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Tuesday, February 1, 2011

Celebrity Rehab and Opioid Dependency


Let's get straight to the question -- What do we really know about addicted celebrities and their drug rehabilitation?

We all are very familiar with the basic media drill. First, the media spices the luminary news "pot" with a lurid story of a celebrity acting badly with embarrassing photographs, angry phone calls, revealing film clips, etc. This is, of course, done to spike public interest and grease gossip blogs. "To get the ball rolling" is the cliche that comes to mind.


Then, the celebrity’s agent, manager, and PR person jump into gear to “fix” the situation. Thus, statements such as “She knows she has a problem so she’s going to rehab" or “He’s under a lot of stress, but he is now dealing with the problem” emerge. A lame analogy may be the weathered plant that merely needs re-nourished. The "fix" is often accompanied by a public statement by the celebrity either affirming guilt or applying blame followed by the obligatory entry into some form of rehabilitation.

Then, the slow spin begins rather quietly, but if that celebrity is not ready for treatment, if he has not truly hit bottom, he will be back in the spotlight again a few months later, usually far worse off than he was before because the rehab did not work. Often the stay was short, and no miracle cure took effect.

Due to the nature of the circus of media fascination with celebrities in trouble the "good" treatment stories go unnoticed. The rich and famous getting clean is not big news. The media dwells on celebrities who have entered rehab and failed to conquer their addictions. So, the stories about these rehabs are full of distortions and misinformation. They are described as spas or mere temporary safe havens from the media spotlight. In truth, most of these rehabs have high quality, intensive clinical programs and they have successfully treated thousands of people.

Although many of these so-called "celebrity rehabs" have scores of positive stories of success, HIPPA and related federal regulations prevent them from telling those stories. Anyone following stories by the misinformed would be surprised to discover that the positive rehabilitation results far outweigh the negative. Rehabs don't stay in business because they have celebrity clients. No such thing as a "celebrity rehab" really exists. ("The Myth of Celebrity Rehab," www.everythingaddiction.com, August 9 2009)

Everyone should reach a basic realization: addiction is a progressive disease that requires intervention and intensive treatment as well as a long-term plan of recovery to be successfully overcome. Unfortunately, not all addicts and come to terms with their dependency and do what is necessary to get clean and sober.

Effective drug rehabilitation confronts drug addiction as it actually exists, in every form and on every front. Since drug abuse is the product of both physical and psychological factors, chronic addicts are sick in both mind and body. The obvious corollary, of course, is that drug abuse rehabilitation programs must aim to effect both physical and psychological healing. Anything less couldn’t ever qualify as drug abuse rehabilitation in the first place. ("The Myth of Celebrity Rehab," www.everythingaddiction.com, August 9 2009)


Nora D. Volkow, M.D.,  the director of the National Institute on Drug Abuse (NIDA), has been instrumental in demonstrating that drug addiction is a disease of the human brain. She was the first to use imaging to investigate the neurochemical changes in the brain that occur during drug addiction. Her studies have documented a decrease in function of the dopamine system in addicted subjects that is associated with a disruption in function of frontal brain regions involved in motivation and drive.

Dr. Volkow has published more than 355 peer-reviewed articles and more than 60 book chapters and non- peer reviewed manuscripts. She was named as one of "20 People to Watch" by Newsweek magazine in its "Who's Next in 2007" feature and was named "Innovator of the Year" by U.S. News & World Report in 2000. Volkow writes the following concerning drug rehabilitation:

"'Rehab' is a commonly used term that can refer to a range of drug treatment options. Teens who read about celebrities checking into residential drug treatment centers--places that look a lot like five-star resorts--may have a glamorized view of drug addiction and treatment for drug addiction. Teens may not 'get' the severity of drug addiction. If they do understand how serious drug addiction is, then they may not know where to get help. Untreated drug addiction presents the risk of serious problems within families and communities, including violence, crime, health emergencies, child abuse, and unemployment."

The drug addiction treatment that matters is rehab that helps addicts get better. Recovery, in the end, is the only viable goal, and the only acceptable outcome of any drug rehab program is sobriety that lasts. Addicts can not get better without help. Drug addictions never die easily, so the addict must seek the best care available.

Two distinct studies conducted by the National Institute on Drug Abuse support research that shows relapse rates are higher for people who receive short-term treatment. The findings show that people who receive treatment for 90 days or longer are less likely to revert to their previous abusive habits.

Some other interesting points:

-  “Treatment programs of 28 or 30 days are still common. But this template was never based on medical evidence," says Dr. David Lewis, Malibu's Visions medical director. "30-day stays were scheduled for bureaucratic reasons -- men and women didn't need to be reassigned if they were away from duty for no more than 30 days. Other treatment centers followed suit, and insurers adopted the standard of 28 or 30 days of inpatient care." (Shari Roan, "The 30-Day Myth," The Los Angeles Times, November 10 2008)

- “Brain scans of recovering addicts support the idea that changes are still taking place three months or more after treatment. Chronic drug use damages the brain, such as reducing the number of dopamine receptors, chemical pathways that allow for normal brain functioning. Changes in the brain during recovery correlate to clearer thinking and more honesty on the part of the patient” – Dr. Harry Haroutunian.(Ronald J Cala II, drugandalcoholrehableaders.blogspot.com, November 13 2008)

- After release from imprisonment many addicts return to drugs and/or alcohol. This supports the idea that it isn’t just abstinence that helps people recover. The U.S. Office of National Drug Control Policy estimated that while some form of treatment was available in 90 percent of the correctional facilities examined, only 10 to 20 percent of inmates used these programs.

