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

2. Geisinger Marworth

4. 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

6. Admission Trend

7. 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.

8. 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

10. 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)

11. Pennsylvania RX Trends

12. 1 Bag = about 100mg
1 Bundle = 10 bags = 1gm
Average reported use per day:
5 to 10 Bags
1 Bag Cost = $10

21. “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”

22. 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.

25. 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

27. VIVITROL

28. NARCAN

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

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