Alcohol and Drug Abuse UPDATE ISSUE II | A PUBLICATION OF McLEAN HOSPITAL BREAKING THE CYCLE OF ADDICTION INSIDE 2 Emphasizing the Importance 4 Group Therapy App Wins 5 Men and Steroids: Making 7 Finding a Way to Recover of Medical Detoxification Innovation Challenge the Case for More Research from Mental Illness ADDICTION DETOX: A STEP TOWARD EFFECTIVE RECOVERY By Nancy Merrill, PMHCNS, BC medications, such as buprenorphine or methadone. At McLean, we use buprenorphine. The evidence supports maintaining Detoxification from alcohol and/or drugs is an important first patients on these medications for extended periods to stabilize step in recovery. However, it’s not only important to take that recovery. However, for patients who decline this or do not have first step, but also to do it safely. access to medication maintenance, opioid detoxification can What Is Detoxification? be accomplished over four to fourteen days, depending on the There are several types of medical detoxification (detox), medication used. including detox from alcohol, benzodiazepines, or opioids. Importance of Detox in a Medical Setting When someone requires alcohol detox, the patient’s alcohol I believe that safety, comfort, and effectiveness are the three intake is stopped fairly abruptly. In order to moderate the most important reasons why detox should be performed in a effects of this quick stoppage, we give them a medication that medical setting. tempers less severe symptoms and helps prevent the more In a medical detox setting, a patient gets 24-hour care. Nurses dangerous symptoms of withdrawal. The medications typically and doctors check vital signs, make sure that the patient’s blood used for alcohol alcohol level is coming down safely, evaluate liver function, and detox are all in the do whatever they can to make the patient feel as comfortable benzodiazepine as possible. Nobody likes to suffer, so I think that this focus family, including on safety and comfort gives people a leg up on their journey diazepam (Valium), chlordiazepoxide (Librium), “I believe that safety, comfort, lorazepam (Ativan), and oxazepam and effectiveness are the three (Serax). Sometimes, most important reasons why detox for alcohol utilizes other classes detox should be performed in of medications, a medical setting.” ABOVE: Opportunities for therapy such as anti-seizure following detox include intensive medications and outpatient treatment, residential to recovery. By getting through this first step without feeling barbiturates. treatment, group therapy, individual terribly uncomfortable, it helps to develop a mindset in patients therapy, or self-help groups. Our detox program that they can stay substance-free, that there truly is recovery at at McLean Hospital, the end of the road. starts with a 24-hour evaluation. During this time, we check the Unfortunately, the vast majority of people who need treatment patient’s blood pressure, pulse, respiration, ability to walk and either try to detox on their own or fail to seek treatment at all. I stand, and other factors to determine how much medication think that a lot of factors contribute to this situation. should be used at the outset. The dosage is then reduced significantly each day, and in most cases, by the end of four to In some cases, there is a lack of accessibility—sometimes real five days, the patient has been detoxed from alcohol. and sometimes perceived. For instance, there may not be enough accessible treatment options in the area where the In order to detox from benzodiazepines, the general approach is to potential patient lives or their insurance may not adequately gradually reduce the patient’s intake of benzodiazepines. Detoxing cover their needs. from benzodiazepines is typically a much lengthier process than detoxing from alcohol, often taking place over the course of weeks Another hurdle is that most programs require abstinence, and or several months as an outpatient. Vital signs will be monitored not everybody wants to do that right away. These people may throughout treatment, and non-benzodiazepine medications may choose to try detoxing by slowly reducing their usage. be used to reduce withdrawal discomfort. Other reasons include not understanding the medical risks For opioid detox, the standard approach is to replace the of stopping on their own, frustration after a failed attempt at illicit opioids a patient is using with safely prescribed opioid detoxing, and the lack of desire to get clean. see page 3 2 Alcohol and Drug Abuse | Issue II ADDICTION DETOX continued from page 2 Potential Effects of Alcohol and Drug Withdrawal hospital/day programs), residential treatment, group therapy, The potential physical and psychological effects of individual therapy, or self-help groups, such as Narcotics benzodiazepine and alcohol withdrawal include shaky hands, Anonymous or Alcoholics Anonymous. sweating, mild to severe anxiety, nausea, vomiting, headaches, Patients may also be offered medication-assisted treatment to insomnia, and urges to drink or to take pills. Opioid withdrawal help them maintain their sobriety. For alcohol use disorders, is