Heroin: Addiction to Recovery Dominic Vangarelli,M.A., C.A.D.C

Geisinger Marworth

Chemically Dependent Person: Family Members :   Chemically Dependent Person: Family Members : Denial Rationalization of use Minimization of the consequences of use Making excuses/justifications for use Worrying about personal reputation and what others in the community are thinking about the family Agreeing with the excuses the addict/alcoholic makes and blaming other people A denial that the family has been affected… “It’s his/her problem, not mine, fix them!” Preoccupation 2. Preoccupation The addict/alcoholic becomes consumed by cravings and thoughts of using/not using The family becomes preoccupied with the addict/alcoholic They begin to feel as if they were walking on eggshells, wondering, waiting, anticipating for any outburst or binge use 3. Attempt to Control Numerous attempts and desperate actions to try and control the use of alcohol/drugs and subsequent failures and short comings The family members try and control or force situations onto the addict/alcohol in a desperate attempt to control them and prevent crisis   4. Increased Tolerance 4. Increased Tolerance Tolerance for the alcohol/drugs significantly increases and this is the hallmark of chemical dependency Enabling behaviors increase, family members begin to “ignore” behaviors and allow the addict/alcoholic to get away with more unacceptable behavior 5. Isolation The addict/alcoholic begins to isolate himself/herself and only associate with people who use They begin to use alone and avoid people They begin to avoid their family members The family members stop socializing with other people and other families The family members try to isolate themselves from the addict/alcoholic “out of sight, out of mind” 6. Guilt & Shame The addict/alcoholic keeps his/her use hidden from others and then battles the shame and guilt with more drinking or drugging They start to feel the shame and guilt from how their drinking/drugging affects the family and others The family members keep the guilt and shame in the house, they will keep their embarrassment to themselves and avoid contact with others

Admission Trend 2010 - 2016

Staggering Stats Over the past 2 years more American's died of opiate addiction that the entire Vietnam War. Drug overdoses cause more deaths than gun violence and car accidents. Opioid overdoses are responsible for more deaths in 2015 than HIV/AIDS did at the height of the epidemic in 1995. In June, the NY TIMES reported that drug overdoses will likely fall between 59,000 and 65,000; a 19% increase from 2015. Drug overdoses are now the leading cause of death among Americans under 50.

Explanation of Death Increase High purity heroin PA Range: 27%-92% Cheap price Prices are cheapest in the US Nationwide - $1.04/mg Regional price for SA is ~$.50-$.75 per mg Prescription opioid abusers Transition to cheap highly pure heroin Returning to heroin after a period of abstinence Tolerance decreased

Top 5 CPDs Distributed Nationwide in 2014 1 - Hydrocodone (7.87 billion dosage units) Estimated U.S. consumes 99% of the world’s hydrocodone 2 - Oxycodone (4.99 billion dosage units) 3 - Amphetamine (1.44 billion dosage units) 4 - Methylphenidate/Ritalin® (958 million dosage units) 5 - Morphine (766 million dosage units)

Pennsylvania RX Trends

1 Bag = about 100mg 1 Bundle = 10 bags = 1gm Average reported use per day: 5 to 10 Bags 1 Bag Cost = $10

“Listening without prejudice” “Med-seeking behavior” Going to different emergency departments to obtain opioids. A chronic pain condition that has not been treated adequately. The previous emergency department was not effective for pain relief. Insurance may not pay for office visits. Telling inconsistent stories about pain or medical history. Cognitive impairment. Psychiatric illness. Medication side effects. Asking for a refill because the prescription was lost or stolen. Cognitive impairment; they may misplace items. Fail to protect supplies, leading to theft by relatives or visitors to their home. Breakthrough pain medications may be carried when they leave their residence. Prescriptions simply ran out because the medication was insufficient. “Listening without prejudice”

Post Acute Withdrawal (PAW) symptoms. Thought Disorders - Difficulty in thinking clearly. Affective Disorders - Difficulty with feelings and emotions. Memory Disorders - Difficulty remembering things. Sleep Disorders - Difficulty sleeping restfully. Psych-Motor Disturbances - Difficulty in physical coordination. Stress Sensitivity - Difficulty in managing stress.

ACUPUNCTURE The most common benefits associated with acupuncture in addiction treatment include: Decreased cravings Decreased depression Decreased anxiety Decreased anger/irritability Decreased headaches Increased concentration Increased sleep quality

VIVITROL

NARCAN

The Continuum of Care Residential/Rehab/Inpatient Day Treatment/Partial Hospitalization Intensive Outpatient Outpatient Treatment Extended Care Halfway House Sober House Transitional Living

Listen without prejudice. Separate the person from the disease. Always look through a lens of compassion.