A NATIONAL BEHAVIORAL HEALTH CARE SYSTEM PATIENTS TREATED:
TREATMENT SERVICES FOR:
LEVELS OF CARE:
• Addiction • Mental Illness • Behavioral Disorders • Dual Diagnosis • Trauma • Eating Disorders • Pain
• Adolescents (12-17 years) • Adults
• Detox • Residential Treatment • Partial Hospitalization Program • Intensive Outpatient Program • Outpatient Program • Continuing Care • Telehealth
LOCATIONS:
San Clemente, California
Los Angeles, California
Palm Desert, California
Rancho San Diego El Cajon, California
Fort Myers, Florida
Pompano Beach, Florida
Chandler, Arizona
El Paso, Texas
White River Academy Delta, Utah
www.sovhealth.com
(866) 212-9314 24/7 Helpline | Most Private Insurances Accepted
CORPORATE OFFICE: 1211 Puerta Del Sol San Clemente, CA 92673
Issue
In this
February 2018
RESILIENT Health
MESSAGE FROM THE EDITOR Welcome to RESILIENT HEALTH............................................ 4
FEATURE ARTICLES UP CLOSE AND PERSONAL: Dave’s Brave Journey: From Borderline Personality Disorder and Alcoholism to Recovery ............................................................................ 5
RESILIENT HEALTH is published monthly and copyrighted by Sovereign Health, Inc., all rights reserved. Permission must be granted by the publisher for any use or reproduction of the magazine or any part thereof. Opinions expressed are those of the authors alone and do not necessarily represent the opinions, policies, or positions of RESILIENT HEALTH or Sovereign Health, Inc. ©2018, Sovereign Health, Inc. Printed in the U.S.A.
Personality Disorders: A Brief Primer.................................... 9
Editor-in-Chief TONMOY SHARMA, MBBS, MSc
Not Just a Phase: Diagnosing and Treating Borderline Personality Disorder in Teens ...................... 17
Managing Editor EDWARD ZINTEL e.zintel@sovhealth.com
Transference-Focused Psychotherapy May Help People with Borderline Personality Disorder............... 20
Communications Manager LISE MILLAY STEVENS, M.A. Senior Staff Writer DANA CONNOLLY, Ph.D.
Fast Facts: Borderline Personality Disorder ...................... 11 PROFESSIONAL PERSPECTIVES: The Connection Between Drug Abuse and Personality Disorders.........13 THE QUIZ CORNER: Test Your Personality: Are You Borderline?.............................................................15
Borderline Personality Disorder and Addiction: A Deadly Combination.......................................................23 Uncovering U-4: The Tip of the Synthetic and Psychoactive Substance Iceberg ..............................................................26
Graphic Designer SEBASTIAN TIRKEY
AT A GLANCE: Addiction Treatment Medications Dominate News Cycle..............................................................29 Prescription Opioids in the Body and the Brain ..............31
Content Specialist AMIT MALAVIYA
TREATING SUBSTANCE USE DISORDERS
FREE SUBSCRIPTION! Sign up for your free subscription to RESILIENT HEALTH at www.reshealth.net today!
A Resolution to Embrace Measurement-Based Care.....34
RESILIENT HEALTH A Behavioral Health Resource from Sovereign Health Publications, Inc. 1211 Puerta Del Sol, Suite 200 San Clemente, CA 92673 Tel: (949) 276-5553 Email: editor@reshealth.net Website: www.reshealth.net
MESSAGE from the Editor
Welcome to RESILIENT HEALTH! Happy New Year and welcome to the inaugural issue of RESILIENT HEALTH. We are thrilled to bring you this new monthly publication chock-full of informative articles, interviews and perspectives on mental health and substance use issues. The magazine will also offer patient stories, quizzes, fast facts and a section for your comments and other general feedback. This first issue focuses on the diagnosis and treatment of borderline personality disorder, a common yet often undiagnosed and untreated mental health condition. BPD is caused by a combination of factors, and can be moderate to severe in nature. In contrast to people with antisocial personality disorder, who often cause harm to others, people with BPD tend to cause problems to themselves. They are at high-risk for suicide, unemployment, homelessness and societal ostracization. People with BPD often have co-occurring disorders, such as substance use, gambling or eating disorders, which wreak havoc on both the patient and her/his family, friends and other loved ones. It is our duty to assure they receive expert, non-judgmental treatment delivered with compassion, and the assurance that recovery is possible. Fortunately, BPD and co-occurring disorders can be overcome through specialized forms of psychotherapy; we discuss some of these in this issue. Once treated, BPD and co-occurring disorders can then be successfully managed, greatly improving the patient’s quality of life in unimaginable ways. In this issue, we explore BPD from A to Z. We hope RESILIENT HEALTH provides the information for you, as a health care professional, to do the same. Welcome aboard! Best wishes for a healthy future and a very successful career.
www.reshealth.net 4 RESILIENT HEALTH | February 2018
www.reshealth.net
Up Close and Personal
DAVE’S BRAVE JOURNEY: FROM BORDERLINE PERSONALITY DISORDER AND ALCOHOLISM TO RECOVERY By Dave Monroe
I
was born David Theodore Monroe IV, a fancy name for a poor child. David Theodore Monroe III left my mother and I when I was just a few months old. Mom remarried and they bought a house in Fallbrook, California. Mom had two more children, a boy then a girl. My stepfather also had two other children who were grown and I hardly knew. Mom was always working and always seemed tired when we were growing up. My stepdad was very strict, and was mean to me when my mother wasn’t around. He yelled at me a lot and made me work with him in the garage after school rather than play with my friends. I couldn’t wait to move out. I left home at the age of 17, right after high school graduation. I worked as a mechanic and went from job to job so as to pay for the room I was renting in Grass Valley. I made friends at the local bowling alley where I began to drink. I loved alcohol right away. A few beers and the intense discomfort I basically felt all the time would melt away. My drinking buddies and I moved into an apartment and had parties all the time. www.reshealth.net
I worked and partied through most of my 20’s. One weekend, my brother and sister came to visit. I threw a party for them. The next day they told me I lived like a slob and to grow up. I threw them out and didn’t speak to them again until mom’s funeral several years later. They were still conceited snobs then, so I stayed away after that as well. My 30th birthday was celebrated at the local pool hall, which my friends had decorated for me as a surprise. There was a band playing and everyone was dancing and having fun when I saw a beautiful woman coming toward me smiling and carrying a tray of beers. The new waitress, Sasha, would later become my fiancé. We fell in love on the spot. I began to realize that my friends were just drinking buddies, that we shared no common interests beyond that. Sasha was the opposite—she was going places. I moved in with Sasha, who was responsible and brought out the best in me. I would only go drinking with the guys a few nights a week.
Our relationship was intense from day one. When it was great, it was really great, but when it got ugly, it got very ugly. We both had tempers. She complained about my drinking and I would accuse her of cheating. Then one night I came home drunk and she told me she wasn’t sure if she wanted to marry me anymore. I punched a hole in the wall and went back to the bar. The night ended with me in jail after a bar brawl where I supposedly knocked some guy’s teeth out. When Sasha bailed me out, she said I either go to rehab or she would leave me. I was angry, sick, miserable and my life was falling apart, so I agreed. After 30 days in rehab, I was feeling considerably better. I actually felt happy. Sasha was happy, too, but I was still worried she would leave. I went to Alcoholics Anonymous meetings to please her, but after a while, I began to admire how the people there handled life. There were a few I even liked, so I started to make friends. I read the book the meeting leaders gave me and decided to try and do what it said so that I wouldn’t have to drink anymore.
RESILIENT HEALTH | February 2018 5
I found a sponsor named Spencer, a retired psychiatrist whose nose was still red after almost 30 years of sobriety. He guided me through the first three steps of my 12-Step program. He bought me coffee and pastries after our meetings and listened to what I had to say. I was sure I had found the one person who had the answers to all my problems. I was also quite sure that once he heard what a terrible person I was, he wouldn’t want to sponsor me anymore. This fear prompted me to work through the steps before he disappeared, in which case I would quit the program entirely. When I got to Step 4, I was told I needed to take a “moral inventory” of myself. Before I could even begin, my mind began dictating a
long list of my faults at a rapid-fire pace. I started writing. After the first few pages, I began to feel very depressed and hopeless again. I thought it was no wonder my fiancé was having second thoughts about marrying me! My mind told me I was destined to be alone and did not deserve to be loved by such a beautiful and successful woman. I called Spencer, who told me to stop beating myself up and to meet him at the diner.
to look at myself. I brought the list I had made, and as I read through it, I realized that every single one of my shortcomings (or “areas of potential growth”, as Spencer would say) were actually simply me responding to other people letting me down or betraying me. I went through the list one by one as Spencer went through coffee refills one by one, listening to every word I said but saying nothing.
