120 people dying every day of opiate overdose,
AM– Oh my gosh
PC– It’s a horrible situation and it’s getting worse partly now because Fentanyl is being mixed with heroin so this is a drug that’s fifty times stronger than heroin even, which is so dangerous that so many people overdose and Fentanyl is so much stronger and it’s just a horrible setup for people to kill themselves by trying to get high.
AM– Yeah. ‘Cause when people are addicted to alcohol, which I believe is still the number one addiction.
AM– It’s like they have more opportunities to live than they do with opiates. And that’s what’s so frightening, I think, to parents.
PC– Yeah, well opiates are so physically addictive that within two or three weeks of trying it, sometimes even sooner, the people are physically dependent. They’ve got to have the drug every day. And then their tolerance goes up and they need more and more and the difference between the dose that gives them a good feeling and a good effect or even relieves withdrawal, and the dose that kills you is very narrow. It has what we call a narrow therapeutic index. So, it’s very easy to accidentally take too much and die.
But even if they don’t die, they live a miserable life by having to be a slave to the drug all day, every day. They’re thinking about where they’re going to get it and what they have to do to get it and they wanna stop but they don’t know how to stop and trying to stop leads to horrible withdrawal symptoms so most people just can’t stand it.
Here at the Coleman Institute, we have developed a very successful way of getting people through the detox off opiates. So trying to get off heroin or any of the opiates, like Oxycontin, is so painful that most people just can’t do it. Even if they go in a hospital and have nurses and doctors giving them medicine, about 25% of people will run away and not complete the detox.
And we’ve developed an outpatient program where usually in three or four days we’re able to use comfort meds and a sort of a thing called micro dose Naltrexone * to actually speed the detox up and make it more comfortable and more successful and we get 98% of our patients through the detox and onto Naltrexone.
And Naltrexone’s a blocking drug, so it goes to the same receptors as the heroin or the Oxycontin, any of the opiates, and blocks the receptor, so usually people have no cravings and they feel good and they can get on with their life. They can start participating in therapy, they can go to support groups and they feel like they’ve got their life back.
We actually have a long-acting version of Naltrexone called an Naltrexone implant and now there’s a one-month injection called VIVITROL® that we use and so that goes into the patient and they lose their cravings for an extended period of time so they can really get on with their life and learn how to actually stay in recovery long-term.
AM– How long does the implant last?
PC– So the implant lasts two months and the VIVITROL shot lasts one month.
AM– Okay, do you see any difference in efficacy between the two?
PC– We find the implant lasts, actually works a little bit better. We think it’s because it lasts longer. You know, cravings, to want to go back and try the drug again has a lot to do with the access to the drug.
So, cigarette smoker, for instance might not be thinking about, if they’ve quit, they might not be thinking about having a cigarette until they realize there’s some available. Maybe they’re at a party, they smell it, or they see somebody smoking, and then if it’s available they feel like, oh boy I think I might have one. Well, opiates are sort of the same thing.
So, when you’ve got a two-month implant in for the first seven weeks, you just know there’s no point in trying it. And so people stop thinking about it and they kind of get on with their life.
AM– Well, after that wears off, do you have another solution after that ?[after naltrexone/VIVITROL]
PC– We recommend that they stay on implants or VIVITROL® for at least twelve months because it takes at least that long for the brain to heal and for the behaviors to start changing.
I mean, the implant and the VIVITROL are just crutches to help people be able to stay off the drugs long enough to be able to make the emotional changes, learn how to deal with stress and with boredom and loneliness and all the other emotions. To learn how to deal with changing your friends so you’re not hanging around with people who are still doing drugs and might tempt you and lead you back. To get on with your life, maybe with career and relationships and things like that.
So, it’s just a start in allowing people to really work a recovery program, to build up your support systems and stuff like that.
AM– I have a question from one of my readers named Emily. And she wants to know the most helpful approach from families and friends to take for those with severe and ongoing addictions.
