Behavioral Health Treatment, Overcoming Drug & Substance Abuse

Written by Dr. Rodney C Brunson

Dr. Rodney C. Brunson, D.O., FASAM, is Board Certified in both Family Medicine with Osteopathic Manipulative Therapy and Addiction Medicine. Among other things, he treats chronic pain, chronic pain medication management and maintenance of pain medications. He treats addictions from ages 16 and older and Family Adult medicine.

Drug addiction — Alcohol abuse — Alcoholic — Smoking cessation —Substance abuse

There are multiple topics under Drug Addiction treatments offered here. In my clinic, drug addiction is as important as treatment for chronic pain. That is because most opioid dependent patients have a past medical history of a painful episode where they were introduced to pain medication (and a large number at an early age). Some say when they took that first pain pill, or that first drink, it was like having a light bulb turn on in their head and they were never able to fully turn it off again. The pain pills never stopped. It’s not a cliche to say that “drugs are very destructive to persons lives and families.”

Unbelievably, everyone is affected by one person’s behavior of using drugs or alcohol. Family and friends are always very concerned about someone in their household’s use of drugs or alcohol. What I have seen in my career is that family members are at a loss as to how to help. The drug or alcohol addicted individual does not know how to ask for help in a way that will not cause more problems. Nor does the family members really know how to offer help in a way that will not alienate the affected person.

Hopefully, somewhere on this page, you will find exactly what road to take on your trip back to the real you. To eventually return to that person not dependent on taking something from your external environment to allow you to function normally internally. Everything written here will not pertain to you. So feel free to skip around to the topics that you feel may benefit you, your family or friends/loved ones. Check out my recommended book list. Most can be found on amazon.com. I have read them all and more; and as you go through treatment with me, don’t forget to ask about books that may be specific for you.

 

Services Offered:

Opioid Use Disorderheroin, fentanyl, injection of drugs, Oxycodone/Oxycontin, Kratum, Buprenorphine detox.

Stimulant Use Disorder- cocaine, methamphetamine, amphetamine, nicotine.

Pain Pill Misuse or Abuse

Sedative/Hypnotic misuse-abuse-dependencyoffering safe detox for Valium, Xanax, Klonopine.

Alcohol Use Disorder

Nicotine Addictionsmoking cessation.

BUPRENORPHINE/NALOXONE TREATMENT
SUBOXONE FILM
SUBOXONE MONTHLY INJECTION
SUBOXONE TABLET
BUPRENORPHINE PATCH

Known as Suboxone by most, Buprenorphine has been used to treat opioid addiction internationally since the 1970’s. It became another “medication assisted treatment” modality (just like methadone) in the 1990’s. Through an act of congress, it was approved as a treatment for opioid abuse and for maintenance/recovery in 2003. It took years before it took hold as a legitimate addiction treatment and believe it or not, it is widely known as a treatment for some patients and health care workers. It is called a miracle drug by some (which it isn’t) because it works so quickly. When one takes buprenorphine it relieves the suffering from opioid withdrawal. That’s right, withdrawal symptoms goes away, and usually 100%.

Furthermore, if one decides to take opioids again the buprenorphine prevents opioids from giving a reward by blocking the feeling of getting a high when taken- making taking opioid pills or heroin unenjoyable. Buprenorphine has to be taken daily, often multiple times per day. Even better, it is now offered in an injectable form. It is restricted to physician administration and is delivered directly to my office. I administer it to the patient once per month. It should be used for at least 6 months before giving that last shot. It is safe and very effective at keeping patients in recovery. Studies also show that it helps to reduce fentanyl overdoses. When it is discontinued it has been shown to have nearly zero withdrawal. Insurance approval is needed but one may pay out of pocket if not covered.

Insurances will cover for buprenorphine cost. Usually they will not pay for the required doctor’s office visits. The office visits fees are the patient’s responsibility. It comes in pill form, film form, LOZ, discs that stick to the inside of the cheeks.

Some Facts:
– Suboxone/buprenorphine is used to treat addiction.
– Suboxone/buprenorphine may be used by physicians for chronic pain off formulary.
– Suboxone/buprenorphine programs are available at your local community doctors’ offices.
– If stable in recovery, patients can be seen in office once or twice a month.
– Suboxone/ buprenorphine are covered by all insurances.
– Addiction medicine doctors can treat patients from 16 years old and up.
– There is no time limit to treat patients using buprenorphine and treatments should not be rushed.
– Buprenorphine may be taken during pregnancy.
– Buprenorphine requires a shorter stay in hospital than methadone according to studies.

