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ddiction is a complex disease involving numerous areas of the brain. It’s a progressive disease—worsening over time, regardless of the substance or behavior of choice. This is about having such a great life, having so much fun & so many friends, there’s no way you would want to screw it up. Addicts tend to be pretty bright folks. They have to be in order to survive despite the fact that they keep “shooting themselves in the foot” and still manage to go on. Isn’t it time that you removed the ball and chain of your addiction? Isn’t it past time that you unleashed the amazing person inside of you who has been shackled by a disease that can turn you into a monster that you never thought you would be? Together, let’s DO that! Once an addicted person starts to inappropriately use, i.e. abuse a substance, all substances and/or behaviors that alter mood are dangerous, whether they are legal or not. All these substances and behaviors must be stopped to stop the progression of this disease. Abruptly stopping some of these substances can lead to death. Medical supervision is required for the safe detoxification of those substances; alcohol, benzodiazepines (like Xanax) & barbiturates can lead to death. Opiate (“pain pills”, heroin) detoxification (“dancing with the cold turkey”) may make one wish they were dead, but won’t kill. What this means, is that addicted folks looking for recovery need to stop using all mind-altering substances; pot, benzodiazepines, alcohol are all dangerous and must be stopped. Typically, a very slow detoxification is done with benzodiazepines, cutting the dose by half a tablet or so every few weeks.

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Boom, Bust, and Drugs Study says economic downturn leads to increase in substance use disorders When the economy tanks, drug abuse goes up.That’s the finding of a new study which shows the state of the economy is closely linked with substance abuse disorder rates for a variety of substances. The study, conducted by researchers from Vanderbilt University, the University of Colorado and the Substance Abuse and Mental Health Services Administration (SAMHSA), found the use of substances like ecstasy becomes more prevalent during economic downturns. Researchers also found that other drugs like LSD and PCP see increased use only when the economy is strong. But for overall substance use disorders, the findings were clear.

“Problematic use (i.e., substance use disorder) goes up significantly when the economy weakens,” says Christopher Carpenter, one of the lead researchers. “Our results are more limited in telling us why this happens.” Researchers say it’s possible that people turn to substance use as a means of coping with a job loss or other major life changes caused by economic pressures, but their particular study did not pinpoint an exact cause and effect. Not all drugs are equal The study showed that a downward shift in the economy has the biggest impact on painkillers and hallucinogens. Rates of substance abuse disorders were significantly higher for those two categories than any other class of drug.

Researchers also found the change in disorder rates was highest for white adult males, a group which was one of the hardest hit during the Great Recession.They say more research is needed to determine exactly how the economy and drug use are related, but they say the study highlighted some key groups for prevention and treatment workers to target during future economic downturns.

“Problematic use (i.e., substance use disorder) goes up significantly when the economy weakens.” - Christopher Carpenter, Vanderbilt University

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Slippery slope Despite some lingering questions, researchers were able to show the significance of the economy’s role in problematic substance use.The study showed that even a small change in the unemployment rate can have a tremendous impact on the risks for substance abuse disorders. “For each percentage point increase in the state unemployment rate, these estimates represent about a 6 percent increase in the likelihood of having a disorder involving analgesics and an 11 percent increase in the likelihood of having a disorder involving hallucinogens,” the authors write. Previous studies have focused on the economy’s link to marijuana and alcohol, with many looking at young people in particular.This study is one of the first to highlight illicit drugs, which given the current opioid epidemic, holds important lessons for those working to curb problematic drug use.

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When it’s needed most The study bears significant weight for treatment facilities and public policy makers in particular. During economic downturns, government agencies typically look to cut spending on treatment programs as a way to save money, something researchers say may be more costly in the end. “Our results suggest that this is unwise,” Carpenter says. “Such spending would likely be particularly effective during downturns since rates of substance use disorders are increasing when unemployment rates rise, at least for disorders involving prescription painkillers and hallucinogens.”

