TCI Blog


Nov 16

November 1, 2016

The Lighthouse

By Joan R. Shepherd, FNP

A podcast I often recommend to patients is The Bubble Hour ( On a recent episode the discussion was about relapse. Two women in long -term recovery discuss what it’s like for them when friends relapse. One of them quoted Anne Lamott, who says, “Lighthouses don’t go running all over an island looking for boats to save; they just stand there shining.”

I really appreciate that notion.

At The Coleman Institute (TCI) we recognize that addiction is a chronic illness. I often tell my opioid or alcohol dependent patients, when a person with diabetes gets his/her blood sugar under control, I don’t say, “Great! Now eat whatever the hell you want, you’ve made it!” On the contrary, the ‘gift’ of having diabetes, is the opportunity to intentionally look at what you are choosing to consume and how you are choosing to exercise to keep your precious body at its best.

Likewise, with addiction.



Oct 16

October 26, 2016

Success Story: Airport Encounter

By Joan R. Shepherd, FNP

On Sunday morning Dr. Coleman and I were returning from a weekend in Boston. We were rolling our bags through the airport when a young man came up to us and excitedly said, “Um, excuse me…don’t mean to interrupt you….but, do you remember me?”

It was a patient who completed a 3 day Rapid Opiate Detox from The Coleman Institute (TCI) six months earlier. He was so excited to let us know how well he was doing. He was traveling with his business, up and down the east coast. He is thriving!

We didn’t ask all the usual questions we would ask him if he were in the office (medical health, hours of sleep, anxiety/depression, relationships, counseling, etc….) but it was clear from his beaming face and energy, that all was well.



Oct 16

October 14, 2016

Low Energy After Opioid Withdrawal

By Joan R. Shepherd, FNP

A patient called the other evening. He finished his rapid opiate detox about a week ago. He has a very physical job and is father of a 4-month-old baby, Noah. Noah is the reason he finally decided he had to stop his drug use once and for all. He has been using high dose opiates for over 20 years, with a few small blocks of abstinence thrown in.

He did well through his detox; he was able to stay pretty comfortable getting off the equivalent of somewhere between 300-450 mg of mixed opiates. He was also using heroin, but didn’t want his grandmother-who was his support person-to know about that. We never mentioned it to her.

His call came because he is so very frustrated with his lack of energy. With a job installing granite counters and a tiny baby, not to mention the mother of this tiny baby who is desperate for his help, this man wants to feel energized. Now. Yesterday. He wants a magic pill and he is certain there is something I can prescribe for him to help.

If there is, I haven’t met it.



Oct 16

October 13, 2016

Naltrexone Therapy Might Be The Right Choice

By Joan R. Shepherd, FNP

I’ve been a nurse practitioner for about 16 years, almost nine of those at The Coleman Institute. When I interviewed with Dr. Coleman, I understood he needed a family nurse practitioner.

It was a nice setting–close enough that I could walk or bike if I chose–and he seemed like a cool, laid-back Kiwi and a reasonable boss. I was strongly considering the position when he informed me that he actually ran two businesses under one roof: in addition to the family practice he also had a substance abuse program where he did outpatient rapid opiate detoxes.

My pretty immediate response was to thank him politely for the interview, and continue looking at other career possibilities. I just didn’t think I wanted to work with that population. With some hesitation I agreed to shadow him in the clinical setting.

A few days later I returned to the office. It was clean, bustling, and friendly. We saw a couple of standard family practice patients, and then I followed Dr. Coleman into our first TCI (The Coleman Institute) visit.

Scott, age 22, was lying on the exam table, one knee bent, his other long leg dangling over the edge. He wore a ball cap and a hoodie. Both his parents were with him and they stood when Dr. Coleman walked in. His mom burst into an ear-to-ear grin, his dad looked self-consciously from his feet to Dr. Coleman, also grinning. Scott raised himself to his elbows, looked at Dr. Coleman and with slow smile and they fist-bumped each other.

This wasn’t what I expected.



Oct 16

October 11, 2016

Escaping Pain With Opiates

By Joan R. Shepherd, FNP

What would you have to give up if you stopped blaming yourself?

I heard this question asked during a podcast by Tara Brach, who teaches topics on meditation. She was making the point that so often the voice that appears and reappears in our head has the tone of Aversive Judgment. This voice is not like the Wise Discrimination voice that cleanly processes problems to arrive at solutions; this is the voice that is telling—if not shouting–the story of What’s Wrong With Me.

When we are stuck in Aversive Judgment mode, it’s uncomfortable. We want to escape. No one wants to stick around to hear a critic going on and on, blaming us for choices we’ve made, mistakes that have hurt others or ourselves, making comments about how we look, how we should look, where we should be in life by now, etc—whether the critic is in our world or in our head.

We can become peculiarly complacent, almost having a nervous treaty with this blaming aversive judgment voice; after all, it’s familiar. It’s the known enemy, and we’ve got our wary dance steps down. When the voice becomes intolerable, there is great justification to escape: opiates, booze, benzos, food, porn, gambling…easy to run from discomfort into the familiar, habitual choices.

But behaviors that rise from self-hatred only make things worse.


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