Addiction Medicine at Shore Behavioral Medicine

Dr. Russ Suboxone® Opiate Withdrawal Control Program

Dr. Russ has developed a two-prong program (physiologic normalization, including treating underlying depression, anxiety, etc.; and behavior therapy to alter how an individual copes with life’s unavoidable daily challenges) that uses Suboxone to stop and then control opiate withdrawal during the phase of brain healing when the brain returns from an altered state, caused by ongoing opiate use, to its normal (pre-opiate use) state. Dr. Russ use’s the Suboxone in decreasing doses to essentially fool the brain into thinking that it has healed from chronic opiate presence, until the healing is complete, at which point Suboxone is no longer needed.

Over the course of 7 years and more than 750 patients, Dr. Russ has refined his Suboxone and behavior therapy program to the point that he can essentially insure lasting recovery provided that the individual is in total compliance with his custom designed treatment program for them.

During the course of this program, each patient is tested using highly sophisticated oral fluid testing to monitor the patient’s compliance and actual substance use, both prescribed and unprescribed is used exactly as agreed to by both Dr. Russ and each patient. While Dr. Russ realizes that occasional relapse is frequently a part of addiction of treatment, he also realizes that there is absolutely no role for lying. Therefore, this program operates with a zero tolerance for lying policy and thus patients are continuously monitored for the truth. Should a patient be found to be repeatedly lying, even about minor things, they are terminated from the program.

Sadly, without absolute compliance and the desire to leave a drug-influenced life behind, Dr. Russ’ highly effective program is of little to no value. In order to avoid an essentially guaranteed likelihood of failure, it is important that people do not attempt this program until they are truly ready to return to all of the joys of sober living and live a life without lies and deceit.

For suboxone follow-up, visits are typically 30 minutes and cost $250, but can be scheduled for 60 minutes for more involved cases and cost $350. 15 minute follow-ups are not available with suboxone treatment due to the amount of information that needs to be covered.

Definition of Addiction (American Society of Addiction Medicine)

Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.

Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.

Addictions are one of the biggest health problems today throughout the United States, ruining lives and causing death in all aspects of society: rich; poor; all ages from early teens to seniors; all races; and both sexes. Widespread presence of addictions is not surprising given the extremely unrealistic expectations of many members of our society. For many, when they realize that they cannot achieve the goals they believe they “should” be attaining, they conclude that they are in some way inferior or a failure. At this point, for many it is easier to turn to some mind numbing drug or alcohol, rather than adjust their expectations and be more accepting of their personal achievements and limitations.

Since fundamental value shifts are necessary for drug or alcohol abusers to stop their behaviors, it is not surprising that 14-28 days in a rehab or several weeks in an intensive outpatient group with 30-50 members does little to change their behaviors and thus their substance abuse typically continues.

Consequently, the long-term success rates for essentially all types of addiction treatment are embarrassingly poor. Rapid relapse of the behaviors and any associated substances is sadly the norm rather than the exception.

When an addiction includes a substance like alcohol and/or an addictive drug, the addiction becomes much harder to treat because BOTH the physiologic problems from the addictive drug and/or alcohol and addiction-based behaviors must be addressed before new healthier behaviors can be substituted for the maladaptive addiction-related behaviors. Sadly, since many treatment programs do not sufficiently address the behavioral aspects, not to mention many lack the expertise to properly address the physiological components, their patients are likely not to have long-term success and thus frequently conclude that their problem is not “treatable”, a situation that is actually worse than no treatment at all.

In my professional opinion, there are several basic reasons for the rapid increase in addicted individuals and the essentially terrible long-term success rates after treatment. While there are many reasons for the worsening problem of addictions, the most important of these reasons are:

1. Our society does not adequately value mental health and tends to avoid mental health issues or tries to keep them secret. Mental health issues are very real and almost universal and do not go away by themselves. Left unaddressed, mental health issues typically grow until an individual cannot comfortably tolerate them and thus has motivation to turn to some drug or alcohol to help them cope with the uncomfortable feelings that result. This process is usually unconscious and thus invisible to the individual, making it very easy for it to blossom out of control.

2. Due to societal attitudes about mental health, there are not enough programs to address the existing substance abuse and other addiction problems, and few if any programs that try to prevent the development of mental health problems. Sadly, due to the lack of proper programs, much of the problem is being handled by law enforcement, which typically responds by putting addicts and alcoholics in overcrowded programs with insufficient staffing that are not typically beneficial, and when incarceration is involved, frequently make the problems worse.

3. There is massive misinformation about the true nature, prevalence causes of addictions and how to treat them. When people are fortunate enough to have access to accurate information and programs that can truly address their needs, if is frequently very hard to sort out the beneficial information and programs from the inferior and misinformed information and programs.

4. In the treatment world, it is common, if not normal to offer false and unrealistic treatment claims that are represented by programs as “fact”. Sadly there are way too many addiction treatment centers that are more driven by profit than producing long-term recovery. While no treatment center would ever admit this, from a business standpoint, relapses are a large part of their business. These sub-optimal treatment techniques and high relapse rates increases the likelihood of a less than successful treatment outcome, which in turn leads addicted people to feel that they are not “treatable”. The net result is frequently a worsening of the overall addiction following many treatment programs.

