Substance Use Therapy

Historically, we have been taught to use the tough love approach or begin scheduling a dramatic intervention. This often results in shame and judgment, even if that is not what was intended. Frequently, these approaches backfire or are just simply ineffective. Subsequently, there is often anger and resentment on both sides, which does not help anyone involved.

Even though buprenorphine is an evidence-based treatment for opioid dependence, there are very few substance use facilities that will prescribe it. According to one study in the Journal of the American Medical Association (JAMA), out of 368 treatment programs contacted in the US, only 29% offered buprenorphine as an option. 21% actively discouraged the use of buprenorphine.

It has happened to the best of us. We start drinking, we remember getting to the bar and that annoying song was playing. We remember ordering a drink and seeing that guy from work…and then we wake up the next morning. We do not feel so great, maybe a headache, maybe nausea, definitely thirsty. We wonder, how did I get here? Why am I wearing two different shoes? Where did I get this panda head? What the hell happened last night?

This may come as a surprise to you, but there are no pharmacological differences between crack and cocaine. The two main differences between them are baking soda and sentencing laws. However, those two things are substantial enough to create some big differences and considerations.

Perhaps the holidays are one of your favorite times of the year. Or, maybe you dread them the way other people dread Tax Day. Even under the best of circumstances, it is not uncommon for people to increase their substance use or relapse during the holiday season.

Caring about someone who struggles with substance use can be many things—devastating, overwhelming, scary, frustrating, confusing, even annoying. It is never simple, with an obvious road map to follow. Most people in this situation have the best of intentions, but little clarity about what to do. This is often complicated by external forces such as shame, stigma, and poor advice.

Methadone treatment is widely criticized, but often, those criticisms are based on myths or lack of understanding. Granted, methadone, like any treatment has its drawbacks. It is not the right treatment for everyone. However, it is an incredibly valuable treatment option and it saves lives. It is worth taking the time to understand.

Perhaps this is a crude metaphor, but let’s compare it to gambling. We know the odds are slightly in favor of the house. You might win, but it is a little more likely you will lose (especially if you keep going back to the table instead of taking your win out the door with you). And some people ultimately lose it all. Fentanyl is not like gambling at a casino. Fentanyl is like one of those cheap carnival games that is rigged—almost impossible to win. The odds of losing are e

I frequently meet people in the mental health field who have no idea what methadone is, or they believe that it is not a real treatment. The cost of this lack of knowledge or refusal to accept it as a valid treatment choice is lives. People who are struggling with opioid dependence need to know their options and should be given the freedom to make their own choice about treatment.

Often, substance use is viewed from a binary perspective. You either use or you do not. Therefore, many treatment approaches treat “users” with the goal of “not using.” However, any time we attempt to view only the ends of a continuum, we are subsequently ignoring the complexities and experiences that are happening in the middle.

Many people feel that the best way to use cocaine is to use it with alcohol. People like the perceived counterbalance they feel occur when the two are taken together. Coke gotten you too jittery? Well, then have a drink. Alcohol making you too tired? Well, then do a line. Studies estimate approximately 75% of cocaine users regularly consume alcohol while using. It is a not-so-secret secret that usually the easiest places to score coke are the places where the alcohol f

Most of us do things every day to mitigate harm to ourselves and each other. We use sunscreen to protect us from harmful UV rays. We try to minimize our sugar intake. We wash our hands and cover our coughs. Harm reduction practices for people who use drugs are just as important as the practices mentioned above. Harm reduction advocates believe that everyone should have access to accurate information so that people can make safer choices.

There is a lot about addiction that seems paradoxical. However, it turns out one can be perfectly rational and have a substance use disorder. It forms some basis of internal shame too. When one can objectively see the problems, the harm done, the pain caused and choose to do it anyway—surely, they must be fundamentally flawed. Or weak. Or immoral. Of course, none of those are true.

Alcohol overdose (or poisoning) occurs when there is so much alcohol in the bloodstream that areas of the brain controlling basic life-support functions shut down. This includes our breathing, heart rate and temperature control. A lethal half dose (LD50) is defined as the dose in which half of the test subjects die. For alcohol, the LD50 is a BAC of 0.45. Inexperienced drinkers are most likely to suffer alcohol poisoning. (I will attest to this.)

Shrooms generally refer to Psilocybin mushrooms. They belong to a class of drugs known as hallucinogens. Hallucinogens change our thought processes, mood, and perceptions. There are three broad categories of hallucinogens (also referred to as psychedelics). Psilocybin is in the serotonin-related class along with LSD and DMT.

Our society has some deeply held beliefs about what kinds of people use drugs and alcohol. This is largely due to the criminalization of addiction, alcohol not withstanding. Usually when people with substance use disorders are portrayed in movies and television, they are shown as devious and dangerous. They are portrayed as volatile and somehow morally compromised.

In 2019, methamphetamine was considered the number one drug threat in Texas. This is partially due to its relative cheap cost and widespread availability. And meth got more potent. Rather than relying on ephedrine and pseudoephedrine, meth is now often made across the border with phenyl-2-propanone (P2P). With this method, it is usually made into a liquid solution and then transported to Texas to "dry houses" where the drugs are prepared to be sold.

Naloxone is a medication that can reverse an opioid overdose. Narcan is the brand name, naloxone is the generic name. The medication works by “knocking” the opioids out of opioid receptors in the brain. All opioids are central nervous system depressants. When taken in excess, they can slow or stop breathing. When naloxone is administered to someone experiencing an opioid induced overdose, it can reverse the effects.