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How Our Occupational Therapists Help Trauma Patients

Most of us take for granted our ability to complete the most basic steps associated with self care and social engagement. We never really consider that brushing one’s teeth, taking a shower, or having even the briefest social interaction with a stranger may be an emotionally strenuous task for some individuals. Naturally, when a person suffering from post traumatic stress disorder (PTSD) tries to explain the difficulty they experience executing daily tasks, it is not uncommon for them to be met with objections or to have their issues dismissed and be told to simply “get over it.” This advice is in no way helpful to the firefighter who is triggered by the sound of their own children crying, after witnessing children dying in a fire while on the job. And this certainly does nothing to assist the war veteran who relives moments on the battlefield everytime they hear the sound of aircraft overhead. From the decades of research on PTSD, one thing is abundantly clear—avoidance is not a viable option. Enter occupational therapy.

What Is Occupational Therapy?

Occupational therapy is a form of treatment for individual suffering from addiction or mental health disorders that interfere with their ability to perform daily tasks associated with living a normal, healthy. Occupational therapy focuses on three main areas:

Occupational therapists will often try to restore a patient’s self-confidence by breaking down big tasks into smaller, more manageable subtasks for the patient. This approach prevents the patient from feeling overwhelmed and gives them a sense of achievement by proving a series of small wins that bring them incrementally closer to achieving a big goal.

Symptoms of Post-Traumatic Stress Disorder

The biggest commonality among first responders, veterans, and survivors of abuse with post-traumatic stress disorder (PTSD) is that it impairs their abilities to move forward after the traumatic event. PTSD symptoms create severe psychological limitations that promote self-destructive behaviors. Through repetition, these behaviors become habits that an individual will feel unable to control, much less stop. PTSD symptoms are usually grouped into four categories:

In his book, The Evil Hours: A Biography of Post-Traumatic Stress Disorder, David J. Morris describes the aftermath of trauma as follows:

Trauma destroys the fabric of time. In normal time you move from one moment to the next, sunrise to sunset, birth to death. After trauma, you may move in circles, find yourself being sucked backwards into an eddy or bouncing like a rubber ball from now to then to back again. … In the traumatic universe the basic laws of matter are suspended: ceiling fans can be helicopters, car exhaust can be mustard gas. 

Understanding Your Emotions Helps Manage Symptoms

Our emotions are an important part of our individual growth and development. They can help us with everything from situational awareness to establishing healthy relationships. Distinguishing between an appropriate emotional response and a dysfunctional one can be a challenge for individuals with post-traumatic stress disorder (PTSD). Our occupational therapists teach patients principles and skills to help them better understand their emotions:

The process of working with occupational therapists is both collaborative and goal oriented, making it easy for patients to track their progress.

The Wise Mind: Balancing Emotion and Reason

When we are in our emotional mind, our actions are predominately based on our emotions and how we are feeling. Our response to stress or triggering situations is extremely reactive as we abandon logic, fact, and reason when our emotional mind has taken over. An example of your emotional mind taking over is when you overreact to a situation because it triggers a negative memory of a similar situation; your fear that something similar to your memory may happen again drives your overreaction, even if it is actually extremely unlikely.

We would all like to believe that we operate from our reasonable mind, however this is not always the case. The reasonable mind is the part of us that is based solely on logic and rational information. It gathers and interprets empirical information from our observations and forms beliefs and opinions based on that information. If drives actions that are are cool, controlled, and strategic. The reasonable mind is very useful in crisis situations. Many military personnel and first responders can tell you, being able to access the reasonable mind when you need it can be the difference between life and death. The reasonable mind is excellent for planning and evaluating big life decisions, however, it is possible to overdo it and fail to recognize and consider the significance of our emotional signals. Overuse can create habits such as minimizing our feelings, and compartmentalizing events that could be pivotal to our development by diminishing our emotional connections to them. Such habits could lead to depression, burn out, or feeling numb.

The wise mind is the integration of the reasonable mind and the emotional mind. It is a functional blend of strategic thinking guided by healthy emotional awareness. It is the capacity to consider past experiences, current perceptions, and theoretical knowledge, to arrive at a constructive understanding of one’s present situation. Our occupational therapists teach our patients techniques to make the wise mind more easily accessible and available to help them manage their trauma symptoms.

Problem Solving: Barriers and Strategies

Problem solving can be difficult for the average person on any given day. It requires us to use all aspects of our mental capacity to analyze a particular set of circumstances and available choices, and then produce a solution. An ideal solution would not only satisfy our immediate need, but would also be consistent with our long-term goals. This process can be extremely difficult for individuals suffering from mental health or substance use disorders as they may not trust their own judgement and or accuracy in assessing a situation.

Barriers to Effective Problem Solving

The first step that our occupational therapists take with patients is to help them identify common barriers to solving problems quickly and effectively, including the following:

Strategies for Effective Problem Solving

Occupational therapist also teach patients a range of effective problem-solving strategies that can be used in different situations, including the following:

Subjective Unit of Distress Scale and Coping Strategies

It can be very difficult for those suffering from substance use and mental health disorders to clearly recognized and understand how they are feeling at any given time. Occupational therapists provide patients with tangible metrics to help them the recognize, isolate, and react appropriately to negative stimuli. The Subjective Unit of Distress Scale (SUDS) works as an emotional gauge, and is a crucial part of therapy. The SUDS protects patients from their more destructive emotions by teaching them practical ways to distract themselves from what they are feeling. The objective is to turn this distraction, which may be unusual to the patient in the beginning, into their habitual response to extreme stressors.  

