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Category Archives: Addiction

  1. Mental Health and Coping During COVID-19 (Coronavirus)

    The following is an article from the Centers for Disease Control and Prevention (CDC). For more information regarding COVID-19, please visit their website.

    The outbreak of coronavirus disease 2019 (COVID-19) may be stressful for people and communities. Fear and anxiety about a disease can be overwhelming and cause strong emotions in adults and children.

    Everyone reacts differently to stressful situations.  The emotional impact of an emergency on a person can depend on the person’s characteristics and experiences, the social and economic circumstances of the person and their community, and the availability of local resources. People can become more distressed if they see repeated images or hear repeated reports about the outbreak in the media.

    People who may respond more strongly to the stress of a crisis include:

    • People who have preexisting mental health conditions including problems with substance use
    • Children
    • People who are helping with the response to COVID-19, like doctors and other health care providers, or first responders

    Additional information and resources on mental health care can be found at the Substance Abuse and Mental Health Services Administration (SAMHSA) website.

    • Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) Disaster Distress Hotline: 1-800-985-5990 or text TalkWithUs to 66746.
    • People with deafness or hearing loss can use their preferred relay service to call 1-800-985-5990.

    Reactions during an infectious disease outbreak can include:

    • Fear and worry about your own health status and that of your loved ones who may have been exposed to COVID-19
    • Changes in sleep or eating patterns
    • Difficulty sleeping or concentrating
    • Worsening of chronic health problems
    • Increased use of alcohol, tobacco, or other drugs

    People with preexisting mental health conditions should continue with their treatment plans during an emergency and monitor for any new symptoms. Additional information can be found at the Substance Abuse and Mental Health Services Administration (SAMHSA) website.

    Coping with these feelings and getting help when you need it will help you, your family, and your community recover from a disaster. Connect with family, friends, and others in your community. Take care of yourself and each other, and know when and how to seek help.

    Call your healthcare provider if stress reactions interfere with your daily activities for several days in a row.

    Things you can do to support yourself:

    • Avoid excessive exposure to media coverage of COVID-19.
    • Take care of your body. