Yes, there is a close link between pain and depression. It’s a vicious cycle — depression can cause pain, but pain can cause depression as well. Once this cycle has started, it’s a snowball effect where your pain makes your depression worse, and your depression makes the pain worse. Many people suffering from depression even report unexplained aches in their back or
Chronic pain can affect mood over time and tends to wear a person down. It also creates other problems that only contribute to depression, such as difficulty sleeping or stress. This chronic pain may also create issues with low self-esteem or may cause social withdrawal or loss of interest in hobbies.
Depression unfortunately, doesn’t just cause pain, it is also linked to other health conditions like
cancer, diabetes, or heart disease.
What is Chronic Pain?
Chronic pain is pain that lasts beyond the usual time it takes for an injury to heal. Chronic pain may also be described as, pain that lasts for longer than three months at a time. Some research indicates that up to half the people suffering from chronic pain also struggle from a depressive or anxiety disorder.
Chronic pain is an emotional condition just as much as it is a physical one. Chronic pain may cause a person to grow isolated from others, or lose the mobility they used to have. Chronic pain can also stem from other conditions like arthritis, migraines, heart disease, or diabetes.Because of the many similarities, it can sometimes be difficult to assess whether a person’s chronic pain triggered their depression, or whether it is the other way around. Someone suffering from chronic pain is three times more likely to develop depression and someone suffering from depression is three times as likely to develop chronic pain. Depression can only further debilitate a person suffering from chronic pain.
Unfortunately, these people are less likely to recognize that they are suffering from depression and thus, less likely to seek treatment. As much as half of the people suffering from depression are diagnosed by their healthcare professionals after only describing physical symptoms. Because pain and depression are so closely linked and difficult to distinguish, it is important to understand both depression and pain and how to treat both. A person may be suffering from a combination of depression and chronic pain if they exhibit some or all of the following symptoms:
● Loss of interest in hobbies or activities
● Depressed mood
● Changes in sleep patterns (sleeping too much or too little)
● Changes in appetite (weight gain or weight loss)
● Feelings of guilt and hopelessness
● Fatigue or loss of energy
● Difficulty concentrating
● Suicidal thoughts
What treatment options are available for depression and pain?
Fortunately, there are a multitude of treatment options that can provide relief from the symptoms of both chronic pain and depression. These include, but are not limited to:
● Ketamine Infusion — An innovative new treatment option, research has shown that IV
Ketamine Infusion can help up to 80% of patients find relief from depression symptoms
● Medication — Analgesics or antidepressant medications may be prescribed, but these
treatments will not work for everyone and may take months at a time before relief is felt.
● Therapy — Psychotherapy or talk therapy can help a person identify harmful thinking
patterns and replace them with more positive ones
● Stress-Reduction Skills — Exercise, meditation, and muscle relaxation are useful in
combating not just pain but also the symptoms of depression.
● Support Group — Consider seeking out a support group made up of others suffering
from depression and chronic pain. These are filled with people suffering from the same
thing as you who may have helpful solutions.
If you think you are experiencing depression and chronic pain, it is important to speak to your
primary healthcare provider for treatment. Seeking out treatment is not a sign of weakness, and untreated depression or chronic pain will only get worse with time.
An innovative new treatment option, Ketamine is an FDA-approved anesthetic that has been found to provide rapid relief from depression and anxiety when infused at a low dose. The FDA
has recently approved Esketamine, a nasal spray comprised of a compound based on Ketamine, for the treatment of depression and other mood disorders. Research indicates that
Ketamine stimulates the regrowth of synapses within the brain, essentially rewiring the parts of the brain that may be causing distress. Ketamine is also available as an infusion. Some
researchers maintain a 75% success rate when treating those suffering from depression or anxiety with Ketamine Infusions.
Detoxing from opioids, alcohol, and other drugs do not have to be horrific experiences.
Using a powerful and natural method of detox known as NAD+ Therapy, many patients report having an easy time coming off addictive substances and a significant reduction or even total elimination of cravings.
Listen To The Full Interview Here
At Ken Starr MD Wellness Group, located in the central coast area of California, patients have benefited from NAD+ Therapy for drug detox for over six years.