Occupational Therapists Help Patients Get Back to Their Lives Faster and Better

Recovery from post-traumatic stress disorder is a difficult process that requires hard work and commitment from the patient. Occupational therapists help facilitate this process and allow patients to return to their normal lives more quickly, with effective coping skills, useful habits, practical knowledge, and effective problem-solving strategies.

Call Us for More Information

If you would like to learn more about the treatment programs provided by EHN Canada, enrol yourself in one of our programs, or refer someone else, please call us at one of the numbers below. Our phone lines are open 24/7—so you can call us anytime.

Integrated Treatment of Substance Use Disorders and Concurrent Post-Traumatic Stress Disorder (PTSD) Is The Most Effective Approach

Post-traumatic stress disorder (PTSD) can develop after an individual has been exposed to a traumatic event such as death, serious injury, or a threat of harm to themselves or to others. When exposed to such events, it is normal to feel intense fear, helplessness, and horror, but in most cases, these feelings are eventually resolved—but, unfortunately, not always. Some people experience long-lasting and intrusive symptoms such as disturbing flashbacks, heightened states of arousal, mood disturbances, and avoidance of memories about the event. These are the symptoms associated with PTSD.

Post-traumatic stress disorder (PTSD) is more common than you might think. An estimated 1-in-10 Canadians will experience PTSD at some point in their lives. Certain populations are at higher risk of developing PTSD because they are more likely to experience traumatic events. Members of the military are often seriously injured, witness the death or injury of others, and have their lives seriously threatened. Many veterans returning from Iraq and Afghanistan report being targets of enemy gunfire, knowing someone who was injured or killed, or even having to handle dead bodies. Such experiences can have a lasting effect on an individual’s mental and emotional well-being.

There appears to be a bi-directional causal relationship between developing post-traumatic stress disorder (PTSD) and developing a substance use disorder. People with PTSD experience persistent and disturbing psychological symptoms, which make them more likely to use alcohol or drugs as coping mechanisms. Conversely, people with substance use disorders are both more likely to experience traumatic events and less likely to be able to process them effectively.

Compared to either disorder alone, concurrent post-traumatic stress disorder (PTSD) and substance use disorders are associated with worse mental and physical functioning, and higher levels of psychological distress. When these two disorders are concurrent, the negative effects can be quite severe: they can impair a person’s ability to work, to maintain healthy relationships, and to maintain a positive outlook on life. As a result, people with concurrent PTSD and substance use disorders will often experience rapidly deteriorating physical and mental health, and should therefore get treatment as soon as possible.

There are several treatment options available for individuals with concurrent post-traumatic stress disorder (PTSD) and substance use disorders, including both medical therapy and psychotherapy. Historically, treatment focused on resolving the substance use disorder first, before proceeding to address the PTSD. However, the historical approach risks exacerbating a patient’s PTSD symptoms: when a patient with PTSD narrowly focuses on trying to resolve their substance use disorders, they are likely to be confronted with challenges and discomfort for which they are not yet adequately prepared. Today, however, most clinicians recognize that patients’ substance use is closely related to their PTSD symptoms. Hence, at EHN Canada, we believe that the most effective treatment approach is through integrated treatment programs that address both disorders together.

EHN Canada’s integrated treatment model acknowledges the fundamental interdependence between post-traumatic stress disorder (PTSD) and substance use disorders. Therefore, we address the two disorders at the same time, usually within the the same treatment program. Substance use disorders are conceptualized as tools—albeit highly dysfunctional ones—that people use to try to manage their PTSD symptoms. We educate patients and provide them with a new, healthier, and more effective set of tools, early on in their treatment programs. This reduces the likelihood that a patient’s PTSD will compromise their recovery from their substance use disorders. Our conviction that the integrated treatment model produces superior outcomes is also supported by patients’ attitudes: research has found that patients with concurrent PTSD and substance use disorders report an overwhelming preference for the integrated approach.

Post-traumatic stress disorder (PTSD) and substance use disorders have a complex interrelationship. EHN Canada treatment programs teach patients how to recognize and manage their symptoms and triggers. We also help patients create solid recovery plans that serve to guide their long-term behaviour changes. EHN Canada’s individualized treatment programs also push each patient to discover their own unique strengths and skills. We encourage and support our patients to further develop these abilities to support their successful recoveries and recovery maintenance. Patients complete EHN Canada treatment programs having developed functional and adaptive coping strategies, as well as assertiveness and effective communication skills. They walk out our doors ready to face the world, full of optimism, and eager to get back to their relationships, families, friends, and careers.

Call Us For More Information About Our Programs

If you would like to learn more about the treatment programs provided by EHN Canada, enrol yourself in one of our programs, or refer someone else, please call us at one of the numbers below. Our phone lines are open 24/7—so you can call us anytime.

Sex Addiction: Too Much of a Good Thing?

Written by Munis Topcuoglu, Editor at EHN Canada.

A valid definition and diagnostic criteria for “sex addiction” have long eluded experts because, historically, definitions and diagnostic criteria have either represented sexually oppressive cultural norms, or they have been vague and imprecise, requiring too much subjective interpretation. Cultural norms, oppressive or otherwise, are not valid bases for diagnostic criteria, because they have no scientific justification. The definition of “too much sex” has varied widely throughout history and currently varies widely throughout the world, and none of the definitions are supported by scientific evidence.

The following excerpt from the book Nymphomania: A History describes a historical example of the problem of diagnosing sex addiction based on cultural norms:

In the Victorian period, both doctors and patients who sought medical help believed that strong sexual desire in a woman was a symptom of disease. Self-control and moderation were central to the health of both men and women, but women’s presumably milder sexual appetite meant that any signs of excess might signal that she was dangerously close to the edge of sexual madness.