The diner was empty, so I saw Spencer right away, sitting at the counter in front of two cups of coffee and two slices of apple pie a la mode. After sitting in silence and eating pie together for several minutes, Spencer told me to take a deep breath and feel proud of myself for having the courage
Step 5 would surely be next, I thought, but Spencer shook his head. Confused, I explained to him that getting rid of my shortcomings simply would mean to cut off all the people in my life who were causing all of these problems. Instead, he put the business card of one of his
6 RESILIENT HEALTH | February 2018
www.reshealth.net
proteges – a psychiatrist – into my pocket! I didn’t need a shrink! I knew he would do this to me, I thought. Spencer wanted out. He was just like all the others. I flew into a rage and stormed out of the diner. I wanted a drink. I thought that I could go to the bar down the street, enjoy a cold whiskey on the rocks and tell the bartender all about the hard luck I was having. I would get nice and drunk. That would really show Spencer what a terrible sponsor he was. But then I remembered how sick I was a few months ago when I quit drinking and did not want to ever go through that again. Instead, I would get high. No, that wouldn’t work either. I got in my car, making sure to peel out of the parking lot as loudly as I could, and sped down the street. Eventually, I went home to bed.
I
n the morning, I saw the card Spencer had given me on the floor next to my jacket. Without thinking, I called the number and wound up making an appointment for that same day. I figured this psychiatrist was surely a quack if it was that easy to make an appointment, but I went anyway. At least I could tell Spencer that not only was he a jerk, but so was his quack friend. The office was dimly lit and smelled like air freshener. There were a few other people there. The receptionists called me in and put me in a room that looked more like a library than a doctor’s office. I was getting madder by the minute. When the doctor walked in, he called me by my first name and told me that Spencer had called him. He asked a lot of questions and made me take a lot of tests.
www.reshealth.net
I was there for a long time. Finally, the doctor sat down with me and explained that I had a condition called borderline personality disorder. He was able to describe to me exactly how my life felt to me and why I was having all of the difficulties I was having. He told me about a special intensive program that could help me. He said if I don’t try it, I could easily start drinking again. I signed up and attended the program, not thinking I would finish it, but I did.
T
he first few weeks of the program were intense. There were times I wanted to quit. My emotions were all over the place. But I stayed with it simply because for the first time in my life, I found people who understood me. Not only did they understand me, but they seemed to appreciate me for who I really was, and I didn’t have to act any special way. I just had to be myself and that felt really good. I learned how other people think and how to react to situations more effectively. Little by little, other parts of my life began to improve. I made true friends at my 12-Step meetings and they helped me tremendously. I got a manager position at a busy auto repair center and a good performance evaluation. Sasha and I worked through most of our problems. We finally got married and moved to Seattle.
and make an amends. He said he would try to pay us a visit. In fact, family and friends are visiting us now more than ever. But that is probably because they love to see our new, beautiful daughter Sophie. In Sophie’s eyes, I see endless hope, joy and love, which are all of the things that make life worth living. Dave’s Brave Journey is a work of fiction and any resemblance between the characters and persons living or dead is purely coincidental.
SHARE YOUR
STORY
If you have a story you would like to share about mental illness or addiction, we would love to hear it. Whether the story relates to you, a loved one, patient, or colleague, understand that others can benefit from your experience and lessons learned. Send your story to stories@reshealth.net
Life isn’t perfect. I still have good days and bad days, like everyone else. My relationship with my siblings is taking some time to repair, but my new sponsor, Freddie, is helping me with that. I still see a therapist and psychiatrist fairly regularly, but I do not take any medications anymore. Just the other day I was able to reach old Spencer to thank him
RESILIENT HEALTH | February 2018 7
PRIME Program
P RO G R A MS O F S OV E R E I G N H EA LTH
Sovereign Health
PRIME Program for Men Sovereign Health offers specialized residential addiction treatment for men 40 to 65 years of age through our Personal Recovery Integrating Men’s Experiences (PRIME) Program. PRIME is a 45 - to 60-day program that includes all levels of care, from detoxification to outpatient treatment. This holistic program focuses on the psychosocial, physical and financial health issues facing mature men in the “prime” of their lives. PRIME helps men establish sober and supportive relationships, manage medical conditions and create new employment opportunities. We attribute much of our success to our recognition that developmental issues vary across the life span. Our treatment program is based on an appreciation that men in their 40s and older face unique challenges. Employing research in the areas of neurobiology and developmental psychology, PRIME is designed to facilitate recovery and healing from arrival to discharge. Patients Served • Men in their 40s, 50s and 60s • Men whose careers, families and relationships have been affected by alcohol or drug use • Men requiring maximum anonymity
Levels of Care • Detoxification • Residential Treatment • Partial Hospitalization • Intensive Outpatient • Recovery Management
For more information, please visit
www.sovhealth.com
Treatment Programs Offered: • Detoxification • Primary Mental Health • Substance Use • Dual Diagnosis • Telehealth
24/7 ADMISSIONS HELPLINE
866.374.0592
FEATURE ARTICLE
Personality Disorders:
A BRIEF PRIMER By Resilient Health Staff
A
personality disorder is a mental condition characterized by rigid and unhealthy thought patterns that negatively impact a person’s social encounters and behavior. People with personality disorders may have difficulties at work, school or home. They may also have trouble maintaining healthy relationships. Clinicians have divided personality disorders into three clusters: Cluster A personality disorders include paranoid personality disorder, schizoid personality disorder and schizotypal personality disorder; these disorders are all characterized by odd or eccentric thoughts and behavior. Cluster B personality disorders include antisocial personality
www.reshealth.net www.reshealth.net
disorder, borderline personality disorder, histrionic personality disorder and narcissistic personality disorder; these conditions all share dramatic, unpredictable or overly emotional thought patterns and behavior. Cluster C personality disorders include avoidant personality disorder, dependent personality disorder and obsessivecompulsive personality disorder; these types are characterized by anxiety or fearful thoughts and behavior.
Symptoms of a Personality Disorder Personality disorders are a broad category of illnesses with many combinations of different symptoms and manifestations. A person with narcissistic personality
disorder would act nothing like a person with schizotypal personality disorder. Here is a short summary of the symptoms associated with each personality disorder that may help sort out what type of problem you or someone you care about might be living with. Individuals with paranoid personality disorder tend to perceive innocent remarks as personal attacks. They are frequently suspicious of other individuals, and may even think people are trying to harm them. The symptoms of schizoid personality disorder are often a lack of interest in personal relationships. They have a limited range of emotional expression and may appear to be cold or indifferent to the people around them.
RESILIENT HEALTH HEALTH || February February 2018 2018 9 9 RESILIENT
People with schizotypal personality disorder may experience hallucinations or believe that they can see hidden messages in the newspaper or television. They may also shun close personal relationships and feel unwarranted suspicion toward other people. Antisocial personality disorder frequently manifests as violent or aggressive behavior. They may lack empathy or violate the law. The presence of borderline personality disorder might be seen in someone engaging in impulsive or risky behaviors. Their relationships tend to be unstable and intense, and they may also engage in self-harm or suicidal behavior.
may fantasize about success and power. Someone with avoidant personality disorder frequently feels inadequate and may be highly sensitive to criticism or rejection. They’re often socially anxious and may avoid new activities or making friends. The manifestations of dependent personality disorder often include excessive reliance on other people to take care of them. They may lack self-confidence and require constant encouragement for even the smallest of decisions. Individuals with obsessivecompulsive personality disorder tend to struggle with extreme perfectionism. They may be unable
line between mental illness and personality disorder is more blurred than scientists previously thought. In the latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM)—the socalled bible of the mental health profession— personality disorders are now grouped with psychiatric illnesses rather than being grouped in a separate category. Nevertheless, often mental illnesses are often confused with personality disorders. For instance, bipolar disorder is frequently mistaken for borderline personality disorder (and vice-versa) because both disorders involve impulsive behavior and periods of depression. The two conditions, however, are very distinct. Unlike people with borderline personality disorder, people with bipolar disorder experience extreme highs. People with borderline personality disorder also tend to experience more difficulties with interpersonal relationships.
Treatment
Individuals with histrionic personality disorder crave attention and will act excessively emotional or dramatic to receive it. Their opinions also tend to be easily swayed by other people. The symptoms of someone with narcissistic personality disorder often manifest as the belief that she/he is more important or “worthy” than other people. They often have an inflated view of their own achievements and
to delegate tasks for fear that another person won’t complete them “correctly.” They tend to be rigid, stubborn and preoccupied with details.
Personality Disorders vs. Mental Illnesses There is no difference between the two; personality disorders are mental illnesses. A study published in The British Journal of Psychiatry found that the
10 RESILIENT HEALTH | February 2018
Personality disorders can be treated. Psychotherapy and medication may be able to reduce some of the symptoms and help people to perceive themselves and their relationships so they may lead a healthier life. Convincing people with personality disorders to seek treatment can be difficult, because they often do not see issues with their behavior and believe that other people are at fault. Although it may be challenging to convince them that treatment is needed, it is very important for them to see a professional who can make a diagnosis and start them on a treatment plan. These disorders do not tend to get better
by themselves, so it’s strongly urged to help someone receive the care he/she needs so they can lead a happier and healthier life. www.reshealth.net
FAST FACTS
Borderline Personality Disorder Borderline personality disorder is a very common yet highly misunderstood condition. Here are some surprising facts:
Q: Who develops BPD? A: Nearly two percent of the population, three out of four of which are women. Q: Are those with BPD at risk? A: Y es, people with BPD commonly are at high risk for anxiety, depression, addiction and suicide.
