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Sunday, January 27, 2013

Drugs, Alcohol and Blood?

I think the Twilight movies and cast of characters are kind of dumb. They are an interesting take on vampirism, being addicted to blood. I won't even get into the psycho-sexual aspects that make these movies popular but as an addiction specialist, I started to think, how would I detox a vampire from blood? Slow taper? Placebo blood type? Blood Suckers Anonymous meetings-1 less human at a time??

For my human patients, there are a lot of simple choices. Psychiatrists are best able to medically detox, stabilize and provide the psychosocial treatment and support necessary to achieve sobriety and prevent relapse. 8.9 million adults in 2009 were either chemically abusing or dependent. That's a whole lot of suffering for something that is fairly easy to treat. Below, I have listed treatments that I use, that are highly effective.

Alcohol--I use tranquilizers/benzodiazepines to detox and prevent withdrawal. Sometimes, I have to add anti-seizure medications or mood stabilizers if withdrawal is complicated. After detox, I stabilize sobriety with naltrexone pills or the new FDA approved Vivitrol injection. Generally the medication regimen is simple and short term. Campral/acamprosate during FDA trials was seen to be effective for alcohol sobriety maintenance therapy. However, the recent COMBINE study found acamprosate no better than placebo. I have found Antabuse/disulfiram helpful and do prescribe this as well.

Opiates--For office based treatment, Buprenorphine is the easiest and quickest way to sobriety and maintenance with minimal to NO withdrawal symptoms--seriously. I use this strategy for all opiate detox including methadone, which a lot of my pain patients take. Tapering off this medication, within 7-10 days or over 30 days can be easily achieved. Using other medications to prevent rebound pain, insomnia or depression is also something I can add that is different from other addiction specialists. All medications can usually wind down within 8 weeks of treatment. This new standard of less medication to achieve more health is my philosophy of mental health overall. Vivitrol injections used monthly after detox prevents relapse: yes PREVENTS. If there is a history of relapses, I maintain patients on buprenorphine to prevent further relapses. Safe, easy daily maintenance is ALWAYS better than relapsing and is EVIDENCED BASED FACT. I don't care what anybody else tells you. Tapering off when you're functional and well, is NOT the big deal everyone makes it out to be.

Stimulants--Really easy to detox from. The real problem here is the crashing mood after detox. I'm able to use mood stabilizers combined with antidepressants like Bupropion, Amoxetine and Modafinil, where patients are comfortable and functional without the white knuckles. These medications also help in preventing relapse.

Tranquilizers, Sedatives and Hypnotics--Taper strategy combined with medications to allow patients to sleep and stay comfortable during detox and to regain and maintain function.

Cigarettes--Chantix, Wellbutrin, e-cigarettes and nicotine patches or nasal spray are helpful. Cognitive Behavioral Therapy with support is the gold standard. Most of my patients have been able to stop within a few months. I often use other psychotropic medications aimed at symptom relief.

Caffeine--Yes, this is a drug I've often seen abused. If you're slamming energy drinks or coffee, wean off. Caffeine should be enjoyed like alcohol, occasionally, a few times a week. Caffeine is highly metabolic and is a major cause of anxiety that complicates detoxification of other drugs. With decaf coffee, you can get the lift without the physical effects. Placebo coffee is psychosomatic medicine at it's best and is what I do.
Now detoxing from blood...um mm. Oh I know, blood thinners! Call it aversion therapy for vampires.


3 comments:

  1. Do you think the naltrexone injectable 90 day pellet is a good idea?

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    Replies
    1. Yes, it is not a prescribed drug that we can use int the United States yet.

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  2. No, I have actually seen patients cut these subcutaneous pellets out of their skin and relapse. In one situation I had to do wound care and start an antibiotic because the pellet removed site became infected. Shots given intramuscularly can't be "taken out" and last a month. This is also good because if other medical/surgical procedures need to be done the shots can be stopped where management with pain medications is possible. Actually, people experience the best analgesia for these surgeries because there is no opiate tolerance after they have been on Vivitrol injections.

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