Suboxone … take it or leave it?

I have had intense opioid addiction in my personal past. I was not just a mild, once-in-a-while Percocet user.

I started with Percocet but quickly moved up the chain. Following spinal back fusion, my doctor gave me OxyContin, saying it was the “drug of choice” to prescribe to opiate addicts and telling me it was nonaddictive. A big pharmaceutical company was infiltrating the medical community, flooding doctors’ offices with samples of OxyContin. Follow the money. Big Pharma, a common term used to describe large pharmaceutical companies, has huge amounts of money at its disposal, giving it the ability to wage a campaign for the drug of the moment. When that drug causes physical addiction, your market becomes a guaranteed customer. I would say their primary motive is to make money. I am far from alone in this opinion, as the lawsuits that followed the OxyContin invasion illustrate that the pharmaceutical company knew all along that OxyContin was highly addictive. Phillip Morris claimed in the 1950s that cigarettes were not additive, and look how that turned out.

I believe—and the statistics support this opinion—that the extreme upswing in national prescription drug abuse followed this flooding of OxyContin into society’s health-care institutions.

For me, this period of time represented a decade of extreme opioid addiction.

The use of OxyContin following my back surgery sent me to a dark place that defies description in the hell it created for me and my family.

Enter Suboxone. My health-care provider claimed that maintenance—meaning daily administration of a substitute opioid—was safer and “a cure” for my unstable use of OxyContin.

Think of the methadone maintenance commonly used for heroin addicts.

I was in the early generation that was given Suboxone maintenance. At the time, it was administered in a gelatin square that went under the tongue. Suboxone was so new when I was prescribed it that it had to be dispensed through an apothecary pharmacy that made the gelatin squares and injected the drug into them.

Enter cross tolerance. Any opiate in any form will tweak the reward pathway in the brain, making it at risk for craving other mood-altering drugs. Suboxone no longer gave me the feeling of euphoria that it had produced in my brain at the beginning of its usage. Suboxone just made me sleepy. So I added amphetamines. Again, my reward pathway was being stimulated by the Suboxone. To make a long story short, I overdosed on amphetamines and ended up in the coronary care unit with a near heart attack as a result of coronary artery spasms caused by the amphetamines.

Now my brain was a complete chemical train wreck on Suboxone and amphetamines.

Upon release from the coronary care unit, I did my research. An antidote to amphetamine overdose is benzodiazepines, commonly known as tranquilizers, with name brands like Xanax and Ativan. So I took benzodiazepines daily to make sure I did not have a heart attack from the amphetamines.

Now I was on the trifecta from hell: Suboxone, amphetamines, and benzodiazepines. And it started with Suboxone.

As I write this blog, I realize I am not expressing the popular current point of view that Suboxone is the answer to our current opioid problem. And with all due respect, Suboxone replacement therapy may work for some.

But as an interventionist who is in the field weekly working with addicts, I see more abuse of the drug Suboxone than is suggested by the current aggressive marketing of it as the solution to the opioid epidemic.

That’s something to think about—and always follow the money.

Stigma……

I sat with a 57-year-old man last week in the emergency room at the hospital. He looked like he was ready to give birth to triplets. His liver had reached its limit to function properly because of chronic alcohol consumption.

His swollen legs literally wept their own tears of the illness as the built-up fluid squirted out of tiny holes in his calves. The leaking fluid reminded me of malfunctioning sprinkler heads.

In his demeanor, he fought to maintain an attitude of a man who had little to worry about. It was a mask, hiding his fear and trying to hold onto a shred of dignity. All alcoholics mistakenly believe that at this point in the disease’s process, what they are experiencing is their fault. This is far from the truth, as is documented in many highly regarded medical journals’ articles on the disease of alcoholism.

As a former long-term registered nurse and now a full-time alcohol and drug interventionist, I knew that he was in for the fight of his life.

But why did he have to be in a fight for his dignity?