Another excerpt from Nymphomania: A History, illustrates the absurdity of Victorian doctors’ culturally biased understanding of the etiology of “nymphomania”:

Eating rich food, consuming too much chocolate, dwelling on impure thoughts, reading novels, or performing ‘secret pollutions’ [i.e. masturbation]… overstimulated women’s delicate nerve fibers and led to nymphomania.

Interesting to note, is that in the Victorian era, the male equivalent of nymphomania “satyriasis” existed in medical textbooks, but was almost never diagnosed in practice—because “a man wanting too much sex” was not really considered a thing. Fortunately, both science and culture have come a long way since then, and we are now able to understand sex addiction in more functional and less sexist terms.

Evidence-Based Definition and Diagnosis of Sex Addiction

If we make the effort, we can minimize cultural bias, and define and diagnose sex addiction based on evidence. The key element for deciding whether or not a person’s sexual behavior is problematic is determining whether or not their sexual behavior results in real negative outcomes. This is the most effective approach for identifying genuinely problematic sexual behaviors and it lays the groundwork for creating effective treatment programs for the people who have them.

Required criterion: negative consequences or endangerment

The necessary criterion for identifying sex addiction is that the person’s sexual behavior actually results in negative consequences or endangerment in one or more of the following ways:

Other signs of sex addiction: loss of control, frequency, consuming focus, and mood regulation

The following features can be signs of sex addiction when they result in negative consequences or endangerment:

The “other signs” by themselves are too subjective for diagnosis

The inability to control, reduce, or stop sexual behavior is only a sign of sex addiction when the person recognizes that the behavior has negative consequences or is unacceptably dangerous. Similarly, excessive frequency and repetition of sexual behaviors, or excessive focus on sex, can only be signs of sex addiction when the individual recognizes the negative consequences or dangers because, otherwise, “excessive” is merely cultural and subjective. It’s also important to note that, for similar reasons, engaging in sexual behaviors that others find offensive or disturbing does not, per se, indicate sex addiction.

What Is the Underlying Disorder?

Experts tend to agree that the problematic and uncontrollable sexual behaviors associated with sex addiction are usually the result of an underlying mental health disorder. They do not agree on which disorder is most often the cause, but the following is a list of possibilities:

Consequently, there does not exist an established standard process for how to treat sex addiction.

Understanding sex addiction as an attachment disorder

At EHN Canada, we find that nearly all of our sex addiction patients have underlying attachment disorders. Our experience has shown us that treating a patient’s attachment disorder is essential for helping the patient to overcome sex addiction, regain control of their sexual behavior, and have healthy and satisfying intimate relationships.

In adults, attachment disorders usually result in problems with intimate relationships that can include any of the following:

Hence, we understand that sex addiction is a relational and intimacy disorder and this understanding informs our approach to designing the most effective treatment programs to help patients overcome sex addiction.

Interactions with concurrent substance use disorders

Sex addiction and concurrent substance use disorders can interact in a number of different ways including the following:

At EHN Canada, we believe that it’s essential to understand how each patient’s sex addiction interacts with any substance use disorders that they may have. We address these interactions in the individualized treatment programs that we design for each patient. This approach allows us to create the most effective treatment programs according to each patient’s unique needs.

EHN Canada’s Sex Addiction Treatment Programs

Patients are admitted to our treatment programs based on screenings that evaluate the negative outcomes of their sexual behaviors and their persistence in engaging in those behaviors. Since we expect that problematic sexual behavior usually stems from an underlying attachment disorder, we analyze each new patient’s history of family relationships and family dynamics to learn about their attachment style. To allow us to further individualize our treatment programs to address each patient’s particular needs, we also screen for the following:

Ultimately, our goal is to develop a deep understanding of what the problematic sexual behaviors mean and signify personally for each patient, rather than try to understand the sexual behaviors in terms of any standard typology. We believe that this understanding allows us to design the most effective treatment program for each patient and reduces the influence of cultural bias.

Helping patients regain control of their sexual behaviors

EHN Canada treatment programs are designed to help patients regain control of their sexual behaviors. This begins with helping patients recognize and fully acknowledge the consequences of their problematic sexual behaviors. Next, we teach them how to identify and predict situations in which their sexual behaviors might have negative outcomes. We also teach patients how to identify triggers for their problematic sexual behaviors and how to address them in healthy ways. Throughout the process, we help patients with concurrent substance use disorders understand how their substance use disorders interact with their problematic sexual behaviors.

Whenever applicable, group education and therapy activities are conducted in small, intimate groups where patients can learn from each other in an environment free of shame and judgment. The following are some of the activities that help patients regain control of their sexual behaviors:

Teaching patients how to build healthy and satisfying relationships

Since we view sex addiction as a relational and intimacy disorder, our treatment programs include substantial education and therapy components focusing on interpersonal work such as effective communication, relationship building, and developing healthy attachments. Due to their interpersonal and experiential emphasis, our sex addiction programs involve more in-the-moment behavioral interventions compared to our other addiction and trauma programs.

Again, whenever applicable, group education and therapy activities are conducted in small, intimate groups where patients can learn from each other in an environment free of shame and judgment. The following are some of the activities that teach patients how to have healthier and more satisfying relationships:

Other elements of treatment programs

The following elements are included in some of our treatment programs or may be optional for patients:

Full recovery takes much longer than other addictions

A full recovery from sex addiction can take three-to-five years after completion of a treatment program. Therefore, long-term success depends on a patient’s commitment to participating in aftercare programs and to continue working on themselves after they complete one of our residential treatment programs.

EHN Canada Sex Addiction Treatment Programs

If you or someone you love needs help with sex addiction, please call us at one of our numbers below for more information or to enrol in one of our programs.

