Answer Addiction

Tag: internet

  • An Open Letter to Addiction Treatment Providers

    An Open Letter to Addiction Treatment Providers

    There’s something wrong with addiction patients feeling the need to ask for medical advice from their communities because they don’t trust their providers.

    Maybe you’re a psychiatrist. Maybe you’re a dosing nurse at a methadone clinic. Maybe you’re an inpatient counselor. Maybe you work in an emergency department, or you’re an OBGYN; maybe you don’t specialize in addiction at all, but you regularly come into contact with people who are struggling with the condition. If you’re a medical professional, and all or some of your clients have a substance use disorder (SUD) diagnosis, this letter is for you.

    I am a person in remission from a substance use disorder. I’m here to tell you that addiction patients need you to understand our condition. That sounds basic, I know. It is basic. But here’s the thing: too many of you don’t understand. I’m not trying to attack you. I’m not saying you’re all misinformed. There are unquestionably many caring and well-informed providers doing excellent work in this arena. But it’s also true that enough of you are misinformed to be causing major problems for SUD patients. And that needs to change. Like yesterday.

    Right now my husband is white-knuckling his way through methadone withdrawal while his clinic works on getting him safely back on his therapeutic dose after one of you, a behavioral health doctor, rapidly dropped him 100 milligrams without consent, for no medical reason, while he was in the hospital for mental health reasons. And in 2014, my newborn daughter went through over a month of neonatal withdrawal from my prescribed methadone, which could have been prevented or lessened if my pre- and postnatal providers had made a few small changes to their protocols; sadly, this kind of medical treatment is still provided to mothers and infants across the country.

    Every damn day SUD patients crowdsource medical information from social media communities and online forums, often due to mistrust in the medical community when it comes to addiction care.

    Sara E. Gefvert, a certified recovery specialist who runs the Methadone Information Patient and Support Advocacy (MIPSA) Facebook group, says that she created MIPSA because she saw members of other communities receiving unreliable responses to medical questions. “Many MAT sites and groups I saw were not monitored frequently for correct and accurate content or were only adding to the misinformation and stigma that persons in recovery face, especially being on medication-assisted treatment.”

    In just one day, questions asked in five separate addiction treatment-focused Facebook groups included: 

    What kind of pain relief options are available during labor while I’m on buprenorphine?
    Should I raise my methadone dose if I have psychological but not physical cravings?
    Is it normal to lose my sex drive while on methadone?
    Am I still in recovery if I drink alcohol occasionally?
    Can cold-turkey opioid withdrawal kill you?
    Is it safe to detox while pregnant?
    Can you combine buprenorphine and methadone?
    Should my methadone be making me nod out?

    And others along those lines.

    These are all medical questions with real world consequences—some dire. The answers to these questions should be coming from trusted providers with medical expertise. Sure, people crowdsource medical information from the internet all the time, but it’s usually about pretty mild concerns, or trying to squirrel out whether they should go to a doctor. On the other hand, these addiction specific questions are often accompanied by complaints that the patient couldn’t get a straight answer from her treatment provider, or that the information she received was the opposite of what she read in a research study or an online article. There’s nothing wrong with people seeking community input on issues they’re facing, especially when the answers are reviewed by knowledgeable and professionally trained administrators like in the MIPSA group.

    There is, however, something wrong with addiction patients feeling the need to ask for medical advice from their communities because they don’t trust their providers.

    This seems to be an especially prevalent issue for medication-assisted treatment (MAT) patients. I was on methadone for about a year in 2013 and 2014, and on buprenorphine from 2014 to June of 2018 (with a short break of about five months in 2016). Before starting methadone, I was actively addicted to heroin for close to five years. In all of that time, I heard a lot of different things from a lot of different doctors, nurses, counselors and detox staff in virtually every region of the country. For example:

    Buprenorphine is only good as a detox aid.
    Buprenorphine works best as a long-term treatment.

    Methadone is more addictive than heroin.
    Methadone creates a dependency but effectively treats addiction.

    Breastfeeding while on methadone is unsafe.
    Breastfeeding while on methadone can help ease neonatal withdrawal.

    I can’t count myself sober if I take medication
    I’m at an increased risk of relapsing and overdosing if I detox.

    Addiction is a disease.
    Addiction is a spiritual malady.

    How was I supposed to tease out the truth from all that?

    With all the confusing and contradictory information that patients receive about addiction, it would be easy for someone to assume that the medical science is still out. In reality, there’s quite a lot of straightforward, peer-reviewed data about substance use disorders. Frankly, there is no excuse for a medical provider to ignore these facts. For example, decades of research have shown that methadone (a long-acting opioid agonist) and buprenorphine (a partial opioid agonist), help deter opioid misuse, decrease the risk of fatal overdose, and may help to correct neurochemical changes that took place during active addiction.

    To quickly address some of the other misinformation I’ve encountered:

    • Both methadone and buprenorphine treatment are appropriate, and in fact designed, for long-term use. Patients who choose to taper from these medicines can do so safely, but there is no generalized medical reason why someone with an opioid use disorder should be forced off either medication.
    • Breastfeeding while on methadone or buprenorphine is considered safe as long as the mother is not using other substances.
    • If a patient is using these medicines as prescribed and is not using other substances in a compulsive manner, they are in remission from their substance use disorder. In other words, they’re sober (though defining oneself with the term “sober” is a personal choice).
    • Addiction is medically defined as a disease. Which means that the onus is on our medical providers to stay informed about the science of this disease.