This fact stirred in me an internal rage with some of the health-care workers assigned to take care of him. I had learned, having taken many alcoholics/addicts to emergency rooms, to not express that rage in ways that would further alienate them from the nurses and doctors.

So I advocated for my patient in quiet but clear clinical terms. This, I have always sensed, is not popular with the ER staff either. My presence is off-putting to them. Is this a projection of mine or the truth? In the end it does not matter.

I believe that being treated with dignity is a birthright. Yes, there are extreme times people have to straighten the course in their lives to earn that dignity back. But when it comes to having the illnesses of alcoholism and addiction, there is still has a stigma that seems to automatically diminish the dignity you are treated with. And in the process of losing dignity, shame about yourself creeps in, and the disease rains down on a person at a time when love is needed the most.

I am not saying that boundaries do not need to be set with people in active addiction, but never withhold your love, which many times is expressed by bestowing on them the dignity that we all deserve.

“What is this?” a bland and accusatory young doctor asks while skimming the contents sitting on top of the man’s backpack and holding up a bottle of aftershave. My patient is sitting on a bed, dangling his swollen legs over the side. He is looking at the doctor with his head tilted down in that peculiar way done by people who wear bifocals. We had waited hours to hear the results of blood work, X-rays, and other tests. We were not eagerly waiting to be shamed. He knew full well his alcoholism had reached a critical stage. He was looking for hope.

Most aftershave lotions have a high level of alcohol in them. Rarely do people carry around a bottle of it in a backpack.

My patient’s father had taken his truck keys from him, preventing him from driving to the liquor store. He had no access to alcohol, and at this point in his disease, it was literally necessary for him to drink to live. Withdrawal from alcohol is life threatening. Thirty percent of patients who suffer delirium tremens, or DTs, from abrupt discontinuation of alcohol die. And the patient knows this through a feeling of impending doom as the process of withdrawal is experienced in a tsunami of physical and mental sensations preparing to cascade the body as the brain begins to start off an explosion of misfiring, causing every vital system in the body to be negatively affected, ultimately breaking down the body’s ability to function. Death follows, and the alcoholic does not experience a peaceful exit from this world.

“Well he brought this condition on himself,” the uninformed public will cry out.

Alcoholics do not choose this hell. Nobody would. Their brains are on autopilot as they drink. But that is only one of the contributing factors that causes an alcoholic to drink. As I have written many times before, alcoholism/addiction is the perfect storm. When alcoholism rears its ugly head, it is the result of three overlapping factors: a genetic propensity combined with psychological and social influences.

In general, emergency room health-care workers increase the psychological component exponentially by expressing their negative perception of the suffering alcoholic through shame. So yes, because of how they treat alcoholics/addicts, particularly in emergency rooms across the country, health-care workers worsen the disease of alcoholism and addiction by lowering the patients’ perceptions of themselves.

In the ER, I jump up—no one shames my patients on my watch. I, too, have been victimized by this biased treatment when being active in my disease.

I grab the aftershave from the doctor’s hand and ask, “What man does not want to smell good while on his way to rehab?” I turn and maintain eye contact with my patient to let him know that I am attempting to protect his dignity, dignity that every patient in that ER deserves.

The doctor gets ready to leave the room. “Hey,” I say. “That big guy the EMT’s just brought in with chest pain, I’m just curious, did you find junk food in his possessions?

I am off-putting, I know, but my goal is for that doctor to maybe, just possibly, shift the way he treats alcoholics and addicts who so desperately need help in America’s emergency rooms.

Hear this: When I am with patients who are entrusted to me, I protect their rights and dignity. And yes, maybe I am a bit pushy in the process, but understanding and expressing empathy to the alcoholic seeking help will ultimately begin the process of healing the psychological component of this disease. Shame will worsen the disease of alcoholism, and worsening a disease is not the goal of emergency rooms, as they attempt to heal the sick.

Please, those of you who deal with alcoholics and addicts, attempt to see past your bias. Educate yourselves. And in spite of the sometimes lousy behavior exhibited by active alcoholics and addicts, which is not always pleasant to deal with, remember you are dealing with a sick mind. But a mind and a spirit that deserve the basic right of being treated with dignity.