References

Groneman, C. (2000). Nymphomania: A History. New York, NY: Norton.

Krueger, R. B. (2016). Diagnosis of hypersexual or compulsive sexual behavior can be made using ICD‐10 and DSM‐5 despite rejection of this diagnosis by the American Psychiatric Association. Addiction, 111(12), 2110-2111.

Ley, D.J. (2012). The Myth of Sex Addiction. London, England: Rowman & Littlefield.

https://en.wikipedia.org/wiki/Attachment_in_adults

When the Most Destructive Force in Your Life Is You, Then It’s Time to Reach out for Help

Opinion by Guest Writer
Written by Lorelie Rozzano, an internationally recognized author and advocate.

If you struggle with addiction as I have, you know the dark, hopeless place that exists on the other side of being high. It’s the thing that every addict tries to avoid—reality. Reality is the time and place when you’re not high or intoxicated and forced to face the consequences of your actions. For me, reality was the morning after. I’d lie in bed and remember all the horrible, embarrassing things I’d done the night before. I would replay each moment wishing I could turn back the hands of time and undo my humiliating deeds. To cope with my painful emotions, I sought relief through substance abuse and then the process would start all over again. I was baffled by my inability to use drugs and alcohol socially. I tried changing how much I used, what I used, and the places I used, but it didn’t help. Each time I consumed a substance, the consequences seemed to get worse. In spite of my good intentions, I continued hurting my family and my life was a mess.

At the time, I didn’t believe I was addicted. I didn’t know I was sick or that my thinking had changed. Addiction is sneaky. It starts with subtle shifts in your perception and behavior. The following are five ways it can play tricks on you.

(1) You’re in Denial

Denial is a primary roadblock to getting help. Denial makes things appear smaller than they are. Denial tells you your problems aren’t that bad. Denial says I’m not hurting anyone. Denial says I can quit whenever I want to. Denial protects you from facing the facts. Denial is dangerous as it minimizes warning signs and perpetuates the problem. No amount of pretending can make addiction go away.

(2) You Make Promises You Can’t Keep

You promise to show up on grandma’s birthday. Yes, you’ll pick up the kids after school. Of course, you’re coming home straight after work. But in spite of your good intentions, you’re unable to follow through. You can’t predict what might happen anymore. You’ve lost credibility. The more you try and control your addiction, the more it controls you. Every time you use the substance, you break hearts and hurt the people you love.

(3) You Manipulate Your Friends and Family

You lie to cover up what you’re doing. You tell people what they want to hear to get them off your back. You may pit parent against parent, or friend against friend. You know who to call when you need money. You’re good at fabricating excuses and making it seem like the problems in your life are never your fault. You blame others when cornered and manipulate your loved ones through guilt and fear tactics.

(4) You don’t tell anyone, but you’re scared, and you cope with your fear by using more

While using the substance was fun in the beginning, now it’s become work. Maintaining your addiction is a full-time job. When you’re not high, you feel fearful and anxious. The euphoric release you once found in the substance has disappeared. You’ve developed tolerance and need increasingly larger doses to produce the same physiological and psychological effects. You’re not using to feel high anymore; you’re using to feel okay and avoid withdrawal symptoms.

(5) You feel ashamed

You know your life is out of control, but you don’t know how to make it stop. You hurt everyone who loves you. Your best thinking is killing you. You can’t look in the mirror. You feel ashamed and avoid people. Shame is an uncomfortable, toxic emotion. Shame tells you you’re unworthy, unlovable, and inadequate. Shame says give up. Shame creates feelings of hopelessness and despair.

Take responsibility

While you’re not responsible for your addiction, you are responsible for your recovery.

Nobody wakes up and says “I’m going to be an addict.” But there is one choice addicted people make, and that’s how long they will stay sick. While addiction isn’t a choice, recovery is.

When the most destructive force in your life is you, then it’s time to reach out for help.

Good intentions followed by broken promises don’t mean you’re a terrible person. Substance use disorder is a progressive disease that if left unchecked can be terminal. But there is hope. Addiction is treatable. Recovery happens when you stop making excuses and start taking action. The key to wellness is breaking your silence and admitting you need help. There’s no shame in wanting to get better and the only way you can fail at recovery is to quit trying.

We Can Help You

If you would like to learn more about the treatment programs provided by EHN Canada, enrol yourself in one of our programs, or refer someone else, please call us at one of the numbers below. Our phone lines are open 24/7—so you can call us anytime.

Recovering from Sex Addiction: Getting out of the Storm and Back to My Life

Opinion by EHN Alumni
Written by Adam W, a recent graduate of the sex addiction program at Edgewood Treatment Centre.

Before I arrived at Edgewood to start working on my recovery from sex addiction, my life was like being in the eye of a tornado. That might be a tough analogy for someone to understand, but I was in the middle of a storm, with no way out. Everything around me was getting caught in the storm and I was simply waiting for it to take me away with it. I couldn’t find my own way out, and I certainly was trying to harm myself enough so that perhaps I wouldn’t wake up. I remember the feeling of despair and this heavy sadness.  When it was suggested I “go away” for a while, to take a break and heal—despite the tremendous arguments I had to not go—I simply gave up and said “okay.” 

I had lost my wife, been kicked out of my house, and had been removed from being a part of my kids’ lives. My family of origin stopped being involved with me, my business was crumbling, and my closest of friends had given up on trying to help. As typical of a pre-treatment story that is—it was and is my story. 