Q: Is there a cure for BPD? A: P eople with BPD respond extremely well to specialized psychotherapy; with the proper treatment, many people are able to manage their symptoms and other negative effects of the disorder.
Q: Where can people with BPD and their loved ones turn for help? A: T here are resources that connect millions of people with BPD and their families across the nation and around the world. In addition to seeking treatment at an accredited facility, there are supplemental resources that are available. BPD is much more common than most people realize, and knowing they are not alone can greatly help begin to reduce their anxiety. Here are a few:
• New England Personality Disorder Association (nepda.org) • Emotions Matter, Inc. is more than an advocacy group as they also promote awareness and support networks (emotionsmatterbpd.org)
• Treatment and Research Advocacy for Borderline Personality Disorder
(TARA4BPD) provides education to patients and families (tara4bpd.org)
www.reshealth.net
RESILIENT HEALTH | February 2018 11
P RO G R A MS O F S OV E R E I G N H EA LTH
ROAR for Women Rebuilding Our Acceptance & Resilience, or ROAR, at our Chandler, Arizona, facility provides comprehensive treatment in a dialectical behavior therapy (DBT) manner to all mental health and dual diagnosis patients in a calm, consistent and appropriate therapeutic community. What differentiates ROAR? It’s not just our use of DBT, everyone does that. Rather, ROAR’s uniqueness resides in its universal use by all Sovereign staff. Whether professional, support, or paraprofessionals, Sovereign staff all speak the language of DBT and Motivational Interviewing. Such consistency contributes to the ongoing success of Sovereign Health of Chandler. It is not just a therapy; it’s a way of life. The constant reinforcement of DBT in ROAR helps patients improve their ability to cope with difficult situations, tolerate distress, strengthen relationships and overcome unwanted behavior. With all Chandler staff members trained in DBT, patients quickly learn new behavioral skills and incorporate them into their daily behavior, which effectively changes their lives. Patients Served • Women • 18 Years and Older
Levels of Care • Residential Treatment • Partial Hospitalization • Intensive Outpatient • Outpatient with Transitional Living • Recovery Management
For more information, please visit
www.sovhealth.com
Treatment Provided For: • Primary Mental Health • Substance Use • Dual Diagnosis • Telehealth
JOINT COMMISSION ACCREDITED
24/7 ADMISSIONS HELPLINE
866.245.7849
FEATURE ARTICLE Professional Perspectives:
THE CONNECTION BETWEEN DRUG ABUSE AND PERSONALITY DISORDERS By Dana Connolly, Ph.D.
T
he 1970s and ‘80s saw a major expansion of drug use in America. In response, psychosocial researchers aimed to pinpoint the problem behind the increased use and work toward solutions. By studying various characteristics of drug users, including personality and personality disorders, scientists tried to identify which factors promoted risk of addiction www.reshealth.net
and other factors that promoted resilience to becoming addicted. Part of this work fueled stereotypes about the moral fiber of addicts, and led many people to blame drug users for falling prey to the wealthy, international drug syndicates’ crimes. Today, understanding addiction as a brain disease that takes away selfcontrol over behavior has helped
to separate addictive behavior from personality traits. Individual personalities before drug use are very different from those under the influence, and most personalities return to baseline when a drug is discontinued. Nevertheless, underlying personality disorders may exist, whether a person has, or does not have, a substance use disorder.
RESILIENT HEALTH | February 2018 13
Zimmerman and Coryell were famous for their work on the prevalence of personality and substance use disorders. In 1989, they reported that about 43 percent to 77 percent of those with personality disorders also had an alcohol use disorder at some point during their lives. In the 1990s, Verheul and colleagues looked at things from the opposite perspective; they reported that 44 percent of people with alcohol use disorder and 77 percent of people with opiate use disorder met the criteria for a personality disorder. Specifically, the personality disorders most often found with substance use were antisocial and borderline. These two mental illnesses are only two of 12 defined by the American Psychiatric Association’s 2013 publication of the Diagnostic and Statistical Manual of Mental Disorders.
T
he DSM-5 describes a personality disorder as “an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment.” Other types include paranoid, schizoid, histrionic, narcissistic, dependent, avoidant, obsessive-compulsive and other disorders. When a person has a substance use disorder and a personality disorder or other severe mental illness, he or she is considered to have a “dual diagnosis.” Data published in 2004 from the National Epidemiologic Survey on Alcohol and Related Conditions revealed that about 15 percent of adult Americans have a personality disorder. The National Comorbidity Survey Replication Study reported in 2007 that about
9 percent had this type of disorder. With a population of 320 million today, that translates to 20 to 50 million people with these mental disturbances. Substance use disorders are also very prevalent in the U.S. population, and are reaching epidemic proportions. Estimates from the 2013 National Survey on Drug Use and Health revealed that about 25 million Americans use illicit drugs, and 60 million have alcohol use issues; only 2.5 million (less than 10 percent) of people who needed treatment for substance abuse received help at specialized centers. Treatment of substance use and personality disorders is difficult; strategies and new therapies have been developed, but are only available at accredited centers that specialize in substance use and behavioral health issues. With the extremely high numbers of people suffering from personality disorders, substance use disorders and dual diagnosis, more public health awareness is needed. Without a doubt, the stigma of needed treatment should not be a barrier, since statistics have shown us that at least one out of every five people need it. Delaying treatment when an individual has substance use issues only ensures more negative consequences and outcomes.
S
ymptoms of underlying mental illness can fuel substance abuse; when people “self-medicate” to alleviate feelings of despair, it only serves to make their despair even worse. This may explain why patients with dual diagnosis and those with personality disorders are at particular risk for suicide. Most people who are active in their addiction to drugs and/ or alcohol exhibit symptoms of personality disorders.
14 RESILIENT HEALTH | February 2018
Even the very sickest people can be treated successfully. Complete detoxification in an accredited facility that provides safe and comfortable environment, followed by a comprehensive diagnostic assessment, is needed before a diagnosis of personality disorder or dual diagnosis can be made. Only then can meaningful treatment begin to address the problem and treat actual underlying issues appropriately. About the Author Dana Connolly, Ph.D. has decades of experience in health care as a clinician, medical researcher, genetic scientist and professor at New York University School of Medicine. She has received numerous prestigious research grants, awards, appointments, and invited lectures around the world. She has published many original, peerreviewed studies and presented her research at national and international venues. She has also been an invited guest editor and reviewer for several high-impact scientific journals. Dr. Connolly is currently a senior staff writer for Sovereign Health, where she translates current research into practical information. In this manner, she provides insight and stimulates multidisciplinary discussion about some of the most important health challenges facing humankind today. Sovereign Health is a health information resource and Dr. Connolly helps to ensure excellence in their model. For more information and other inquiries about this article, contact the author at d.connolly@sovhealth.com.
www.reshealth.net
Test Your Personality:
Are You Borderline? While no one feels self-assured and confident about everything all of the time, people with BPD display characteristic symptoms that can make their lives very difficult. Take this brief test to see if you have any of the common symptoms of BPD: My adult life is full of insecurity, chaos, misfortune and unstable relationships. TRUE/FALSE My close relationships are like extremely intense rollercoaster rides. TRUE/FALSE I resort to drastic measures to avoid abandonment. TRUE/FALSE I have more than one impulsive behavior that I wish I could control, such as impulsive spending, sex, drug or alcohol use, reckless driving or binge eating. TRUE/FALSE I have had self-mutilating behaviors, and suicidal gestures or threats more than once. TRUE/FALSE I have extreme episodes of anxiety, depression or irritability regularly. TRUE/FALSE I almost always have a sense of profound emptiness. TRUE/FALSE I have anger issues and rage that can be difficult for me to control. TRUE/FALSE Under stress, I can either get very paranoid, feel suddenly cut-off from myself and the situation or not remember part of what happened while I was stressed. TRUE/FALSE
If you answered “True” to five or more questions, then you might want to talk to a qualified mental health professional. Bring this quiz with you to your appointment so that you can share some of the things you have been feeling. Remember, many people have been able to overcome BPD with proper treatment and are living healthy, productive lives. A Note to Our Readers: Please be aware that any score on this test does not confirm or deny a diagnosis of BPD. The questions were informally based on the American Psychological Association’s Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, diagnostic criteria for BPD. www.reshealth.net
RESILIENT HEALTH | February 2018 15
P RO G R A MS O F S OV E R E I G N H EA LTH
PROGRAM Sovereign Health
POWER Program for Women Sovereign Health is proud to announce specialized residential treatment services for women 40+ years of age through our POWER Program in Palm Desert, CA. Primary Opportunities for Women Experiencing Recovery (POWER) Program creates hope and recovery for mature women who are struggling with addiction or behavioral health disorders as they recover their physical and mental health. POWER includes all levels of care from detoxification to ongoing care management. The entire program was designed to provide the highest quality care possible to women over 40 and their families, from medical experts to specialized therapeutic modalities. This integrative program utilizes evidenced-based care and medical technology to diagnose and treat all underlying and cooccurring disorders to promote lasting recovery. POWER helps women manage health conditions, repair relationships and establish sober and supportive networks. Patients Served • Women in their 40’s, 50’s, and 60’s • Women whose health, families, occupation or relationships have been affected by substance use or mental illness • Participants must voluntarily enter the program • Must be medically stable and ambulatory • Not actively suicidal, homicidal or psychotic
Levels of Care • Detoxification • Residential treatment • Partial hospitalization • Intensive outpatient • Ongoing care management and telehealth
For more information, please visit
www.sovhealth.com
Treatment Programs Offered: • Detoxification • Primary Mental Health • Substance Use • Dual Diagnosis • Telehealth
24/7 ADMISSIONS HELPLINE
866.296.5401
DIAGNOSING AND TREATING BORDERLINE PERSONALITY DISORDER IN TEENS By Resilient Health Staff
A
pproximately 1.6 percent of adults in the United States struggle with borderline personality disorder (BPD), according to the National Institute of Mental Health (NIMH). This estimate, however, may be closer to 5.9 percent, since BPD often goes undiagnosed. Personality disorders, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), cannot be diagnosed until age 18 because children and adolescents go through often drastic personality changes throughout their development. Nevertheless, the National Institute of Mental Health (NIMH) reports that BPD usually develops during adolescence or early adulthood. Professionals in the mental health field believe there are benefits to identifying and treating BPD in adolescents. The disorder is characterized by instability of www.reshealth.net
mood, behavior and interpersonal relationships. The exact causes are unknown but are believed to be a combination of genetic, environmental and social factors. The DSM-5 states the diagnostic standards for BPD to be the presence of at least five of the following symptoms: Engaging in extreme efforts to avoid perceived or actual abandonment Instability in terms of intense relationships that swing from extreme love and idealization to dislike and devaluation Instability about their selfimage and identity Impulsive and self-damaging nature as it relates to spending money, sexual relations, substance abuse, binge eating or reckless driving Recurring self-harm and/or suicidal thoughts or actions Mood reactivity in the form of intense irritability or anxiety
A chronic sense of emptiness Extreme anger and difficulty controlling it Dissociative symptoms and/or stress-related paranoia When these symptoms are present in adults, it is indicative of BPD. But when these same emotions and behaviors are found in adolescents, they are often misdiagnosed as other mental health disorders. Impulse control is common among teenagers with BPD, and so are identity problems and the distinct black-and-white mentality outlined above. Dr. Blaise Aguirre, a leading expert in adolescent BPD, shares that adolescents struggling with the personality disorder often exhibit additional symptoms not mentioned in the DSM-5. These include susceptibility to the feelings and emotions of other individuals, and viewing themselves as contaminated
RESILIENT HEALTH | February 2018 17
FEATURE ARTICLE
Not Just a Phase:
or evil in nature. Oftentimes, adolescents with BPD also develop intense same-sex friendships that lead to sexual intimacy despite their self-identification as being heterosexual.
C
o-occurring disorders— the presence of more than one mental health issue or a mental health illness with a substance use problem—are common in the BPD community. The NIMH states that approximately 85 percent of individuals with BPD concurrently struggle with another mental health disorder. BPD accompanied by another disorder are different in each of the sexes. In girls with BPD, who make up approximately 75 percent of those with the disorder, typical co-existing disorders include severe depression, eating disorders and anxiety disorders. In boys, the most common cooccurring disorders with BPD are substance abuse and antisocial personality disorder. Teenagers with BPD are at high risk for suicidal thoughts and/ or actions. Approximately 4 to 9 percent of all individuals struggling with BPD end their own lives. Early diagnosis and treatment can help reduce these numbers. Though BPD can be difficult to treat, there are different therapy approaches that have proven effective in managing the symptoms of the disorder. These include: Cognitive behavioral therapy (CBT) focuses on helping a person to become aware of ways of thinking that are automatic, but are inaccurate and harmful (for instance, having low self-esteem); the therapist helps the patient to question the negative thoughts, understand how they affect emotions and behaviors, and change self-defeating patterns.
18
Dialectical behavioral therapy (DBT) is a form of CBT designed to enhance the effectiveness of CBT; DBT emphasizes treating psychosocial aspects, such as how a person interacts in different environments and relationships and potential overly-intense emotions and reactions in these relationships. Schema-focused therapy is used to focus on patients’ “schemas”—enduring and selfdefeating patterns or “themes” (for example, “I’m not a lovable person”) that typically begin early in life and get in the way of accomplishing one’s goals and getting one’s needs met. In addition to psychotherapy, there are medications that can be used to treat the symptoms of BPD. Mood stabilizers and antidepressants can help with mood swings and the
general dissatisfaction with life. Antipsychotics medications can help to control symptoms of rage and disorganized thinking. In times of extreme stress, a person with BPD may need to be hospitalized for a time until suicidal thoughts or reckless behavior can be treated.
T
eens go through many changes as they approach adulthood. Changing moods and heightened emotions are not unusual. Nevertheless, their behavior needs to be closely observed for signs that their behavior is extreme, they are thinking of harming themselves and/or they are sinking into the quagmire of depression. If there is reason for concern, help should be sought immediately. It is important to establish a diagnosis as soon as possible so that treatment can be initiated. Early intervention can change, or even save a teen’s life.
Teen Dating Violence Awareness Month Romantic relationships between teenagers are incredibly complicated. The undertaking of a relationship, very often, requires more maturity than most teens have developed. These relationships are more likely to be riddled with problems including communication, jealousy, and selflessness. As a result, teenagers are more likely to be involved in relationships that are unhealthy, violent, and/or abusive. Red Flags in Teenage Relationships Unhealthy or abusive relationships take many forms, and there is not one specific behavior that causes a relationship to be categorized as such. However, there are certain behaviors that should be cause for concern. Behaviors that should raise a red flag include: • Excessive jealousy or insecurity; • Invasions of privacy; • Unexpected bouts of anger or rage; • Unusual moodiness; • Pressuring a partner into unwanted sexual activity; • Blaming others for problems in the relationship and not taking any
responsibility for the same; • Controlling tendencies; • Explosive temper; • Falsely accusing; • Vandalizing or ruining personal property; • Taunting or bullying; or • Threatening or causing physical violence.
Studies have found that negative or abusive behaviors in unhealthy relationships are more likely to increase over time. Abuse escalates as the relationship progresses, and victims are more likely to sustain substantial injuries or harm. If you believe that you may be in an abusive or unhealthy relationship do not hesitate to ask for help. Teenage dating violence is more common than you know; you are not alone. For more information on Teen Dating Violence Awareness Month, go to https://teendvmonth.org.
FAC I L I T I E S O F S OV E R E I G N H EA LTH
Sovereign Health of Rancho San Diego San Diego, California Sovereign Health of Rancho San Diego is designed specifically to treat adolescent and teen patients struggling with substance use, mental health disorders and behavioral problems. Our residential facility is staffed by a compassionate and multidisciplinary treatment team who are trained to work with adolescents through every step of their treatment. Upon admission, our clinicians diagnose any underlying condition which may be present such as anxiety or depression. After a thorough assessment, patients are given a customized treatment plan to achieve the most successful outcomes. The San Diego facility sits on 25 acres of mountainous landscape with green belts and trees surrounding the property. It is the perfect place for adolescent patients to recover in a safe, tranquil and rural location. Accredited by the Joint Commission, our program utilizes evidence-based treatment modalities combined with a holistic focus for a well-balanced recovery. In addition, the San Diego facility holds a Community Care License from the Department of Social Services. Our licensed clinicians and multi-disciplinary medical professionals use several approaches to combat each presenting condition. Patients Served • Males and Females • 12 – 17 Years Old
Levels of Care • Residential Treatment • Partial Hospitalization • Intensive Outpatient • Recovery Management
For more information, please visit www.reshealth.net www.sovteens.com
Treatment Programs Offered: • Adolescents Only • Primary Mental Health • Substance Use • Dual Diagnosis • Telehealth • Eating Disorders • Gender Diversity & Transgender Identity Service
JOINT COMMISSION ACCREDITED
24/7 ADMISSIONS HELPLINE
866.348.4818
RESILIENT HEALTH | February 2018 19
FEATURE ARTICLE
TRANSFERENCE-FOCUSED PSYCHOTHERAPY MAY HELP PEOPLE WITH BORDERLINE PERSONALITY DISORDER By Resilient Health Staff
B
orderline personality disorder, often shortened to BPD, is a personality disorder characterized by impulsive and reckless behavior, difficulties regulating emotions, and unstable relationships with other people. People with BPD typically react strongly to abandonment, whether real or perceived, and may experience recurrent episodes of self-harm and suicidal behavior.
Unlike mood disorders (e.g., depression and bipolar disorder), no medications have been approved for patients with BPD. Some forms of therapies can reduce symptoms, such as cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), Systems Training for Emotional Predictability and Problem Solving (STEPPS) and transferencefocused psychotherapy (TFP).
What is transferencefocused psychotherapy? Transference-focused psychotherapy, also known as psychodynamic psychotherapy, is a therapeutic technique designed specifically for individuals with borderline personality disorder. TFP aims to help patients better understand and regulate their emotions by fostering a close therapist-patient relationship.
Research for the technique has been encouraging. In a yearlong study, researchers found that TFP reduced impulsivity, anger, irritability and suicidality in individuals struggling with borderline personality disorder.
Evidence of improvement with TFP In 2016, a group of scientists led by David Perez, M.D., Assistant Professor of Neurology at Harvard Medical School, published a study in the journal Psychiatry and Clinical Neuroscience on the effect of TFP on the behavior and brain activity of individuals struggling with BPD. The study group consisted of 10 individuals with BPD; the researchers scanned each patient’s brain with functional magnetic resonance imaging to determine areas of function prior to treatment. The patients then completed a course of 50-minute, twice-weekly TFP sessions; each patient completed an average of 76 sessions. After the full course of therapy was completed, the researchers rated each patient’s symptoms to detect any improvement and obtained another fMRI brain scan. The results were impressive— compared to their pre-therapy symptoms, the patients demonstrated reduced aggression and an increased ability to regulate their emotions. In addition to the improved symptoms, the patients’ brain activity was significantly different as well. There were also notable differences seen on the brain scans. When compared to the initial scans, the researchers noted that patients had increased activation in brain regions associated with emotional and cognitive control, and decreased activation in brain areas associated with emotional reactivity. www.reshealth.net
“These preliminary findings demonstrate potential TFPassociated alterations in frontolimbic circuitry and begin to identify neural mechanisms associated with a psychodynamically oriented psychotherapy,” the study’s authors concluded. “These results advance our currently limited understanding of neural mechanisms associated with psychodynamically-oriented psychotherapy,” they added. Since this is only one study — and since the researchers only examined the brains of 10 people — more research is
needed before scientists can conclusively say that TFP heals the brains of people with BPD. The study results are encouraging, however, and point toward what most researchers already believe— mental health disorders are brain diseases, and need to be treated accordingly. There are many paths to wellness for people with BPD. If you or someone you know has this disorder, find a treatment facility that uses the most current, scientifically-based methods of treatment. It can change the course of a life for the better.
RESILIENT HEALTH | February 2018 21
P RO G R A MS O F S OV E R E I G N H EA LTH
Intensive Family Program At Sovereign Health, we recognize that the family is an integral part of each patient’s recovery. We also recognize that families are unique in their strengths and challenges. The Intensive Family Program (IFP) at Sovereign creates the opportunity to mend broken relationships and bring families closer together during their loved one’s journey into recovery. Sovereign’s IFP encourages family members to actively participate in family group activities and therapy while their loved ones are in treatment. Our patient’s individualized treatment plan actively involves the family’s strengths in order to support both the family’s ability to heal itself while supporting the patient’s recovery. Sovereign Health’s two-day Intensive Family Program is offered monthly to patients and their family members at each treatment location. The program gives families the chance to come together and learn about the patient’s specific diagnosis while spending quality time with their loved one. Patients Served • Adolescents • Adults • Males, Females and Transgender
Levels of Care • Detoxification • Residential Treatment • Partial Hospitalization • Intensive Outpatient • Recovery Management
For more information, please visit
22 RESILIENT HEALTH | February 2018 www.sovhealth.com
IFP Services: • Presentations by clinical staff • Personal and family goal setting • Reading and reflection • Workshops • Individual, group and family psychotherapy • Psychoeducation
24/7 ADMISSIONS HELPLINE
855.250.2703 www.reshealth.net
A DEADLY COMBINATION By Lise Millay Stevens, M.A.
A
lso known as BPD, borderline personality disorder is a serious mental illness that affects more than 4 million U.S. men, women and children, and often goes undiagnosed, misdiagnosed and/or untreated. BPD has symptoms that make it difficult to have normal relationships, keep a job, and function normally in life. Because of the off-putting symptoms and erratic behavior associated with BPD, individuals who have it often face a life of seemingly impossible barriers and social ostracization. As a result, many people turn to drugs and alcohol to relieve the stress and stigma of their disease. In the very worst-case scenarios, individuals may even feel compelled to take their own lives when their inability to cope with the day-to-day becomes overwhelming, to the point of hopelessness.
What Are the Signs of Borderline Personality Disorder? There are certain symptoms indicating that you or a loved one might have BPD and/or an addiction to drugs or alcohol. Ironically, BPD can be easily missed in people with addictions because both conditions share www.reshealth.net
similar characteristics, including: Impulsive, self-destructive behaviors Mood swings that range from being severely depressed to having manic periods of intense energy Manipulative, deceitful actions and behavior A lack of concern for one’s own health and safety, and repeatedly engaging in dangerous behavior despite the risks A pattern of instability in relationships, jobs and finances Fear of abandonment Distorted view of reality There are other telltale signs of BPD, including panicked and frantic efforts to avoid real or imagined abandonment, and unstable personal relationships that are extremely close and turn suddenly to dislike and anger. Other serious symptoms are common, such as having a distorted self-image, chronic feelings of emptiness, loss of touch with reality, and having stress-related, paranoid thoughts.
Who Is at Risk for BPD? There are circumstances that can increase the chance of having BPD. Although research hasn’t found an exact cause, it often runs in the family—frequently, parents,
children or siblings also have BPD or another personality disorder. BPD is also more common in dysfunctional families; children who feel neglected or suffer the trauma of sexual or other abuse have a higher risk for the condition. The brain itself can play a role; the impulsivity, emotional instability and unpredictable behavior associated with BPD may be caused by abnormalities in areas of the brain that control mood, behavior and emotions. The brain’s chemistry may also be involved, as imbalances in certain neurotransmitters can also affect how a person thinks, feels and behaves.
A Deadly Duo People who have BPD are more likely than others to use drugs and alcohol to numb feelings such as their fear of abandonment and feelings of anger. Although addiction with any mental health condition—a so called dual diagnosis—is always serious, the combination of BPD and substance use is particularly lethal. Drugs and alcohol tend to bring out the very worst symptoms in people with BPD, such as rage, depression and suicidal thoughts. This is of grave concern as statistics show us that suicide is a staggering 400 times higher in people with BPD compared with the national suicide rate.
RESILIENT HEALTH | February 2018 23
FEATURE ARTICLE
Borderline Personality Disorder and Addiction:
Bipolar Personality Disorder with Addiction Can Be Treated Because BPD and addiction share many of the same characteristics, it can be hard to distinguish one disorder from the other, but treating both simultaneously is important. There are barriers to overcome when treating people with BPD as they are prone to making impossible demands, becoming hostile and paranoid, and may suddenly turn on their providers. However, there are treatment options that have been successful in helping people to lead healthier and happier lives. One approach that has proven effective in both children and adults with BPD is dialectical behavior therapy (DBT), which can help patients to manage the overly-intense emotions and mood swings that are typical of the disorder. DBT helps patients to understand and manage these extreme emotions by developing skills in the following areas: Support: DBT helps patients identify their strengths so they can build on them; highlighting strengths also helps improve selfesteem and their outlook on life. Cognition: DBT helps patients make changes in behaviors, thought and assumptions that are damaging; for example, instead of, “If I get mad at a family member, they won’t love me anymore,” remembering “People don’t get along perfectly all the time.” Mindfulness: The therapist helps patients to be aware of triggers for mood changes to help them control mood swings. Avoiding drugs/alcohol: Patients are urged to become aware of environments and relationships associated with substance use so they can avoid certain people and places.
Reducing cravings for medication: There are several anti-addiction types that help minimize drug and alcohol cravings; patients also encouraged to identify situations that trigger urges to use so they can manage their emotions without using. Establishing goals: The therapist promotes a step-bystep approach to sobriety such as going one day without using, then another day, etc. Psychotherapy: One-on-one sessions with the therapist helps to teach patients how to adapt in stressful situations; special emphasis is given to suicidal feelings and anger management; the therapist encourages patients to concentrate on activities and relationships that improve their quality of life and lift their mood. Group therapy: By hearing from other patients with BPD, addiction and other disorders, patients can learn coping skills from their peers; a group setting also helps them practice regulating their emotions, developing interpersonal skills and practicing mindfulness. Borderline personality disorder is a very serious mental disease that is often accompanied by addiction to drugs or alcohol. People with this problem have high rates of depression and suicide, and find it almost impossible to navigate the responsibilities of a job and
24 RESILIENT HEALTH | February 2018
relationships with family and friends. If you think you or a loved one has BPD, seek professional help as soon as possible. Remember, there is hope in treatment for BPD and addiction. About the Author Lise Millay Stevens, M.A., has more than 20 years of experience as a writer, editor and communications specialist in the health care field, having worked for the American Medical Association and the New York City Department of Health and Mental Hygiene. She served as President of the American Medical Writer’s Association’s Chicago Chapter, and has instructed both health leaders and budding writers on effective, culturally-competent and literacy-appropriate health care communications. Lise spent part of her childhood in Barcelona, Spain, and is fluent in Spanish and French. She is an experienced interpreter and translator and received cultural competency communications training from the City of New York. Lise received her Bachelor’s in French (cum laude) and Master’s in Spanish (magna cum laude) from Cleveland State University. Lise serves Sovereign Health as a Communications Manager, writing, editing and crafting communications strategy for the company while performing quality control for many of the company’s internal and external publications and other communications. www.reshealth.net
S E RV I C E S O F S OV E R E I G N H EA LTH
Addiction / Dual Diagnosis Sovereign Health is a leader in the treatment of addiction, mental health disorders and dual diagnosis. Dual diagnosis refers to a mental health condition and substance abuse occurring simultaneously. Sovereign believes that addiction is a chronic brain disease that may include periods of relapse. It is important to note that repeated relapses after periods of sobriety may indicate the presence of an underlying disorder requiring professional treatment.
Specialized Services Offered:
At Sovereign Health, we specialize in the complex assessment and multidisciplinary care required to successfully treat patients who are struggling with dual diagnosis. Our behavioral health team of masterand doctoral-level therapists are uniquely qualified to treat the mental health conditions that often accompany substance abuse.
• Detoxification
We attribute much of our success to the holistic approach we employ with each individual patient. Multidisciplinary aspects of care are all interrelated and each person has different needs. From arrival to discharge, our treatment team includes each dual diagnosis patient in all decision-making related to his or her own plan of care.
• Telehealth
Patients Served • Adolescents • Adults • Males, Females and Transgender
Levels of Care • Detoxification • Residential Treatment • Partial Hospitalization • Intensive Outpatient • Outpatient • Recovery Management
For more information, please visit www.reshealth.net
www.sovhealth.com
• Primary Mental Health • Substance Use • Dual Diagnosis • Eating Disorders • Pain Recovery • CROSS: Christian Recovery Offering Significant Success • POWER: Primary Opportunities for Women Experiencing Recovery • PRIME: Personal Recovery Integrating Men’s Experiences
24/7 ADMISSIONS HELPLINE
RESILIENT HEALTH | February 2018 25
866.877.8351
FEATURE ARTICLE
Uncovering U-4:
THE TIP OF THE SYNTHETIC AND PSYCHOACTIVE SUBSTANCE ICEBERG By Dana Connolly, Ph.D.
I
n the past, China was ravaged by the West through the Opium Wars. Today, Western countries appear to be the ones being targeted, as synthetic drugs pour over our borders from China and elsewhere. Sadly, these substances are taking the innocent lives of our youth, while leaving devastated families and communities in their wake. As the government remains powerless to do anything to curb the growing problem, Americans have no choice but to protect themselves.
the dangers of U-47700 (also called U-4, Pink or Pinky) and other such substances (you can read Natasha’s story at http://bit.ly/2ygsquM). U-4 was also implicated in the death of two young boys from Utah as well as part of the drug cocktail that took the life of the music artist Prince. While nothing can bring back those who have already been lost, perhaps lives can be saved by spreading awareness into this dangerous new trend.
The recent tragic loss of Orange County college student Natasha Heim has helped bring to light
The chemical name for U-4 is 3,4-dichloro-N[2-(dimethtlamino) cyclohexyl]-N-methylbenzamide.
26 RESILIENT HEALTH | February 2018
It can be taken by mouth, taken rectally, inhaled, or injected. It has been aggressively promoted over the internet as a research chemical or as a substitute for prescription painkillers or heroin. Physical effects are dose-dependent, but can include pinpoint pupils, slow and shallow breathing, cyanosis (turning blue) and unresponsiveness. As of Nov. 14, 2016, U-4 has been temporarily placed on Schedule I for 24 to 36 months, at which point it will be decided if it should be permanently categorized as such. The scheduling system of the Drug Enforcement www.reshealth.net
Administration (DEA) consists of five categories into which various substances fall, with Schedule I substances having no known medicinal value and a high potential for causing physical dependency. Schedule I drugs are illegal to possess or sell. But even if the substance is permanently categorized as Schedule I, a slight modification to its molecular structure would allow a new, unscheduled drug to be born. Legal loopholes have allowed the drug to be sold to Americans on the street, in nightclubs, and delivered directly to the door through online orders from China. By altering the chemical composition of a drug and packaging it as a prescription painkiller or heroin, drug dealers can skirt the laws banning such substances in the U.S. Because these ever-changing chemical compounds are untested in humans, sometimes their fatal effects are not known until it is too late. To understand the magnitude of the problem, we asked Michael Lynch, M.D., about U-4 and the clinical and social implications of such substances. Dr. Lynch
is the medical director at the Pittsburgh Poison Center and an assistant professor in the Division of Medical Toxicology, Department of Emergency Medicine Divisions of Adolescent and Pediatric Emergency Medicine and the Department of Pediatrics at the University of Pittsburgh School of Medicine. “We are seeing more and more of these novel synthetic opioid overdose cases lately. I believe our first documented case was last January, and they have been increasing ever since,” Dr. Lynch explained. “We recently have acquired the ability to test for U-4 in our toxicology laboratory, but most centers do not have that ability. Therefore, the actual number of U-4 overdose cases nationwide might be underestimated. We may only be seeing the tip of the iceberg.” He added, “Fortunately, U-4 is similar enough to other opioids so that those who overdose can be treated with the same antidote, naloxone, if they are able to receive help in time. I urge anyone who has a friend or loved one who is taking opioids to ask their doctor for a prescription for a naloxone
WHAT YOU NEED TO KNOW ABOUT U-4 (AND SIMILAR SUBSTANCES) • They are sometimes referred to as designer drugs • They may or may not be detectable on urine drug screens • They most often have not been tested for safety in humans or even animals • The manufacturing process is unregulated, so concentrations vary from very low to lethal levels • They may contain toxic additives
www.reshealth.net
RESILIENT HEALTH | February 2018 27
FEATURE ARTICLE
emergency kit and learn how to use it. It could mean the difference between life and death.”
benzodiazepines, stimulants, cannabinoids and hallucinogens are also being created and sold through similar avenues.
Synthetic opioid substances are not the only dangerous so-called designer drugs on the market. Substances like barbiturates,
Other terrifying examples of these novel psychoactive substances are the synthetic cathinones. These
Stronger opioids can mean a quicker death. Opioid or painkiller abose is a dangerous avenue for those seeking to numb their existance and feel euphoria. It’s a one way street - to untimely death. Synthetic opioid compounds are being formulated at exponenetial increased potency. When used recreationally it’s not a matter of if, but how fast these drugs can kill you. Used for extreme and acute pain and also to help terminal patients die painlessly.
MO
Not all opioids are created equally. Some can dig a far deeper hole for users than others. Here’s how four commonly-abused opioid drugs compare in strength to morphine:
RPH
INE HER
OIN U-4 770 0 FEN
TAN Y
L
CAR
FEN
3 TIM STRO ES NG TH ER MOR AN PHIN E
7.5 T I STRO MES NGE THA R Synthesized from MOR N morphine, heroin was PHIN E once sold legally. Now it’s a highly addictive street narcotic which can be injected, smoked or inhaled. First created in the late 1970s as an alternative to morphine; Later classed as a research chemical. Known as “pinky,” this drug is often produced in clandestine Laboratories. In medicine, it’s used to treated severe pain. However, a rash of recent overdoses was linked to fentanyl produced in clandestine Laboratories.
50 T O TIME100 S STRO N T GER MORHAN PHIN E
Normally, carfentanil is used to sedate elephants. Unfrotunately, it’s been used to cut street opiates in several states. According to Time, it was responsible for nearly 300 everdoses this summer.
People who abuse painkillers are dissatisfied with life, desperate to “Live” but so willing to die by using these ever-more lethal opioids. Don’t let this be you. Call Sovereign Health and learn how we can help you discover A Better Way to a Better Life.
10, 00 STR 0 TIM ES ON TH GER MO AN RP HIN E
TAN I
L
drugs have a molecular structure similar to the stimulant found in the plant, except the synthetic versions tend to be much stronger and much more dangerous. Because these drugs can be manufactured to appear like bath products, they are sometimes called “bath salts.” Synthetic cathinones are notorious for causing paranoid and psychotic behavior, and possibly even violent behavior. Whether or not psychoactive substances should be legal or illegal remains controversial. While the synthetic opiate U-47700 is no longer legal in the U.S., it is merely the tip of the novelsynthetic-psychoactive iceberg. These substances, such as U-4, can be created and distributed internationally faster than they can be identified and regulated. As a result, Americans are being slaughtered by these untested and highly toxic substances. The dangers of taking novel synthetic psychedelics far outweigh the benefits. People who use them socially are literally risking their own lives and perhaps even the lives of those around them. Those who use them as a desperate attempt to ease the terrible discomfort from opioid withdrawal must understand that safe and comfortable detoxification is available. In the throes of addiction, getting more drugs may seem like the only available option, but such thoughts are merely the effects of the drugs themselves. People can and do recover. If you or a loved one is struggling with opioid addiction, alcohol or other drugs, know you are not alone. Things can begin to get better as soon as today.
Sources: Drug Enforcement Administration: CNN; National Institute of Drug Abuse, Sovereign Health Research Kristin Currin-Shechan and Brian Moore / Sovereign Health
28 RESILIENT HEALTH | February 2018
www.reshealth.net
AT A GLANCE:
ADDICTION TREATMENT MEDICATIONS DOMINATE NEWS CYCLE Referral to Treatment Opportunities Missed by Judicial System https://www.healthaffairs.org/doi/10.1377/hlthaff.2017.0890
A
new study from the Johns Hopkins Bloomberg School of Public reports that less than five percent of people referred for opioidrelated treatment by the judicial system are sent to medicationassisted treatment (MAT) programs. The authors note that, in contrast, 40 percent of clients referred for opioid treatment by other sources, such as hospitals, physicians and even people who found treatment themselves attended programs that used MAT. The study results are alarming for a number of reasons. According to numerous studies, programs that use MAT, because of its efficacy at controlling cravings and symptoms of withdrawal, are more effective at achieving treatment retention and reducing opioid use. In the study, the authors highlight the missed opportunity when opioid users are not referred by the courts to treatment programs that do not use MAT. “One solution is for policymakers to require criminal justice entities to support medications both within criminal justice settings, such as jails and prisons, and to encourage their use when justice-involved persons are referred for opioid use disorder treatment,” lead author Noa Krawczyk stated. “Efforts can www.reshealth.net
be made to reduce stigma and educate criminal justice staff about the benefits of these medications in improving health and criminal justice outcomes.
FDA Approves Novel Injectable Buprenorphine Speaking of MAT, on December 1, the U.S. Food and Drug Administration announced the approval the first injectable form of buprenorphine product for patients with opioid disorder who are already stabilized on addiction medication. This new formulation has the potential to reduce relapse and improve medication adherence in people striving to recover from addiction. Another advantage is that, as it is injected once a month, it will improve medication adherence and prevent patients from selling their buprenorphine on the drug black market. According to the FDA, the new, injectable buprenorphine – Sublocade – should be used only as a part of a complete treatment regimen that includes counseling and psychosocial support. Improving access to prevention, treatment and recovery services, including the full range of medication-assisted treatments is one the five points in the FDA’s
strategy to combat the U.S. opioid crisis. A drawback of Sublocade is the price tag; a cool $1,580 monthly. That cost could be offset by money saved on patient relapse and related emergency room and hospital expenditures.
Medications for Alcohol Use Disorder Underutilized The media has focused on the opioid epidemic as of late, but the fact is that excessive alcohol use continues to kill at a higher rate than drug overdose did in 2016. According to the Centers for Disease Control and Prevention, there were 88,000 U.S. deaths from alcohol-related causes each year from 2006 through 2010. Another 15 million currently live with alcohol use disorder. Adding medications to treatment can be helpful for patients with alcohol issues but should only be prescribed on a case-by-case basis. Acamprosate, for example, tends to only help those who have the classic withdrawal symptoms, such as the shakes and anxiety. Naltrexone is recommended for milder cases who are more interested in cutting down on their alcohol consumption rather than abstaining.
RESILIENT HEALTH | February 2018 29
P RO G R A MS O F S OV E R E I G N H EA LTH
Nutritionally Assisted Detox (NAD) Nutritionally Assisted Detox (NAD) is an intravenous (IV) therapy that is used to detox those suffering from addiction to drugs and/or alcohol without the use of other addictive medications. NAD offers 5-, 10- or 14-day therapy sessions and restores cognitive functioning while diminishing withdrawal symptoms, fatigue, depression and anxiety. NAD is a natural solution to detox therapy and weans the body off its physical dependency in a fraction of the time that it would take with regular detox medications. This innovative therapy treats addiction at its source: the brain. Sovereign Health of San Clemente is a leading provider of mental health and addiction/dual diagnosis treatment services. For many patients, the journey to recovery begins with detox. NAD is a natural process that does not consist of any addictive substances. Patients experience virtually no side effects or cravings and have a significant reduction of withdrawal symptoms. NAD ultimately expedites cellular regeneration, restores brain health and improves cognitive functioning.
Treatment Programs Offered: • Detoxification • Primary Mental Health • Substance Use • Dual Diagnosis • Telehealth • Eating Disorders • Pain Recovery
Patients Served • Men and Women • 18 Years and Older
NAD Features • No addictive medications • Confidential and private • Electronics allowed with WiFi access
For more information, please visit
www.sovhealth.com
JOINT COMMISSION ACCREDITED
24/7 ADMISSIONS HELPLINE
855.782.0654
FEATURE ARTICLE
PRESCRIPTION OPIOIDS IN THE BODY AND THE BRAIN By Resilient Health Staff Prescription opioids, like all opioids, are addictive. The American Society of Addiction Medicine notes that in 2014, roughly 2 million Americans aged 12 years and older had a substance abuse disorder involving prescription opioids. Teenagers rarely have chronic or debilitating pain, yet they use and often become addicted to these medications because of the euphoria they produce. This pleasure comes at a terrible price.
P
rescription opioids (OxyContin, Vicodin, etc.) provide the user relief from chronic and often debilitating pain when taken as prescribed. But according to one report, nearly 1 in 3 opioid prescriptions is being abused. www.reshealth.net
Serious Physical Effects of Opioid abuse Donald Teater, M.D., medical advisor to the National Safety Council, wrote a white paper on the effects that opioids have on the body, “The Psychological
and Physical Effects of Pain Medications” a top-to-bottom analysis of what opioids can do to nearly every system . Some of the side effects of prescription opioids are very serious, and can result in damage to body tissues and functions. Teater notes that opioids slow down the contraction and relaxation of the esophagus and intestines, resulting in constipation for 40 to 90 percent of individuals who take these drugs. Slowing this action can cause nausea and vomiting (the chemical properties of the drugs alone can also cause nausea and vomiting). Roughly a quarter of the people who take opioid pain medications have these side-effects. Another common disturbance is
RESILIENT HEALTH | February 2018 31
gastrointestinal bleeding, which is particularly prevalent in seniors who take opioids. Opioids can also slow down breathing; this causes carbon dioxide levels increase, which in turn signals the brain to increase respiratory rate. As a result, a person who overdoses is at risk for suffocation because opioids interrupt the carbon dioxide loop that allows an unconscious individual to keep breathing. The malfunction of this loop in a conscious person leads to labored breathing. The higher the amount of opioids ingested, the higher the risk the individual will stop breathing. Hormones are also affected by opioid use; gonadotropinreleasing hormone (GNRH) stimulates the production of estrogen and testosterone (sex hormones), which drops with opioid use. More than half of individuals on chronic opioid therapy have low levels of these sex hormones. In addition to lowering libido (sex drive), which is bad enough, low GNRH puts individuals at risk for infertility, impotence, compression fractures, osteoporosis, menstrual irregularities and even alterations in perception of gender role. Opioids have a very scary effect on the brain. A study published in the Journal of American Geriatrics (see summary on Medscape) found that individuals 65 years of age and older who regularly use opioids or nonsteroidal anti-inflammatory drugs (NSAIDs) have a higher risk for dementia and cognitive deficits when compared with their peers who took low or no dosages of these medications. There are several other ways that these drugs have an impact on our brain functions. People who
Side Effects
Abuse of prescription painkillers such as OxyContin and Vicodin can have debilitating effects on the brain and body of an addict during both abuse and withdrawal.
Effect of opioid abuse
Anxiety and headaches
Difficulty breathing
Clammy skin and rashes
Slowed digestion, resulting in constipation
Effect of opioid withdrawal
The brain’s pleasure center drops dopamine levels and stops creating new opioid receptors
THE
THE
HEAD
BRAIN
THE
THE
LUNGS
Achy, twitchy muscles
MUSCLES
THE
THE
SKIN
SKIN
THE INTESTINES
THE INTESTINES
THE
BLADDER
Chills and gooseflesh
Nausea accompanied by cramps and diarrhea
Difficulty urinating
Serious health problems and even death can result from the abuse of prescription painkillers. The Sovereign Health Group treats opioid addiction with evidence-based and holistic treatments to ensure the best chance at a lasting recovery. Contact us today for more information. Source: Business Insider; Carleton University; National Institute on Drug Abuse
take opiates are more prone to episodes of depression, memory loss, impairments in hearing and vision, loss of coordination, impairment in movement and balance, problems with reading, writing and communicating. After prolonged use, opiates can cause
32 RESILIENT HEALTH | February 2018
mental retardation, a vegetative state and death. People with opiate addiction can be helped and placed on a path to recovery. The physical symptoms can be improved or even reversed with rehabilitation and recovery. www.reshealth.net
S E RV I C E S O F S OV E R E I G N H EA LTH
Pain Recovery Program The Pain Recovery Program at Sovereign Health is designed to help individuals whose pain derived from physical injury has led to an addiction to prescription and / or illegal drugs. Addiction is a chronic and multidetermined brain disease that often includes relapses and may include physical pain as an initial trigger. Sovereign Health’s integrative approach to pain recovery focuses on the biological, social, environmental and personality variables that maintain the addiction to pain medication. Depending on each patient’s unique situation, our mission is to reduce the patient’s primary reliance on addictive medication and enhance their nonpharmacologic pain recovery. Sovereign Health is a leading, national provider of behavioral health treatment, focusing on chronic pain, trauma, eating disorders, mental health and substance use disorders. Our clinicians use the latest measurement-based treatment modalities as well as alternative therapies to foster holistic recovery. Patients Served • Men and Women • 18 Years and Older
Levels of Care • Detoxification • Residential Treatment • Partial Hospitalization • Intensive Outpatient
For more information, please visit www.reshealth.net
www.sovhealth.com
Program Goals: • Lower pain level • Improve the quality of life • Identify the negative emotions that reinforce pain • Re-establish meaning, purpose and social relationships • Decrease dependency on medical professionals
JOINT COMMISSION ACCREDITED
24/7 ADMISSIONS HELPLINE
RESILIENT HEALTH | February 2018 33
866.432.5686
SPECIAL SECTION
Treating Substance Use Disorders:
A Resolution to Embrace Measurement-Based Care Why Measuring Treatment Outcomes is a 21st Century Mandate for Treating Addiction
W
e are well into the second decade of the 21st century. On almost a weekly basis, new discoveries gleaned from advanced neuroimaging techniques, rigorous clinical trial outcomes data, and the development of novel neuropsychiatric medications are opening new pathways in addiction treatment. Individuals with substance use, and those with the comorbidities of addiction and an underlying psychiatric condition, should be reaping the benefits of evidence-based addiction treatment. But sadly, data show that health care professionals are not implementing evidence-based science (Scott & Lewis, 2015) in treating the 21.5 million Americans who have a substance use disorder (SAMSHA, 2016).
Dr. Tonmoy Sharma, MBBS, MSc CEO, Sovereign Health
of symptoms, and empowers patients to participate in their own care while improving their outcomes (Lambert et al.; 2005).
I
n 2015, the Kennedy Forum released an Issue Brief titled “Fixing Mental Health Care in America: A National Call for Measurement-Based Care in the Delivery of Behavioral Health Services,” which illustrated the domino effect caused by a
D
espite the deleterious effects of not implementing an MBC model, clinicians have been slow to change. It is worth noting that, in general, it takes 17 years for 14 percent of research to reach consumers (Balas & Boren; 2000). In addition, clinicians have negative perceptions about MBC, including that the burden of training themselves and their staffs is too onerous, negative feelings about prescribed manuals and protocols, and a belief that specific evidence-based practices may not be appropriate for their clients and their practice settings (Scott & Lewis, 2015).
W
References
e know that quality health care, including substance use and addiction care, should be firmly rooted in established biomedical research. Measurement-based care (MBC) — the practice of basing clinical care on client data collected throughout treatment (Scott & Lewis, 2015) — is a core component of evidence-based practices (Klerman, Weissman, Rounsaville & Chevron, 1984; Beck & Beck, 2011). Over the past decade, MBC has emerged as an incontrovertible, evidence-based method that can be used for virtually any health issue (Lambert et al., 2003; Trivedi et al., 2007), and research has shown that applying MBC (such as monitoring symptom change using idiographic assessments) is beneficial for improving client outcomes (Weisz et al., 2011). Overall, MBC elucidates treatment progress, allows for adjusting treatment plans as necessary, reduces exacerbation
services. Providers and, indeed, entire health care systems miss opportunities for ongoing improvement. A lack of symptom rating scales precludes individual practices and health care networks from proving the efficacy of their treatment protocols to third-party payers. This lack of empirical data on treatment success leads to chronic federal and state underfunding of behavioral health treatment, and decisions about reimbursement for services rendered are not aligned with treatments that are proven to be the most beneficial (Kennedy Forum, 2015).
non-MBC approach in behavioral treatment. The conclusions are mind-boggling; per the Brief, a mere 18 percent of psychiatrists and 11 percent of psychologists monitor the efficacy of specific treatment approaches by routinely administering symptom rating scales and therapist assessments to their patients. This lack of assessment cements clinical inertia, and creates barriers to improving clinical
G
iven the stakes, we cannot accept that these perceived barriers to MBC are insurmountable, unresolvable or even valid. A lack of evidence-based treatment spells failure for clinicians, institutions, health care networks and, most importantly, our patients. Let us resolve to embrace our brave new world of clinical innovations and scientific advances that enable us to provide the best measurement-based care for substance use and addiction treatment.
Balas, E. A., & Boren, S. A. (2000). Managing clinical knowledge for health care improvement. Yearbook of Medical Informatics, 65–70; Beck J.S., Beck A.T. (2011). Cognitive behavior therapy: Basics and beyond. New York: Guilford Press; Kennedy Forum (2015). Fixing Behavioral Health Care in America: A National Call for Measurement-Based Care in the Delivery of Behavioral Health Services; http:// thekennedyforum-dot-org.s3.amazonaws.com/documents/KennedyForum-MeasurementBasedCare_2.pdf; Klerman G.L., Weissman M.M., Rounsaville B.J., Chevron E.S. (1984). Interpersonal psychotherapy of depression. New York: Basic Books; Lambert, M. J., Whipple, J. L., Hawkins, E. J., Vermeersch, D. A., Nielsen, S. L., & Smart, D. W. (2003). Is It time for clinicians to routinely track patient outcome? A meta-analysis. Clinical Psychology: Science and Practice, 10, 288–301; Lambert, M. J., Harmon, C., Slade, K., Whipple, J. L., & Hawkins, E. J. (2005). Providing feedback to psychotherapists on their patients’ progress: Clinical results and practice suggestions. Journal of Clinical Psychology, 61, 165–174; Scott K., Lewis C.C. (2015). Using Measurement-Based Care to Enhance Any Treatment. Cognitive and Behavioral Practice, 22:49-59; Simons, A. D., Rozek, D. C., & Serrano, J. L. (2013). Wanted: Reliable and valid measures for the science of cognitive behavioral therapy dissemination and implementation. Clinical Psychology: Science and Practice, 20, 181–194; Substance Use and Mental Health Services Administration (2016). Mental and Substance Use Disorders. SAMSHA; Rockville, MD. https://www.samhsa. gov/disorders; Trivedi, M. H., Rush, A. J., Gaynes, B. N., Stewart, J. W., Wisniewski, S. R., Warden, D., … Howland, R. (2007). Maximizing the adequacy of medication treatment in controlled trials and clinical practice: STAR*D measurement-based care. Neuropsychopharmacology, 32, 2479–2489; Weisz, J. R., Chorpita, B. F., Frye, A., Ng, M. Y., Lau, N., Bearman, S. K., … Hoagwood, K. E. (2011). Youth Top Problems: Using idiographic, consumer-guided assessment to identify treatment needs and to track change during psychotherapy. Journal of Consulting and Clinical Psychology, 79, 369.
S E RV I C E S O F S OV E R E I G N H EA LTH
Next Step Program Sovereign Health offers the Next Step Program to all of its patients to prepare and motivate them toward community integration. Next Step assists patients with academics, volunteering, employment and other important life skills that focus on completing tasks and reaching goals. Next Step helps patients take the necessary steps for continual progression through the individual recovery process and for sustaining healing and recovery after treatment. Next Step screens patients at various levels of care prior to entering the Intensive Outpatient Program. The screening process is necessary to determine the barriers that may prohibit long-term remission and to assist in identifying personal goals that support positive self-esteem in recovery. Patients Served • Men and Women • 18 Years and Older
Levels of Care • Intensive Outpatient • Outpatient
For more information, please visit
www.sovhealth.com
Next Step Program Provides: • Building Resumes • Role-playing for Interviews • Researching Careers • Interviewing Opportunities • Volunteering Opportunities • Discharging Plans
24/7 ADMISSIONS HELPLINE
866.601.6829
1211 Puerta Del Sol, Suite 200 San Clemente, CA 92673 (949) 276-5553 www.sovhealth.com
36 RESILIENT HEALTH | February 2018
www.reshealth.net