Cigarettes are the Gateway Drug

http://cdn2.momjunction.com/wp-content/uploads/2014/09/teen-smoking.jpg Cigarettes. Lethal in ways not spoken of often enough. For those individuals with a propensity for addiction, cigarettes are the gateway drug.

From drugabuse.gov:

“Similar to other addictive drugs like cocaine and heroin, nicotine increases levels of the neurotransmitter dopamine, which affects the brain pathways that control reward and pleasure.”

In my second book, Painkillers, Heroin, and the Road to Sanity, I write about the brain science of addiction. Physical addictions boil down to getting dopamine hits to the brain. Every puff of a cigarette taken will set off the neurotransmitter chain letter that will end up producing dopamine in the brain.

When I say cigarettes murdered my mom, maybe it would be more accurate to say that the cigarette companies in the ’50s—which are still lurking around today, maybe less obvious but still a powerful global force—got untold numbers of people addicted to their product in America and around the world through their false advertising. Always follow the money.

For some, the addiction to cigarettes never goes further than smoking. But I believe that for those who are inherently predisposed to the disease of addiction/alcoholism, most likely through genetics, cigarettes are the gateway drug that wakes up the monster in the brain, making the mind vulnerable to a smorgasbord of other addictive substances.

When I see a teenager smoking, I see into the future: a dark cloud looms around them, like the smoke that is circling their head.

I digress.

“Joani, a phone call from your sister,” someone yells. This can’t be good, I think. My sister lives 3,000 miles away, on the opposite coast to me in Maryland.

“Hey,” I say. Like me, my sister is straightforward in her approach to communicating.

“Mom is in the hospital. She was typing at work, and her fingers would not work. They think she might have had a stroke. She has been admitted to the hospital for testing.”

I know—this phone call is heralding her imminent death.

Starting maybe in second grade, I would hide my mom’s carton of cigarettes. I always knew somehow that cigarettes were her nemesis, even without being told so at such a young age. How did I know this? Only the universe has the answer to that question. In the long run, it made little difference, other than perhaps preparing me for the premature death of my mom, caused by metastatic lung cancer from her years of smoking.

She was also a daily beer drinker and a lifelong benzodiazepine user. She did not drink large quantities of alcohol but had marked personality changes after a few beers. Most likely the effects of the alcohol were enhanced by the tranquilizers she was consuming. But the trifecta was in play: cigarettes, beer, and benzodiazepine. Cigarettes preceded the other two substances by years. I believe cigarettes woke up that monster in her brain, the disease of addiction. Her father was a raging alcoholic who smoked as well.

I left work immediately to arrange a flight home to Arizona, where I was to meet my sister and go to the hospital. That night, after arriving at my apartment and while preparing to leave for what I considered to be my real home, I sat of the edge of the tub and sobbed into a towel. It was the beginning of grief I was not sure I could survive. I was in my early 30s, not married. My dad had been gone since I was 17 in a car accident: he had been driving while intoxicated.

My mom was a flawed woman. Her parenting skills would not get her a gold star. But I knew, felt, that she loved me intensely, was proud of my achievements, especially my nursing career. As I aged, she and I became great friends. She was my family entire. And I was going to lose that. And she would lose her life, and not quickly. My father’s car accident seemed way more humane: he was dead on arrival at the hospital.

But those nine-and-a-half months it took for the cancer to take her life were the worst and the best time of my life. Looking back, I would not have missed that period of time that she lived with me and died alongside of me, but I never want to go through an experience like that again. The grief brought me to knees, as I howled at the moon, looking upward in hopes of getting just one last glance of the mom who meant the world to me.

I started smoking at age 15. Yes, in spite of my deep-seated feelings about the dangers of cigarettes, peer pressure, in the end, was stronger than my beliefs about smoking. Anybody who knows me knows how that turned out. My disease of addiction progressed to a level that almost defies words in its consumption of my mind and soul.