I quickly packed my personal belongings in Calgary and travelled to Edgewood, soon realizing that I was no longer alone in this storm. The men’s sex addiction group in my treatment program was a critical part of my recovery and healing. I could speak with men who could relate to the pain and shame associated with engaging in problematic sexual behaviours for many years. Although the group structure throughout the week was tremendous for unpacking a lot of stuff, the ability to really do the work in the confidence of men who were walking a similar path made me feel safe to express, accept, and move on from that part of my life. In previous treatments and therapy, I had never been able to explore my problematic sexual behaviours and the associated guilt, shame, and sadness that I held inside. If I had not addressed that pain, I would not have been able to grow and find my footing in recovery. 

Some of the highlights of the program at Edgewood include the sacredness of the room, the compassion from the other men, and the guidance from the sex addiction therapists. The ability to share my story, the unheard version of my life that I was unable to previously share in co-ed settings, with other men who were willing to do the same, was transformational in my healing and essential for my recovery.

I learned that the work, meetings, groups, walking with men in recovery, and service to others are all lifelong habits and commitments that I need to make daily to continue to enjoy the blessings of recovery and good mental and spiritual health. It’s not a destination but a journey of awakenings, blessings, and sharing and giving that allows me to enjoy my life today.

The opportunity to give back in some small way to this program, and to the men with whom I walked, is something I cherish and for which I am thankful.

With gratitude for being in recovery from sex addiction,

Adam W.

We Can Help You!

If you would like to learn more about the treatment programs provided by EHN Canada, enrol yourself in one of our programs, or refer someone else, please call us at one of the numbers below. Our phone lines are open 24/7—so you can call us anytime.

More Information About Our Sex Addiction Programs

You can also find more information about our sex addiction programs on our website:

Four Things You Need to Know About Fentanyl to Stay Safe

Fentanyl has been a problem in Canada for several years now and the situation is not getting any better. It feels like every day brings a new report about an overdose, an arrest, or a large shipment seized on its way to a Canadian city. Fentanyl is a synthetic opioid typically used to treat severe and chronic pain; for example, it is often prescribed for cancer patients. Understandably, digesting all the information from numerous news stories and constant buzz can be difficult, so here we are providing some quick facts about fentanyl in Canada.

(1) It’s Fast and Deadly

Fentanyl is 50 to 100 times more toxic than morphine and 100 times stronger than heroin. It’s so potent that you can overdose on as little as two milligrams. When ingested, it can reach your brain within minutes and cause respiratory failure. Many of the reported deaths have happened this way: someone takes half a pill, falls asleep and never wakes up.

(2) It’s Highly Addictive

Just like any other opioid, fentanyl is extremely addictive. Many users report craving it after just one use. Also like other opioids, regular users build a tolerance: they need to use more and more to get the same high, which is very dangerous with such a toxic drug.

(3) It’s Often Cut into Other Drugs

Fentanyl has been found in many other drugs like heroin, cocaine, and oxycodone. Often, people who think they’re buying oxycodone will really be getting Fentanyl. It has no odour or taste, and it’s invisible, so using a testing kit is the only way you can tell if it’s in your drugs.

(4) A Lot of People Are Dying

Given that you can overdose on an amount the size of two grains of salt, it’s not surprising that people are dying. This is especially true because many people are consuming fentanyl unknowingly through other drugs that are laced with it. People who do consume it intentionally, usually consume non-pharmaceutical street fentanyl produced by an amateur chemist. This implies that impurities and toxicity can be even higher than pharmaceutical fentanyl. Also, dealers often combine it with caffeine, meth, or heroin which increase the probability of a negative reaction or overdose. Vancouver has the highest rate of deaths from overdose in Canada, most of which are likely from fentanyl and other similar opioids like carfentanil. So far, this year (as of the end of September, 2018) there have been over 260 deaths from suspected overdose in Vancouver.

Safety Resources

TestKitPlus Fentanyl Testing Kit
Bunk Police Fentanyl Testing Kit
DanceSafe Fentanyl Testing Kit
How to get a naloxone kit if you live in BC

We Can Help You

If you would like to learn more about the treatment programs provided by EHN Canada, enrol yourself in one of our programs, or refer someone else, please call us at one of the numbers below. Our phone lines are open 24/7—so you can call us anytime.

What you should know about Opioid Use Disorder

As declared by Health Canada and the Centers for Disease Control and Prevention in the United States, North America is in the midst of an Opioid Crisis. It is widely accepted that the crisis has resulted from the proliferation of prescription opiate use, the wide spread availability of potent opiates such and Fentanal, limited access to appropriate treatment and the lack of a timely and comprehensive public health strategy.

“Opioids” refer to natural and synthetic painkillers derived from the poppy plant. The related term “opiate” refers to medications that use natural opium poppy products. For example, the drug heroin is an opiate. Physicians typically prescribe opiates to relieve acute pain from injuries and surgery in situations such as accident, dental procedures or caesarian section. Opiates are also used in oncology for chronic palliative cancer pain. Some well know opiates include:

  1. Morphine
  2. Codeine
  3. Heroin (Diacetylmorphine)
  4. Hydromorphone (Dilaudid)
  5. Hydrocodone (Vicodin, Lortab)
  6. Opium
  7. Oxycodone (OxyContin, Percocet)
  8. Oxymorphone
  9. Meperidine (Demerol)
  10. Methadone
  11. Fentanyl (Sublimaze, Actiq)
  12. Tramadol

To be diagnosed with Opioid Use Disorder (OUD), individuals must meet certain criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Under DSM–5, the current version of the DSM, anyone meeting any two of the eleven criteria during the same 12-month period receives a diagnosis of OUD. The severity of OUD—mild, moderate, or severe—is based on the number of criteria met.

