The answer to this question will depend on which physician you ask. The “party line” is to tell patients to stay on Suboxone maintenance from six months to two years. However, my approach is to always tailor the answer to the individual patient. The studies show that opiate addiction has a high rate of relapse. However, this statement does not take patient individuality into account. There are different biologic, psychiatric,
CBT for Substance Use Disorders – Part III
One of the key components of CBT is the “functional analysis”. In a functional analysis, the following are identified before and after each episode of drug and alcohol use: Triggers Thoughts Feelings Behaviors Positive consequences Negative consequences A functional analysis is done together in sessions, as well as individually by the patient outside of sessions. The idea behind the functional analysis is that if patients understand their behavior, and remember
CBT for Substance Use Disorders – Part II
I teach patients that the time period in between substance craving and substance use is critical. Cravings will progress to relapse unless an intervention is made. There are a few specific CBT interventions that are used: 1.Going with the craving Many patients are surprised to learn that cravings are actually time limited. Cravings start, intensify, reach a peak intensity, decrease, then finally resolve. Understanding that cravings are time limited gives
Cognitive-Behavioral Therapy (CBT) for Substance Use Disorders – Part I
Cognitive-behavioral therapy, or CBT, can be a very effective treatment for drug and alcohol dependence. CBT is based on social learning theory. The assumption is that patients learn how to use drugs and alcohol. Because this is a learned behavior, it can eventually be “unlearned”. CBT is called cognitive therapy because that is exactly what it is – patients think their way out of cravings and potential substance use with
Opioid Agonist Therapy
My opinion is that the ultimate is to be able to stay abstinent without any medication. However, this is not always possible. In general, by the time patients come to see me, they have been unable to maintain any consistent sobriety, if any, on their own. Fortunately, there are now more medications than ever to help patients stay abstinent. Patients who abuse opioids eventually develop tolerance (need more of the
Inpatient Opioid Detoxification – Part II
Some patients elect to do what is called a “non-opioid” detoxification. This can be accomplished as an outpatient as well as via inpatient opioid detoxification. Just like it sounds, with this type of treatment, opioids are not used to taper the patient off of their opioid of abuse. Instead, the patient stops “cold turkey”, and the withdrawal symptoms are managed with symptomatic medications (as discussed in the “Outpatient Opioid Detoxification”
Inpatient Opioid Detoxification – Part I
Blogging on hurricane day in New York City. There are actually three different ways to taper off of opioids: 1. Suboxone taper (discussed in the previous blog) 2. Methadone taper 3. Non-opioid detoxification Most people know methadone as the medication that is given at a clinic as a daily dose for opioid dependence. However, it is also used for inpatient opioid detoxification. It is illegal to use methadone for outpatient
Outpatient Opioid Detoxification
In drug and alcohol detoxification, a medication is given that is the same or similar to the drug being abused. The initial dose is tapered up until withdrawal symptoms are alleviated. The medication is then given in tapering doses down over a specified period of time. Suboxone is a unique opioid that is used for outpatient detoxification. Suboxone only partially stimulates the opioid receptor – i.e. it is a “partial
Opioid Withdrawal
Opioids are the category of drugs that include Heroin, Percocet, Oxycontin, Vicodin, Lortab, Tylenol with Codeine, and Ultram. Technically speaking, Ultram is not an opioid. The pharmaceutical companies developed and marketed Ultram as a non-narcotic alternative to the other drugs mentioned. However, it does act at the opioid mu receptor. I see patients that abuse Ultram and become addicted to it. Symptoms and signs of opioid withdrawal, ranging from mild
What is Medical Detoxification from Drugs and Alcohol?
Detoxification is medically supervised withdrawal. Alcohol and many drugs have a characteristic withdrawal syndrome – i.e. – a characteristic set of signs and symptoms – that develop when the substance is taken away. Withdrawal symptoms can range from uncomfortable to life threatening. In medical detoxification, a drug that is the same or similar to the one being abused is started at a high milligram dose, then gradually tapered down to