Video: By Ted Salin, 10 minutes
Part 2: 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.
He strives to find the best way to make the process as effective as possible to achieve a higher percentage of those who make it through detox and onto recovery and beyond. I like that he adjusts his techniques and treatment plans to fit the patient and strives for the best outcomes and maintaining an open mind with new and traditional approaches which inspires me to be the same way.
So while I don’t “endorse” here on Emotionally Naked, like you I want answers and I specifically reached out to Dr. Coleman for this video.
AM= Anne Moss, DC= Dr. Coleman, MAT=Medically Assisted Treatment, VIVITROL®= naltrexone (generic name), benzos= benzodiazepines (e.g. xanax, valium)
AM – Hi, this is Anne Moss Rogers from Emotionally Naked and today we’re back with Dr. Coleman from the Coleman Institute.
AM– I’ve read a lot about medication assisted treatment (MAT) and if you could comment on that as it relates to 18 and under, or 25 and above.
DC– Sure, so medication assisted treatment (MAT) basically is a term where we used medication to help recovery rates and in the past, we know that when people don’t use medication, they relapse almost always.
So one study that I saw showed a study with 124 people who went into treatment, into a hospital, for opiate dependence, heroin or methadone or something like that and they wanted to get clean, and after three months, only four of them were still clean.
So 97% of people have failed within three months and a lot inpatient rehabs are seeing the same kind of things– where they have somebody for 28 days and then almost as soon as they get out, they’re back using again. So methadone started to be used in the seventies as a medication assisted treatment to give people a stable medicine so that they wouldn’t relapse back to street drugs and it’s a good treatment for the right person. I recommend it to a number of people.
Suboxone became available around 2002 and that’s similar to methadone, it’s an agonist, so it actually is an addictive drug but it’s very long acting and it doesn’t really get you high because instead of going up and down like heroin or short acting drugs, it’s just long acting so people can function on it, get jobs, have relationships, and all of those things and it’s an effective drug that you can see your doctor once a month and stay on a stable dose.
We specialize in naltrexone which is third type of medication assisted treatment because it blocks the receptors completely so it’s non-addictive and it lowers…. it stops cravings most of the time because it’s this long acting version or one month for the VIVITROL®, or a two month for the implant. So some kind of medication assisted treatment is necessary.
The one we used, naltrexone, we prefer provided the patient is willing to really work a recovery program because if they don’t come back for the next implant, or if they don’t come back for the next VIVITROL, they can relapse and then they can overdose because they don’t have any protection. Whereas on suboxone or methadone, their receptors are already full of an opiate and so if they relapse they don’t usually have an overdose, it’s not good– but they can get back on track a little bit easier.
AM– Okay, well, has anybody ever gone from either the methadone or the suboxone to the VIVITROL?
DC– We do it all the time, that’s 20% of what we do… is people who the suboxone’s worked well for, so maybe they haven’t used any street drugs now for a year or two, they’re going to their 12-step meetings, they are in counseling, they’ve got a job, they’re in a good relationship, they’re ready to get off the suboxone, and we then will get them off that and put them on the naltrexone.
It’s a great way to do a transition from the agonist treatment to the naltrexone treatment.
AM- So that could be two years or more?
DC – It’s a long-standing drug, it’s a long-standing disease, I mean, this is what we call a chronic disease and relapse can happen any time and so we wanna use our medication assisted treatment (MAT) long enough until the patient’s really changed. They need to be different than the person they were when they were actively using.
AM– How would you approach an 18 year old differently?
DC – Well, the problem as we said with people who are under 25, and particularly under 21, is that they’re emotionally immature and they don’t have much wisdom, they don’t have good thinking ability so a lot of times they’re better off to be on a suboxone type of drug or a methadone drug so that they can grow up– so that they can stay safe long enough to grow up and learn what they want out of life, maybe get into a college or get into, you know, some kind of career and get the therapy so they can learn how to be more emotionally mature and then they’re ready for the naltrexone.
So that’s not always true but it tends to be a little bit more effective that way because if we try to put someone who’s really not that serious about recovery on naltrexone they usually fail or they frequently fail so it’s partly about motivation. If they’re really motivated and willing to really do the work necessary, then they’re ready for full abstinence and be on naltrexone.
