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Welcome

TO INSYNERGY! Congratulations! You have just made the commitment to make your life more meaningful. As our name implies, the word SYNERGY refers to two or more forces combining to have a more powerful effect than its individual parts. INSynergy brings together biological (genetics), psychological (emotional) and environmental, models of addiction medicine in a way where results are more long lasting and robust. INSynergy is the Premier Alcohol and Drug Rehab Treatment Center in St. Louis, MO. We provide an alternative approach to traditional 12- step and AA treatment programs. We are guided by evidence-based treatments and the latest advances in alcohol and drug rehab, allowing for the effective treatment of addictions to tobacco, alcohol, heroin, and other opiates. Our innovative program incorporates FDA approved anti-craving medication, counseling, psychiatric and psychological services. These latest advances in treatment help people resume their productive lives.

Addiction is a Treatable Disease. However, prior to coming to INSynergy, many people may not understand that there are many forces at work in addictive behavior. Genetics and family influence, mood disorders, impulsivities, cravings, personality structure, and environment all contribute to addiction. All must be addressed to decrease the risk of relapse. This is the principle of SYNERGY. We feel that this basic principle of synergy provides a modern day solution to drug and alcohol addiction. With both your commitment and understanding of this process, our program will deliver results that grow and continue to be more evident over time. Cooperation, honesty, commitment, eagerness to learn about oneself, mindfulness, patience, and resilience, are all important elements not only for a successful treatment plan, but important to take with you after your time at INSynergy. Welcome again and we hope that your time here at INSynergy will be a life changing experience that will be filled with long lasting memories. Regards,

Arturo C. Taca, Jr., M.D., Medical Director, INSynergy Board Certified – American Board of Addiction Medicine Diplomate – American Board of Psychiatry and Neurology


Life is more than just staying sober. – Unknown


TA B L E O F C O N T E N T S

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About INSynergy Who we are and how we work.

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What to Expect What is involved in treatments.

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Therapy Understanding the different types of therapy.

Medications Understanding how medication can help. Explanations of the different types of medications that can be used.

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Frequently Asked Questions A list of frequently asked questions by new patients and a list of 10 freightening facts about prescription pain pills.

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Success Tips for Patients 10 tips for patient success.


ABOUT INSYNERGY

Some people want it to happen, some wish it would happen, others make it happen. – Michael Jordan


About

INSYNERGY Finally, An Innovative Addiction Treatment Program That Will Change Your Life We know that many patients struggle with the decision of how to manage their addiction. There are often many questions running through their minds. 4

Should I get involved in a 12-Step Program?

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Should I check myself into a 30 day inpatient program?

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I’ve failed so many rehabs. Am I hopeless?

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Why do I keep on relapsing?

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Is there anything else other than detox?

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Is there anything new that can help me with cravings?

I’m more moody and anxious when I detox. Why stop using when I feel worse after I stop? 4

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I can’t leave work while I’m in treatment. What should I do?

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Will therapy help me?

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How do I get these cravings to go away?

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Is it too late to get my life back on track?

INSynergy was created as the single answer to questions just like these. Dr. Arturo C. Taca, Jr., FABPN, board certified by the American Board of Addiction Medicine, recognized that advancements in the field of addiction medicine opened up new doors for people struggling with addiction. That’s why INSynergy was created.

Arturo C. Taca, MD MEDICAL DIRECTOR Diplomate – American Board of Addiction Medicine Diplomate – American Board of Psychiatry and Neurology

Dr. Taca is a leader in addiction medicine and continues to set benchmarks for the innovative field of medically assisted recovery programs. Board Certified by both the American Board of Addiction Medicine and the American Board of Psychiatry and Neurology, he also carries the distinct honor of serving as a diplomate for both boards. In addition to his board certifications, Dr. Taca was voted one of the “Best Doctors of America in Psychiatry” by his peers. Only 5% of all doctors in the U.S. are recognized with this distinction and are selected by a consensus of more than one million votes cast by doctors across the country. 1


ABOUT INSYNERGY

As a result of his expertise in the field of addiction medicine, Dr. Taca regularly delivers lectures on topics like the biology of addiction and cutting edge medical treatments to local and national organizations. Before INSynergy, Dr. Taca established the very popular Integrated Neuroscience Program and served as the Medical Director of Assisted Recovery Centers of America (ARCA) where he developed programs that led to higher standards of addiction treatment. He completed his psychiatric residency training at St. Louis University where he was the Chief Resident of the Department of Psychiatry. He is currently a clinical instructor and continues to teach and supervise Psychiatric, Internal Medicine, and Transitional Medical residents at the St. Louis University School of Medicine Department of Psychiatry and St. John’s Mercy Medical Center.

Patricia Kennedy, Ph.D. LICENSED PROFESSIONAL COUNSELOR LICENSED MARITAL AND FAMILY THERAPIST Dr. Kennedy brings to INSynergy experience in individual, marital and family counselor for children, adolescents and adults. Her specialties include: Multi-problem families, marital conflict, family counseling, medication, sexual abuse, anxiety, depression, chemical dependency, co-dependency, adult children of alcoholics, parent/child problems, school related problems, grief issues, children and adolescent issues, physical abuse, self-esteem issues, spiritual issues, and Christian counseling. She completed her Ph.D. at University of Delaware, Newark, Delaware-Behavioral Science.

