Scott Webb: Welcome to part 2 of our two-part series on addiction. In part 1, addiction psychiatrist, Dr. Jason Fields, discussed the science behind addiction, what addiction does to the brain, and the opioid crisis. And today in part 2, Dr. Fields will share his expertise on the variety of treatment options that are available to folks and how spirituality helps recovery. 

Welcome to BayCare HealthChat. I'm Scott Webb.

Dr. Fields, it's great to have you back today to continue our discussion on addiction. I want to have you get started today by sharing the medications that are used to treat opioid addiction.

Jason Fields, MD: Fortunately, we have improved matriculating, getting people into treatment through hospitals and ERs that are introduced with an overdose because we have best practice medication assisted treatment or medication assisted therapies with three different medications that are saving lives when used for this chronic disease of addiction for opioids.

And they are methadone, which is prescribed only out of opioid treatment programs under federal and state regulations, as well as buprenorphine, more commonly called Suboxone, when it's combined with another drug called naloxone, and also we have naltrexone taken orally once a day or long acting naltrexone, which is given once a month, an injection, to help keep people safe from overdose. 

Scott Webb: So let's talk now about the various treatment options and levels of care.

Jason Fields, MD: So treatment is important. There's multiple components to effective addiction treatment. First of all, there's different levels of care. So there is anything from outpatient level of care up to residential level of care. Some individuals, when they come in chronically using opioids and other substances, especially alcohol or benzodiazepines, require detox first.

So, when patients present, their risk of dangerous detox is assessed by the provider and they may need to go to a detox center first to safely get off of these medicines and get supportive medications and prevent dangerous detoxing sequelae like seizures, for example.

Now, after detox, you want them to go to the appropriate level of care. Some people are appropriate for outpatient treatment, especially if they have, let's say, safe housing, supportive other individuals. If they have an environment where they are likely to succeed outpatient. Some folks need to go into an inpatient facility where they're taken out of the environment that they can't recover in.

So once you decide on an appropriate level of care, then we set forth a treatment plan that includes both medications and therapy. So medications we've talked about, especially with opioid use disorder and how effective they are. So the standard of care when you're treating opiate use disorder is to give individuals education on all these three medications available to them and their efficacy.

They significantly reduce the likelihood of an overdose, they keep people in treatment in the appropriate level of care, and they interrupt the craving mechanism, so you're not craving opioids, if you're on the proper amount of medication. And some of the medications, like long-acting naltrexone, prevent overdose, actually block the effect of opiates.

So the medications are a critical part of that. And these medications, like other chronic diseases, when you bring somebody into remission from a chronic disease like diabetes with insulin, your physician keeps you on the insulin, right? So, these medications, once introduced and once they're on an effective dose, you should keep these folks on medications long term. And educate them about the benefits of that. Not everyone does, but being on these medications long term gives the best outcomes. Important with treatment is psychosocial support, critical and super important. Not everyone will engage psychosocial services, but it's recommended.

And what is that? That is therapy. Therapy with a licensed provider, skilled in helping individuals, helping people with behavioral therapies like cognitive behavioral therapy and motivational enhancement therapies and specific trauma therapies. So the therapy component is important because you have someone that is newly sober and trying to deal with all these emotions that they have not been experiencing.

And how do you stay sober when you're experiencing fear, when you're experiencing pain, when you're experiencing sadness, when you're experiencing joy and excitement? You know, in active addiction you use over all of those feelings. And so therapy helps people maintain sobriety and disconnect certain triggers with a using outcome. Identifying things that are good for their recovery and setting priorities in their life like that. So therapy in conjunction with medications definitely gives the best outcome.

Host: Yeah, Doctor, this has been great today. There's so much information and a lot of good food for thought, if you will. I just want to finish up, and have you discuss the role of gratitude and spirituality in recovery.

Jason Fields, MD: Spirituality is best defined as finding purpose in life using a source other than oneself, a so-called higher power. Finding out, you know, what makes you tick, what is the meaning of life. Spirituality is a very useful tool that can be found in recovery.

And spirituality is best found in 12 step programs and other supportive self-help programs. In conjunction with early recovery, we strongly recommend that people participate on some self-help course for themselves that helps them identify their goals in life, what makes them happy. A lot of folks in active addiction have forgotten that.

People in early recovery, if they are participating in a 12 step program like Alcoholics Anonymous, Narcotics Anonymous, or a more secular program like SMART Recovery, S-M-A-R-T, which is heavily available online, for example, by a licensed professional. Those venues give people access to other people in recovery, help identify that they lack control in the substance that they are trying to recover from, and help them go on a course of finding purpose in their lives without the substances.

It helps them not use over emotions, experience emotions like sadness, without having to be mood altered. So it's a useful tool. There have been a lot of studies with spirituality and 12 step recovery that show neuroplasticity, the phenomenon of neuroplasticity. And what that is, is the brain heals itself, and the pathways that have been shut down by active addiction can reappear over time.

This happens not immediately, but with people that are experiencing spirituality, self-described as experiencing a spiritual awakening, you can do studies that show that there are new neural pathways laid down, and that is called neuroplasticity. The brain reconnects. It recovers. And some of these pathways that were really active in active addiction are very quiet now.

And these pathways don't bypass the pre-addicted brain pathways. So it's a wonderful thing to see. And there's a saying in 12 step recovery that we do recover. And it is so true because spirituality can yield, neuroplasticity can yield the brain healing. 

Host: You know, it really does feel, Doctor, especially when I've hosted other podcasts on addiction, I'm always encouraged when we get to the end, cause it really does feel like there's a lot of room for optimism, you know, in treatment, the medications, the healing that can go on. I just really appreciate your compassion, your expertise, everything today. Thank you so much.

Jason Fields, MD: You're so welcome.

Scott Webb: If you or a loved one is experiencing addiction, get connected with a BayCare provider at (877) 850-9613 or call 2-1-1 for resources.

Host: And that wraps up this episode of BayCare HealthChat. Always remember to subscribe, rate and review this podcast and all of the other BayCare podcasts, so we can share the wealth of information from our experts together. I'm Scott Webb. Stay well.