As a community we can learn from each other, share experience. Any one of us might be a “first responder” to someone who lives here and suffers illness. If you have something to say, join in the Community Conversations. Look at “Can You Help“. Come to the BI NAMI events that are advertised in The Block Island Times and on the Block Island Bulletin Board. Make contact or comment in these community posts. Scroll down below. Write a post – please ask. You might have found an article of interest – please send.
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.
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.
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.
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.
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.
 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.
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.
Telemedicine – A Post from Board Member Socha Cohen, published in the BI Times
Is Doing the Numbers Enough?
Since its inception, the Tele-Medicine program provided on Block Island has serviced 29 patients, three of whom were escorted off-island by the case worker, Tracy Fredericks. Butler Hospital and Brown University offer the services of a psychiatric intern free of charge under the condition that Block Island pay for the salary of a case worker who receives an hourly wage: the more patients she helps, the higher her wage. In conjunction with a large donor, and the financial support of the Town, NAMI-BI has been raising funds to support Tracy’s salary which ranges from year to year depending upon her case load. “We are providing services to a community where there had been none in the past,” says Gloria Redlich, coordinator of the Coalition for Seniors. “Inherent in mental illness is that for many there are obstacles to reaching out for care.”
National data support Dr. Brownstein, NAMI-BI largest donor, stating, “it’s estimated that 30% of people will have a mental health problem at some point in their lives. In all populations studied, 1% suffer from schizophrenia, and 5% have major depression. 9.3% of people 12 and over needed treatment for illicit drug or alcohol use in 2009. Things have gotten worse since then. So whether they’re taking advantage of the telemedicine program or not, it seems likely that a significant fraction of folks on the island are likely to need it sooner or later, and when the population swells to 10,000 or more in the summer months, the need expands markedly.”
Elspeth Crawford, board member of NAMI-BI and leader in Emotional Education, adds, “Provision of health service of any kind is not about monetary capital, e.g. what you get when you re-model the pavilion, it is about social capital, what a healthy community looks like in the future. Not providing the service has hidden costs on the future that affect us all. There would more disruption and expenditure in relation to other community services, and also, each person who is ill is not a lone person, but may have family and others, all of whom, including the ill person, are less able to contribute to our community and economy if their energy has to be directed in countless ways keeping stability.”
“In short, the bad news is that we’re still not serving as many people as we probably should be”, continues Dr. Brownstein, “and we need to figure out how to “market” the program better. The good news is that we have a program to market–one that probably saves lives. What’s a life worth?
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:
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 …
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 …
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 …
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.
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.]
A video – What is depression? Well worth watching as even if you are not a sufferer it is really helpful with regard to enabling those who do suffer.