Steve Reimann, MA, LPC, CASAC, CCGC LICENSED PROFESSIONAL COUNSELOR Mr. Reimann brings to INSynergy over 30 years of addiction treatment experience. He has extensive experience in utilizing novel approaches to addictions such as acupuncture and auricular therapy, in which he is specifically trained. He also has expertise in working with PTSD and trauma utilizing EMDR. Mr. Reimann is certified in advanced substance abuse in addition to being licensed in professional counseling. He specializes with persons with pain pill/heroin addictions, treating gambling, and sexual and other process addictions. 2


ABOUT INSYNERGY

Ashley Halker, BA PROGRAM DIRECTOR Mrs. Halker brings to INSynergy highly efficient triaging skills, personable attitude and patient focused mindset. Her experience at Mercy Hospital St. Louis has allowed her to understand the co-morbid factors that affect substance abuse and mental illness. She has extensive experience assisting patients and families to understand treatment options, and showing compassion while a family struggles with substance abuse and mental illness. Mrs. Halker graduated from Westminster College with a Bachelors of Science in Psychology in 2009 at which time she joined the intake department at Mercy Hospital. Her focus is triage of emergency psychiatric illness and co-morbid substance abuse disorders. She is also a registered EMT in the State of Missouri.

Rick Flanagan GROUP LEADER ASSOCIATES DEGREE IN HUMAN SERVICES CERTIFICATE IN ADDICTION STUDIES Rick Flanagan comes to us after completing his Associate’s Degree in Human Services along with a specialized certificate in Addiction Studies. Addiction counseling is Rick’s 2nd career having a long tenure working at Chrysler for 32 years! Rick completed his Internship for his Addiction Studies program here at INSynergy, and was hired for his outstanding performance. “I really want to give back to society in a different way and help them overcome their addictions with new and improved treatment solutions that have been available in the recent years.” Rick enjoys “the healthy lifestyle” and is a former Golden Gloves Boxer from Texas. He loves to go running and work out with his wife, and loves spending time with his grandchildren.

Cheryl Ritzman MA, LPC, SQP LICENSED PROFESSIONAL COUNSELOR # 008604 Ms. Ritzman brings to INSynergy over a decade of counseling experience in the field of addiction treatment, including both inpatient and outpatient treatment services. At Hospital – Saint Louis, she brings experience in assessing and counseling in the areas of mental health issues and co-occurring disorders. Areas of specialty include Cognitive Behavioral Therapy, Motivational Interviewing, trauma issues, grief and loss issues, and cultural and gender issues related to addiction. Ms. Ritzman completed her Master’s Degree in Professional Counseling at Lindenwood University. 3


ABOUT INSYNERGY

If you have tried other treatments that haven’t worked or you just didn’t know where to start, then you’ve come to the right place. Addiction is treatable. At INSynergy, our outpatient treatment program acknowledges that there are often several forces that contribute to addictive behaviors. 4 Genetics 4 Psychological and Mood Disorders 4 Emotional Factors 4 Cravings Uncovering the components of your addiction is like putting together the pieces of a puzzle that will allow you to finally see a true picture of what’s driving the addiction. Unfortunately, traditional treatment programs often overlook the power of these combined factors and therefore, do not treat the addiction as a whole. As a result, only a couple pieces of the puzzle are addressed, the program doesn’t sustain, and patients leave feeling hopeless with nowhere to turn. Many have gone through numerous detox programs with poor outcomes. Detox ALONE does not represent treatment. It’s only the 1st step. Promoting long lasting sobriety is the challenge that INSynergy has experience with implementing. Fortunately, there is hope! When you treat all the components of your addiction, you’ll see the power of SYNERGY. More importantly, you’ll quickly see progress and then, after the initial six months in the program, life changing results.

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ABOUT INSYNERGY

Our Integrated Treatment Approach. INSynergy offers the best Drug and Alcohol Treatment Program in St. Louis, MO. We use an integrated approach with a system of medical professionals, psychiatrists, psychologists, therapists, and advocates to treat the whole person, not only the addiction. INSynergy is staffed by experts in Addition Medicine. Many times co-occurring conditions are overlooked such as depression, bipolar depression, anxiety, ADHD, and other psychological issues.

HOW INSYNERGY WORKS

INSynergy requires that these Co-occurring conditions are identified and effectively treated. Treating the whole person decreases risk of relapse. So How Will The Program Work? 1. We will create a plan to detox you from your chemical dependence. 2. We’ll investigate the best FDA-approved anti-craving drugs that will help you stay on track with your sobriety. 3. We will evaluate for mood disorders that oftentimes increases the risk of substance abuse or relapse. These conditions may include: anxiety, depression, bipolar disorder, ADHD, or Post Traumatic Stress Disorder. 4. We’ll create your individual, group and family therapy program that will give you the skills to make your treatment lasting. 5. Monitoring Sleep Patterns, Diet and Nutrition Classes, and fitness and exercise lectures are also incorporated in the treatment plan. All the staff here at INSynergy look forward to helping you get your treatment program started and answer any questions you may have. We know you have come to the right place to finally kick your addiction and change your life.