PC– Boy, this is a question that I know you get pretty much every day and I get every day because the disease that affects the patients that are so affected by the drug affects everybody around them.
I mean, I just can’t imagine how terrifying it is to know that your kid is using heroin and every single night they’re out using again and you try getting them into treatment and they don’t wanna go. And, you know, you just live in fear that something horrible is gonna happen.
PC– It’s a horrible situation and the families need a lot of support. So, I think the answer is that the families need to get help. They need to learn as much as they can about the addiction and about recovery. They need ongoing support through twelve-step meetings, through therapy, through church, through advisors, because each day is a different day.
There are some days when you have to say no to your child, I’m not gonna lend you any money. And other days you wanna say yes to your child, let’s go to treatment. You have to be ready to deal with the emotional backlash because the patient with the addiction is often angry, they’re frustrated, they’re not thinking right. Their brain is affected by the drugs and so sometimes you can’t have a coherent conversation.
AM– Do you find that families that are more well-educated are able to, do they have better outcomes? Or are they just able to manage?
PC– Of course. The more you can learn and the more support you can get, the better. It’s just like dealing with a child that’s five-years-old. I mean, they don’t really know what they’re doing and so your job as a parent is to try to set boundaries and sometimes that means saying no to them. It always means loving them.
It always means, you know, being willing to extend a hand in saying, we’re here for you when you want help. We won’t ever abandon you. Tough love comes up a lot. And it’s a really difficult thing to know when to say no, I’m not gonna pay for that or I’m gonna let you go to jail and suffer the consequence of what you do.
Sometimes that’s the absolute right thing to do. It allows the patient to get detoxed and start thinking more clearly and really evaluate whether they are ready to change.
AM– What I’ve noticed is that I think that people who are using really aren’t themselves.
PC– They’re not.
AM– And so parents are reacting emotionally to that behavior when I really feel like they need to not be emotional but it’s so hard because it’s your child.
PC– It’s so hard because they look like they’re talking sensibly and they’re making sense. And to the person with the addiction, they feel like they’re making sense. It’s a little bit like talking, we all know talking to a drunk person who’s really drunk is of no use at all because they’re not being sensible. Well, opiates and other drugs affect the thinking in similar ways. Not quite as dramatically but the person with the addiction, they’re not thinking clearly.
They’re not really able to evaluate the true consequences of their behavior. They’re not able to evaluate risk and what’s a sensible decision and what’s not. They think they know it all and they often make horrible mistakes and you have to pick and when you choose to talk to them. And that’s why the support comes in because sometimes you’ve got to say things to them that you don’t want to say.
AM– What about kids, maybe under eighteen or nineteen, with substance use disorder? Do you treat them differently than you do those who are a little older?
PC– The principles are kind of the same. But you have to recognize that the younger the child is and the sooner they started the drug use, the more emotionally immature they are, the less wisdom they have, the less understanding they have of what’s a good risk or what’s a reasonable approach and being able to make good, healthy decisions.
You know, we know the brain doesn’t fully mature until age 25 and so anybody under the age of 25 just isn’t operating with a full deck. They think they are. You know, we all thought we were when we were that age but the truth is as we get older we see the world a lot more clearly of how it really works.
AM– Well, I think they’ve had the opportunity to mature and develop those executive functions and I think that doing drugs takes away that ability.
PC– It stunts it dramatically. These are mood-altering drugs and the way we mature and grow up is by feeling our emotions. We feel loneliness, we feel boredom. We feel frustration and anger and anxiety. We’re supposed to feel those things. We’re supposed to feel them as naturally as we can so that we can then use the frontal lobe of our brain to then process that and figure out, okay, what does that mean? What do I do? How do I change my behaviors, how do I grow up?
And if you’re smoking pot all day long or if you’re doing drugs all day long, you don’t process that well and so you don’t learn from your mistakes and from experience.
AM– I’ve always said to a lot of people, you can’t heal if you can’t feel. So, you’re feelings are important because they drive the behavior to make that change.
PC– They allow you to evaluate and make choices.