Dr. Starr and his team have a long history of helping patients overcome addiction, and they offer an extensive “menu” of nutrient-based therapies which sets them apart from the vast majority of addiction treatment programs.
The Story of Ken Starr MD Wellness Group
Dr. Starr trained in emergency medicine and worked full time in the ER for almost 20 years.
- Around 2010, he relocated from Eugene, Oregon to California.
- It was around this time that he started to become more and more interested in addiction medicine.
- It soon became apparent to Dr. Starr that in his community there weren’t enough choices for people to get treatment for substance use disorders.
- When a friend of his in Portland told him he had been prescribing Suboxone in his psychiatric practice, Dr. Starr’s interest was piqued.
And when Dr. Starr’s older brother died from an overdose, it just became crystal clear that he needed to be focusing on drug and alcohol treatment.
Dr. Starr started doing Suboxone prescribing around 2011 to prevent people from overdosing and on heroin.
Later he teamed up with a woman he met that was a counselor, in recovery, and had experience with programming and running groups, and they created a company together with the goal of expanding services beyond simply prescribing Suboxone for opioid use disorder.
Ken Starr MD Wellness Group grew quickly because they were really the only people doing it in the area, they weren’t expensive, and they took great care of people.
And that’s how things started.
- Fast forward 8 or 9 years, and now they’re the largest drug and alcohol program in the county, and it’s possible that they’re the biggest in all of the three surrounding counties as well.
- They currently have a 4,000 square foot building, hundreds of patients, and a great reputation.
Over the years, Dr. Starr has become board certified in addiction medicine twice, he became a fellow in the American Board of Addiction Medicine, and their company got CARF-accredited and state licensed.
Dr. Starr got started with and continues to use the traditional treatment pathway, but several years ago their main focus became “Bio-Hacking Recovery,” giving people alternative treatments like NAD+ Therapy, IV Nutrient Therapy, as well as educating patients on nutrition, exercise, meditation, supplementation, and other alternative modalities for addiction recovery.
Dr. Starr has even taken the biochemical domain of recovery a step further by formulating a line of premium supplements called CLEAN, which can help patients accelerate recovery and feel their best faster.
- Click here to visit GetCleanSupplements.com, and Dr. Starr created a special coupon code for podcast listeners to save 10% off their entire order.
- Simply enter the coupon code Elevation while you’re checking out to get the discount.
Dr. Starr’s treatment facility is unique in this respect because there are not a lot of people doing what they’re doing.
There simply isn’t a lot of money in it, as the main way to make money is in residential treatment, which some people absolutely need, however, there is also a superabundance of people that do very well using outpatient or intensive outpatient treatment, which is what Ken Starr MD Wellness Group offers.
Learning About NAD+ Therapy
Around 2013, Dr. Starr had a patient who stated they were going to do Brain Restoration Therapy in Lousiana.
After the patient returned home from his treatment, he was detoxed, felt great, didn’t have cravings, and said it was from his NAD+ treatment. The patient encouraged Dr. Starr to learn about this type of therapy.
Dr. Starr was skeptical when he first heard about NAD+, but he made some calls and was able to talk a man named Dick Metsayer, who is known in the small NAD community as “The Grandfather of NAD in America.”
- After learning about NAD+ Therapy from Dick Metsayer, Dr. Starr said: “Tell me how to do it!”
- But Dick said, “Oh no… if you want to learn NAD you gotta come here to learn.”
- And even though Dr. Starr was extremely busy with his own treatment program, he went to Springfield, Louisiana that summer, and what he saw changed his life.
- Dick was detoxing patients off opioids, alcohol, methamphetamines — even patients on over 100 mg of methadone — who were feeling fine during the process.
After he was mentored in NAD+ Therapy, Dr. Starr brought this new knowledge and skillset back to California and integrated NAD+ into their treatment program, and in doing so giving them the honor and reputation of being the longest-running NAD+ program on the West coast.
And from that point on to present day, NAD+ is the staple of their detox program due to NAD’s powerful ability to relieve withdrawal and accelerate recovery…100% naturally.