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W H AT T O E X P E C T

What is the meaning of life? To be happy and useful. – Dalai Lama


What to Expect What Will My Treatment Involve? 1. Initial Medical Evaluation Medical staff will perform an initial evaluation to see what factors are involved in your addiction (including any underlying psychological disorders such as ADHD, Bipolar disorder, anxiety, PTSD, etc). They will also determine if medications should be prescribed for detoxification, psychological disorders and cravings. 2. Blood Work Blood work will be taken to provide further assessment to the initial medical evaluation. 3. Assessments Our staff clinicians will work with you to develop your individualized treatment program. 4. Detoxification If detoxification is required, most patients find that our outpatient approach is effective in their treatment. However, we will also make a recommendation for an inpatient approach if it is absolutely necessary. 5. Individual and Group Therapy (Cognitive Behavior Therapy) Cognitive Behavior Therapy aims to solve the distorted thinking, automatic negative thoughts, tendencies to catastrophize, and maladaptive behaviors and emotions associated with your addiction. Through weekly individual and group therapy, we will help you recognize, avoid and cope with situations in which you are most likely to abuse alcohol, drugs or nicotine. 6. Marriage and Couples Therapy At INSynergy, we offer this type of therapy with our Ph.D. who has specialized training this field. 7. Family Therapy Oftentimes, family members are the mostly affected by addiction. We offer group counseling sessions specifically for family members only. These weekly meetings for family members are exposed to lectures of the biology of addiction and also find support from other family members sharing their experiences of the challenges and solutions to dealing with addicted relatives. This type of support group for your family is designed to help you improve your family and social relationships. 8. Weekly Medical Care Medical staff will continue to closely evaluate your progress. They will make any necessary adjustments to your medication as well as make recommendations for your personal care. 9. Discharge Planning After stabilizing during Phase I (6-month) program, a detailed discharge plan will be outlined to help maintain sobriety and psychological stability. Referrals to the community are outlined to insure that treatment not end at INSynergy. Oftentimes, current clients enter our Phase II (Aftercare) program for another 6 months of superior treatment. This is completely voluntary and is heavily discounted compared to Phase I. Special Referral Programs are also available to current INSynergy clients designed to extend their program experience for free. This comprehensive treatment model offers a complete package of therapy that encourages participation from all family members that are affected by addiction.

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W H AT T O E X P E C T

What to Expect From Your Treatment Our goal is to help you achieve and maintain your sobriety. However, life is more than just staying sober. The field of Addition Medicine is expanding at such a fast rate that “new biological concepts” of Addiction are shared with our clients. INSynergy should be able to help you with the following: 4

Reduction in the frequency of your addictive behaviors.

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Reduction in the amount you consume.

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Fewer relapses.

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Extended sobriety that was a challenge in the past.

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An improvement in your overall mood.

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Less depression.

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Less anxiety.

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Less compulsivity.

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Improved family functioning.

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Better social relationships.

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Better physical health and fitness.

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Better diet and nutrition.

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Improved legal problems.

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Better sleep.

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Improved discipline.

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Improved tolerance to stress. Being more resilient.

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More energy.

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Improvement in concentration, focus, and memory.

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Better relationships with family and friends.

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Better understanding of your personality structure.

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what may have been contributing to addiction such as untreated or under treated mood disorders or past trauma.

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Better understanding of the biology of Addiction.

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Eventual elimination of your addictive behavior.

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In the end….a healthier YOU!!!!


A Messy Room means you have a Messy Mind, so clean up your room and life will be better for you. – Dra. Basilisa Montemayor Taca


THERAPY

A pessimist sees the difficulty in every opportunity; an optimist sees the opportunity in every difficulty. – Winston Churchill


Therapy Along with medications, you will find that INSynergy’s therapy sessions are critical to the long-term success of your recovery. In therapy, we will teach you new skills that will help you recognize and resolve the unproductive thinking and behaviors that are associated with your addiction. The skills learned in therapy are the keys to a successful, lasting sobriety. At INSynergy, we offer four different types of therapy: 1. 2. 3. 4.

Individual Therapy Group Therapy and Lectures Marriage and Couples Counseling Family Group Therapy

Individual Therapy Each week you will participate in individual psychotherapy (personal counseling) with one of our experienced psychologists, counselors, or therapists. Our counselors all have advanced training in the field of Addition Medicine. Your individual sessions will focus on a Cognitive Behavior Therapy approach where we will aim to recognize, avoid and cope with situations in which you are most likely to abuse alcohol, drugs or nicotine. Unlike traditional psychotherapy that primarily focuses on past experiences, Cognitive Behavior Therapy focuses on current experiences or situations that can contribute to your addiction. Items such as exercises in “re-training your brain” so you can work on eliminating the old behaviors and distorted thinking that contribute to your addiction. Instead, your brain will now be trained to have a new perspective on these situations and instinctively incorporate these new skills when faced with similar circumstances in your life.