“Spending would likely be particularly effective during downturns since rates of substance use disorders are increasing when unemployment rates rise.” - Christopher Carpenter, Vanderbilt University

Dr. Oenbrink and the Appalacian Wellness Staff

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About

We are a team devoted to you, your health, happiness & future.We, as a team, are here to serve you, to improve your life.‚e staƒ of AppalachianWellness has experienced many, if not all your problems ourselves.We have known your suƒering and are recovering from these issues.We know pain and we know the joy that comes from relief.We want you to experience that gift as well! We are your servant; highly educated, experienced, ready to anticipate and exceed covering your needs. ‚e word “servant” needs to be expounded on.We’re not here for you to walk up to the counter and place an order like you would at a diner. Dr. Oenbrink grew up in Palm Beach County on the southeast Florida coast. Sports-–shing is a popular activity down there. Numerous “charter boats”

are available for hire to take anglers (–sherman/woman) out to catch “the big one”. ‚e angler who charters the boat spendsmost of his or her time in the “cockpit”-the back of the boat where the –ghting chair is to be ready to hook & –ght the big trophy –sh. ‚e –ghting chair faces the back of the boat enabling the angler to keep an eye out on the baits that are trolled behind the boat and be ready if a “strike” happens—a big –sh getting hooked. It’s not the most comfortable seat on the boat. Sun beats down, the front of the boat blocks any breeze or view of what’s ahead of the boat. ‚e angler trusts the captain atop the žying bridge to guide the boat to the –sh. ‚e captain is the servant; he provides expert service to his customer. Appalachian Wellness is like that. We want to get your health back to the point that you no longer need our service. How many businesses have a goal like that? YOU are our priority!

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Talkin’ ‘Bout My Generation

NIDA Researchers Develop Screening Tool for Teen Substance Use This article is a condensed version of a piece that originally appeared on the National Institute on Drug Abuse (NIDA) website.

Teens’ use of addictive substances often goes undetected by health care providers. But NIDA-supported researchers have developed a Brief Screener for Tobacco, Alcohol and other Drugs (BSTAD), to help spot teens’ problematic habits. In a recent study, BSTAD developers Dr. Sharon Kelly and colleagues at the Friends Research Institute in Baltimore examined the frequencies of use likely to qualify a teen for a diagnosis of an alcohol use disorder (AUD), nicotine use disorder (NUD), or cannabis use disorder (CUD). The frequencies proved to be surprisingly low, according to the researchers.

Teen drug substance use revealed For the study, the BSTAD survey employed a few, simple questions about teens’ use of alcohol, tobacco or drugs within the past year.The teens’ BSTAD responses revealed that 22 percent had used alcohol in the past year, 16 percent had used marijuana, 10 percent had used tobacco, and 3 percent had used at least one illicit substance other

than marijuana. (Original article by Eric Sarlin, M.Ed., M.A., NIDA Notes Contributing Writer) 28

“ Health care providers should have a one-on-one discussion with teens who indicate any substance use to assess level of risk, provide brief advice, and, if necessary, recommend further assessment for a treatment intervention. “

-Dr. Sharon Kelly, Friends Research Institute

Analysis of the data showed that almost all teens who reported on the BSTAD that they had consumed an alcoholic beverage on two or more days during the past year had an AUD. Conversely, teens who reported drinking on fewer than two days were unlikely to have this disorder.The corresponding BSTAD cut point for an NUD was nicotine use on two or more days during the past year and for a CUD was marijuana use on two or more days. BSTAD enables early detection Using these cut points, the researchers found that the BSTAD was highly sensitive. Ninety-six percent of teens with an AUD, 95 percent with an NUD, and 80 percent with a CUD would be flagged as likely in need of further assessment for a brief intervention or referral to treatment. BSTAD’s specificity was also high: 85 percent of teens without an AUD, 97 percent without an NUD, and 93 percent without a CUD reported use below the cut points, and so would be correctly classified. “Very low substance use frequencies were found to be optimal in identifying these disorders,” Dr. Kelly comments. The BSTAD does not distinguish