The Eleven Symptoms of Opioid Use Disorder (OUD) as per the DSM-5:

1. Opioids are often taken in larger amounts or over a longer period than was intended.

2. There is a persistent desire or unsuccessful efforts to cut down or control opioid use.

3. A great deal of time is spent in activities necessary to obtain the opioid, use the opioid, or recover from its effects.

4. Craving, or a strong desire or urge to use opioids.

5. Recurrent opioid use resulting in a failure to fulfill major role obligations at work, school, or home.

6. Continued opioid use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of opioids.

7. Important social, occupational, or recreational activities are given up or reduced because of opioid use.

8. Recurrent opioid use in situations in which it is physically hazardous.

9. Continued opioid use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.

10. Tolerance, as defined by either of the following:

a.    A need for markedly increased amounts of opioids to achieve intoxication or desired effect.

b.   A markedly diminished effect with continued use of the same amount of an opioid.

Note: This criterion is not considered to be met for those taking opioids solely under appropriate medical supervision.

11. Withdrawal, as manifested by either of the following:

a.    The characteristic opioid withdrawal syndrome

b.    Opioids (or a closely related substance) are taken to relieve or avoid withdrawal symptoms

Dependence Vs. Addiction- What’s the difference?

 

 

Joshua Montgomery, Director of Operations- Bellwood Health Services

Transcript from video:

When we talk about addiction and when we talk about opiate use, a lot of things come up. There are a lot of questions around: What’s dependence? What’s tolerance? What’s pseudoaddiction? What’s actually addiction? And they are all very great questions.

Addiction is a neurobiological disease that has genetic, psychosocial and environmental factors. It’s characterized by poor impulse control, compulsive drug use, continued use of the drug despite any consequences to their finances, their mental or social well-being and there’s a craving for the drug.

People question about addiction versus physical dependence and so we see physical dependence in individuals who are chronic pain sufferers. We also physical dependence on things like anti-depressants and so forth.

The physical dependence is the body’s adaptation to a particular medication and what happens is the body becomes so use to it that without it, it kind of has a negative reaction, so the body needs that medication. Therefore, it creates dependence and a tolerance as well. Some individuals question well, I’m taking an opiate, I may be physically dependent, will that progress into an addiction? And that’s not always the case. A lot of individuals, who take opiates as prescribed, may be dependent. And chances that they are- will never acquire an addiction. Where we see individuals that shift from dependence to addiction are individuals that often have some concurrent mental health disorder, maybe there are some stressors going on in their life, maybe it’s provided some sort of secondary relief.

The best thing that you can do is reach out, reach out to a family member, a friend, your physician. If you don’t feel comfortable with that, reach out to a professional.Certainly, looking to resources in the community.

At the Edgewood Health Network, we’re a national organization, so we do have outpatient offices throughout Canada. We have residential facilities. We’re a good start. What’s nice about when you call a facility like ours, a facility that’s comparable, is the fact that they should have a continuum of care as we do. And that allows the client to recognize, ‘Do I have an addiction? Am I abusing? Is this a pseudoaddiction? We can really help to determine where you kind of fit on that spectrum of abstinence to addiction.

So, again just to wrap up: You gotta reach out, you gotta seek help, and there’s a lot of help out there.

 

Joshua MontgomeryJoshua Montgomery RN, joined Bellwood as the Clinical Manager of Intake and Assessment in 2014. Joshua graduated from Conestoga College’s Nursing Program and received his Registered Nursing certification in 2004. He began his nursing career at Grand River Hospital working in the area of pediatrics. While working in this area, he accepted a position with the hospital’s acute mental health and addictions services. Throughout his career, Joshua has gained experience working in a variety of roles, the majority of which has been acquired in acute mental health and addictions at Grand River Hospital. Roles included front-line nurse, prime nurse, patient flow coordinator, and patient relations coordinator.
While working in the area of mental health, Joshua developed many departmental processes designed to enhance the hospital’s care delivery systems, one of which was adopted by the entire organization. Following his time with acute mental health, he coordinated the opening and operations of Mount Hope Day Hospital, a facility focusing on mental health, in 2010.

One of Joshua’s greatest passions, second to helping others, is optimizing people’s abilities to help others.

How Do You Know If Someone Is Addicted to Drugs or Alcohol?

Man drinking beer“I drank too much the other night, that won’t happen again!” “I just need one more hit. I’m fine!”  You may have often heard people you care about say these phrases and not think twice about them- until recently. Perhaps, there have been changes in their behaviour that have you concerned.

Changes in behaviour can be a sign of mental illness or addiction. Unfortunately, many people don’t understand what addiction is or how it develops. Addiction is not something that happens overnight. It’s not something you decide to try as you would decide to try Starbuck’s latest Frappuccino.

The World Health Organization (WHO) states that addiction and mental illness affects approximately 10% of the population at any point in time. WHO also reveals that one in four families has at least one member currently struggling with addiction or mental illness. Addiction has no boundaries.

At Bellwood, we’ve seen all walks of life enter our doors and all of them share the same disease. Many of them have lost, or are on the brink of losing so much because their drinking or substance use has spiraled out of control. How do you define addiction? How do you know if someone’s drinking or drug abuse has become a larger problem than previously believed?

Addiction is the inability to stop using a substance despite the negative consequences experienced. People have many different reasons why they become addicted but there is one thing they do share in common. That is the desire to change the way they feel or in some cases, numb the pain. The feelings they get from using alcohol or drugs are what can lead to substance abuse and eventually result in physical and psychological dependence.

Individuals struggling with addiction may:

 

Other common characteristics of addiction include disconnection and isolation. Trauma or previous experiences in a person’s life may have been the reason why the person turned to substances to medicate unpleasant emotions. As a person plummets deeper into the disease of addiction, isolation becomes more apparent.