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THERAPY

Group Therapy and Lectures The majority of your INSynergy therapy work is done in group therapy. Many patients find this Non-12-Step approach very enlightening and the most popular component of the program. Group sessions consist of other INSynergy patients, including Aftercare (Phase II) patients. In group therapy, you will continue to learn how Cognitive Behavioral Therapy can effectively change the way you think. In addition, some sessions are structured in a lecture type format where we will take a look at the ‘Biology of Addiction.’ Many patients find that understanding what happens to their body when certain drugs enter their system provides better perspective on their addiction. As a result, patients can work through any feelings of personal guilt or other negative emotions associated with their addiction. Marriage and Couples Therapy Research and many studies have supported the importance of marriage and couples counseling during substance abuse treatment. This type of therapy has been shown to produce more abstinence, happier relationships, fewer couple separations and lower risk of divorce than does individual-based treatment. At INSynergy, we offer this type of therapy with our PhD who has specialized training this field. Family Group Therapy Often patients don’t realize that your family members can also be psychologically affected by living with you or interacting with you while you’re struggling with addiction. Once a week, family group therapy is offered as part of the INSynergy treatment program. We find that offering group therapy to our patient’s families allows the whole family system to heal together and improve the long-term recovery process. A Personal Approach to Therapy Our medical director, in conjunction with our licensed counselors, therapists, and psychologists will work with you to determine you personal therapy program. We will recommend which therapy sessions you should attend and how often so you can have the greatest impact on your recovery process.

In the middle of difficulty lies opportunity. 12

– Albert Einstein


THERAPY

Philosophy of Care INSynergy is committed to implementing scientific advancements and discoveries in the field of addiction medicine. Advancements in anti-craving medications for alcohol, opiates, and nicotine, along with Cognitive Behavioral Therapy allow INSynergy to treat persons as outpatients without disrupting busy lifestyles. INSynergy believes that treatment does not have to be a painful, humiliating, disruptive experience. Treatment is local, practical, and highly effective. INSynergy- A NEW type of recovery based on science and research. A modern day solution to drug and alcohol addiction Facts About Addiction: 1. Drug and/or alcohol addiction is surprisingly common. Approximately 1 out of every 8 Americans is living with some form of addiction. 2. Approximately 70 percent of people who are using illegal drugs are employed. 3. Of all fatal accidents on roads, more than 50% involve alcohol. 4. Children of addicts and alcoholics are four times more likely to become addicts and alcoholics themselves than children of non-addicts. This supports the genetic factor in addictions. 5. One in ten people who drink become alcoholics. It may only take using a drug like heroin once or twice to become addicted 6. More high school students are using opiate pain pills as gateway drugs before they smoke cannabis. 7. More people were killed this year from opiate overdoses versus car accidents in the first time in US history. 8. Teenager binge drinking, cigarette smoking decreased this year while cannabis use and prescription pain pill addiction increased. 9. Cannabis is addicting that oftentimes leads to psychotic features such as paranoia and auditory hallucinations. 10. Research is active in Addiction Medicine. Studies are underway with novel approaches to addiction including vaccines, implants, and new psychotherapies that address trauma.

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M E D I C AT I O N S

Life is very interesting... in the end, some of your greatest pains, become your greatest strengths. – Drew Barrymore


Medications How Can Medications Help Treat Drug Addiction? Different types of medications may be useful at different stages of treatment to help a patient stop abusing drugs, stay in treatment, and avoid relapse. Treating Withdrawal. When patients first stop abusing drugs, they can experience a variety of physical and emotional symptoms, including depression, anxiety, and other mood disorders; restlessness; and sleeplessness. Certain treatment medications are designed to reduce these symptoms, which makes it easier to stop the abuse 4

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Staying in Treatment. Some treatment medications are used to

help the brain adapt gradually to the absence of the abused drug. These medications act slowly to stave off drug cravings, and have a calming effect on body systems. They can help patients focus on counseling and other psychotherapies related to their drug treatment Preventing Relapse. Science has taught us that stress, cues linked to the drug experience (e.g., people, places, things, moods), and exposure to drugs are the most common triggers for relapse. Medications are being developed to interfere with these triggers to help patients sustain recovery 4

Identify and treat Mood Disorders. There is a high association with certain psychological and psychiatric conditions and substance use disorders. This is the concept of DUAL DISORDERS. If not identified accurately and properly treated, impulsive behaviors, self medication, and depression and anxiety can lead to relapse. Most associated are conditions such as depression, bipolar disorder, anxiety, ADHD, and trauma. Many of these conditions are effectively treated with the appropriate type of medication along with counseling. 4

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M E D I C AT I O N

Evidence-Based Approaches to Drug Addiction Treatment This section presents several examples of treatment approaches and components that have an evidence base supporting their efficacy. Each approach is designed to address certain aspects of drug addiction and its consequences for the individual, family, and society. Some of the approaches are intended to supplement or enhance existing treatment programs, and others are fairly comprehensive in and of themselves. The following is not a complete list of efficacious evidence-based treatment approaches. More are under development as part of our continuing support of treatment research.