Researchers encourage regular screening Both the World Health Organization and the American Academy of Pediatrics recommend screening all adolescent patients for substance use since problems later in life often originate in adolescence. Still, many providers do not regularly screen their patients for substance abuse. “Providers are extremely busy and need a quick and valid screening measure for identifying teens who use substances,” says Dr. Kelly. She and colleagues developed the BSTAD in response to a NIDA call for new tools to fill this need. To create the BSTAD, Dr. Kelly and colleagues added the questions about tobacco and marijuana to the widely disseminated National Institute on Alcohol Abuse and Alcoholism screen for youth alcohol use. In the validation study, the FRI research team administered the BSTAD in person to half of the participants, and the rest of the participants self-administered the instrument on an iPad. The teens reported a strong preference for the iPad. The iPad version offers the potential extra convenience that results can be automatically transferred into a teen’s electronic medical record. 

the severities of the disorders, she notes, so when it flags a teen, providers need to follow up with questions to determine appropriate interventions or referrals to treatment. Furthermore, Dr. Kelly says, “Health care providers should have a one-on-one discussion with teens who indicate any substance use to assess level of risk, provide brief advice, and, if necessary, recommend further assessment for a treatment intervention.” Providers also should rescreen teens regularly, because onset of substance use can occur abruptly during adolescence. Pediatrics recommend screening all adolescent patients for substance use since problems later in life often originate in adolescence. Both the World Health Organization and the American Academy of

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Sign of the times Experts say the newly approved implant also provides a big boost to the concept of medication-assisted treatment (MAT) in general. For years, the idea that someone could achieve recovery through the use of drugs like methadone and buprenorphine was rejected by many professionals in the eld who saw complete abstinence as the only true sobriety. Many still hold that belief, but attitudes appear to be changing. Top government oŽcials say they want to increase the amount of MAT taking place at the country’s treatment centers. Several states as well as the federal government have enacted laws making it easier for physicians to prescribe medications like buprenorphine, but they say too few patients receive the medication they need. National Institute on Drug Abuse, in a statement. “is product will expand the treatment alternatives available to people suering from an opioid use disorder.” ] [ "Opioid abuse and addiction have taken a devastating toll on American families.” - Dr. Robert M. Cali, FDA Commissioner “Scientic evidence suggests that maintenance treatment with these medications in the context of behavioral treatment and recovery support are more eective in the treatment of opioid use disorder than short-term detoxication programs aimed at abstinence,” said Dr. Nora Volkow, director of the

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edication-assisted treatment is growing in popularity and acceptance among addiction recovery professionals. And now it’s taken a revolutionary step forward that could oer renewed hope to thousands of people struggling with an addiction to opioids. is summer, the U.S. Food and Drug Administration approved a new buprenorphine implant to treat opioid dependence. Buprenorphine had previously been available only as a pill or a dissolvable lm placed under the tongue. But the new implant, known as Probuphine, can administer a six-month dose of the drug to keep those dependent on opioids from using by reducing cravings and withdrawal symptoms. "Opioid abuse and addiction have taken a devastating toll on American families,” FDA Commissioner Dr. Robert M. Cali said in a statement. “We must do everything we can to make new, innovative treatment options available that can help patients regain control over their lives.” e implant comes in the form of four one-inch rods that are placed under the skin on the upper arm.e implant must be administered surgically and comes with the possibility of certain side eects, but experts say it could be more convenient and more eective for patients.ey say by eliminating the need to take pills, ll prescriptions and generally manage their medication, it makes it easier for people to focus on the other areas of their recovery while making it less likely someone will lapse in their treatment plan.

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Although the implant is certainly a new alternative, it has yet to show any increased success in keeping people from relapsing compared to the pill or lm tablet. In a study of the implant’s eectiveness, they found that 63 percent of people given the implant were free of illicit drugs at six months, compared to 64 percent of people who took buprenorphine by pill. Still, those rates are much higher than the success rates of people who follow abstinence-only treatment plans. And oŽcials hope the new implant will lead more people to get MAT, increasing the number of successful recoveries across the country.

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WHY REC OVE RY? Why “Medication Assisted Treatment” of recovery? (Because it’s the gold standard per numerous government agencies and not using it is considered medical malpractice!)