Diving Deep into the Science of Bio-Hacking Recovery
So NAD was the first alternative treatment that they integrated, but then Dr. Starr became more and more interested in the nutritional and metabolic aspects of recovery, and this curiosity and passion led him down a new path where he began learning about Myer’s Cocktails, B12 shots, ATP deficiency, and other biochemical and nutrient-based therapies for addiction recovery and brain repair.
Dr. Starr likes to use these nutrient-based healing modalities because they help people rebuild their “neurochemistry soup” a lot faster than if they just let the brain heal on its own time, which can be a very slow and painful process without these interventions.
Nowadays Dr. Starr’s treatment center offers IV vitamins, glutathione, Myer’s Cocktails, and other nutrient-based therapies in addition to NAD+, while still providing traditional methods of detox, outpatient and intensive outpatient treatment, Suboxone, and more.
Now they have people coming in from all over the country to get treatment… and their success stems from a combination of meeting people where they’re at, giving them customized treatment protocols based on the person’s needs/desires/resources, and providing compassionate person-centered care.
Here are some of the main topics discussed in this episode:
- NAD+ mechanisms of action
- Theories on why NAD+ helps for drug and alcohol detox
- The origin of NAD+ therapy
- NAD+ deficiency from alcohol consumption
- REAL NAD+
- Nasal Spray Pure NAD+ Coenzyme 1
- Individualized treatment protocols for opioid use disorder
- Medication-assisted treatment options for opioid use disorder
- Opioid-Induced Endocrinopathy
- Switching over from methadone to Suboxone
- Supplements for tapering off methadone, Suboxone, Subutex, Zubsolv, etc.
- Reward Deficiency Syndrome
- Kratom properties, risks, addiction, and withdrawal
- “The dose is what makes the poison”
- Taking “dopamine holidays”
- The need for insurance reform to help patients have easier access to treatment
- Importance of being mindful of the different treatment options available
- Importance of having support while going through addiction and while getting help
- The difficulty of chronic pain patients that really need opioids to get the right opioid and dosage due to the latest CDC opioid prescribing guidelines
- Ketamine infusions for pain relief
- Benefits of looking for and trying non-opioid and natural therapies for chronic pain
Resources mentioned in this episode:
Original podcast and blog post by Elevation Recovery: https://elevationrecovery.com/nad-treatment-for-opioid-withdrawal-alcohol-detox/
Visit Elevation Recovery Here: https://elevationrecovery.com
Benzodiazepine Withdrawal is Treatable with NAD+ Therapy
I know a secret that other physicians don’t seem to know. Benzo withdrawal sucks! And lasts a long, long time.
Benzo withdrawal can last for months, even years. Patients feel depressed, anxious, and can’t sleep. Worse yet is that not sleeping and feeling terrible makes it all that much worse. Because you didn’t sleep you’re now more tired and depressed.
Your doctor didn’t think that keeping you on Klonopin, Valium or Xanax was a big deal; until you tried to stop. Benzos cause some serious and lasting changes to the central nervous system. But with time, nutritional support, medication and education patients can and do recover.
There is a lot of interest in using NAD+ for benzo recovery. We have quite a bit of experience in this field. NAD+ works for benzo detox, but often needs to be used differently when used for alcohol or opiate withdrawal. For both alcohol and opiate withdrawal, patients can stop their drug of choice and detox. With benzos that doesn’t always work. Basically, benzos are stickier, and the repair process is slower.
Here are 3 examples of how to use NAD+ to detox off benzodiazepines
The Test Dose
One option I like to employ when I have the luxury is the test dose. I offer patients a couple of days of IV NAD while they continue their regular benzo dose. I want to know if they’re going to respond and how it makes them feel. Patients really like this option because they don’t need to invest a considerable amount of money and time into a program not knowing if it’s going to work. Patients can come up for as little as 2-3 days for IV NAD+ and discover for themselves if that limited amount of NAD+ will alleviate any withdrawal symptoms or have a positive effect on their current condition. An ultra short course of NAD is not a substitute for a program, but it’s a good introduction for patients. We can get an early view of who is going to respond. For those patients who feel better, I can confidently recommend a full NAD Program to completely detox. That means 10-14 days of IV NAD+.
