Tuesday, August 25, 2020

Hyperalgesia: Opioids Actually Worsen Pain

opioid-induced hyperalgesia and chronic pain

Opioids are most often prescribed for the management of chronic pain. However, new research suggests that these medications may actually increase a person’s sensitivity to pain over time. This phenomenon, called hyperalgesia, provides further caution to healthcare providers about the long-term prescription of opioid pain medication.

Opioid-Induced Hyperalgesia

The word hyperalgesia literally translates to over (hyper) + pain (algesia), and it refers to an increased sensitivity to painful stimuli, which may be caused by damage to nociceptors or peripheral nerves. Hyperalgesia may take several forms, including occurrences in focal, discrete areas (primary), or diffused over all areas of the body (secondary). It can be caused through injury or, as recent research now shows, long-term use of opioid painkillers.

When a person experiences increased pain response due to opioids, their condition is referred to as opioid-induced hyperalgesia (OIH). Reports of this disorder have increased with the nationwide surge in opioid prescription over the past decade.

This condition may seem counterintuitive. How can medication meant to reduce pain actually result in worsened pain? While opioids work by blocking pain, the body reacts to their action by increasing the number of pain receptors. Acclimation to these medications also results in lower levels of endorphins, which serve as natural soothers for pain. When your endorphin levels dip, it is more difficult to deal with injuries and stimuli on your own.

Put simply, due to neural changes, something that wouldn’t normally result in pain will generate a pain response in a person with hyperalgesia, and painful occurrences will be stronger than normal.

Symptoms of Opioid-Induced Hyperalgesia

This condition has three main symptoms. The first, as stated above, is an increase in the intensity of pain felt over time. Second, people with hyperalgesia will experience spread of the pain to another location other than their point of injury. Finally, OIH results in an increase in the discomfort felt from external stimuli.

These symptoms present themselves even when a person increases their dosage of pain medication, with or without the advice of a physician. In fact, they will likely worsen with a heightened opioid dosage.

OIH is assessed through bedside tests, which include the pain intensity response to a cotton swab, finger pressure, pinprick, and cold or warm stimuli.

Other Side Effects of Opioids

Hyperalgesia is not the only health issue caused by long-term opioid use. These drugs have been the source of America’s opioid epidemic, a massive health crisis characterized by rapid dependence and addiction. Even with prescribed use, these drugs are incredibly habit-forming, meaning that people recovering from surgery or seeking help for chronic pain may find themselves reliant on opioids (and affected by OIH).

Signs of opioid addiction include…

  • Drowsiness or nodding off mid-conversation
  • Significant weight loss
  • Poor personal hygiene
  • Flu-like symptoms
  • Financial problems
  • Craving the drugs or increasing one’s dosage
  • Worsened work performance
  • Stealing money, items, or medication
  • Sleep problems

Addiction is a disease that affects the entire person, physically and mentally. People who develop a dependence on opioids may find themselves unable to function without them. They may exhibit drug-seeking behavior, cravings, and compulsive use. Over time, these behaviors may damage a person’s life, personally and professionally. It is vital for people with OIH to seek professional help as soon as possible.

Treatment for OIH

The best approach for the treatment of hyperalgesia is the tapering and even eventual discontinuation of opioid pain medications. This process may take a long time and will require the advisement of a physician and addiction specialist, who together will oversee the patient’s progress and response to the tapering. People who discontinue their opioid prescriptions may experience withdrawal, but with proper medical supervision, it is possible to limit one’s discomfort, symptoms, and existing pain while overcoming a dependence on these drugs.

Find Recovery from Opioids

Fortunately, evidence-based treatment is available. If you or a loved one have developed a dependence on opioids which has resulted in OIH, there is hope. At Hemet Valley Recovery Center and Sage Retreat, our team of clinicians can help you to overcome hyperalgesia and opioid dependence.

Our California Chronic Pain and Addiction Treatment Program is designed to help individuals who rely on narcotic analgesics to seek alternative pain management solutions. We provide medically managed detoxification and chemical dependency treatment supplemented by targeted therapeutic groups.