And it started with cigarettes.

After writing this blog, as I closed my computer, the phone immediately rang. (I am not writing this for literary drama)

“Hi,” a mom says quietly. I know the tone well.

“Tell me, what is wrong,” I immediately ask.

The tears come. “My daughter was suspended from high school for selling drugs.”

I quickly tell her about the blog I just wrote.

“Can I ask, does your daughter smoke?”

“Yes, she started with the cigarettes at 15.”

Bingo.

Now it is time to help this kid get back on track.

Until then . . .

CNN: Shame On You, Your Producers and Anthony Bourdain

CNN: Shame on You, Your Producers, and Anthony Bourdain

I am an alcohol and drug interventionist. Daily I listen to fearful,heartbroken families talk about their children’s use of alcohol and marijuana. Kids’ brains are forever changed by using alcohol and marijuana before their minds have had a chance to fully develop around the age of 25. As the National Institutes of Health tells us, every year until the age of 25 that we can keep kids off of alcohol and drugs, the greater the chance is they will not develop substance-use disorder.

“See, Mom,” my 16-year-old son says, tapping me on the shoulder. “Anthony Bourdain got famous and kept his show going for 10 years by drinking alcohol; booze must not be that bad.”

I boil with the irresponsible behavior that CNN and Bourdain are promoting with a commercial for his show. Sure, Bourdain looks hip to kids: tatted, tanned, wearing sunglasses. He is an mature man who should have more respect for his influence on the youth that look up to him. Mentor our youth with your media influence.

CNN, please explain how you could allow this commercial to play over and over again, influencing our children into believing that drinking alcohol is “cool” and the reason that world traveler Bourdain is successful. Kids see, they hear, and it becomes ingrained in their minds that “booze” is cool and can cause a man to be successful. I had to explain marketing to my son and the negative effects it can cause. Follow the money,Max, I said. It is a catchy commercial—and in truth, a very damaging one. Think of the cigarette-smoking Marlboro Man of earlier generations.

This week, Bourdain is smoking pot on TV in Seattle. It’s another damaging message to our youth.

Here’s a challenge to you, Bourdain. Take my calls for a day and listen to parents’ tears and fear. Please, CNN and Bourdain, end this damaging campaign you have going on. Take it a step further and apologize to the public and see it for what it is: reckless endorsement of alcohol and drug use. Predicating your success on alcohol is simply reprehensible and a part of society’s problem, not the solution.

“Mom, does your history of sexual abuse still affect you?”

“Mom, does your history of sexual abuse still affect you?”

My son asked me this question after reading my memoir, The Interventionist. What follows is an excerpt from my first book, The Interventionist.  

Let me preface this excerpt in an attempt to help people understand why it takes decades for survivors to speak up. Primarily, it is shame. Somewhere in our wounded soul we believed the abuse was our fault. Our silence protects us from taking misdirected blame upon ourselves. It also protects us from the outer world that too many times reinforces the thought that it was, indeed, of our making. As I have matured, I have come to terms with the reality of the situation that happened to me as a child and that it was not my fault.

This illumination of the truth to myself has been hard won. Experienced professionals using many forms of psychotherapy have walked me through the fires of mistreatment that rained down upon me as a kid. Walking through those flames has provided me with vital healing.

I was forced to deal with the sexual abuse when my unremitting addictions would not abate. As I have stated, addiction, when it rears its ugly head and manifests itself, is the perfect storm of three factors—genetics, psychology, and social influences—that are colliding and show themselves in a variety of destructive behaviors.

When I was detoxed and mentally stable enough, a wonderful therapist at La Hacienda Treatment Center in Texas took me on a journey into my past of sexual abuse. Other therapists have continued the work she started.

I did not want to go there—to look at what had occurred to me when I was a kid, just 11 years old. My inner shame was so deep that if brought out into the light of day, I might need to take responsibility, and I felt that the truth—the twisted truth in my brain—had the power to destroy me. Ironically, it was destroying me by not dealing with it. I was medicating the past hurts to the point of life-threatening addiction.

