SunCloud Health offers integrative, intensive outpatient and partial hospitalization for adolescents and adults of all genders – “Supporting your desire to live free from self-destructive behavior as you embark on a life long journey of recovery”.

Exploring the pain of opioid addiction in a powerful new musical

GUEST POST by Shale Marks, LCSW, CADC

SunCloud Health’s core philosophy met the artistic world on the evening of April 20, when staff therapists attended the performance of “Contact High: A New Musical” at the Northbrook Theatre.

Sally McQuillen, LCSW and I were honored to meet the cast and creators of this new musical drama, which focuses on the lives of high-school students who are caught in a web of mental health issues that include opioid addiction.

Participating in a talk-back after the show gave us the chance to answer questions from the audience about opioids, recovery and other mental health challenges. Conversations like these are a crucial part of SunCloud Health’s mission, as we actively seek ways to contribute to the community’s understanding of mental health.

A young opioid addict with nowhere to hide

As I sat watching the musical, it struck me how deeply the character named Jean struggled with her addiction. She seemed to ache for connection, not only with herself but also with friends and the community. Like many young people, Jean seemed like a leaf blown by the wind, desperately searching for comfort – yet suffering the extreme discomfort of her disease as it dragged her from one moment to the next. She sought a resting place in a world where it seemed there was no friendly direction, no safe spot to hide.

It struck me that Jean is exactly the kind of person we hope to reach at SunCloud Health. The ache in her heart is the same ache that echoes in the hearts of all of our patients. It reminded me of the commitment we’ve made to our clinical philosophy, which is a tapestry of principles that hold our team accountable to our patients and each other. Our philosophy empowers us to perform what we think of as “soul surgery” for the people we serve.

The healing value of empathy

At SunCloud Health, we are guided by an agreement that places empathy at the core of everything we do. Our agreement states:

“We agree to search for non-pejorative or phenomenologically empathic interpretations of our client’s, our own, and other team members’ behavior. We agree to assume we and our patients are trying their best, and want to improve. We agree to strive to see the world through our patients’ eyes and through one another’s’ eyes. We agree to practice a nonjudgmental stance with our patients and one another.”

As we work with people in group settings, we challenge their belief systems, providing the care, compassion and attention they may have missed in their formative years. We welcome them as therapists who acknowledge our own humanity and fallibility and are ready to guide them as they move forward in recovery.

If we as a community could truly touch empathy, I believe there would be a deeper understanding of the underbelly of addiction. So often, conditions such as PTSD, depression and other mood disorders are the driving force behind substance use. Our ability to acknowledge and treat these conditions is often the first meaningful step toward healing.

Sally and I felt honored to discuss these issues with everyone who came out to see “Contact High” – and we thank show creators Kyle Reid Hass and Jeremy Swanton for inviting us to be part of this unique production, which will soon make its New York debut. I feel certain that this new musical will open hearts and minds with every performance.

At SunCloud Health, our hope is that we can continue to contribute to the community in an authentic way, addressing the power differentials that exist between therapist and patient, government and citizen, parent and child so that we can all move a little bit closer to humility, compassion, empathy and healing.

Amid the Opioid Crisis, the Addiction Crisis Rages On

At SunCloud Health, we are very concerned about the record level of deaths caused by opioid overdoses. At the same time, we are mindful that the opioid epidemic is part of a much larger problem – the addiction epidemic.

It is crucial to remember that addiction is a brain-based illness that is not caused by a specific drug or substance. (Here is the official ASAM definition of addiction.)

When we focus on the drug and not the underlying problem, we’re in danger of missing the bigger picture.

Understanding the ways addiction plays out in our lives

As we’ve seen, addiction to opioids can kill – and kill quickly. Addiction to these drugs has claimed the lives of hundreds of thousands of people nationwide. And while worried parents are focused on the dangers for their children, the truth is that people of all ages from all walks of life can become addicted.

While we can’t turn away from this reality, we need to realize that other addictions kill, too. People who suffer from food addiction can lose their lives, though the pattern usually works more slowly and subtly than with opioids. Alcohol addiction claims 3 million lives worldwide each year, far more than opioids.

Lethal overdoses can also come from mixing highly addictive substances such as benzodiazepines – sold under brand names like Xanax, Klonopin, Ativan and more – with other drugs, including opioids. The news is filled with tragedies involving deadly combinations like these.

When we realize how many ways lives can be lost, we begin to see that the story doesn’t begin and end with saying, “Opioids will kill you.” In and of themselves, these drugs don’t kill, and in fact, they have many beneficial medical uses. Opioids kill only when someone develops an addiction to them. Addiction is the deadly root cause that we must address – in all of its various forms.

How people recover from addiction

At SunCloud Health, we have successfully worked with hundreds of people facing addiction to drugs, alcohol and specific behaviors such as gambling, eating, or relationships, sex and love. In helping them recover, we focus on the underlying brain disease of addiction rather than their drug or behavior of no-choice per se. (We refer to substances this way because we know that when someone is addicted, they can’t stop by will power or choice alone.)

Effective recovery begins with exploring the unique history of the person suffering from addiction. We look at the individual’s life from a biological, psychological, spiritual, and social perspective. Details of family history, including any sources of trauma, are taken into account.

People suffering from addiction have often been hurt in other ways before turning to their drug of no-choice for reward or relief. If you grew up in environment where you were abused, ignored, criticized or neglected, you have a greater-than-average chance of developing mental health issues later in life, including addiction. We take all these factors into account as we create a treatment plan to help you.

At SunCloud Health, you will benefit from a skilled and caring staff that views you as a whole person. We know that you are more than just your addiction. Even with your current struggles, you have many strengths. We will show you how to tap these strengths as you work to get your life back on track.