Another option that I’ve learned over the years is using the NAD+ Infusion to alleviate the withdrawal symptoms during an outpatient detox. What does that mean? Most patients at this point are doing a slow and gradual outpatient taper. Many hit a wall. At a certain dose they just can’t get below that amount. I’ll have patients come in to the clinic and do NAD infusions until they stabilize at that dose and feel good. Patients usually need less than a week to push past their previous limit. In this case, we’re not using NAD to completely detox off opiates rather we’re using it to help stick the landing on the last benzo dose reduction. Patients can stay on this lower dose during the infusion days. This is a successful technique which is great for patients. They’ve accomplished a dose reduction and only have to come into our clinic for a week or less.
If patients are on a low dose of benzo but just can’t get through that last little bump we can stop the benzo and drip IV NAD+. In this situation patients stop their benzo and we detox them. The NAD does the heavy lifting but we’ll use amino acids, and calming IV nutritional infusions. These infusions may contain taurine, magnesium and other ingredients the body seems to like during this period. We’ll also send patients across the road for a few days of HOCAT treatment. Most patients need at least 10-14 days of IV NAD to comfortably and effectively detox of benzodiazepine medications.
Every patient has a unique genetic blueprint in this constellation of benzo dependence which will determine how they respond to different therapies.
If you or someone you know is struggling with benzos and is ready to be done. Have them give us a call. We have answers.
Ken Starr MD
Board Certified Addiction Medicine
A while ago I wrote a blog about Lofexidine ( Lucemyra). I basically said that there’s not a ton of data but what seemed clear is that it’s crazy ridiculous expensive and really not any better than Clonidine. At a 1000X higher price. Well, I proved to be right.
Dr. David Juurlink MD Ph.D. from Sunnybrook Health Sciences in Toronto, Canda wrote a terrific summary of the most complete, robust up to date study on lofexidine. Just published in the May/June 2019 edition of the Journal of Addiction Medicine. ” Safety and Efficacy of Lofexidine for Medically Managed Opioid Withdrawal: A Randomized Controlled Clinical Trial” Fishman MD, Tirado MD, Alam MD.etc. al.
This was a multicenter Double-blind placebo-controlled study of 603 patients at 18 different US Centers. Keep in mind two of the authors are paid consultants to the manufacturer of Lofexidine. What did we learn?
- Lofexidine does slightly reduce withdrawal compared to placebo.
- As mentioned in my previous blog, Lofexidine and Clonidine are pharmacologically and structurally similar
- A review of all randomized trials comparing lofexidine with clonidine in patients suffering opioid withdrawal have shown the reduction of withdrawal symptoms are the same.
- The benefit of lofexidine on withdrawal is maximal by day 2. No difference from placebo is evident by day 7.
- Clonidine has slightly more side effects such as light-headed, dizzy and drowsy.
- 7 days of Lofexidine in the US is about $1700 compared to $1 for Clonidine
” In short, lofexidine can be viewed as a slightly safer version of clonidine that offers patients with opioid withdrawal marginal clinical benefit for perhaps a few days, at a cost of more than $3000o over a typical 2 week treatment period.”.
Drug company price gouging for a “me too” drug for the most desperate and vulnerable of patients.
Ken Starr MD
This weeks post is from our guest contributor Bethany Hatton. PreventAddiction.info
Helping Your Loved One Through Addiction
It’s difficult watching a loved one suffering from addiction. While you want to reach out and help them, you must make sure that you are reaching them in the right way. It’s also critical to take care of yourself and remember that the road to recovery lies in their hands. Let’s discover what practical steps you can take.
Before Approaching Your Loved One
You may know for certain that your loved one has a substance use problem or you may just suspect it. Before approaching him, be sure that you are on the right track and that there is not another issue that should be addressed. Check out the signs of alcoholism from Healthline.
Mental health issues such as anxiety, trauma and depression can co-occur with drug and alcohol addiction. Each of these should be treated. Read more about other conditions that can co-occur with addiction in this guide from the National Institute on Drug Abuse.