Through our biopsychospiritual model, patients learn alternative pain management strategies in group therapy, breathing techniques, music, poetry, yoga, acupuncture, exercise, physical therapy, massage, and other tailored programs.

To learn more about our services, contact us today.

Wednesday, August 19, 2020

What is a Case Manager? | Case Management Explained

case manager providing case management services
As a person finishes their time in an inpatient or residential treatment program, the transition back to “real life” requires careful consideration. This is when case management services become important. A case manager provides guidance, support, and much-needed resources to program alumni, while also ensuring that they remain on track after leaving HVRC. Today, we’ll discuss what a case manager is and what they do on a daily basis.

Case Management Explained

A case manager serves as your advocate in the early stages of recovery. They will gather information about each client’s situation – including their history of substance use, home life, and more – during the screening or assessment phase of intake. After learning as much as they can about each person’s addiction and daily life, they work with the client to create a fully individualized treatment plan. Addiction treatment is not one-size-fits-all; in fact, it requires a tailored approach in order to be successfully addressed. As a client goes through the program, case managers frequently check in to monitor progress and modify the treatment plan as needed.

Case management also involves caring for a patient after they have left a residential program. There are many individuals who require an additional level of support after treatment, including ex-convicts, people with mental illness, those with co-occurring health conditions, and the homeless. A case manager advocates on the client’s behalf, ensuring access to medication, follow-up care, and services like job training, housing opportunities, and doctors’ appointments.

The Duties of a Case Manager

The daily responsibilities of a case manager are varied and require several core competencies. These individuals have a history of education and training on the subject of addiction treatment, and they are prepared to support individuals at all phases of recovery.

Case management tasks include:
  • Supporting and providing case management services to existing clients and alumni
  • Developing personalized treatment plans for each client
  • Ensuring that treatment plans align with each person’s needs
  • Monitoring client progression and revising case management as needed
  • Participating in meetings with each client
  • Continuing to attend trainings and educational seminars to advance education in the field of addiction treatment
  • Creating outcomes reports and highlighting success stories
  • Helping clients to access much-needed resources during and after treatment
  • Documenting each person’s needs and progress based on state and local requirements
  • Conducting crisis intervention as needed

Does This Service Help You Stay Sober?

Ultimately, each person is responsible for their own sobriety. No one can ensure that an individual never picks up a drink or drug again. However, ongoing support from a case manager can make a difference in a person’s risk of relapse.

By contacting agencies like insurance providers and community partners, it is possible for case managers to make the transition from rehab to home life an easier one. These support services can allow former clients to access important financial help, trainings, and childcare services, which lessen their stress on a daily basis. Through these resources, an individual will feel more supported in the early stages of their journey.

Additionally, case managers can help clients to access benefits they may not have known about. By working with social security and disability offices, it is possible to arrange for a client to have food stamps, Medicaid coverage, low-cost health insurance, and more. They can also create a network of support that is waiting for someone after treatment in the form of AA or NA meetings, local church groups, or support groups specific to a co-occurring condition or past trauma.

In short, case management can make an enormous difference in a person’s life, during and after treatment. If you have been to treatment before and are struggling, we encourage you to reach out for case management services today. Our team is standing by to help you access the financial and support services you need.

Find the Support You Need

At Hemet Valley Recovery Center and Sage Retreat, we understand that navigating the world after treatment can be complex and intimidating. This is why we offer a robust array of case management services. Our team of experts will work with you at all phases of recovery, ensuring that your fully individualized treatment plan is tailored to your needs every step of the way. From intake to aftercare, we’re here for you.

To learn more about our case managers and how they can help you to recover, please contact HVRC today.

Monday, August 10, 2020

What Drug is Most Commonly Abused by Older Adults?

Whether it’s problem drinking or the misuse of prescription medication, substance use is a significant problem for older adults – in fact, it is one of the fastest growing health issues in the United States. This pattern of behavior often goes unchecked because people are unlikely to confront older relatives about their drinking or drug use. Today, we’ll analyze substance use in the elderly, answering the question: What drug is most commonly abused by older adults?

