Substance Use Therapy

We know how we feel when we drink, but how well do we understand the mysterious alchemy which is taking place? Why might we feel more relaxed? Why might we be interested in stealing traffic cones? Why is there vomit on my refrigerator? Depending on your relationship with alcohol, you might have more serious and worrisome questions, like what are the effects of alcohol on my brain and body and are they permanent? Or why is it feeling hard not to drink?

Many of us use or come to depend on the effects of drugs without quite understanding how they work. All drugs (well the good ones anyway) affect our brain and are thusly referred to as psychoactive drugs. A psychoactive drug is one that crosses the blood brain barrier and subsequently cause changes in our mood, perception, and brain function. This includes everything from coffee to heroin.

For most of us, alcohol takes up a lot of space in our brain, for one reason or another. But how much do we know about it?

In 2020, Texas saw an increase in overdose deaths of 31.9%. Just two years earlier, GovernorAbbott blocked two bills, Senate Bill 305 and House Bill 2432, despite significant support from the House Select Committee on Opioids and Substance Abuse.

Hangovers may be ubiquitous, but research around on the topic is not. Surprising, right? Apparently, the research is so scant, they have not even produced an agreed upon definition. The National Institute on Alcohol Abuse and Alcoholism defines a hangover as “set of symptoms that occur as a consequence of drinking too much.” They then provide a list of symptoms so long it calls to mind the prescription drug commercials and their possible side effects.

As grim as these numbers may be, the situation is not hopeless. There are steps that people who are actively using can take to keep themselves and others safe. Below are some tips and resources to help reduce harm.

Change is hard, especially changing our habits. Compounding the difficulty is often the expectation from others and ourselves, that change should happen quickly. Our modern society is partially to blame for this. Entire bathroom remodels are shown in 30-minute episodes. The 8 Minute Ab work out video did not make $20 million because we are all amazing at being patient. So, we decide need, want, must make a change and then we become utterly defeated because…change is hard.

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.

This is important, so I am going to repeat myself. You are NOT an addict or an alcoholic. You are a person. You may struggle with drug and alcohol use. You may have a substance use disorder. You may be addicted to something. But first and foremost, you are a person.

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?

Just because someone gambles does not mean their behavior is problematic. People gamble to socialize, for the excitement of possibly winning, or simply because they enjoy it. And when people keep their gambling low risk, it is easier to continue to enjoy it.

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.

Eat better. Exercise more. Quit smoking. Get organized. Drink less alcohol. Wake up earlier. Stop using drugs. Spend more quality time with your family. Spend less time on screens. Many of us make the same resolutions year after year, only to see them fail by March…or January 15th. And yet, the next year we will resolve to make many of those same changes again. So why aren’t we succeeding? Well, lots of reasons. According to research, we are more likely to stick to resoluti

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.

During my work as a clinician, I have encountered many kinds of people, with varied and complex issues. However, the most predominant theme I have seen are feelings of worthlessness. It would be simple to cross reference that trait with the list of depression symptoms, check a box and pat my clinician self on the back for making the correlation between feelings of worthlessness and depression. But, as anyone forced to take a statistics course knows, correlation does not imply

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.

Our stress response is commonly referred to as the fight or flight response. When we perceive danger, our body prepares us to take needed action. Our sympathetic nervous system is activated due to the sudden release of hormones. The sympathetic nervous systems stimulate the adrenal glands triggering the release of adrenaline and noradrenaline. This results in an increase in heart rate, blood pressure, and breathing rate. Our pupils dilate and digestion stops or slows down.

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