I was not responsible for what happened to me, I know that now. My addiction, in part, protected me from that shame. They were intertwined within me, my addictions and my sexual abuse history. I chose to deal with what was the unthinkable, to me, in an attempt to save my life from narcotic addiction. But it took three-and-a-half decades of my life before I found the courage to deal with it. The wound is that deep and complicated. That is what you are seeing currently on TV today, women/men who could not deal with what occurred to them sometimes decades earlier.

So as I told my son, “The abuse no longer affects me daily, but we are always a sum total of our lives’ experiences, and I will never forget.”

I have forgiven the child within me who thought the experience was her fault. And I am sober. The sexual abuse was part of the puzzle of my unremitting addictions. But I am not done yet. Sober yes, but something continues to haunt me. My personality traits that were destructive to my life have turned out just as life threatening as chemical addiction.

My diagnosis of borderline personality disorder (BPD) was born out of the ashes of a chaotic childhood with both my parents and the perpetrator of my sexual abuse. Genetic factors were most likely, as researchers tell us, the catalyst in the very beginnings of my life that allowed BPD to come alive in me. But like all disorders, the medical community believes environmental factors push that gene forward, allowing it to manifest in pathological ways.

My third book, Wrecking Ball: Living with Borderline Personality Disorder, which I am currently writing, chronicles the origins, injuries, and ultimate success of living with BPD. My journey continues, and I am not a victim; I am a survivor.

I fear for my safety at a gut level. Something that rarely happens to us, I think, in this life. And I am taken back to another time, when a man in a car changed my life in ways I probably will never completely comprehend.

# # #

It was a time of confusion, fear, trauma, and ultimately the abrupt end of childhood. It took place, with one exception, exclusively in a car. It lasted approximately two years.

I was eleven years old when it started. I want to write that I was afraid, but I told myself when I started this book that I owed both the reader and myself the truth. To alter the facts, to rewrite history, will neither help me heal nor bring to light how it is that pedophiles perpetrate their crimes on children.

So let me say, I was not afraid. I was loved, nurtured, and affirmed by a man. Confused, certainly, and in over my head, but I was given everything I was missing at home, especially from my father.

It was a pro-con situation. He gave me love, and I gave him oral sex and my childhood. I needed the love that badly.

My family had just moved to Arizona from California. While our house was being built, we moved into an apartment complex. We were living next door to a family of four: Milton, Naomi, and their two children, a boy and a girl. Naomi used to make the best meatballs every Sunday. Every weekend they had a huge Italian meal.

Naomi pierced my ears. Kissing my cheek and placing an ice cube on my ear lobe, she told me I was beautiful. Their family was everything mine was not. They were noisy, outwardly affectionate, and generally happy seeming.

Milton was charming, affectionate, and talkative. His daughter, who was just a bit younger than me, was frequently in his lap, absorbing his attention and interest. I do not recall my father ever having me in his lap, or touching me in any way. When I say my dad was devoid of any emotional closeness, I mean this in the extreme. My main emotion toward him was extreme fear. He was completely alien and unavailable to me in any way. He was an alcoholic.

I am sure Milton recognized the emotional landscape of our home. Our dysfunctional, emotionally barren, and fear-ridden home was a pedophile’s orchard. The child was ripe for picking.

We had heavy drapes in the living room at the apartment. Did he know I was home alone? Of course he did. Why would I still persist in thinking that his every move with me was not completely calculated? Innocence lost dies hard, maybe even now. He knew I was home alone.

I hear a tiny tapping noise at the window. I cannot remember if I responded at first or not. Eventually I peak around the drapes. I see Milton standing by a heavy cement column that supports the walkway above.

He stares at me; I do not remember if he smiles. I remember his eyes, the intensity of his gaze. A grown man’s lust for a little girl, I presume now.

He moves from behind the column, coming into full view. His penis is exposed outside of his pants.

I am shocked and utterly confused. I am a child.

