Addiction Psychiatry- Prescription Opioid Dependence

Prescription opioid dependence is becoming a cause for concern for addiction psychiatry as many people are started on these drugs for pain or many start using opioid based Over-The-Counter(OTC) medication and develop a dependence on them. Some research has shown that the prognosis of this is better than Heroin dependence. A recent paper further confirms my personal experience of treating this problem in Wales. The good news is that prescription opioid dependence can be managed well with Subutex or Suboxone along with psychosocial support. A long term maintenance may not be required in such instances.

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Anxiety Management, Meditation & Psychiatry

Some degree of anxiety is important for the normal functioning of man. Complete absence of anxiety would result in a very lazy world! Can you imagine doing absolutely nothing for the rest of your life? On the other hand, too much anxiety can not only result in affecting your functions on a day to day, but can put a strain on others around you as well. Like other private psychiatrists, I see anxiety in its dysfunctional form to be a very common complaint. Medication can be helpful when anxiety is of a degree that falls within one of the Anxiety Disorders or sometimes for lesser degrees of anxiety but psychological interventions are useful across the full spectrum. Mindfulness, relaxation, meditation, breathing exercises, target relaxation are some very basic interventions which are useful.

As part of comprehensive psychiatric treatment for anxiety, I use some clinical interventions and for the benefit of everybody I am sharing Calming the body, a podcast that can help in relaxating the body and being aware of the ‘moment’. As many of the dysfunctional anxieties are either related to the baggage we carry from the past or are too worried about the future, being in the moment becomes important!

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Recovery- Addiction Psychiatry and Beyond

Recovery is not only a fundamental theme of my working philosophy as a private psychiatrist working in Wales, which is reflected in the company logo- ‘Serenity/ Recover the peaceful way…’, it is infact the most topical subject talked about in Addiction Recovery in UK at present.

So when does recovery happen, what is recovery and whom do we call to be in addiction recovery- whether a person who is totally abstinent or someone who is on Substitute Program for Opiate Dependence and carries on functioning as a useful and contributing citizen of our society? In my view, Addiction Recovery starts from the time an individual decides that some help is needed and takes steps to facilitate the needed change. From then on I consider it as a journey, a journey to achieve the goals and ambitions that one sets out to achieve in order to make best use of one’s naturally given potentials. Some may argue that the end point may be being free from drugs or alcohol and maintaining sobriety but given the nature and the current knowledge of Addictions as a Chronic Brain Disorder (Evolutionary models of Addiction are discussed in Royal College of Psychiatrits in Wales Summer Newsletter Pg 16), the end point may actually be much broader than mere abstinence achievement. In my opinion, it includes an integration and consolidation of the pharmacological and psychosocial supports to improve the functioning of the individual in order to feel a valued human being and very much part of the society.

So, when it comes to addiction recovery, I am thinking of Motivational Interviewing as an approach to facilitate change, I am thinking of phases of preparatory work before detoxification from drugs or alcohol, I am thinking of Assertiveness training, I am thinking of relapse prevention psychological interventions, I am thinking of pharmacological options- Naltrexone (Oral, Injectable and Implants), Subutex, Suboxone, Disulfiram, Accamprosate, Topiramate, Baclofen etc, I am thinking of optimising other underlying physical and mental health needs, I am thinking of linking with social interventions- vocational training, occupational issues, voluntary work to name a few. With all these tailored to an individuals needs, I believe that Addiction Recovery is an achievable and palpable reality and with the right support it can be done ‘the Peaceful Way…’

And finally, it does not need to be restricted to Addictions as the principles are valid for people suffering with Mental Health Problems as well. What matters most is the value of being human.

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Benzodiazepine Addiction

Benzodiazepines are group of drugs that have been used within the medical profession for a very long period of time and the primary indications are those of treatment of Anxiety disorders and as Hypnotics (drugs aiding sleep). The debate regarding their long term use and their effects still continues.  A dependence syndrome or addiction is a recognised complication of long term use.

In my clinical practice, I see a variety of people who have been using Benzodiazepines and largely fall into groups- ones using them for their anxiety, ones who are using to get a head out of them or to enhance the effects of other substances that are using and the ones who are dependent on them. The people who use them for anxiety need a much different approach to manage than the other two groups. I often use Anxiety management techniques and recently have been using ‘Target Relaxation’ with benefit whilst optimising the anxiety disorder. (Will be soon putting up a podcast for ‘Target Relaxation’).

People who are dependent are either buying legitimate prescriptions or are using street benzodiazepines which are being sold by various street names- the most popular ones being MSJs (which is allegedly a Sri Lankan Pharmacy Supply), Blues, Yellows, Dog Valiums, Dodgies to name a few. The challenge with these is that, it is likely that their is no standardisation in the active compound in two consecutive tablets and we are currently trying to get some of these tested. The lack of standardisation means that the effects of the tablets may be unpredictable and from the people whom I see, I have been informed that the Blue ones are particularly unpredictable.

To manage the dependence, detox options are available and need to be incorporated with supportive interventions. A controlled and monitored reduction regime, tailored to clinical needs of the patients has been successful in my experience- what some have termed as ‘Bespoke’ detox. I hope and wish that I don’t have to see you with this problem and so that I don’t see you with this problem, here’s a video by Wobbly Stan on the effects of Benzodiazepines that might be helpful to avoid getting into Benzos in the first place.

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