Substance Use and Older Adults: The Statistics

While illicit drug use is normally associated with risk-taking young people, research shows that more than one million Americans over the age of 65 have a substance use disorder. According to SAMHSA, the Substance Abuse and Mental Health Services Administration, alcohol remains the most common drug of misuse. Their research demonstrated that 978,000 older adults had an alcohol use disorder, while 161,000 could be diagnosed with an illicit drug use disorder.

Combined data from the National Surveys on Drug Use and Health (NSDUH 2007-2014) indicate that during the past month, six million older adults drank alcohol, 132,000 used marijuana, and 4,300 used cocaine. On an average day in 2011, there were over 2,000 drug-related emergency room visits for older adults; of these, 290 involved illegal drug use, use of alcohol combined with other drugs, or nonmedical use of pharmaceuticals.

These numbers are staggering, and experts warn that they will grow. They warn that the baby boomer generation faces relatively higher drug use rates compared with previous generations. This cohort will experience the negative consequences of substance use, which include legal trouble, incarceration, physical and mental health issues, social and family problems, and potential death from overdose.

The dangers are known, and researchers must ask: If their risk is lower, how do older people become addicted to drugs and alcohol?

How and Why Do Older People Become Addicted?

The Office of Alcoholism and Substance Abuse Services divides older adult substance abuse into two discrete categories: individuals who have used substances for many years, and those who formed addictions later in life. People in each of these groups face different obstacles that create a perfect storm in which addiction can form.

Individuals who began misusing drugs and alcohol earlier in life probably did so as a result of environmental conditioning, genetic predisposition, or as an attempt at self-medication. As one uses substances over time, they develop a tolerance; as such, they require more and more of the drug or drink to achieve the same effect. Because addiction is a progressive, chronic disease, it is possible for someone to begin using drugs or alcohol recreationally, only to find themselves dependent on that substance in the long run.

Older adults who begin drinking or using later in life may be triggered into this pattern of behavior. Individuals who are diagnosed with an illness, dealing with chronic pain, severely injured, or coping with mental illness may find themselves struggling to get by. Older people go through a lot of transitions in their age – they retire, friends and family members pass away, or they may be relocated to an assisted living facility. These troubling instances can serve as a catalyst to substance abuse.

Finally, older adults who are prescribed highly addictive medications may struggle to adhere to label instructions. Even when used under the supervision of a medical professional, ongoing use of opioid pain relievers can result in chemical dependency.

No matter how an older adult finds themselves addicted to drugs or alcohol, it is vital to identify that they have a problem as soon as possible.

Signs of Addiction

It can be challenging to identify substance abuse in older adults. As we age, our health deteriorates. Because of this, health care providers may overlook the signs of addiction entirely. Its symptoms can overlap with the effects of medical or behavioral disorders like depression, dementia, or diabetes.

Signs of addiction in older adults include…
  • Changes to eating and sleeping habits
  • Unexplained injuries or chronic pain
  • Irritability or depression
  • Difficulty concentrating or remembering
  • Becoming isolated and secretive
  • Experiencing financial difficulty
  • Worsened personal hygiene
If you believe that a senior citizen in your life has developed an addiction, it is vital to seek treatment as soon as possible.

Treatment for Older Adults

The U.S. Department of Health and Human Services recommends that older adult treatment plans involve age-specific programming, a focus on coping with depression and loss, a pace appropriate for older individuals, staff members who are experienced in working with this population, linkages with other supportive services, and a focus on rebuilding one’s social network. We provide these services and more at our well-appointed, single-floor facility. At HVRC, we have created a track specifically tailored to the needs of older adults.

To learn more about our age-specific addiction treatment services, contact HVRC today.

Wednesday, August 5, 2020

How to Explain Addiction to a Child: A Guide

explaining addiction to a child
In America today, more than eight million children live with parents who are addicted to drugs or alcohol. Living in a home with parental substance abuse can be frightening and confusing for anyone, but especially so for the very young. A child may struggle to understand why their parents behave a certain way, as they face unclear communication and erratic, unpredictable behavior from the adults in their life. This often results in kids making up their own explanations for what is happening; unfortunately, they may even blame themselves for parental substance abuse.

To make matters worse, family members are often hesitant to bring up addiction, or they may ignore the problem altogether.

