Mental Health, Mental Illness, on Block Island

bringing services and support for those who are ill and education for mental health to all on Block Island


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Medications for Quitting

Medications that May Help for Quitting Toxic Substances

 

Author: Elizabeth Perry, Warren Alpert School of Medicine class of 2019

Medical content edited by Mark Clark, MD, Medical Director, Block Island Medical Center

BIHS Community Health Outreach Series 2018

 

A few weeks ago we provided an article discussing tips for quitting smoking.  This follow up article is about medications that are now available to assist in quitting a variety of toxic substances, or, “Medication Assisted Treatment.”

 

Anyone who has tried to give up a bad habit knows how hard it can be. For substances like cigarettes, alcohol, and opioids, our bodies also get hooked on them, making them even harder to quit with will-power alone. If you are at the point of using any of these substances every day then your body has grown accustomed to them, and you may even get sick if you try to quit cold turkey. There are now a few different medications that can help you quit, either by preventing withdrawal, or by decreasing urges. If any of the medicines from this quick overview sounds like something you want to try, then the next step is to ask your doctor about it.  We are ready and able to assist you at the Block Island Medical Center.

 

Smoking cessation:

There are 3 main medications that have been shown to help people quit smoking. The first is actually a group of products, many of which are available over the counter, called nicotine replacement therapy. This includes patches, gum, and lozenges. Paying for these products out of pocket can get pretty expensive, but some insurances cover them, so ask your doctor about options for help covering the cost.

Two other prescription medications have also been shown to help. The first one is called bupropion or Wellbutrin, and the second one is called varenicline, popularly known as Chantix. Both of these medications have been shown to reduce the symptoms of nicotine withdrawal, making it easier to fight cigarette cravings. Patients taking varenicline are almost 3 times more likely to succeed at quitting smoking than patients who are not taking any medication.[1]

While it is great to quit smoking by going cold-turkey, if this is not something that has worked for you in the past it is worth asking your doctor about medications that can help.

 

Alcohol cessation:

Alcoholism has touched almost everyone’s life either personally, or through watching friends and family struggle. This can be one of the hardest drugs to quit, but there are now a few medications out there that can help. However, if you develop symptoms when you do not have a drink, like anxiety, shaking, sweating, or hallucinations, then it is safer to quit in a detox program rather than on your own at home. Detoxification can sometimes be a very serious or life-threatening process and for that reason it sometimes needs to take place in the hospital.  Your doctor can help you to decide which setting is correct for you.

Naltrexone is a medication that can be started before a person quits drinking. It can be administered as a daily pill or as a monthly shot, and it has been shown to decrease a person’s urges to drink. It actually blocks opioid receptors, so it will negate the effects of opioids too. This would not be a good choice for a person who requires opioids for pain control.

Disulfiram, also called Antabuse, must be started after a person has not had a drink for 24 hours. It can help deter a person from drinking again because when it is mixed with alcohol it causes negative side effects. These effects include flushing, nausea, vomiting, and dizziness, which make taking a drink a pretty unpleasant experience. If you are having trouble staying sober, but you want to, ask your doctor about these medications.

 

Opioid cessation:

If you or someone close to you is using opioids every day then medications to keep withdrawal symptoms at bay can be really helpful. There are a few options available.

Methadone is a long acting opioid that has been used the longest as a treatment for opioid addiction. It is very effective, but often requires visiting special methadone clinics daily, especially in the beginning, in order to receive the daily dose of methadone. For some, this can be burdensome, but these specialized clinics also often have groups, social workers, and other supports to help with quitting.

Buprenorphine, or Suboxone, is a medication that can be taken at home, usually in a form that dissolves under the tongue. It partially stimulates opioid receptors in the body, while methadone fully stimulates them; as a result, some people find it less sedating than methadone. Buprenorphine is used by thousands of people to control the urge for opiods while avoiding the risks and side-effects of abusing opioids. These medications do not provide a “high,” however they do effectively reduce the physical urge to use opiod type drugs.

Naltrexone, the same medication used for alcohol urges, can also be used to help people quit opioids. It blocks opioid receptors completely. That means that if a person who is taking naltrexone takes an opioid, they will not feel the effects of it. Naltrexone must be started after a person has withdrawn from opioids, while methadone and Suboxone can be started before someone withdraws.

 

This has been a very brief summary of some of the medications available to help quit smoking, drinking, and taking opioids, but the first step is always feeling ready to make a change. You can get more information about any of these medications at your doctor’s office.  We are ready and willing to confidentially discuss your substance use concerns with you at the Block Island Medical Center, in order to help you to make the best choices regarding treatment.

 

 

[1] Cahill K, Stevens S, Perera R, Lancaster T. Pharmacological interventions for smoking cessation: an overview and network meta-analysis. Cochrane Database Syst Rev 2013; 5:CD009329.