Specialized help for people who have more than one diagnosis

Sometimes, people who are dealing with addiction have more than one mental health condition. You may have heard the term co-occurring disorder or dual diagnosis before. These terms simply mean that there is more than one issue to deal with – and they must be seen as part of a total pattern within the person’s life.

At SunCloud Health we specialize in helping people who are suffering from multiple diagnoses. Many are affected by mood disorders, post-traumatic stress syndrome, eating disorders and other serious issues. They may misuse alcohol and drugs, or develop addictions to work, love and sex, gambling, shopping and other activities.

If you’re reading this article and feeling worried about yourself or someone close to you, now is the time to reach out. You’ve already taken the first step by seeking information and understanding. Take the next step by making a confidential call to 844-202-3161, or email us here. We are ready to support you or your loved one.

Pain as a Vital Sign

The death rate from overdose of prescription narcotics now exceeds that of automobile accidents; and the number of overdose deaths from prescription pain relievers has more than quadrupled since 1999. In order to understand the drastic rise in prescription opioid and heroin addiction over the past two decades, it’s important to consider contextual changes that have taken place simultaneously.

In 1996 the American Pain Society introduced pain as a 5th vital sign, and the Joint Commission adopted it as a standard in 2001. So, in addition to the objective vital sign which serve as indicators of a patient’s health status (respiratory rate, temperature, blood pressure, and pulse), medical professionals are required to ask if patients are in any immediate pain. If the answer is yes, they ask patients to assign a number to their pain on a subjective scale of 1 to 10 with10 being the most painful.

It’s no coincidence that when pain was introduced as a vital sign, the number of opiate pain reliever prescriptions rose dramatically, pain clinics began to pop up in cities all over the country and the rates of opiate addiction (and overdose deaths) began to skyrocket. Yet, many people fail to connect the dots between increase in exposure to prescription opiates and the rise of the heroin epidemic. Inappropriate and negligent prescribing of opiates has been a major culprit in the increase of addiction and a major contributor to relapse among those who have achieved sobriety.

Fortunately, a few weeks ago the American Medical Association in Chicago recommended that pain be dropped as a vital sign. In response to this resolution, critics have argued that with this change, patients’ pain will be ignored, and it will make it harder for pain to be assessed and treated.

If this change makes it harder for pain to be treated in the irresponsible way that we’ve been doing it, then I am all in favor. But for critics to suggest that advocates of this reform are in favor of disregarding or ignoring pain is really missing the mark. With the fast-paced speed of our healthcare system, rooted in our “fix it” (and quickly!) culture, “treating” pain has become synonymous with writing narcotic pain med scripts.

With an average office visit for a primary care patient lasting only 15 minutes, physicians are rarely afforded the time to administer the comprehensive psychosocial evaluations, pain treatment history, addiction risk assessment and psychiatric evaluation that were initially recommended by the American Pain Association as an integral part of pain assessment—a necessary step prior to treating or prescribing. Further, most physician receive precious little in the way of addiction training as medical students, and become doctors who are unequipped to assess addiction risk or identify early (even late) warning signs. What we are left with is a system in which physicians rely solely on the number a patient assigned (1-10) to their pain in order to determine the course of treatment, and most jump to opioid pain medication as the first line solution. Unfortunately, “treatment” often comprises spot treating symptoms, while neglecting to attend to the whole person, and failing to consider long-term consequences of a “Band-Aid,” one-size-fits-all approach to healthcare.

Of course physicians are not ultimately to blame in this equation. Really, this issue speaks to some of the broader problems with our healthcare system today: the separation of mind and body, the lack of adequate training in addiction, behavioral health, and alternative therapies, the emphasis on symptoms rather than wellbeing, and even the reimbursement system which rewards quantity over quality of care.

The debate should center less on what is or is not considered a vital sign, or how we are assessing pain, and more on how we are responding to it. Pain, just like emotion, is our body’s way of communicating a need. What if we were to listen to this message and hone in on the function of our symptoms? If we are too quick to numb, distract from, or extinguish symptoms, we may miss the smoke signal that our body is sending us; potentially putting ourselves in danger or at risk of creating secondary problems down the line.

As with most experiences, pain is multidimensional. According to the Cleveland Clinic, “psychological factors always play a role in pain – they may increase it or diminish it and can even eliminate it all together.” The Cleveland Clinic also notes “many chronic pains are due to changes in the nervous system rather than due to illness or damage to the body.” Since we know that trauma often leads to neurobiological and neurochemical changes in the body—to include abnormal regulation of opioid neurotransmitters— it makes sense that we should attempt not only to identify the root causes of a patient’s pain but also to look at pain from a bio-psycho-social-spiritual framework.

Particularly problematic would be to write a prescription for opioids for the trauma survivor whose pain may have a large psychological component. The opioids would likely mask the underlying issues while potentially introducing the patient to a host of new problems—since she is already more vulnerable to developing an addiction due to the lasting physiological and emotional impact of her earlier trauma.

The bottom line is strong medicine comes with strong side effects. Opioid medications are not an appropriate first line of treatment for many patients with pain.

Imagine an approach to treatment in which an integrated team worked together to create a patient-centered care plan with a rehabilitative emphasis. What if your primary care doctor worked in collaboration with a psychiatrist, physical therapist or musculoskeletal specialist, and psychotherapist to provide coordinated care with an emphasis on sustainable, long term, health outcomes that matter to the you? What if your doctor took the time needed to assess your history and risk factors? What if your doctor had the training to do so and also the knowledge about alternatives to just writing another prescription?
If we could spend more time unifying around a comprehensive approach to treating pain, and less time worrying that people will lose access to opiates, I imagine opioids would no longer be making headlines and would no longer be followed by the word “epidemic.”

And I believe we can do so in a way that does not interfere with those patients who need long term opiate medications being able to get them.

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