We offer compassionate, non-judgmental treatment of this disease. We also set certain boundaries. The keys to success in our program are simple; Show up for your appointments on time. Let us know in advance if you are late or cannot make it and need to reschedule (we may be able to work somebody else in need into your slot if we know you’re not going to be able to make it on the day of your appointment—this helps others!).

Show respect and behave accordingly. We try to show our patients the respect that they deserve and expect the same in return. Follow the suggestions made by our staff—we’re one of the few businesses that hope to get you better to the point that we lose you as a “customer”. (What kind of business model is that?!?!) Alcohol and drugs/behaviors of abuse on the patient questionnaires must not be used; this is simply a matter of your life or death! Cross-addiction kills!

Please be thorough in completing ALL paperwork, every attempt will be made to have it available online so that it can be done prior to your appointments. We STRONGLY recommend the 12-Step programs (below) and daily meeting attendance (you know you devoted time to using on at least a daily basis, recovery demands no less) until a good sponsor suggests that you can back off on the meetings. The medicines do NOT “heal” you—the meetings do that. The only purpose for the medicines is to keep you

comfortable so that you can pay attention, participate and absorb what happens in the meetings. You need to be totally & RIGOROUSLY HONEST with us. We’re your servants. We’re here to help you. If there’s something else going on, we need to know about it. None of us are clairvoyant! As much as we want to help, we’re NOT mind readers! Is there another mental illness manifesting that needs therapy? Tell us what’s going on in your head! Patients are helped with the process of detoxification. Visits

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are initially done on a weekly for six weeks, if they are working the program, have urine tests without inappropriate results, then transition to visits every 2 weeks for another six visits is an option. Once this is done there can transition to visits every four weeks. Patients are not “kicked out” of our practice if they have a urine test demonstrating that they’ve continued to abuse drugs. What to expect if you are unable to keep totally clean or follow all the keys to success above. The most important thing that you can do, is be RIGOROUSLY HONEST! If you’ve had a “slip”, tell us before we find

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We offer compassionate, non-judgmental treatment of this disease. We also set certain boundaries.

out about it through your urine test result!! We do NOT follow “three strikes and you’re out!”. We’re in this together, with you, to support you. This is NOT a game! This disease has a nasty habit of killing people. If your urine results show unexpected results 3 times in a row, we’ll move you to the head of the ICU, the bed right in front of the nursing station. In practical terms, that tells us that you’re unable to go a full week without using. We’ll try seeing you twice a week to see if the more frequent reminders (office visits) that you have a terminal illness that will kill you works better for you. At this point you may want to get into an Intensive Outpatient Program (IOP) in the area. If the 1st bed in the ICU isn’t enough and you continue giving us urine tests with undesirable results three times in a row, then perhaps you need some time off to re-assess whether you’re truly ready for and desire recovery. We give these patients “a month off” with no visits or meds to allow them to re-assess where they are mentally and emotionally. If you really DO think you’re ready for recovery and just can’t do it on an outpatient basis, then you need inpatient care, generally with a 28-day program. Methadone users are treated with a multiple medication protocol that minimizes the difficulties that go with that change; from Methadone to Buprenorphine. Typically, after a week, they’re ready to stop the Methadone permanently. It may be a bit uncomfortable, but won’t be anything like the misery of coming off high-dose Methadone without any other support!

We encourage our patients to let us know of any difficulties they may be experiencing in the pursuit of their recovery. It’s not uncommon that other problems are uncovered early in the recovery process. Having an experienced team in place to help you through these difficulties may be just what you need for successful long-term recovery! Attendance at 12-step meetings such as NA and/or AA are also very highly recommended. Attendance at these meetings cause the same brain chemistry changes that are produced by the drugs. The big difference is that the meetings are healing as opposed to use of the drugs which furthers this progressive disease. Ideally, meetings are attended with other people in the same room. Some of these groups are not located locally enough to allow this however, online and phone meetings are available for these other groups. Addiction is a family disease as well. To increase chances of successful recovery, it’s very helpful for the family members, friends and close associates to become familiar with the disease of addiction and their possible role in furthering the disease within the addicted person. Attendance at these meetings* is also encouraged. Family members and other support persons are always welcome to join you for your appointment.

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