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Shame/ Pain/ What do we do?

This is an article where every sentence is worth reading, e.g. “Shame may be lived as a state of loneliness, or addiction or felt as numbness and chronic pain.” There are also two very good videos included, making sense of the ways we function.

Empathy, shame and medical professionals


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Reports

Brought by NAMI RI, on February 6 2017, two programs took place in BI school: “Inside Mental Illness” for High School Students and “Parents and Teachers as Allies” to which all in the community were invited. Click here to access the slides that accompanied these interactive events.

Articles in BI Times report the activities of NAMI BI. From the search using “NAMI”, see these recent items:

  • NAMI-BI plans funding, programs for 2017

    Posted: Fri, 12/23/2016, 7:30am By Pat Tengwall
    NAMI-BI). Board members committed to renewing their request to the Town … the summer, Fredericks said. The NAMI-BI affiliate persuaded the Town … professional help,” according to NAMI-BI’s annual appeal letter. NAMI-BI obtained …

  • NAMI to expand educational role

    Posted: Sun, 01/22/2017, 10:15am By Gloria Redlich
    Executive Director of the NAMI state chapter, who is emphasizing the … The next NAMI-BI meeting is scheduled for Feb. 23 at 9 a.m. at the Harbor Church. Gloria Redlich NAMI to expand educational role …

  • NAMI to focus on heroin and opioid use

    Posted: Fri, 10/14/2016, 9:45am By Gloria S. Redlich
    opioids on Block Island NAMI caseworker Tracy Fredericks acknowledged that … NAMI-BI should sponsor a panel discussion with national experts and members of the local community. NAMI Chair Steve Hollaway suggested that …

  • NAMI-RI director vows assistance

    Posted: Sun, 11/13/2016, 8:00am By Gloria S. Redlich
    The Block Island affiliate of NAMI (the National Alliance on Mental Illness) recently hosted Cindy Elder, Executive Director of the NAMI state … recently taking up the post at NAMI-RI, Elder has identified several goals …

 

see also letters from Vin Carlone and Mark Clark on the Opioid Crisis.


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Cannabise Use and Psychosis

An article here on research regarding the link between cannabis use and psychosis. It is from a group of scientists working in UK who say that cannabis use can lead to psychosis in certain people. the risk may be greater if use begins early, during adolescence. It may not be a risk to other people, but it needs to be taken seriously.

More research is needed to clarify strength and vulnerability factors in individuals, but that there is a link for some, and a loss of life potential, is already clear.

[This study is from the Guardian and reflects UK statistics, but recognizes trends elsewhere. Far more teenagers seek treatment in the UK for cannabis use than for any other drug including alcohol.]


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Compassion and Our Selves

Please let us know the URL to any websites/articles/blogs/stories/videos/books etc you think visitors would find interesting or useful. A brief review of what the contribution is about would be useful too. We will add a post – others are found by scrolling down here. Hopefully this will grow into a resource for us all. However, NAMI BI cannot monitor all the information on other sites and we are not responsible for it. Please let us know if any link or articles suggested seem inappropriate or unhelpful.

bodyscoreA book was recommended by Arietta Slade – it is well worth reading: The Body Keeps the Score, by Bessell van der Kolk.

I am impressed by the integration of neuroscience (in a way I could understand) with a variety of therapies, experience of talk, body, and mind.

A great book.

And, a great article:

Self-Compassion in Kids from uwhealth.org, August 19, 2015 By Shilagh Mirgain, PhD

It turns out psychologists may have gotten it wrong. compassionkidOver the years, there has been a tremendous emphasis in our society on building kids’ self-esteem. Psychologists now think we should be teaching children how to develop self-compassion instead.

The problem is that self-esteem is often developed by social comparison, meaning it requires a person to feel special and superior to others on a variety of dimensions. Kids feel good about themselves when they get the A, win the game, receive the trophy and sometimes even by putting other kids down to make themselves feel better. But this constant comparison needing to be better than other kids instills a belief that it is not ok to be average.  When things don’t go well, feelings of superiority slip and self-esteem takes a nose dive, leaving kids vulnerable to anxiety, insecurity and depression.

What’s the solution?

Teach children how to develop self-compassion. Self-compassion is learning to extend understanding, compassion and encouragement to yourself when things don’t go your way, treating yourself the way you would a close and treasured friend.  Research shows increasing self-compassion has all the benefits of self-esteem but without the downsides. Unlike self-esteem, self-compassion reduces anxiety, lowers feelings of embarrassment when you mess up, and is associated with steadier and more consistent feelings of self-worth.

