AKSHAV!

“IF I AM NOT FOR MYSELF, WHO WILL BE FOR ME? AND IF I AM ONLY FOR MYSELF, WHAT AM I? AND IF NOT NOW, WHEN?”  - HILLEL 80 BCE

AKSHAV = HEBREW FOR URGENTLY NOW!


I AM AN ADDICT/ALCOHOLIC, WHAT CAN I DO TO HELP MYSELF NOW?

  • Tell someone I need help: parents, spouse, doctor, clean and sober friend, peace officer
  • Contact the number on insurance card for “member services, behavioral health mental health”
  • Call 211 for information about behavioral health in your community
  • Try out a self help group: live meetings, information on a website, phone meetings, internet meetings
    • 12 step: NA, AA, OA
    • Refuge Recovery
    • Lifering
    • Celebrate Recovery
    • SMART recovery
    • Women in Recovery
  • get a naloxone kit in case of accidental overdose at any pharmacy, methadone clinic. No Rx needed
  • get clean needles at needle exchange. Available at the county
  • use your smart phone for recovery, too: Sober Grid, Cassava SM, Sober Tool, Recoverize.com
  • Be honest with your doctor, therapist etc even if you are not ready to change yet
  • register to vote and VOTE get information at any post office, mail in ballot online or even apps on your phone
  • small things to maintain myself while using/getting help
    • take a multivitamin, B complex, Vitamin D, Magnesium
    • eat as much real food as possible especially protein and fruit and vegetables
    • drink an extra glass of water first thing every day
    • write down 5 things you are grateful for with pen and paper every day
    • say please and thank you and little things to help others like holding a door open
    • call someone you care about to just let them now you are ok right now 
    • 1 minute meditation: breathe in for a count of 4 hold it out for count of 4 hold it do 5 times
    • take your regular prescription medication even if you are using
    • put with wallet a list of emergency phone numbers and a list of drugs you abuse
    • copy of your ID and insurance info with a loved one
    • ID bracelet
    • Join YoungPeopleinRecovery.org It is an advocacy group to help build transitional housing, vocation and educational resources as well as support for those with addiction and their loved ones.  We are building a chapter in Santa Cruz as we speak

I AM SOMEONE WHO CARES ABOUT AN ADDICT/ALCOHOLIC WHAT CAN I DO TO HELP THEM NOW?

  • Believe there IS HOPE
  • Tell them you love them no matter what, seriously
  • Go to Al-anon yourself
  • Understand that Addiction is a chronic disease similar to cancer, diabetes or heart disease and requires some basic elements that are unique
    • compassion – no judgement
    • the medical field does NOT have many conventional tools like chemotherapy or insulin and we are just figuring out how to manage the disease
    • It is a complex problem that includes physical craving, poor choices, unhealthy lifestyle and so the treatment is not simple such as going to a residential facility for 30 days, taking a medicine or going to a meeting.  Those are important but are only a small part of recovery.
    • Like cancer that sometimes comes back...Relapse is common and real; NOT a catastrophe or disaster although it can end in those.  The goal of treatment is NOT never have a relapse the goal is having a healthy life...we need to change the way we think or we spend too much energy on preventing the next relapse rather than energy building a life of recovery
    • Peer support is critical for ongoing treatment both for the person new in treatment and one who has been treated for many years.  That element does not come on a prescription pad but we DO understand it is critical.
    • Provide a healthy meal in a neutral place. Bring a bottle of vitamins a jug of fresh water make eye contact say thank you for the food
    • Offer to attend or drive to a self help meeting or medical appointment
    • make phone calls for peer support together
    • Sit and do a written 5 item gratitude list together
    • Do 1 minute of counted breathing together: close eyes breathe in 1-2-3-4 hold out 1-2-3-4 hold repeat
    • Make a 411 card for the wallet with emergency numbers, insurance info, contacts, list of abused substances for emergency personell 
    • ID bracelet
    • Get them a Narcan kit and keep one on you and in your home at all times.  You can them at the methadone clinic and at any pharmacy without an Rx
    • give a 60 second hug
  • Join YoungPeopleinRecovery.org It is an advocacy group to help build transitional housing, vocation and educational resources as well as support for those with addiction and their loved ones.  We are building a chapter in Santa Cruz as we speak
  • Get more more information and newer information remain inspired:
    • TED talks: “rat park” 3/29/16 panel from summit on substance abuse and heroin addiction
    • http://nationalrxdrugabusesummit.org/2016-presentations/

