Staying clean over the Holidays

For most people, the holidays are joyful. But for the newly recovering addict, it can be a very stressful time. It can be filled with challenges, memories that may lead back to old habits, and possibly to relapse.

Relapse is defined as the return to drug or alcohol use after a period of abstinence. It is preventable, if you take steps to anticipate the challenges the holidays may present, and prepare for the people, places, things and events to come. The following tips can help you meet your goal of staying clean and sober this holiday season:

1. Create a list of phone numbers of support persons, and carry it with you. Include emergency numbers such as AA/NA hotlines.

2. Go to 12-step meetings - more often than usual.

3. Attend "clean and sober" celebrations - often sponsored by AA and NA. Avoid parties where alcohol and/or drugs may be present, especially if in early recovery.

4. If you must go to a party, call someone from your support list, possibly bring them with you, spend as little time there as possible, and make arrangements to do something "clean and sober" afterwards.

5. Practice saying "no" to offers of alcohol or drugs.

6. Help someone else. Take the focus off yourself by volunteering at a local shelter.

7. Find other ways to relax and enjoy the holidays. Distract yourself. Avoid triggers.

8. Talk to your family and friends about your goals for the holidays. Hold yourself accountable.

9. Don't give in to cravings. Remember: they will pass.

10. Have reasonable expectations. Shame, guilt and disappointment can trigger relapse.

For more information and support, contact http://www.aa.org/ or http://www.na.org/

Do you have a drinking problem?

Are you what you call a "social drinker"? Maybe you don't think you have a problem, but people keep telling you that you do. Just how much drinking is "too much" drinking? Where do we draw that imaginary line between social drinking and alcohol abuse?
Alcohol is a substance that is only legal for those of a certain age. Its use affects nearly every part of the body. It is carried through the bloodstream to the brain, liver, other internal organs and muscles - through the entire body. The effects can occur in minutes, and last for several hours. Alcohol is a depressant. It can also make some people more aggressive.
Alcohol can have an effect on a person's motor coordination, making it more difficult to perform tasks like driving or even walking. It can impair memory, and sometimes even blackouts can occur. Under the influence of alcohol, people tend to have poor impulse control, poor judgement, and difficulty making good decisions. All of this leads to risky behaviors that they might otherwise not engage in.
Alcohol problems range from abuse to dependence. Alcohol dependence is the most severe. According to the American Psychiatric Association, people who meet 3 of the following criteria within 1 year are diagnosed with alcohol dependence:
* Evidence of tolerance - needing to drink more to get intoxicated
- the effects of intoxication are reduced with continued use of the
same amount of alcohol
* Symptoms of withdrawal - sweating, nausea, vomiting, anxiety; severe enough to
cause disruption of work or personal life
* Repeatedly drinking more than intended
* Unable to cut down or stop, despite wanting to do so
* Spending a lot of time drinking, recovering from drinking, or obtaining alcohol
* Giving up other activities in favor of alcohol
* Drinking despite persistent physical or psychological problems
Alcohol abuse is less serious, but still requires attention. Abuse is diagnosed is there is 1 or more of the following behaviors within a year:
* Failure to meet obligations at work or school due to alcohol use
* Repeated use of alcohol in dangerous situations, such as driving
* Repeated legal problems related to alcohol use
* Continued alcohol use despite repeated interpersonal problems, arguments, or fights
Even if your drinking does not meet criteria for abuse or dependence, you may still have a problem severe enough to put you at risk for health problems. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines an "at-risk" drinker as follows:
Men: more than 4 drinks per day or more than 14 drinks per week
Women: more than 3 drinks per day or more than 7 drinks per week
Just what is meant by a "drink"? These are standard drink measurements - even though the size of the beverage differs, they contain the same amount of alcohol:
12 oz. beer
8 oz. malt liquor
5 oz. wine
1.5 oz. brandy
1.5 oz vodka, gin, whiskey
So how do you know where you fit into all of this? There is a very simple test you can take, only 4 questions, that can help you decide if your drinking is serious enough to seek professional help. It's called the CAGE: (adapted from NIAAA website)