There are several ways to help foster self-compassion in kids, including:

Mindfulness

In a world driven by distraction, teach your child how to be in the moment. Some ways to do so include:

  • Help them notice things around them, savoring positive experiences when they occur. Teach them how to be present with themselves.
  • Encourage them to take 3 deep breaths when feeling stressed, overwhelmed or distracted to return to the moment and back to their center.
  • Help them develop awareness of their thoughts and feelings, to not ignore them but to also not become overwhelmed by them either.
  • Help them learn how to observe non-judgmentally their internal experience, understanding that they don’t have to believe every thought they think, especially the negative ones, and that emotions, like ocean waves rise and fall if you just let them be.
  • Help your children identify those moments of struggle and difficulty as opportunities to practice self-compassion.

Validate their experience, such as saying, “oh this is a difficult moment,” or “that was really tough to go through,” make them aware of what they are feeling by labeling their emotions “oh you’re sad,” or mad, scared, hurt, etc. and talk through their reactions.

Kindness

Kindness begins when we understand that we all struggle. Teach your children to talk kindly to themselves versus being critical. This builds a stable sense of self. Self-criticism isn’t helpful and only produces a variety of negative consequences, including feeling badly about oneself.  Next time your children start saying something critical, point this out to them and then teach them to reframe these thoughts into something positive and forgiving. The way we communicate with our children establishes a blue print for how they will eventually communicate with themselves. Talk to them in a non-critical way. Teach them how to self soothe during difficult times. Say to a small child, “Let’s practice hugging ourselves like mom and dad do to make you feel better. You can do this for yourself when you feel bad to remember how much you are loved.” Teach older children to put their hand on their heart to self-soothe when upset. These small gestures help them value and feel good about themselves just as they are no matter what is going on.

Teach kids how to be kind to others. Ask what they did in their day to make someone happy, find volunteer opportunities to do together as a family, encourage your kids to write thank you notes, recognize regularly when someone did something nice for another in the family.

Compassion for Others – Common Humanity

Remind your children that they are not alone in experiencing this difficult thing, other kids feels the exact same way. Everyone struggles, feels inadequate, does not get approved of, or fails at something in life. It’s part of our common humanity.  This helps normalize what a child is going through and reduces shame and embarrassment over mistakes made and not feeling good enough.

Encourage them when they see people throughout their day to offer them compassion. Teach them to wish others well, saying silently or verbally to others, “may you be happy, healthy and free from suffering.” . When our sense of self-worth is based on being a human being intrinsically worthy of respect, rather than on achieving certain ideals, our sense of self-worth is much less easily shaken. And that will make for a very good school year ahead.

This school year, instead of seeking to become extraordinary and special, encourage your children to find the wonder and marvel of the ordinary. How to sit with sadness in themselves and others, the comfort that a touch of a hand can provide, the warmth of compassion for themselves and others struggling. Teach them the simple pleasure of wishing someone else well, happiness and ease. Make these ordinary moments come alive for them. Then the extraordinary will take care of itself.

Gratitude

It’s so easy to focus on what’s wrong. Teach your children to focus on what’s right. Studies have shown that children who cultivate gratitude in their lives have better social relationships and do better in school. Make gratitude a part of your daily conversation. During dinner or as part of a bedtime ritual, ask children to share three things they’re grateful for about themselves and their lives. Ask them to reflect on why these things occurred to deepen their appreciation and understanding of the good things in their lives, including aspects of themselves, and not take it for granted.

As we talk about mindfulness, kindness, compassion and gratitude, what we’re really talking about is putting more love out in the world. And that can be one of the most meaningful gifts we can give our children.


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Articles of Interest – 1

Please let us know the URL to any websites/articles/blogs/stories/videos/books etc you think visitors would find interesting or useful. A brief review of what the contribution is about would be useful too. We will add a post – others are found by scrolling down. Hopefully this will grow into a resource for us all.

However, NAMI BI cannot monitor all the information on other sites and we are not responsible for it. Please let us know if any link found here seems inappropriate or unhelpful.

Mental Illness is the cinderella of Health Services. In the TED video below, Thomas Insel shows that much is still to be learned. We do however know that recovery is possible, but that too frequently stigma and silence surround sufferers and their families. This page is for sharing information and sources of information.

Our first collection –

NAMI The home site of National Alliance on Mental Illness – a huge resource

NAMI Rhode Island Local information – happenings in Rhode Island, other affiliate organizations

Time to Change A UK site aiming to reduce stigma and increase involvement with lots of information, personal stories and good ideas, from the charities Mind and Rethink Mental illness

Inside the Brain A blog with regular updates on neuroscience research

Alive Inside – a trailer to a film about the effect of music


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Share Reading / Articles of Interest

Please let us know the URL to any websites/articles/blogs/stories/videos/books etc you think visitors would find interesting or useful. A brief review of what the contribution is about would be useful too. We will add a post – others are found by scrolling down. Hopefully this will grow into a resource for us all.

However, NAMI BI cannot monitor all the information on other sites and we are not responsible for it. Please let us know if any link found here seems inappropriate or unhelpful.