-According to Kathryn E. McCollister, Ph.D., and researchers at the University of Miami (2004), a number of studies concluded that providing substance abuse treatment to offenders only while they are incarcerated is not effective in rehabilitating them. These studies showed that offenders receiving in-prison treatment without formal aftercare (continuing treatment after they leave prison) had recidivism and drug relapse rates similar to offenders who did not receive any treatment. (Robert Wood Johnson Foundation’s National Substance Abuse Policy Research Program)


Rehabilitation For Opioid Addiction 

Opioids are narcotic drugs that are generally prescribed to manage pain.Many of these drugs are habit-forming and physical dependence may lead to withdrawal side effects when the medication is stopped. Because of the potential habit-forming nature of these drugs most prescriptions cannot be refilled and a new prescription must be obtained after each preceding prescription runs out.

The many different opioids include natural opioids such as morphine, (heroin is easily made from morphine) and codeine; semi-synthetic opioids such as oxycodone, oxymorphone, hydrocodone, and hydromorphone; and fully synthetic opioids such as methadone, fentanyl, and pethidine. 

 
A. The Severity of Opioid Wave
 
Opioid dependence is widespread (much more common than most people think) It is estimated that more than 1.6 million people in the US are dependent on painkillers and other opioids. Opioid dependence affects men and women of all ages, races, ethnic groups, and educational levels. According to the National Survey on Drug Use and Health (NSDUH):
  • An estimated 5.2 million people aged 12 and older misused prescription painkillers in 2007
  • More than 33 million people aged 12 and older had misused pain relievers in their lifetime
  • Approximately 153,000 people used heroin in 2007
Opioid dependence can happen to anyone—a friend, a neighbor, a co-worker, a spouse, a brother, sister, or parent. Yet a recent national survey, Prescription Painkiller/Heroin Addiction; Its Treatment, found that nearly half of the public is unaware that misusing opioid prescription painkillers is as harmful as abusing heroin.

Fortunately, as more people come to understand that opioid dependency is a medical condition, more people are getting treatment.

B. How Opioids Work

When people use opioids, their brains gradually get used to the drug and become less sensitive to it. As a result, they need more of the drug to achieve the desired effects. This is called tolerance, and is part of being physically dependent.

People who are psychologically dependent may continue to use a drug despite serious negative effects on their lives. Psychological dependence can reach the point where people have uncontrollable cravings for the drug—and are willing to take significant risks to obtain it, regardless of the harmful consequences to themselves, their families, their jobs, or their community.

Opioid misuse can reset the brain’s chemistry to think the drug is necessary for survival. When a person's brain tells him that he can’t live without a drug, dependency can quickly lead to compulsive drug-seeking behavior. The World Health Organization and the National Institute on Drug Abuse have defined dependence on opioids—prescription painkillers and heroin—as a long-term brain disease.

Opioid dependence can be treated effectively with medication-assisted treatment combined with proper counseling. Dependency demands treatment. Shame or stigma often keep people from getting the help they need. People with other chronic medical conditions such as diabetes, high blood pressure, and asthma also benefit from medical treatment combined with behavioral changes, so, logically, the same may be said of those suffering with the disease of opioid dependency.Only knowledgeable, trained physicians can administer the most successful programs.

Opioid dependence is more than a physical condition. Emotions and behavior are also part of the problem—which is why counseling is such an important part of treatment.

C. The Path of Opioid Dependency

According to Reckitt Benckiser Healthcare, people who become opioid dependent often move along a path that can look like this:
  1. Medical or recreational drug use
  2. Relief of pain, with heightened feelings of pleasure
  3. Repeated drug use
  4. Changes in the brain
  5. Cravings and symptoms of withdrawal when drug is absent
  6. Inappropriate drug use to end withdrawal symptoms and/or to seek pleasure
  7. Drug dependence
D. Some Initial Questions For Those Who May Be Dependent

This may be helpful for self-analysis; however, a medical doctor should be consulted when the first signs of dependency occur.These questions refer to the past 12 months:
  1. Have you used drugs other than those needed for medical reasons?
    Yes No
  2. Do you misuse more than one drug at a time?
    Yes No
  3. Are you always able to stop using drugs?
    Yes No
  4. Have you ever had blackouts or flashbacks as a result of drug use?
    Yes No
  5. Do you ever feel bad or guilty about your drug use?
    Yes No
  6. Does your spouse (or your parents) ever complain about your involvement with drugs?
    Yes No
  7. Have you neglected your family because of your use of drugs?
    Yes No
  8. Have you engaged in illegal activities in order to obtain drugs?
    Yes No
  9. Have you ever experienced withdrawal symptoms (felt sick) when you stopped taking drugs?
    Yes No
  10. Have you had medical problems as a result of your drug use (such as memory loss, hepatitis, convulsions, bleeding)?
    Yes No 
     
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