5. The portion of the mental health treatment world that deals with addictions typically does not have the time, nor resources to do what is needed to produce lasting recovery from addictions. This has contributed to the general societal belief that drug addicts cannot be treated successfully, which in turn reduces opportunities for rehabilitated addicts and alcoholics.

Many people think of addictions as being limited to abusing some drug or alcohol, but in reality an addiction is any behavior that an individual engages in repeatedly and without the ability to stop despite a clear negative impact on their life. This more accurate definition of addictions means that addiction is a much bigger problem than many studies report, because they are predominantly focused on addictions that focus on substances and alcohol. The true scope of addictions also includes purely behavioral problems like gambling, compulsive shopping, attempts to correct distorted body images, aberrant sexual activity and a multitude of other behaviors that in moderation are not a problem, but have become very problematic to an individual because of the magnitude of the time the individual engages in the behaviors and their prioritization of importance of that behavior.

Treating Addictions

Central and essential to success to treating addiction, whether an addictive substance or alcohol is part of the picture or not, is the individual’s desire and willingness to do whatever is necessary to challenge and modify the existing (normal) maladaptive behaviors and beliefs that have contributed to and/or developed from the active addiction. Put simply, as is the case with all behavioral health issues, it is essentially impossible to produce long-term success with an individual unless they truly desire to make the necessary changes to produce a better life for themselves.

My basic rule of human behavior is an excellent gauge to determine whether an individual has sufficient motivation for change to succeed with addiction treatment because it applies to all humans in all situations where change is needed. Thus it applies in all areas of behavioral health and is particularly important when dealing with addictions.

The Basic Rule of Human Behavior

People will resist change by maintaining their current behavior until the perceived effort of maintaining the behavior exceeds the perceived effort of changing the behavior OR the perceived benefit from change greatly exceeds the trouble (real and imagined) generated by the change process.

In order to use this rule of behavior to its fullest potential, it is critical to determine how individuals assign the effort involved in maintaining a behavior, and how they formulate their perception and beliefs of the benefits of the behavior change. Frequently insight oriented therapy techniques are necessary to obtain this information and to help individuals see their pretreatment distortions in their beliefs and how they contribute to their maladaptive and addictive behaviors.

Sadly, when a substance, either alcohol or a drug, is part of the addiction, eliminating its use almost always becomes the main focus of treatment, with little or no emphasis on the behavioral component of the addiction. The net result of insufficiently addressing the all-important behavioral component is an extremely high rate of relapse of use of associated substance since people typically revert to their former behaviors unless trained to do otherwise.

Not only is the rate of relapse as high as 90% with some substances when the behavioral component is not sufficiently addressed, but typically upon relapsing, the individual frequently increases their consumption of the substance to much higher levels than what they were using prior to treatment. Therefore, it is safe to say that ineffective treatment is frequently worse than no treatment at all.

It is my professional belief based on 30 years of treating general addictions and 7 years of treating over 900 opiate abusers with Suboxone®, that in order to obtain lasting positive treatment results in a large percentage of patients a 2-prong approach to treatment is essential. The first prong is physiological normalization (returning the person’s body chemistry back to the pre-drug/alcohol usage state at a minimum if not better with treatment of contributing problems like anxiety and depression). The second prong must focus on perception and behavior change so that the individual will respond to the unavoidable pressures of life without turning to drugs or alcohol. Said another way, effective treatment occurs when an individual is returned to a sober state as a norm AND they have replaced their tendency to hide in drugs and/or alcohol when life gets tough, with more adaptive coping behaviors.
Only when an individual is no longer suffering from the active physiologic effects of the substance or the immediate after effects of the substance is it possible to have meaningful gains with the behavioral second prong of the treatment. This is true because abnormal physiological states are typically very physically uncomfortable, greatly reducing an individual’s ability to think clearly and greatly reduces their determination to adopt the new healthier coping mechanisms and behaviors necessary to overcome addictions.

As part of this first prong of physiologic normalization one must also correct any significant psychiatric problems like depression, anxiety, OCD, impulse control disorders or psychosis that could easily contribute to an individual feeling overwhelmed and thus increase their need to hide in their addictive substance and/or behavior. In addition to removing these critical fundamental uncomfortable symptoms, the treatment of these disorders helps promote a feeling of positive change that subtly, but powerfully, encourages people to work to improve their lives.

Since the second prong of treatment is behavioral and psychological, it is essential that the individual regularly be reminded of the improvements of the overall quality of their life since they recovered from their addiction so that there will be a lot of reinforcement of the new beliefs and behaviors, making it much harder for the individual to insidiously slide back into their addictions.

It is my professional opinion that the single most important first step at trying to address the current out of control addiction situation is creating a site available to all people where they can access information that is accurate, realistic, helpful where the primary goal is not business, but helping people recover from addiction and alcoholism so they can become productive members of society once again.

Other Addictions

Dr. Russ also treats alcohol addiction, amphetamine addiction, benzodiazepine dependence, as well as a numerous purely behavioral addictions, like sex, shopping OCD, etc.