Pharmacotherapies Heroin/Opioid Addiction Buprenorphine and Suboxone Buprenorphine is a partial agonist (it has both agonist and antagonist properties) at opioid receptors that carries a low risk of overdose. It reduces or eliminates withdrawal symptoms associated with opioid dependence but does not produce the euphoria and sedation caused by heroin or other opioids. In 2000, Congress passed the Drug Addiction Treatment Act, allowing qualified physicians to prescribe Schedule III, IV, and V medications for the treatment of opioid addiction. This created a major paradigm shift that allowed access to opioid treatment in general medical settings, such as primary care offices, rather than limiting it to specialized treatment clinics. Buprenorphine was the first medication to be approved under the Drug Addiction Treatment Act and is available in two formulations: Subutex速 (a pure form of buprenorphine) and the more commonly prescribed Suboxone速 (a combination of buprenorphine and the opioid antagonist naloxone). The unique formulation with naloxone produces severe withdrawal symptoms when addicted individuals inject it to get high, lessening the likelihood of diversion. Physicians who provide office-based buprenorphine treatment for detoxification and/or maintenance treatment must have special accreditation. These physicians are also required to have the capacity to provide counseling to patients when indicated or, if they do not, to refer patients to those who do. Office-based treatment of opioid addiction is a cost-effective approach that increases the reach of treatment and the options available to patients. Many patients have life circumstances that make office-based treatment a better option for them than specialty clinics. For example, they may live far away from treatment centers or have working hours incompatible with the clinic hours. Office-based addiction treatment is being offered by primary care physicians, psychiatrists, and other specialists, such as internists and pediatricians. 16


M E D I C AT I O N

Patients stabilized on adequate, sustained dosages of methadone or buprenorphine can function normally. They can hold jobs, avoid the crime and violence of the street culture, and reduce their exposure to HIV by stopping or decreasing injection drug use and drug-related high-risk sexual behavior. Patients stabilized on these medications can also engage more readily in counseling and other behavioral interventions essential to recovery and rehabilitation. Vivitrol (Extended Release Naltrexone) Vivitrol (Extended Release Naltrexone) is a long-acting synthetic opioid antagonist with few side effects. An opioid antagonist blocks opioids from binding to their receptors and thereby prevents an addicted individual from feeling the effects associated with opioid use. Naltrexone as a treatment for opioid addiction is usually prescribed in outpatient medical settings, although initiation of the treatment often begins after medical detoxification in a residential setting. To prevent withdrawal symptoms, individuals must be medically detoxified and opioid-free for several days before taking naltrexone. When used this way, naltrexone blocks all the effects, including euphoria, of self-administered opioids. The theory behind this treatment is that the repeated absence of the desired effects and the perceived futility of using the opioid will gradually diminish opioid craving and addiction. Naltrexone itself has no subjective effects (that is, a person does not perceive any particular drug effects) or potential for abuse, and it is not addictive. However, patient noncompliance is a common problem. Therefore, a favorable treatment outcome requires an accompanying positive therapeutic relationship, effective counseling or therapy, and careful monitoring of medication compliance. Many experienced clinicians have found naltrexone best suited for highly motivated, recently detoxified patients who desire total abstinence because of external circumstances.

Tobacco Addiction Nicotine Replacement Therapy (NRT) A variety of formulations of nicotine replacement therapies now exist, including the transdermal nicotine patch, nicotine spray, nicotine gum, and nicotine lozenges. Because nicotine is the main addictive ingredient in tobacco, the rationale for NRT is that stable low levels of nicotine will prevent withdrawal symptoms—which often drive continued tobacco use— and help keep people motivated to quit. Bupropion (Zyban®) Bupropion was originally marketed as an antidepressant (Wellbutrin®). It has mild stimulant effects through blockade of the reuptake of catecholamines, especially norepinephrine and dopamine. A serendipitous observation among depressed patients was the medication’s efficacy in suppressing tobacco craving, promoting cessation without concomitant weight gain. Although bupropion’s exact mechanisms of action in facilitating smoking cessation are unclear, it has FDA approval as a smoking cessation treatment.

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M E D I C AT I O N

Varenicline (ChantixŽ) Varenicline is the most recently FDA-approved medication for smoking cessation. It acts on a subset of nicotinic receptors (alpha-4 beta-2) thought to be involved in the rewarding effects of nicotine. Varenicline acts as a partial agonist/antagonist at these receptors—this means that it mildly stimulates the nicotine receptor, but not sufficiently to allow the release of dopamine, which is important for the rewarding effects of nicotine. As an antagonist, varenicline also blocks the ability of nicotine to activate dopamine, interfering with the reinforcing effects of smoking, thereby reducing cravings and supporting abstinence from smoking.

Combined With Behavioral Treatment Each of the above pharmacotherapies is recommended for use in combination with behavioral interventions, including group and individual therapies, as well as telephone quitlines. Through behavioral skills training, patients learn to avoid high-risk situations for smoking relapse and to plan strategies to cope with such situations when necessary. Coping techniques include cigarette refusal skills, assertiveness, and time management skills that patients practice in treatment, social, and work settings. Combined treatment is urged because behavioral and pharmacological treatments are thought to operate by different yet complementary mechanisms that can have additive effects. By dampening craving intensity, medications can give patients a leg up on enacting new strategies and skills.

Alcohol Addiction Vivitrol (Extended Release Naltrexone) and oral Naltrexone Naltrexone blocks opioid receptors that are involved in the rewarding effects of drinking and the craving for alcohol. It reduces relapse to heavy drinking, defined as four or more drinks per day for women and five or more for men. Naltrexone cuts relapse risk during the first 3 months by about 36 percent but is less effective in helping patients maintain abstinence. Acamprosate Acamprosate (CampralÂŽ) acts on the gamma-aminobutyric acid (GABA) and glutamate neurotransmitter systems and is thought to reduce symptoms of protracted withdrawal, such as insomnia, anxiety, restlessness, and dysphoria. Acamprosate has been shown to help dependent drinkers maintain abstinence for several weeks to months, and it may be more effective in patients with severe dependence.