similar but often also involves diarrhea, which can lead to naltrexone can be administered via a pill or an injection, and dehydration as well as vomiting, chills, leg cramps, depression, other approved treatments include acamprosate, disulfiram, watery eyes, runny nose, and a strong craving for opioids. and topiramate. For opioid use disorder, monthly doses of Severe cases of benzodiazepine and alcohol withdrawal may injectable naltrexone, buprenorphine, or methadone will be life-threatening. Benzodiazepine withdrawal can lead to reduce cravings and promote abstinence from opioid use. seizures, and severe cases of alcohol withdrawal can lead to All medication treatments should be regularly monitored for seizures or delirium tremens (a life-threatening confusion state effectiveness by a prescriber or care team. If you would like in which a person may experience hallucinations and distress). more information about our medical detox services, please After Completing a Detox Program contact our Alcohol and Drug Abuse Inpatient Program at 844.222.6037. We recommend that patients continue with some type of therapy after completing a detox program and continue Nancy Merrill, is a psychiatric nurse and the program medication maintenance for opioid use disorder. Opportunities director of the Alcohol and Drug Abuse Inpatient Program for therapy include intensive outpatient treatment (partial at McLean Hospital. GIVING MEANING TO OUR MISSION McLean Hospital receives hundreds of letters annually from people touched by the hospital’s dedication to improving the lives of individuals and families affected by psychiatric illness. The excerpts below are from grateful patients who benefited from McLean’s alcohol and drug abuse treatment programs, including its award-winning inpatient and residential services. “I want to thank you for your “From my first day here, I “I found my 30 days “McLean staff gave me life, and time and the caring love you knew I was in the right place at invaluable. New friends, I am forever grateful. There showed me. For some reason, the right time. Thank you.” faculty, environment, comfort, couldn’t be a nicer place to you all seemed to bring out the listening, and being listened regain awareness! You’re all magic in me. I’ll never forget to. I am grateful that I had wonderful folks, and vital to this place, but most of all, I’ll the opportunity to be part of wellness in the world.” never forget the people who the program, and that I now make it all happen. You’ve have the positive thoughts shown me the door and how and attitude to continue my to open it. That is, I think, the adventure and succeed using most precious gift that anyone all the tools presented to me.” could give me.” 844.425.8964 | mcleanhospital.org 3 McLEAN’s INTEGRATED GROUP THERAPY APP WINS INNOVATION CHALLENGE A team from McLean Hospital won this year’s Partners To address this issue, app users will take part in a daily check-in Connected Health Innovation Challenge (CHIC) for a proposal during which they respond to questions concerning their use of to create a digital platform that brings integrated group therapy alcohol or drugs, their mood, and whether they had faced high- (IGT) to individuals with co-occurring mood disorders and risk situations. App users will also be able to interact with a substance use disorders. The team, which competed against digital coach, which could suggest activities and options to help more than 50 other submissions, will receive 200 hours of manage conditions. In addition, the app will offer customized service from the Partners Connected Health Innovation team recommendations based on the IGT curriculum and collect to help with design, software development, and research, along information from users to help make better recommendations. with 100 hours from ObjectFrontier Software to In the future, Cronin said, the app could facilitate produce the working digital platform. “group interaction, allow people to input emergency contacts, and offer crisis According to Cheryl Cronin, services.” MBA, MA, business manager at McLean Hospital’s Anna Munro, LICSW, Fernside Signature clinical team manager at Recovery Program, Fernside, added that she the digital platform, has had success using called Integrated apps as an adjunct Support Now, to clinical care with could bring her patients with IGT to millions addiction and of individuals mood disorders. who may not “These days, people be receiving the are attached to help they need. their phones, and apps can give people “There are about 3.3 reminders, help them million people with get organized, and co-occurring mood and move forward with their substance use disorders in treatment plans,” she said. the United States alone,” she reported. “We are very thankful Dawn E. Sugarman, PhD, a that we won the competition, clinical psychologist in McLean’s because we know IGT works, and this Division of Alcohol and Drug Abuse, app could help this huge population of people said that the proposed IGT app would be the get access to treatment that can help them.” first of its kind to help people with these coexisting disorders.