AM – And they’re usually not mature enough for that step?
DC– Some are but frequently they’re not if they’re under 21.
AM– Erica would like to know your opinion on benzodiazepine and when it’s appropriate and not appropriate when there’s a history of alcohol abuse.
DC– So benzodiazepines is the class of drug that of course Xanax, Valium, Klonopin, and Ativan. Also the sleeping medicines, Ambien, are kind of in that kind of class as well.
They’re sedative drugs so they’re an anxiolytic, so they just calm down your anxiety but they do that by attaching to the receptors in the brain that your brain naturally uses to calm yourself down so they’re highly addictive. When people start taking Xanax, they very quickly get dependent on them and then they start having withdrawal symptoms ’cause their brain’s not making its own natural calming down benzodiazepine.
AM– So then it’s a crutch?
DC– It’s worse than a crutch because you’re physically dependent on it and then you need it. So there’s sort of two main problems. One, is that your brain stops making it so you’re now dependent on it and the second is by calming down the natural anxiety, you’re again aren’t feeling your true emotions and so you’re not growing and you’re not changing and you’re not able to deal with the stress that was causing the anxiety in the first place. You know, the key to emotional health is feeling your feelings, like you said earlier, and then learning how to dispute the abnormal tapes or the messages or change the things in your lifestyle so that you’re not feeling anxious anymore.
You know, if someone comes home from work and they’re stressed out and, you know, they wanna take a Xanax because their boss is making them mad, well taking the Xanax might make you feel better short term but it doesn’t change the fact that your boss is making you mad, you know, you need to feel that emotion and then change something, either talk to the boss or change your job or just change your attitude about it.
So, you know, benzos are not helpful. When somebody has a substance abuse problem it’s even worse because their brain is biologically predisposed to becoming addicted to drugs and if they’ve been addicted to alcohol or cocaine or other drugs, then any of the benzodiazepines are just another addiction so it’s just really switching one addiction for another.
AM– Do you see that a lot, people switching one addiction for another?
DC– We see it all the time, you know, people don’t get the idea that chemical dependency is the problem. The real problem is that some people, about 10% of the population, are born with a pleasure center that’s a little deficient in dopamine is the best way we think about it and so when they take an addictive drug that releases dopamine, they really like the feeling. It gives them stronger effect than a regular person and so they keep doing it over and over and if they stop, you know, doing alcohol but they use benzos, they’re just in as bad shape. If they stop heroin, but they use cocaine, they’re no better off. They need to learn how to be abstinent and off all drugs and get on with their life and learn how to deal with reality.
AM– Do you detox people off alcohol? And if you do, do you do a medically assisted treatment after that drug as well?
DC– We’ve been detoxing people off alcohol for 20 years. The truth is young people don’t usually need detox off alcohol because physical dependence gets worse and worse as people get older, their tolerance gets worse, and their body doesn’t tolerate the alcohol as much so we tend to do alcohol detoxes on people over 35 or 40.
It’s a great detox, we usually do that in three days. At the end of that we usually put people on VIVITROL or naltrexone implants as well because it turns out that alcohol works through the same opiate receptors as heroin does. When we use VIVITROL or naltrexone, it takes the cravings for the alcohol away and it takes the pleasure that they get from drinking alcohol away so people can get into recovery and stay in recovery much better.
AM– Do you ever utilize anything like antabuse?
DC– We do use Antabuse quite a lot, yeah, again Antabuse is a great drug, especially in the first month or two when people’s cravings are high and you can have them take this drug that gives them two or three days where they just can’t drink at all because they’ll get deathly ill so it’s a nice way to sort of interrupt the pattern of their drinking every day every time they have a craving.
AM– Makes sense.
DC– So, yeah, we use that a lot.
AM– Well, I think that we’ve learned a lot today, Dr. Coleman, especially from a professional that’s been doing it 20 years. So I want tell you how much I appreciate your participation today and Anne Moss Rogers and Dr. Peter Coleman from Emotionally Naked. – Thank you.
Part 1 Interview: Dr. Peter Coleman on Addiction Detox and Recovery