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M E D I C AT I O N

Disulfiram Disulfiram (AntabuseÂŽ) interferes with degradation of alcohol, resulting in the accumulation of acetaldehyde, which, in turn, produces a very unpleasant reaction that includes flushing, nausea, and palpitations if the patient drinks alcohol. The utility and effectiveness of disulfiram are considered limited because compliance is generally poor. However, among patients who are highly motivated, disulfiram can be effective, and some patients use it episodically for high-risk situations, such as social occasions where alcohol is present. It can also be administered in a monitored fashion, such as in a clinic or by a spouse, improving its efficacy. Topiramate Topiramate is thought to work by increasing inhibitory (GABA) neurotransmission and reducing stimulatory (glutamate) neurotransmission. Its precise mechanism of action in treating alcohol addiction is not known, and it has not yet received FDA approval. Topiramate has been shown in two randomized, controlled trials to significantly improve multiple drinking outcomes, compared with a placebo. Over the course of a 14-week trial, topiramate significantly increased the proportion of patients with 28 consecutive days of abstinence or non-heavy drinking. In both studies, the differences between topiramate and placebo groups were still diverging at the end of the trial, suggesting that the maximum effect may not have yet been reached. Importantly, efficacy was established in volunteers who were drinking upon starting the medication.

Combined With Behavioral Treatment While a number of behavioral treatments have been shown to be effective in the treatment of alcohol addiction, it does not appear that an additive effect exists between behavioral treatments and pharmacotherapy. Studies have shown that getting help is one of the most important factors in treating alcohol addiction, compared to getting a particular type of treatment.

Be quick but don’t hurry. – John Wooden

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F R E Q U E N T LY A S K E D Q U E S T I O N S

In the end, it’s not the years in your life that count. It’s the life in your years. – Abraham Lincoln


F.A.Q. As you enter the INSynergy program, it is not uncommon to have questions. Our staff is always available to answer any question you may have. We have also outlined below a list of questions frequently asked by new patients. How soon will I feel better during detox? You should begin feeling better quickly depending on type of detox. New advancements in the field of Addiction Medicine allows INSynergy to treat withdrawals swiftly with more comfort. Patients are often amazed how quickly detox can occur and have a relief from their symptoms. Is Detox all I need? No. Detox ALONE is not considered treatment. It is only the first step! Detox alone is not associated with good outcome and without a solid program, increases risk for future relapses. It is very important that you take advantage of all components of what INSynergy focuses on. Detox, anti-craving medications, and effective counseling! How long should I come to treatment? We find that the most successful treatment outcome is when a patient is fully engaged in the initial 180-day program (Phase I). Many patients choose to participate in INSynergy’s 6-month Aftercare program to increase the long-term success of their recovery. (Phase II-Aftercare) Who will I see in the program? Each client will see our Program Director for a brief orientation. Then our board certified Medical Director will evaluate and screen for other psychiatric disorders and treat accordingly. Group and individual therapy is conducted by our therapists and counselors and at times will be conducted by our psychiatrist. We have a highly trained staff, with advanced training in the field of Addiction Medicine, supporting you to assist in a successful recovery. Should I see the staff psychiatrist? Our staff psychiatrist sees all patients and addresses any underlying medical, psychological, and psychiatric situations that may be driving your addiction. What are Dual Disorders? Dual disorders can also be referred to as Co-Occurring disorders or Co-Morbid Disorders. Dual disorders refer to the presence of a mood disorder or mental health (such as anxiety, depression, bipolar and ADHD) combined with a substance abuse disorder. It has been estimated that 37% of alcoholics and 53% of drug abusers also have at least one serious mental health disorder. Conversely, it has been estimated that 29% of all people diagnosed psychiatric issues, abuse either alcohol or drugs. Over 60% of persons with Bipolar Depression have substance abuse issues. Patients with ADHD also have an increased risk, not only substance abuse, but divorce, traffic accidents, failure at work, and of course, poor academic performance. Patients often find that when they are correctly diagnosed and treated for psychiatric issues, their success in treating their substance abuse disorder greatly increases. This is why it is very important to identify other forces that greatly influence addictive behavior.

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F. A . Q .