I have seen a penis only one other time in my life. I saw my father in the reflection of the mirror as he stepped from the shower. I have no brothers.

I move back from the window, and the heavy drape quickly drops back into place, momentarily protecting me. And that is the end of my initial indoctrination.

Things become fuzzy. I remember that after the window incident, Milton continued to be friendly as if nothing had happened. He continued to foster a strong friendship between us. The grooming process was under way.

The first time it happened, I cannot remember why I was in his car. Over the years, the car rides revolved around his picking me up to babysit for his children. We had moved from the apartment complex, and I was the family babysitter. As I write, I realize this was odd. His daughter was one year younger, and his son was about my age or slightly older. I was young to babysit.

He always had a box of Kleenex on the dashboard of the car and never seemed to expect me to swallow. He never instructed me to, as far as I can recall. It seemed huge to me, and foreign. I had no idea what was happening in sexual terms. We never kissed, he never fondled me. I sucked, and that was all. It did not seem to take much time. He would tenderly wipe my mouth with a clean tissue when we finished.

This all took place in a car until one night. My memory is very foggy, but I remember that we went into an office. The lighting was dim. I recall that he was on top of me as I lay on a sofa. Funny, the things I do remember—the beige leather sofa, shiny with no arms, modern style.

His penis is just on the outside of me, between my legs. I am not sure if I had panties on or not. My mind tells me he ejaculated before entering me. And that is all I have ever been able to recall.

It ended soon afterward. I told a school friend what was happening, and she told my mom. I don’t know why I told my friend, but maybe, feeling that the intensity of the situation had shifted, I could no longer keep the secret.

When my mother approached me about it, I was sick with shame and refused to discuss it. She in turn told Naomi, who came rushing over to our house.

I was hastily preparing to leave the house. As I quickly ran from my home, Naomi caught up to me. Throwing her arms around me, she brought me to the curb, and the two of us sat, side by side. She held me and cried, repeatedly telling me to just think of it as a “bad nightmare.”

It would come to my knowledge, through my mother and her investigation, that Milton had a strong history of pedophilia, as well as a gambling addiction to the horse track. Apparently, the family had owned a car dealership on the East Coast. Through civil legal action taken against him for similar pedophile behavior, they had lost the family business.

Naomi must have known what was taking place between her husband and me. And she did nothing, allowing it to continue. This violation, above all else, is what hurt me the most as I matured and began to understand the situation.

I remember telling my mother that Milton threatened me, saying if I told anyone he “would cut me up, including my ears.” That was a lie—a lie told by a kid who felt guilty.

Twenty years later, my mother was dying, and I was helping her die. It would be a special time for both of us. Lung cancer was killing her. Her addiction to cigarettes had caught up to her.

We were watching the story of actress Patty Duke on TV. Molestation is a part of Patty’s story. My mother, for the first time, asked me a question that must have been in her mind for a long time. When you know your time is limited, you start finishing up unfinished business.

“Why did you never tell anyone what was happening between you and Milton? I don’t understand why you went along with it.”

My heart crumbled. Her inference was clear. It was my fault for being a willing participant.

I broke down. Through my tears I could barely speak. I attempted to explain to her how the relationship works between an opportunist pedophile and a little girl needing love. No Hollywood ending here, in my mom’s last days.

She could not or would not understand. I believe that for her to take any responsibility for the dysfunctional home environment that fostered the relationship between Milton and me was beyond her emotional capabilities. Even within our flawed family, I always knew my mom loved me. And I loved her. I was unwilling to hammer out our family’s dark past as we attempted to say our final good-byes. I could not hurt her in that way.  Sometimes, forgiving others is a gift we give to ourselves, too.

Milton always smelled of Brute cologne. For years afterward, I secretly kept a bottle of it in the bottom draw of my dresser. Uncapping the bottle, I would breathe deeply. I was a young girl remembering a man who made her feel loved.

No criminal or civil action was ever sought against him.

Epilogue

I did attempt to find Milton about two years ago, ready in real time to deal with him. He was dead.