Claire (not her real name) juggles a lot in her life.
She is a full time college student.
She works part-time.
She is getting married over Thanksgiving.
She has an opioid addiction.
Her first attempt to complete college failed when she started using pills at age 20. She never believed the occasional pill she took to catch a little buzz would ever result in her life being completely undermined. She quickly developed a tolerance and started using daily. She was caught with drugs and detoxed in jail.
When she left jail she did a 30-day treatment program. She was pretty involved in Recovery Meetings for the first several months, but as time went on, she felt less of a need to attend. She worked, met Tommy, a nice guy—who had no experience with drugs—and she told me she started to think of herself as someone who really wasn’t an addict. She drank a little with her friends and smoked some pot from time to time.
She decided to return to school to complete her degree and she and Tommy set a date for their wedding.
The pressures of being back in school full time while continuing to work were worse than Claire anticipated. She started drinking regularly to relieve the mounting anxiety she felt with her intense schedule, as well as planning a wedding. Drinking escalated to several drinks daily. She was sleeping poorly and waking up feeling horrible. Memories of previous failures in school haunted her. She felt like she was on a slippery slope. It wasn’t long before she turned to pills. She reasoned that using opiates briefly would help her stop the cycle of drinking she found herself in. (See Dr. Coleman’s latest article on how drugs mess with the decision making part of your brain!) Pills, difficult to find and very expensive, quickly turned to heroin.
Fortunately Claire came to see us after only a couple of months of heroin use. She wanted to be on long acting naltrexone, which had worked for her in the past.
Naltrexone is an opiate antagonist, or blocker. When it’s in a person’s body, it prevents opiates from having a place to ‘land’. The naltrexone occupies the opioid receptors, but doesn’t cause euphoria and doesn’t create physical dependence. It is available in two long acting formulations, a monthly injection called Vivitrol® or an implant that lasts for most people about two months.
Her insurance covered Vivitrol®, but in order to use naltrexone the opiates must be out of the body, otherwise it will precipitate withdrawal. Going cold turkey wasnt an option.
We prescribed several 2/0.5 mg Suboxone® strips for Claire and created a tapering schedule to have her completely off within two weeks. Before she could get the Vivitrol®, she needed two more weeks free of Suboxone®. This was the most worrisome part of our plan, leaving her vulnerable to relapse.
Claire met with our Recovery Support Specialist, Bridget Walsh, and together they came up with a plan to keep her accountable and opiate free during those two weeks. In Richmond, students at VCU have access to excellent Collegiate Recovery resources through the Rams In Recovery program. Claire contacted them as well as a counselor specifically recommended by Bridget to deal with some other issues Claire was facing.
Two weeks later Claire returned to the office and received her Vivitrol® injection. At the time I am writing this article, she remains opiate free.
Recovery from an addictive substance can be a complex process and many people dealing with it have a multitude of unique moving parts to manage. By the time a person is in the throes of physical dependence, unraveling oneself may feel overwhelming. At The Coleman Institute, we are pretty good at breaking down these seemingly insurmountable situations into workable steps. If you or a loved one are struggling to find your own path to freedom from opiates or other addictive substances, please give us a call. If we are not the right fit for you, we can probably steer you toward someone who is.
Joan Shepherd, FNP