What is the group counseling doing for me? Group counseling is part of our Cognitive Behavior Therapy (CBT). Patients will learn various methods to deal with their addiction including relapse prevention techniques, triggers, coping strategies and techniques for integrating your feelings, thinking and behaviors. This is where we “re-train your brain” to focus on “healthier” thinking and habits. As recovery progresses, you will become a role model for other patients in the group who are just in the initial stages of their recovery. The COMBINE study, recently done by the National Institute of Drugs and Alcohol, concluded that the combination of an anti-craving drug for alcohol (naltrexone) and Cognitive Behavior Therapy was the best approach in treating alcoholics. Is INSynergy against the 12-Step or AA programs? No, INSynergy supports the fundamental messages of the 12-Step programs. However, we feel that clients focus on CBT during the program while the 12-Step programs are widely available in the community. We encourage additional sources of support along with what INSynergy can offer. Many INSynergy clients use the 12-Step principles along with the powerful concepts of INSynergy to gain a more robust effect in their recovery. Many simply use the INSynergy approach as an alternative to the 12-Step program. Will there be other components of the INSynergy program besides taking medicine and going to therapy? Yes, the INSynergy program is a comprehensive treatment program designed to treat the body as a whole. Baseline blood work usually is ordered to screen for medical issues. Referrals Neuro-psych testing and sleep studies are oftentimes suggested to rule out other psychological and medical issues that may contribute to mood disorders or addictive behavior. Urine and blood drug screening can occur to help assess compliance. Along with medications and therapy, we will also help you improve your diet and nutrition, sleep hygiene and exercise patterns. Weekly “healthy living” lectures and activities are popular components of the program. Diet, sleep and exercise can lift your mood and help your body heal itself. This increases your ability to have a long-term, successful recovery. When all of these issues are addressed, you will see a difference in your overall wellbeing and happiness. What is the difference between Vivitrol™ and Naltrexone? Vivitrol™ is an injectable time released form of naltrexone that is taken once a month. Vivitrol acts on the brain’s receptors for pleasure, blocking the receptor’s ability to gain any reaction from chemicals such as alcohol. This is theorized to reduce an alcoholic’s craving for alcohol by slowly releasing the drug over the course of a month. When administered properly, a Vivitrol treatment can: 4 Prevent a relapse to opioid dependence after detox 4 Treat Alcohol Addiction (Alcoholism) To be effective, Vivitrol treatment must be used with recovery programs, such as counseling. 22


F. A . Q .

Is the medication Vivitrol™/Naltrexone addicting? No, Vivitrol™/Naltrexone is not addicting. Vivitrol™ is a non-controlled substance that is non-habit forming, or addicting. Does Vivitrol™ work for heroin and opiate pain pills? Yes, Vivitrol™ was just recently approved by the FDA in treating opiate addiction after detox. This can provide protection from the effects of heroin or pain pills and promote long lasting sobriety one month at a time. Before this, Vivitrol and naltrexone had FDA approval for treating alcoholism by reducing the cravings for drinking. The physician will evaluate your condition and prescribe the most effective treatment for your recovery. What is Suboxone? Suboxone is an effective, safe medication approved by the FDA for use in the treatment of opioid addiction. Suboxone can be used as a detoxification or maintenance medication however we encourage a slow taper that may go beyond the time here at INSynergy. This will decrease risk of early relapse. Do I have to go to a hospital to get detoxed? Most of the time detoxification can be safely achieved as an outpatient. However, if medically necessary, we also have relationships with programs that will detox our patients in a hospital setting and then discharge directly to our program. If I require hospitalization, is the hospital detox program included in the cost of my INSynergy treatment program? No, however, the hospital detox program may be covered by your insurance. We recommend checking with your insurance provider for details. Will my insurance pay for my INSynergy treatment program? At this time INSynergy does not accept insurance. Because this is an intense outpatient program, insurance coverage is unpredictable and often not covered. Is this program confidential? Yes, the INSynergy program recognizes the need to protect the reputation of our clients. Many of our clients have sensitive reputations to protect. Professionals in business, medical and nursing professionals, and students, all find the INSynergy program a practical option. Our goal is to assist our patients in their recovery without disruption to their professional, personal, or academic lives.

Can I contact the clinic after hours? Yes, our staff is available 24/7 by phone. We can be reached at 314.649-STOP (7867)

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F. A . Q .

Here are 10 frightening facts about prescription pain pills: 1. Prescription drug abuse kills more people than traffic accidents. A recent study by the Journal of the American Medical Association said that people who are prescribed high doses of prescription pills may have a greater risk of death. In fact, drug overdoses and brain damage from long-term drug abuse killed an estimated 37,485 people in 2009, which surpassed the death toll from traffic accidents by 1,201 people. This alarming number of deaths is expected to rise, according to the U.S. Centers for Disease Control and Prevention. 2. Between 1998 and 2008, treatment admissions for prescription painkiller dependence grew 400%. Drug treatment admission rates have risen dramatically over the last decade, specifically for prescription pain med dependence. According to the Substance Abuse and Mental Health Services Administration, the treatment admission rate for opiates other than heroin grew 400% in 2008, which was up from 2005. This means that for every 100,000 population, 45 people aged 12 and older have sought treatment for their prescription pain med abuse. 3. Sixty percent of teens who abused prescription pain pills tried them before the age of 15. Teens and young adults abuse prescription drugs more than any other illicit drug, except marijuana. According to the United State Drug Enforcement Agency (DEA), one in seven teenagers admits to abusing prescription drugs for non-medical purposes, and 60% of the teens who abused prescription pain pills experimented before the age of 15. 4. Seven in 10 people who abuse prescription pain pills obtained them from a friend or relative. According to the Substance Abuse and Mental Health Services Administration, a staggering number of people obtain their prescription pain meds from a friend or relative for free. Seven in 10 people got their prescription painkillers from a friend or relative, whereas nearly 10% bought them from a friend or relative, and five percent took them from these people without asking. 5. About 120,000 Americans are hospitalized each year for overdosing on opioid painkillers. Prescription pain pill addiction has killed thousands of Americans each year. About 120,000 Americans go to the emergency room each year for overdosing on opioid painkillers. Prescription pain pill abusers can easily overdose if they take higher doses than directed, combine drugs, or use them with alcohol.