C Have you ever felt you should cut down on your drinking?
A Have people annoyed you by criticizing your drinking?
G Have you ever felt bad or guilty about your drinking?
E Eye opener: Have you ever had a drink first thing in the morning to steady your nerves
or to get rid of a hangover?
If you answer "yes" to any 2 questions, you should see a health care provider for advice about your drinking. Alcohol abuse and dependence can have serious consequences, both for the patient and his or her family. But it is a treatable disease.
The following websites may also be of use:
http://www.niaaa.nih.gov/

http://www.aa.org/

Especially for teenagers:
http://www.abovetheinfluence.com/

http://www.teenshealth.org/

Information you can trust

Thousands of Americans look for health information online everyday. But how do we know if the information we're getting is accurate? One way is to follow the advice of the Health on the Net Foundation (HON). Since 1996 they have offered certification to health websites that meet certain standards of honesty, disclosure, privacy and accuracy, known as the HONcode.
As consumers of health information, it is important to know how to access a reliable source, and how to tell a good source from one that is questionable. HON offers advice on how to do this:
* Use more than one website to check information. It's like getting a second opinion.
* Ask your health care provider to refer you to a good website.
* Check the source of the information. Who is the author?
* Check their privacy policy.
* Are they HON certified? Is it valid?
* Be wary of extreme claims and "miraculous" cures.
* Don't substitute online advice for actual medical care.
* Be careful ordering from online pharmacies: there may be legal restrictions, and some
have been involved in scams in the past.
For more details about health information on the web, the 8 principles of the HONcode, and the HON Foundation, log on to www.hon.ch

A change of focus ...

The original focus of this blog was to offer news and updates in addictions nursing. However, after further consideration, I have decided to make this a more patient-focused endeavor. Why? There are numerous ways for health providers to obtain information about addictions. We can access journals, consult colleagues, participate in continuing education, attend conferences, and more.

Where does the average person go for advice? Some information online is sound, some is not. Sometimes friends are well-meaning, but their information may not always be accurate. Often people are ashamed or afraid to approach their health care provider when they have a problem. That is, assuming that they even realize they have a problem.

For those reasons, and because I strongly believe that health education is a vital part of the nurse practitioner role, this blog will be dedicated to patient education issues. Hopefully the information will be of value to patients struggling with issues of substance use and abuse, and to their families.

Methadone is safe and effective treatment

According to figures released last year by the Substance Abuse and Mental Health Services Administration (SAMHSA), nearly 600,000 U.S. citizens began ilicit opiate use in 2008. Add that to the hundreds of thousands of Americans already abusing heroin and prescription pills, and we have a significant problem in this country that continues to grow.
Methadone has long been used as one option for the treatment of opiate dependence. However, despite its long term use, it remains largely misunderstood. The stigma associated with addiction remains, even after a person enters treatment. This seems especially true of patients receiving methadone, as they are often seen as "substituting one drug for another".
What can health professionals tell patients who are seeking treatment, and may have questions about methadone? The most important thing is to stress that addiction is a disease, and we must treat it as such. Methadone is a medicine used to treat the disease. When used properly, there is no "high" associated with methadone and it is very safe. People can function well, and restore their lives to a productive level.
Honesty is important, and patients should be encouraged to confide in those they can trust, for support. If they are employed, and drug testing is required, they should reveal that they are in treatment. Participation in methadone maintenance treatment (MMT) can not be held against a person, thanks to the Americans with Disabilities Act. Workers should be encouraged to work with their employee assistance program, if one is available.
Information about MMT for health professionals can be obtained from SAMHSA at www.SAMHSA.org and Addiction Treatment Forum www.atforum.com as well as your local health department.