You may also have been told to avoid your addicted loved one. While that is appropriate in certain situations, it might not be the entire story. Psychology Today explores how having compassion doesn’t mean you are “codependent” or “enabling.” The author instead sees compassion as a way to empower you to help your loved one. Only you know the right answer to this question but certainly get away if your life or health is at risk.
How To Approach Your Loved One
Once you are certain there is a problem, it’s time to decide how to approach them. Very Well Mind has a detailed article on steps to take, including:
- Establishing trust,
- Communicating the problem, and
- Getting them into the treatment process.
You should also expect to experience difficulties. The person might be resistant to admitting they have a problem or to getting help but you also shouldn’t wait until they “hit bottom.” Read more guidelines on helping someone you love from the National Council on Alcoholism and Drug Addiction.
Finally, be careful of how you talk to this person. Express love and concern, not condemnation. Here are 11 things you should not to say to an addict from The Fix.
Taking Care of Yourself
It’s important that while you are seeking help for your loved one, you are also taking care of yourself. Encounters can be strained and stressful, even as he moves into and through recovery. You may experience resentment and hostility. Read these top 10 survival tips for loving an addicted person from a registered clinical counselor.
Depending on your relationship, you might also want to seek counseling for yourself to make sure you are practicing and managing your own self-care.
Programs For Addiction Treatment
Today, there are numerous treatment programs available to help your loved one. Each will appeal to someone different. They include:
- 12-step programs, such as AA and NA, which have the longest history of treatment.
- Religious-based treatment, such as the Teen Challenge, which is Christian-based, or Buddhist Recovery.
- Holistic programs that emphasize treating the mind, body, and spirit. These can include therapy, fitness, nutrition, mindfulness and more.
- Secular programs that focus on self-empowerment such as SMART Recovery and Moderation Management.
- Evidence-based programs like Cognitive Behavioral Therapy.
Learn more about finding the right program from this post at the New York Times.
You also might want to consider a program called Community Reinforcement and Family Training (CRAFT). According to the Center for Motivation and Change’s website, this program “teaches family and friends effective strategies for helping their loved one to change and for feeling better themselves. CRAFT works to affect the loved one’s behavior by changing the way the family interacts with him or her.” This is a recovery route that supports the whole family.
Helping a loved through addiction is a compassionate response to a difficult problem. Be sure to take the right steps and take care of yourself as you do.
JB is a 27 yr old male patient of mine who had a deep and insightful experience with ketamine. I invited him to share this with our readers
My First Ketamine Experience
I’m writing this excerpt on my experience with my first ketamine infusion therapy treatment in hopes of helping someone else out there that may find my background to resonate with them. For those of you that are reading this, you likely share some similar life challenges that I’ve endured. To give you a brief summary, I was diagnosed with a very misunderstood “autoimmune disease” before my Sophomore year of college which likely triggered my diagnosed adult ADD, depression, anxiety, and poor coping mechanisms by using narcotics to escape. Treatment lasted a year and a half for this autoimmune disease but it changed my personality, cognitive function, and overall homeostasis completely. It’s been almost 10 years since then and I can happily say I’ve been a patient of Dr. Starr’s for about a year and a half. I trust him, his staff, and I’ve always felt he has had my best interest in mind. I have been on antidepressants for 9 years and my body has been flooded with a cocktail of prescribed (and eventually non-prescribed) anti-anxiety meds and narcotic painkillers. Over the last two years, I had decided to pursue my dream of having a career in healthcare. Being the science nerd that I am, it was only natural that I asked Dr. Starr about this new ketamine infusion therapy when I first heard he had been offering it. I even wrote an extensive research paper on Ketamine HCL as my topic for my pharmacology course (which I got a 100% on) so it’s safe to say that I did my fair share of research on this drug. In the last few months, I’ve done well in all areas of my life except for the constant background noise of anxiety and depression that rarely leave me alone. The stress from this often goes to my stomach, causing unbearable pains. I isolate when I’m in pain and my life is put on halt. Overall, I’m a young person living a healthy lifestyle, has had success in going back to school while running a business, and done well with managing my medications from my doctors so why was I still finding myself not leaving my bed due to depression for days at a time? I wish I had the answer for you but I can tell you that I am 100% confident that those days will be over if I continue with ketamine infusion therapy.