Is Methadone the Answer?
In my experience working with methadone, I have found that my patients would feel a mild high from the treatment and that getting off methadone can be difficult and severe. The cost for attending the methadone clinics is not free. Treatments can cost up to $20 dollars per day which is usually paid for by Medicaid or some health insurance companies. But, if you lose your insurance, you will acquire these costs. There are also strict federal guidelines in maintaining sobriety including urine tests for the patient. I have seen patients get detoxed very quickly but are released from the clinic for failing too many urine tests or for not paying the bill. With that said, I’ve also seen some methadone clinics with an abundance of compassion and success with their patients.
Methadone doesn’t always mix well with some pharmaceuticals if not careful, one can overdose on Methadone. The drug has been around since about 1963 and can be used for treating chronic pain. Methadone studies have been shown it to decrease the spread of HCV and HIV and it can lower the number of deaths from overdose. Methadone is a good choice for treatment of chronic pain and opioid addiction. But it is not my first choice.

Some more facts about Methadone:

  • Methadone when used for addiction must be given in a federally approved clinic, daily at first then some days of the week small bottles are allowed to be taken home.
  • Methadone is not supposed to get one high. It will cause sedation if mixed other drugs or if too much is taken, you’ll become sedated, unconscious and your breathing may become affected.
  • Taking too much methadone can be fatal.
  • Usually given once daily in a heavily monitored distribution desk at a clinic- multiple times daily when taken for pain.
  • May be prescribed for chronic pain. Unlike opioid pain pills (methadone is an opioid too) there are rare ups and downs (withdrawals).
  • It is very inexpensive when using cash and great for spinal, nerve, and other pain.

 

HOW DOES THE SUBOXONE PROGRAM WORK?

Dr. Brunson accepts first substance abuse patients to WALK-IN without an appointment. Subsequent visits are by appointments. Seen by a physician the first and every visit scheduled visit. Patients are examined for general health and for physical complications of illicit substance use ( jaundice, MRSA, needle injection sites for abscess or cellulitis, heart murmur, swollen liver, nasal septal problems ) to name a few. A determination is made of the level of withdrawal the patient is in. Medication may be administered in the office or the patient can be allowed to take the medication home to get started if competent (prior use in programs can understand and follow directions.) A prescription is usually given on the first visit. Enough medication is given to stop withdrawal and to prevent it from recurring.
Patients return to the office for another urine check to assure the medications are being taken. More medications are prescribed. Signs of withdrawal are noted if any. Subsequent visits are timed based on how the patient is recovering. Usually the patient is seen by the physician monthly. The patient may suffer from a co-occurring mental / behavioral problem. This condition will need treatment. Psychiatrists are needed at this point and seen along with the addiction specialist. After the patient is stabilized they will need counseling/AA/NA group or one on one talk therapy. Pregnant women will need a high risk obstetrician. If patients do not have a primary care physician they will be offered to become a patient of Dr. Brunson in his Family Medicine clinic.

 

HOW LONG DOES THE AVERAGE PATIENT HAVE TO STAY ON BUPRENORPHINE OR SUBOXONE?

For some only few weeks, but for some it could be several years. There is a set time frame for how long to stay on MAT or buprenorphine. Dr. Brunson treats patients individually based upon their needs.

 

HOW OFTEN WILL I HAVE TO GO TO SEE THE DOCTOR?

Federal guidelines require the patients on MAT to be seen at a minimum one time per month.

 

IS IT DIFFICULT COMING OFF (DETOXING) SUBOXONE OR BUPRENORPHINE?

It can be if the detoxing or weaning part is done too rapidly. It is best to set up a plan with the physician to detox at a tolerable rate. Withdrawal should be avoided if the symptoms cannot be tolerated. Dr. Brunson usually detoxes the patient through his offices. It may take months or years. It should be attempted when the patient is READY. Not when the office personnel or family members or the insurance payers think so. That decision is between the doctor and the patient. Both have a lot at stake on the patient’s success. So the answer is “stop taking it when you are ready”.

 

HOW WILL I KNOW WHEN I DONT NEED BUPRENORPHINE ANYMORE?

“YOU WILL KNOW WHEN YOU DON’T HAVE TO ASK THE QUESTION.”

 

ALCOHOL ADDICTION (Alcohol Use Disorder)

Resources: NIH, NIAAA, ASAM, AMA.

The number of drinks, exceeding a certain number of drinks, can become severe drinking. Severe drinking should be managed by an addiction medicine physician. The specialist may tell you that you have “alcohol use disorder” AUD. The defining criteria by the DSM 5 for AUD is as follows; “ AUD is a chronic relapsing brain disease characterized by compulsive alcohol use, loss of control over alcohol use intake, and a negative emotional state when not using alcohol”.

Problem Drinking: Unhealthy drinking or binge drinking that puts your health at risk. The blood alcohol concentration goes to 0.08. To get it that high men consume about 5 drinks or more and for women 4 or more drinks in 2 hours. Binge drinkers usually do not drink daily- they could be weekly or monthly.

At risk or heavy drinking: for men it is less than four drinks daily or fourteen drinks weekly. For women less than three drinks daily or seven drinks weekly. Think that you may have a drinking problem? There are many signs of problem drinking or unhealthy drinking. If one surrenders to “what is true” he/she will get better.

sources:
www.nih.gov
www.niaaa.nwww.niaaa.nih.gov
www.asam.orwww.asam.orgwww.asam.org