Do these behaviours sound familiar? If you’re concerned about a loved one’s drug or alcohol use, or perhaps it is yourself that you’re concerned about, Bellwood has an online quiz for alcohol and drug abuse. Responses to these questions may indicate that you need to talk to an addiction counsellor.

  1. Do you ever get drunk or high alone?
  2. Has drinking or using drugs stopped being enjoyable?
  3. Do you find that your choices of friends are selected based on your alcohol/ drug use?
  4. Do you drink or use drugs to cope with your feelings?
  5. Is it difficult for you to imagine a life without drinking alcohol or using drugs?
  6. Do you plan your life around your use of drugs or alcohol?
  7. Do you drink or use drugs to avoid dealing with the problems in your life?
  8. Are you ever not completely honest about your use of drugs or alcohol?
  9. Have relatives or friends every complained that your use of drugs or alcohol is damaging your relationship with them?
  10. Has your use of drugs or alcohol caused problems with motivation, concentration, memory, and relationships, at work or with your health?
  11. Have you failed to keep promises you made about cutting down or controlling your use of drugs?
  12. Do you feel anxious or concerned about how to obtain more drugs or alcoholic beverages when your supply is near empty?

 

Addiction is a disease that affects many people and is often described as a family disease. It’s important that you consult with a professional to get a better understanding of what’s happening with your family member or with someone you care about. Bellwood Health Services is an addiction treatment centre that provides support and treatment options for individuals, family members and employers.

Talking to someone is an important step towards addiction recovery. Give us a call at 1-800-387-6198 or email us at [email protected] to learn how we can get you started on your path of recovery.

What You Need To Know About Lethal Drug W-18

W-18, a drug referred to by the media as “a Frankenstein,” is making headlines because Health Canada has confirmed a number of Fentanyl overdoses in connection with it. Scientists state it’s more potent and lethal than Heroin or Fentanyl.[1] Originally, it was created to relieve pain several years ago and forgotten. W-18 has shifted back to Canada and has Canadian law enforcement officials concerned for the health and safety of people who are unknowingly ingesting drugs purchased on the streets that could potentially contain W-18.

Although Alberta is the main province that has seen W-18 in traditional street drugs, this opioid can quickly reach other Canadian provinces because of the current lack of regulation for it. It’s important that information about this drug be shared so that that people are made aware of the risks from using it. The following are some quick facts about W-18:

  1. 1. It’s extremely potent: It’s described as “One of the most dangerous drugs on the whole spectrum of synthetics or analog”[2] It is “10,000 times more powerful than morphine and 100 times more potent than Fentanyl.” [3]
  2. 2. The Likelihood of overdosing from W-18 is very high: Anyone that comes into contact could overdose immediately and needs medical attention right away.
  3. 3. It’s being mixed with other drugs: Even if you’re not looking to use W-18 you might unknowingly ingest it. People are cutting it up and mixing it with other drugs such as Fentanyl. Others may also sell it as Heroin or OxyContin.[4]
  4. 4. It’s very accessible: W-18 isn’t regulated in Canada yet. Technically, anyone can purchase it online or have it delivered to them in the mail. Health Canada states it is expediting the process of getting W-18 in the federal Controlled Drug and Substance Act.[5]
  5. 5. First line responders are preparing themselves for the worst: Emergency room doctors across Alberta are anticipating a rise in overdoses from W-18.[6]
  6. 6. Many Canadian scientists and healthcare professionals believe Naloxone may help with overdoses from this lethal opioid but it’s not a concrete solution to the problem.[7]

The Edgewood Health Network does not encourage recreational drug use at all. We want everyone to be aware of what W-18 is and the high risk of overdosing if you ingest it. If you know someone who is using drugs such as Heroin, OxyContin or Fentanyl, please find help.

Recreational drug use is usually a sign of something more serious than presumed. When you seek help for ingesting W-18 or any opioid, please ensure you are under the supervision of a doctor.

We are always available to discuss drug addiction and treatment in Canada 1-800-683-0111.

 

[1] Warrnica Marion. Canadian Police Fight a Frakenstein in New W-18 Street Drug. CBC News. (April 24, 2016) Retrieved From https://www.cbc.ca/news/canada/edmonton/street-drug-w18-delay-1.3550642

[2] Warrnica Marion. Canadian Police Fight a Frakenstein in New W-18 Street Drug. CBC News. (April 24, 2016) Retrieved From: https://www.cbc.ca/news/canada/edmonton/street-drug-w18-delay-1.3550642

[3] Dangerous Drug W-18, More Powerful Than Fentanyl, Originally Invented in Alberta. CTV News. Published on April 21, 2016. Retrieved from: https://www.ctvnews.ca/canada/dangerous-drug-w-18-more-powerful-than-fentanyl-originally-invented-in-alberta-1.2870077

[4] Warrnica Marion. Canadian Police Fight a Frakenstein in New W-18 Street Drug. CBC News. (April 24, 2016) Retrieved From https://www.cbc.ca/news/canada/edmonton/street-drug-w18-delay-1.3550642

[5]Consultation- Proposal Regarding the Scheduliing of W-18 Under the Controlled Drugs and Substances Act and it’s Regulations: Health Canada. Published on February 13, 2016. Retrieved From: https://www.hc-sc.gc.ca/hc-ps/consult/w-18-eng.php

[6] Balca Dario. Alberta Police Warn of W-18, A Drug Far More Powerful Than Fentanyl. CTV News. Published April 20, 2016. Retrieved on: https://www.ctvnews.ca/canada/alberta-police-warn-of-w-18-a-drug-far-more-powerful-than-fentanyl-1.2867760

[7] NewlyDeadly Peril Looms For Drug Users; Bracing For Trouble. The Province. Published March 4, 2016.