I have not had any aches or pains in my body since my treatment, experienced very little to no anxiety, and am sleeping better at night. I’ve continued my regimen of lowering my doses of medications that I’d like to get off of with ease and am actually hopeful for the future. The most important thing I got out of my experience was a true love for myself. This treatment varies for everyone and is a tool that I chose to use to look introspectively. I feel there’s a common theme with others who have had this treatment done and that it can be self-guided. I chose to ask whatever Higher Power there is questions during the treatment and I found answers. It’s also pretty dang cool that this drug actually creates a something called “synaptic plasticity” in your brain. This basically means that it helps regenerate neurons that have the potential to release the chemicals that a depressed person may be lacking. Goodbye antidepressants! No…it’s important that I work with my team of physicians and slowly taper but yes, that is my goal and I have faith with the right amount of ketamine infusion treatments, I can be med free and HAPPY. The true value in this treatment is that it’s experiential. I suggest that if you decide to do it, get your money’s worth and look deep inside to find where the pain (physical, emotional, or traumatic) lies to address it. There is no negative experience with this drug (from what I’ve found) and simply an overall sense of acceptance, positivity, and serenity. It’s been 5 days since my infusion and while I do feel that the level of happiness I had the first few days after has dwindled, I find happiness knowing that I can constantly remind myself of my experience with my journal and this blog entry. I sincerely hope that this blog entry gives at least one person hope, courage, and desire to make a change and take the chance I had. It was the best experience in my life and pray that it continued to researched, recognized and ultimately approved by the FDA so the millions of Americans out there suffering can have access to alternative treatment with ketamine.
This weeks blog comes to us from our guest Bethany at Preventaddiction.info
Anyone who’s ever struggled with a drug or alcohol problem knows that checking yourself into rehab and maintaining sobriety is only half the battle. Getting your life back on track can be even more daunting. But before getting started, it’s important to release the shame of the addiction itself, or it can be impossible to have the confidence and fortitude to move forward. Once you let go of shame, it’s time to focus on repairing your life. Here are the key things that should be on every recovery survivor’s to-do list.
Tweak your resume so that it only reflects key employment experiences, and don’t feel pressured to tell the truth about a time gap. It’s completely okay to say you had to take time off to deal with a family situation. Craft a strong cover letter that outlines all of your strengths so that these points can be a topic of discussion should you get an interview. Tap local job resources that cater to recovery survivors, as they can provide guidance, education, and placement assistance.
Fixing Financial Ruin
Between losing jobs to spending every last dime to feed an addiction, it’s not uncommon for recovery survivors to struggle with debt long after sobriety. Once you acquire a job, create a plan to pay down your debt. While bankruptcy can relieve this pressure, it should only be a last resort, as it can make it difficult — if not impossible — to rent or buy a car or house. Consider entering a consolidation program and/or speaking with a financial advisor to help lower your interest rates and put things into perspective. You may also want to work with a credit repair specialist, especially if you have a lower credit score than you think you should have. All too often in addiction, people are financially abused while they’re under the influence, and if your credit score suddenly took a plunge, it’s possible someone you once used with stole one of your credit cards or even your identity. A credit repair pro can help remove these errors from your report, thereby boosting your score.
Make an appointment with your doctor before starting any new program, as there may be some underlying conditions (osteoporosis, heart problems, etc.) that occurred during the abuse period. Establish a healthy eating routine that’s void of sugar and junk food, and opt for easily digestible foods (think fruits, vegetables, and rice) to counteract symptoms of withdrawal. Gradually add in lean protein, healthy fats (think salmon and avocados), nuts, and a wide array of veggies. When it comes to exercise, it may be smart to start slowly by walking outdoors to get your body used to functional movement while reaping the benefits from mood- and bone-boosting vitamin D.