Experts recommend being honest and up front with children whose parents are addicted to drugs or alcohol. This openness and shared understanding can pave the way for personal growth and common-sense next steps. Today on the blog, we’ll share with you our top tips for how to explain addiction to a child.

Why Should I Tell Them?

When a parent, sibling, or other family member is addicted to drugs or alcohol, a child’s entire life changes.

Children living in homes with people who abuse drugs and alcohol may find their lives unpredictable and scary. They may even think their parents’ substance use is their fault, or they can feel guilty or ashamed while trying to protect family secrets. It’s also common for children of addicts to feel abandoned, since their loved ones are not emotionally available to engage with or support them.

Young people who feel unsafe or unwanted tend to withdraw or act out, which can put them at greater risk of becoming addicts themselves. In order to break this cycle, it is necessary to be honest with them about their loved one’s substance use.

Remember above all else that the goal is to help a child better understand the disease of addiction. The conversation should be a way for them to have questions answered, assuage themselves of guilt, and know what’s going on with their loved one. It can also aid them in knowing their own predisposition to addiction later in life. The conversation should not be a chance to get the child on someone else’s side, turn them against their loved one, or scare them.

How Much is Appropriate to Explain?

There are some topics that are very difficult for children to understand, and addiction is one of them. When telling a child about the substance use of a parent, sibling, or more distant relative, it’s important to consider their age. By tailoring your conversation to their cognitive level, you will avoid overwhelming them and can help them to understand the issue at hand.

For very young children, this age appropriate conversation may involve describing addiction as being “sick.” Consider using books or other aids to guide you through this process. The older the child is, the more you can share; however, be careful not to provide too much upsetting information. Additionally, monitor your attitude while talking about this particular topic. The child may already resent the addicted family member. Instead of upsetting them further, seek to help them understand their feelings and the situation without creating prejudice or anger.

The Disease Model of Addiction

Be sure that the child understands that addiction is a disease. By letting them know that their parent is sick just like a person with any other condition, such as diabetes or high blood pressure, you can significantly decrease the stigma around substance abuse. Tell them that they are not alone, and that millions of families are in the exact same situation.

You do not need to use this opportunity to launch into a full explanation of addiction; instead, focus on addressing the child’s concerns and helping them to develop a general understanding around the topic. This conversation is the time to tell them that their parent is sick and that it is not their fault. Later, you can talk to them at length about the disease model of addiction if necessary.

The Seven C’s

The National Association for Children of Alcoholics is an organization whose purpose is to eliminate the adverse impact of substance use on children and families. They recommend using the seven C’s to help young people better understand and cope with addiction in the home. They are…

  • I didn’t cause it
  • I can’t cure it
  • I can’t control it
  • I can care for myself
  • By communicating my feelings
  • Making healthy choices
  • And celebrating myself

These seven C’s are useful for combatting helplessness, guilt, shame, and other negative feelings that may arise throughout a loved one’s recovery or continued drug use.

Finding Support

In addition to providing an age-appropriate explanation, adults should find ways to support the children of addicts. Perhaps the simplest approach to this is to ask the child how they feel in a situation – for example, if they’ve seen Daddy get angry and throw things, or if Mommy has fallen asleep while talking to them. Having these conversations brings family secrets to light and allows the child to feel seen, heard, and supported through difficult times.

Teenagers may benefit from participation in Alateen, a version of Al-Anon for younger people dealing with a loved one’s addiction. In a group setting, participants may share experiences, discuss difficulties, and provide encouragement for one another.

Do You Need Help Explaining Addiction to a Child?

Telling children about addiction is a difficult task. However, with the right level of preparation, it is possible to use this conversation to help the child to feel supported, loved, and informed. At HVRC, our Family Program can help young people to better understand their parents’ drug and alcohol misuse, strengthening the family unit. To learn more about our evidence-based approach to addiction treatment and family healing, contact us today.

Tuesday, August 4, 2020

The Art of Storytelling | Learning from the Past


Storytelling as a Tradition

The art of storytelling has long been a respected skill and an important tradition in many cultures. Over the course of history, community elders and their stories have been regarded as a treasure trove of society's knowledge, history, and wisdom. Older members of a community were encouraged to share their stories with younger generations, keeping the oral tradition alive. Today, medical and social science researchers are interested in more than just the importance of storytelling as a means of teaching and entertaining, but also cognitive health.