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F. A . Q .

6. Prescription painkillers are the leading cause of fatal overdoses. Prescription painkillers cause more overdose deaths than street drugs like heroin, cocaine, and amphetamines, according to the Centers for Disease Control and Prevention. In the past, most overdoses were caused by illegal narcotics and took place in big U.S. cities. However, the number of deaths from opioid painkiller overdoses has more than tripled from 1999 to 2006, resulting in 13,800 deaths. 7. Opioid painkillers have increased the number of unintentional drug poisoning deaths in the United States. The rate of unintentional drug overdose deaths in the United States have risen tremendously between 1999 and 2007. During that time, more than 28,000 people died from unintentional drug poisoning. This alarming number has been attributed to the increase in both legal and illicit prescription opioid painkiller usage. 8. Three in 10 teens think prescription pain killers are not addictive. A large majority of teenagers believe that prescriptions pain relievers are not addictive and “much safer� than illegal drugs. Additionally, 56% of teens think prescription drugs are easier to obtain than street drugs. Teens can easily access prescription pain pills from their family members or friends, and they justify taking the pills because a doctor prescribes them. 9. Prescription pain pills are the second most commonly abused drug among teens. As stated above, a high percentage of teenagers think that prescription pain pills are not addictive and less harmful than street drugs, which explains why teenagers abuse this drug more than any illicit drug, except marijuana. Prescription pain meds are the second most commonly abused drug by teens, and they are the most widely misused type of prescription drug overall. 10. Prescription pain pill abuse and overdose death rates are highest in rural America. Although prescription drug abuse is rampant throughout the United States, the highest rate of prescription opioid abuse and fatal poisoning occurs predominantly in rural states within the Appalachian and Southwest region. Kentucky, Ohio, Tennessee, West Virginia, and neighboring states are some of the most troubled areas for prescription pain pill abuse.

In the middle of difficulty lies opportunity. – Albert Einstein 25


1 0 T I P S F O R PAT I E N T S U C C E S S

Mistakes are your best teachers. – Unknown


10 Tips F O R PAT I E N T S U C C E S S 1. Get started right away on your treatment plan. Work with our staff within the first week of treatment to develop your individual treatment plan. 2. Dive into your treatment plan. Becoming fully engaged in your program will ensure your commitment to change and improve your rate of success. 3. Take all medications as prescribed. Whether medications are used for detox, cravings, mood, concentration, or sleep, make sure that you take them as prescribed. This is an important concept of maintaining sobriety, even after your time at INSynergy. 4. Attend weekly therapy sessions. Attend at least two group therapy sessions and one individual session each week. 5. Outline a structure for your day-to-day life. Writing this structure out is often helpful for patients. 4 Sleep – What are the times will you aim to go to sleep each night and wake up each morning? Developing good sleep patterns will improve your quality of sleep. 4 Exercise – Find a physical activity that you enjoy and can stick to. 4 Diet/Nutrition – Evaluate your grocery purchases and dining habits and develop a plan for healthy eating. Consider taking vitamins to supplement your nutrition if necessary. 4 Educate – Allocate time to learn/educate yourself about the biology of addiction and the triggers that lead to addictive behavior. 6. Develop a weekly plan to balance the priorities in your life. Again, some patients find that it is most helpful to have a written plan, either journaled or on a calendar. Consider each week how you will balance your time with: 4 Employment/Work 4 Personal Interests 4 Family 4 Belief System/Religion 7. Attend Cognitive Behavior Therapy lectures. Concepts from individual and group therapy sessions will help you “re-wire your brain” and change your thinking, beliefs and behaviors. Weekly CBT work-shops are designed to help you as you’re working through your program with your therapist. 8. Continually review and re-evaluate your plan and progress. Use your counselors, therapist, psychiatrist, etc. to help you. 9. Involve your family members and significant others in your recovery. INSynergy offers an ALL INCLUSIVE experience that invites the whole family system during your recovery. Keeping family and friends up to date on your recovery will help them better understand your program and keep you accountable to someone else. This can be beneficial for both you and them. 10. Extending your Care (Aftercare) It is essential that you continue to expand your knowledge about yourself and the advancements of addiction treatment even after your time at INSynergy. We recommend that you continue to engage in active treatment in the community. We can offer recommendations so that your medical and therapy experiences are not interrupted. Many INSynergy clients continue treatment in our PHASE II Aftercare program which is essentially a continuance of PHASE I. This will offer 6 more months of ALL INCLUSIVE access to INSynergy’s Staff Psychiatrist, individual, group, marriage, family therapy. PHASE II is heavily discounted. Other options to extending your care is our REFERRAL program which will extend your care by 2 months when you refer a client to our program. To avail of this referral program extension, you must be a current client of INSynergy.

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New INSynergy Client Binder  

Welcome to INSynergy!!! This publication is a brief orientation about our innovative 6 month outpatient program. Again, welcome and looking...

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