Starting a New Hobby — Or Rediscovering an Old One
Considering that you need to occupy your time with something other than an illicit substance, Health News Digest explains that there’s never been a better time to pick up a few new hobbies. However, make sure the activity — and any other individuals participating — won’t trigger a relapse. If venturing to faraway places is your favorite pastime, you’re going to have to learn how to travel without the temptation of margaritas on the beach and drug-infused parties, so consider signing up for a sober vacation where you can learn to have fun without being under the influence. Consider getting a dog, as it’s been proven that hounds can help recovery survivors stay sober by decreasing stress, replacing feelings of emptiness with feelings of love, and promoting activity via daily walks and exercise. Taking care of a dog can actually be a lifesaving hobby.
According to Everyday Health, relationships of all kinds take a toll when one is addicted to drugs and alcohol, yet there’s no one-size-fits-all approach to repairing them once you’re sober. Each relationship needs individualized attention and ample time to heal — this is another reason why it’s so important to let go of feelings of shame first. You’ll have to humble yourself and realize that some relationships may be too damaged to repair.
Getting back on track when suffering from a drug or alcohol addiction is tough — but it’s not impossible. It’s important to get healthy, find a job, and fix any credit you may have damaged as a result of your addiction. While that could take some time, before long, you’ll discover that sobriety is possible and sustainable.
Despite that fact that substance abuse has been defined as a chronic, relapsing disease, we don’t treat it the same as we do other conditions such as diabetes or obesity. And yet the parallels are clear: Imagine for a moment that you are obese. You’ve struggled with it for years, your family and friends give you a hard time about it, your doctor warns you about it. It’s not clear why this is a problem for you— is it genetics? Behavior? Underlying depression? Why is it that other people can eat as much as they want without gaining weight? Physically speaking, you shouldn’t be overweight and yet you are, despite your best efforts otherwise. It’s costing you your health, your happiness, and taking years off your life. Well consider this: how is drug abuse any different? Food addiction is real, just as alcohol addiction and opiate addiction are real.
One of the main differences is that while substance abuse can often be hidden or minimized, it is impossible to hide obesity— it is right there in the open, for all to see. This leads to more judgments and psychological harm, of course; but it also leads to increased visibility in terms of effective, long-term treatments. Imagine if we treated obesity the same way we treat addiction— saying to an overweight person: “Why don’t you go to ‘fat camp’? We’ll send you there for a few weeks and you’ll be fixed. You’ll learn everything you need to know about how to lose weight, eat healthier, exercise and adopt a healthier lifestyle. Then you’ll come home and, bam, you’ll be good.”
People who lose weight and keep it off have adopted a healthier lifestyle. They gradually made better choices and slowly lost the weight. They ate a little better, maybe exercised a little more but it added up. Months later their weight is down. We don’t take obese people who are addicted to food and admit them into 28 day rehab program and expect them to be fixed. We don’t expect them to come out thin. Why do we continue to do this with substance use disorders? We have good evidence that patients with substance abuse disorders show no long-term benefit from completing a residential program compared to an outpatient program. In fact, relapse rates with opiates and alcohol approach 90% within months of leaving such a program.
A chronic disease like obesity can be managed with counseling, education, exercise, accountability, check in’s, peer support, and sometimes medications. I believe drug addiction is no different. The patients who I see doing well are those who have embraced those tools; accountability, education, peer support, drug testing, and have invested in learning the tools of relapse prevention. By no means is this a science-based statement, but of all the patients in the last 6 years who I have treated in the clinic compared to the ones who went to a residential program, the patients who completed an outpatient program and continue to participate in some programming do better by far.
In the same way we don’t think that obese patients can come out of a 28 days residential program and be cured, let’s not think it works for addiction patients. Patients with eating disorders or substance abuse disorders have a lot in common. Patients with serious substance abuse disorders need ongoing treatment. For some, it may begin with a residential program, but for their treatment to continue to be successful it requires ongoing maintenance and accountability.
And with all that said… this doesn’t even get into the moral and legal ramifications of treating substance abuse differently from other chronic medical conditions! Stay tuned as we address this in the next post.
- Finney JW. The effectiveness of inpatient and outpatient treatment for alcohol abuse: the need to focus on mediators and moderators of setting effects. Dec 1996. Addiction. Vol 91, issue 12. Pages 1773-1796.