Belonging and Acceptance

Storytelling goes far beyond the relating of culturally historic stories, myths, legends and lessons. It provides a means of belonging, acceptance and unity. Storytelling allows one to learn from the past and solidify an identity that may be unknown or misguided. The cultural act of storytelling from one generation to another provides a sense of being one with another, a belonging, and can evoke feelings of pride and diminish the thoughts and feelings of loneliness and not being understood. It is a way that our ancestors have created continuity in rituals and customs that define a family structure, regardless of education, finances and community stature. 

A family system is held together by unspoken mores and bonds that are seen, but too often, not understood. When generations take the time to provide such lessons, in the form of storytelling, it creates a bond that cannot be duplicated through other avenues. Storytelling sends the message that, no matter what you have done or the decisions you have made, you belong to someone, you belong to a system, and you are not alone. It is in these moments that the brain is introduced to a structure, a certain dynamic that makes sense in a world that may not. It allows for the cognitive process to minimize fears and embrace the decision-making process that has formed in our brains as influenced by past familial generations. 

Processing Reality & Overcoming Loneliness

Storytelling helps to activate multiple senses, solidify thoughts and bring our emotions into reality. It allows for our internal self to come to life and become real. It is imperative to feel if we are to heal! And, although it may be frightening to bring life to our stories, it is through this act that we create connections that help us through times of darkness and loneliness. This is when we breathe life to our values, morals and ethics that may have been forgotten or lost.

In the world of addiction and alcoholism, the feeling of loneliness is far too common. The belief that family and friends have given up on us is far too great to combat. And the thought that no one will understand and that family and friends have abandoned us is a reality that holds true in the minds and hearts of many who suffer from the disease of addiction. Through the simple act of storytelling and listening to storytellers, those feelings and beliefs can be transformed. This transformation can then be the catalyst to those seeking motivation and hope for sobriety and emotional and mental wellness.

Storytelling and 12-Step Meetings

In the rooms of Alcoholics Anonymous and all of the other 12-step realms, the use of storytelling is of the utmost importance. One is free to share his or her own story, give it life while taking the power out of its secrets and invisible stronghold. When others hear their own story, when others can relate and when others can learn from it all, it allows a sense of healing emotionally and cognitively. Within this healing come solutions – solutions to our sense of wellbeing and the tragic stories that we tell ourselves that we must succumb to. 

It gives those suffering from the disease of alcoholism and addiction a chance to see that we are not alone, even when we may think we want to be. This is seen with the most power within Step Five of the 12-steps. This is the part of our recovery journey that allows us to share with our sponsor, our Higher Power and ourselves the exact nature of our past. It is a sacred section of one’s journey in recovery where solutions become an epiphany, a sense of belonging becomes inherent and the shame and guilt of our secrets diminish into a path of healthy wellness.

Change Your Story

The act of storytelling is also aligned with the successes of psychotherapy. A client can use this act through the use of narrative therapy in sessions. Through this approach, the client is free to tell his or her story from the vantage point of being the sole author of his or her life’s journey. Taking it a step further, the therapist helps the client identify his or her own strengths to apply them as solutions to questions, concerns and struggles. It helps to separate the problems experienced from the person and allows the client to see it strategically in order to identify areas requiring change. The benefits of such an approach in the therapeutic room goes beyond a professional telling the client what to do, it allows the client the opportunity to bring the therapist along the journey so that no one has to ever experience it alone.

There is so much more to the act of storytelling, beyond that of entertainment. It can actually be the one thing that alters one’s decision to accept the strength that is already within to change and reunite with the family system that can never be broken. The freedom that comes along with sharing our stories, past and present, is one that cannot be experienced through any other means. When we share our stories with a genuine sense of vulnerability, we take the power out of their secrets. We find the freedom and genuine self-worth that was hidden behind our own negative connotations of self. We allow others who share the same story to unite with us and for us on a journey of wellness that can only be successful when we make the decision to no longer try and do it alone.