Fentanyl Facts: What you need to know about the drug showing up in Canadian cities

Fentanyl is all over the news right now. It seems that there is a new report every day about an overdose, an arrest or a large amount seized on its way to Canadian cities. Fentanyl is a synthetic opiate typically used to treat severe and chronic pain. It is often prescribed to cancer patients. With so much buzz and so many news stories, it can be confusing to wade through the information, so here are some quick facts about Fentanyl and it’s use in Canada.

  1. 1. It’s strong and fast:

Fentanyl is 50-100 times more toxic than morphine and 100 times more potent than heroin. Its so strong that as little as two milligrams can cause an overdose. After ingestion it can reach your brain within minutes and cause respiratory failure. Many of the reported deaths have happened this way; someone takes half a pill, falls asleep and they never wake up.

  1. 2. It’s often cut into other drugs:

Fentanyl has been found in many other drugs like heroin, cocaine and oxycodone. In fact, buyers often think they’re buying Oxy when they’re really getting Fentanyl. The drug has no smell or taste, and you can’t see it so there is no way to tell if other drugs have been laced with it.

  1. 3. It’s addictive:

Just like any other opiod, Fentanyl is extremely addictive. Many users report craving it after just one use. And like many drugs, users often build up a tolerance. They have to use more and more to get the same high, which is very dangerous with such a toxic drug.

  1. 4. People are dying:

When an amount about the size of two grains of salt can cause an overdose, it’s not surprising that people are dying. Especially when users don’t always know that their drugs contain Fentanyl. Even when you do know, you might be getting street Fentanyl. This is non-regulated and non-pharmaceutical, meaning that it was probably created by a dealer somewhere. The toxicity levels are rarely accurate and the drug is often combined with caffeine, meth or heroin so you really don`t know what you’re getting. Thus far in 2015, there have been 145 deaths connected to Fentanyl in Alberta and 66 in British Columbia. And it is both recreational and long-term users that are dying.

Of course, we don`t encourage recreational drug use in any way, but we want everyone to be especially careful with Fentanyl. The risk of overdose it too large. If you are using Fentanyl or know someone who is, please seek help. While we can`t speak for everyone, we find that opiod use is rarely recreational, and is often a sign of a deeper problem. Drugs and alcohol can take over your life so quickly and once they do, each time you use is a risk. When you seek help, make sure you find a place that you can safely and medically detox under the supervision of a doctor. Our phone lines are always open if you need to talk about opiod abuse or just want more information. 1-800-683-0111

Look for a more in-depth article about Fentanyl in our upcoming fall issue of Phoenix Magazine. Subscribe here: https://www.edgewood.ca/e-subscriptions

Substance Use and Addiction: What Does Work Have to Do With It?

glasses upCould your job be encouraging a substance use disorder?

Addiction can affect anyone, regardless of their job.  But there are certain fields where substance abuse and addiction are more common, and they tend to have a few things in common. Research shows that high stress, low job satisfaction, long hours or irregular shifts, fatigue, repetitious duties, boredom, isolation, irregular supervision and easy access to substances can all contribute to the problem. But what groups are most affected?.  We know that employees in the arts and entertainment, mining and food services are more likely to report heavy drinking in the past month compared to other employment groups. On the other hand, employees working in healthcare and education are the least likely to report heavy alcohol use. 

Risk Factors Explained:

There are several factors associated with different types of jobs that may lead to an increased likelihood of problematic substance use. Low employee visibility and isolation can be high risk for substance use and misuse. Jobs that involve a substantial amount of travel, and therefore less direct supervision such as some sales jobs, construction or contracting jobs, can lead to increased substance use.  In addition, social and workplace norms around drinking and drug use can also contribute to the problem. Some work environments are more permissive that others and it has been found that perceived acceptability of drinking by coworkers is one of the strongest predictors of drinking behaviour. In some industries such as the food and beverage service industry, alcohol is easy to acquire right on the job, making it easier to consume. Therefore the normative belief that it’s okay to have a drink while at work, coupled with the easy access to alcohol can make it extremely likely that an employee in a bar or restaurant will consume alcohol while on the job. If the employee works every day, it can become a daily habit that can ultimately lead to it’s misuse and possibly abuse.

Another important contributing factor is the issue of employee stress. Stress can come from various sources including physical hazards or heavy workloads, tight deadlines, low job security and workplace conflict. These factors can lead to an employee feeling little or no control over what happens at work. Jobs that offer very little control, combined with increasing demands, can place the employee at risk for substance use as the alcohol or drugs may be the employee’s form of coping with the demands and stress of the work environment. Therefore employers should be aware of possible stressful situations and should emphasize work/life balance with employees.

What to do?

It is important to note that not all employees working in high risk occupations will go on to develop an addiction. Instead, it is likely that a combination of several causes, including construction-workerindividual factors such as genetics, social, cultural, and mental health issues, places an employee at greater risk for developing a substance use problem. In order to minimize this risk, it helps if employers are aware of the common signs of substance abuse and receive adequate training in how to approach an employee that might need help.

It is also important to establish clear organizational policies about substance use in the workplace. Employees need to have clear expectations about workplace rules and repercussions that would follow should an employee choose to break those rules. Employers should also be aware of how the work environment or job features may lead to maladaptive coping or other unwanted behaviours such as drinking alcohol or using drugs. This knowledge could shape the workplace culture such that employees feel empowered to approach a supervisor when concerned or taking some time to rest and recover when feeling stressed or overwhelmed.

So pay attention to the signs.  Try to minimize stress, isolation and fatigue. Work on creating a culture where health and self-care are more important than drinking and using.