NEW INFORMATION ABOUT TREATING ADDICTION

  • COMPLEX CHRONIC DISEASE:
    • Similar to cancer, diabetes and heart disease
    • Each patient is an individual and requires INDIVIDUALIZED TREATMENT PLAN
    • Very few conventional treatments like chemotherapy or insulin or other pills
    • It is a COMMUNITY disease and thus needs community treatment
    • Understand that like cancer that sometimes comes back...Relapse is common and real; NOT a catastrophe or disaster.  The goal of treatment is NOT never have a relapse the goal is having a healthy life...we need to change the way we think or we spend too much energy on preventing the next relapse or punishing the relapse rather than energy building a life of recovery
    • Peer support is tantamount “One alcoholic helping another
    • Warm chicken---”less IS more” harm reduction is a strategy that works for some people
    • Have them get an ID bracelet
  • Have a contract whenever you rx and scheduled drug: opiates, benzos, stimulants.  An MA can provide and have ready. Resign annually. Here is an example: http://www.aafp.org/fpm/2001/1100/fpm20011100p47-rt1.pdf
  • Basic self care IS also tantamount
  • mulitvitamins, Vit D, Magnesium, B complex
  • more water
  • Asking your patient do you need help with drugs or alcohol is AS important as checking their blood pressure, listening to their heart, ordering blood test
  • Engage family and friends encourage Al-anon and unconditional love
  • See your clients with the Addiction frequently.  Weekly if using and/or newly detoxing or transitioning from treatment programs to SLE, home, etc until 3 months then monthly for the first 1-2 years
  • Offer to drug test to help them stay clean and accountable
  • Most important about:    
    • YOUR PTS ON CHRONIC OPIATE OR BENZODIAZEPINE RX’S
      • DO NOT ABRUPTLY STOP THOSE RX’S. YOU MAY PRECIPITATE A DANGEROUS WITHDRAWAL THAT COULD LEAD TO OTHER MEDICAL COMPLICATIONS OR YOUR PATIENT SEEKING ILLEGAL SUBSTANCES. 
      • Evaluate baseline conditions the rx’s are for and effectiveness and need for rx. If you feel they should come off of either due to opiate induced hyperalgesia, addiction  r other issues help to create a safe plan including pain management psychiatric services, referral to addiction specialist
      • Go slowly and see them frequently.  It is ok to wean off rx’s safely over a year. 10%/month is a reasonable strategy
    • OPIATES
      • accidental overdose is very common. 
      •  needle exchange info:
      • MAXIMUM EXCHANGED 100/VISIT
      • SC 1080 EMELINE M 8-12; T 5 – 7; F 8 – 12 WATSONVILLE 9 CRESTVIEW DR M, T,W,TH 5:30 – 6:30PM AND T/W 9:30 – 11:30 am
      • naltrexone kits
      • no Rx needed can get from any pharmacy. You should keep a supply in your office to give to your addicts or patients with high dose chronic Rx opiates
      • http://www.santacruzhealth.org/Portals/7/Pdfs/SSP/SSPFAQ.pdf
  • Methandone clinic: 
    • JANUS OF SANTA Cruz THE COMMUNITY CLINIC
    • Methadone Maintenance and Detox Program 
    • 1000 Emeline Ave. Building A
    • (entrance in back)
    • Santa Cruz, CA 95060 
    • (831) 425-0112284 Pennsylvania Ave. Suite #2
    • Watsonville, CA 95076
    • (831) 319-4200
  • Buprenorphine (Suboxone) is another opiate used for maintenance therapy ANY doctor can RX after taking a basic course and getting certified.  It is NOT for everyone but learn about it can be done online: http://www.samhsa.gov/medication-assisted-treatment
  • It is now available in cartridge form.  Good for 6 – 12 months. To get certified on how to do the cartridge or a list of existing providers contact https://braeburnpharmaceuticals.com/
  • Naltrexone is an opiate receptor blocker and can help minimize cravings.  It is available in 
  • generic pill form.  50 mg daily make sure client tells caregiver, sponsor that they are taking daily dose for accountability. Have them take in am
  • monthly IM injectable form (Vivitrol-brand) 380mg IM simple shot.  It can be delivered to your office for the patient without having to have it in stock
  • https://www.vivitrol.com/HCP/VivitrolResources
  • Alcohol
    • stopping abruptly is risky for seizure and death instruct patients to notify their loved one go to get appointment or call MD or go to ER and not stop alone or in secret
    • B vitamins, especially thiamine and Magnesium very important
    • Home detox with Librium clonidine and atenolol with daily visits and bp checks
    • Some other supplements to help: amino acids, lavendar
    • Some medications that can help include:  naltrexone (both oral and Vivitrol), baclofen, buspirone, gabapentin, acamprosate, topamax, zofran
    • Have your addicts join YoungPeopleinRecovery.org It is an advocacy group to help build transitional housing, vocation and educational resources as well as support for those with addiction and their loved ones.  We are building a chapter in Santa Cruz as we speak
  • Excellent resource of other resources:  http://www.addictionrecoveryguide.org/holistic/nutritionexcellent 
  • REMAIN INSPIRED AND GET MORE INFORMATION
    • 3/29/16 National Rx Drug Abuse and Heroin Summit
    • http://nationalrxdrugabusesummit.org/
    • NIDA: https://www.drugabuse.gov/