    Ultimately, you can’t be held responsible for everything your patient does. But you do have a responsibility as a treatment provider to give your patients accurate and informed medical advice.

    According to the Substance Abuse and Mental Health Administration (SAMHSA), about 20 million adults in the United States have a substance use disorder. So we’re not talking about some rare condition that only a handful of specialists can be reasonably expected to understand. This is a common, treatable disorder with a robust body of solid research behind it. You need to read that research. You need to stay informed. If you don’t have an answer to a patient’s question, you need to refer them to an accessible colleague who will. You took an oath to do no harm. Staying informed about addiction medicine is part of keeping that oath.

    Sincerely,

    Elizabeth Brico

    View the original article at thefix.com

  • When Teens Hurt Themselves…Online

    When Teens Hurt Themselves…Online

    “You should just kill yourself.” I thought that if people thought the messages I was saying to myself were coming from other people, they would be more willing to help me out.

    Trigger warning: The following story discusses self-harm.

    What happens when social media becomes the weapon of choice for self-harm; when the cyberbully is also the victim?

    Alicia Raimundo says she created ghost social media accounts to cyberbully herself as a teen in the hopes of validating her story. It was a coping skill, says the Toronto resident, now 28, and the only way she could think of to place her pain on full display in the hopes of friends and mental health experts coming to her aid. She didn’t know it then, but has learned since, that this form of anonymously posting critical, derogatory or otherwise hurtful comments about oneself is what mental health experts are now referring to as digital self-harm.

    “I thought that if people thought the messages I was saying to myself were coming from other people, they would be more willing to help me out,” Raimundo says, adding that she often posted mean comments others had said to her in person but for which she had no documentation or evidence. “I would say things to myself like: ‘You should just kill yourself,’ ‘You are a fake,’ ‘you are not worthy of love or support.’” 

    Raimundo, who has worked in the mental health field for eight years, says she also sent herself messages that read ‘You are hideous,’ and ‘You are just pretending and everyone will find out soon enough.’ She would rationalize the negative and violent messages she would send to herself, she says, by telling herself that the negative somehow served as a balance for the good in her life. 

    Raimundo’s story, although new to those unfamiliar with digital self-harm, is not unique. A survey published in late 2016 in the Journal of Adolescent Health asked 5,593 middle and high school students from across the US to share their experiences with cyberbullying and digital self-harm. Of those surveyed, about six percent reported anonymously posting something mean about themselves online. Males were more likely to engage in digital self-harm at 7.1 percent reported, with female respondents reporting at 5.3 percent. According to the survey, risk factors for vulnerable teens include sexual orientation, experience with school bullying and cyberbullying, depressive symptoms, and drug use.

    Teens who engage in physical self-harm also often struggle with depression, post-traumatic stress disorder, and/or difficulties with emotional regulation, says the American Psychological Association. It is important to note, however, that not all teens who cyberbully themselves have a mental illness.

    “Teens typically are experiencing many intense feelings and events for the first time, and during an already intense period of self discovery and understanding,” says Texas-Based Licensed Marriage and Family Therapist Associate Stephanie Bloodworth. “There are different reasons they may engage in digital self-harm, but the underlying force so often seems to be that they are seeking some kind of solution to their feelings of self doubt or low self worth.”

    These teens need help, says Bloodworth, but mental health caregivers and adult support figures should take care not to minimize the experience and mental pain of those they are trying to help. 

    “From a solutions focus, teens don’t need a different perspective, [such as saying] ‘This isn’t the end of the world, you know,’” Bloodworth says. “They need tools to help them handle what does feel like the end of the world they knew. They need tools and help to get the attention and support they need in healthy and appropriate ways.”

    Raimundo, the mental health professional who used to cyberbully herself as a teen, agrees.

    “I broke out of the cycle of digital self-harm by finally finding supports that listened to me and validated my story. People who I could speak openly and honestly to about engaging in digital self-harm, why I was doing it, and who would hold the space for me without judging me,” she says. “People saw me as someone trying to ask for help but not knowing all the right words to do so. They saw those messages as something that was actually happening in my head and addressed it as such.”

    Raimundo now works as an online Peer Supporter for Stella’s Place. 

    “I really wanted to create safe spaces online for people to reach out for help, because I found getting help from people who understood the internet as a community was really hard,” she says. “I wanted to provide positive spaces and places for people to access behind their phones and break out of the negative cycles they find themselves in.”

    Raimundo believes her experience with digital self-harm helps people open up if they are engaging in digital self-harm because it’s such a stigmatized form of self-harm that isn’t well understood. 

    “When they chat with me, it’s my hope that they are chatting with someone who gets it and can walk alongside them in their journey to recovery.”

    Raimundo also offers this advice to those who may find themselves in a position to help teens digitally self-harming themselves. Approach the situation with empathy and a listener’s ear, she says.

    “Don’t jump to the idea that we are doing it for the LOLs or because we are emotional vampires. Listen to why we are doing it, and try and connect us with the help with we need,” says Raimundo. “Yes, people engaging in these behaviors are crying for help, and we should give it to them.”

    If you or someone you know may be at risk for suicide, immediately seek help. You are not alone. Options include:

    View the original article at thefix.com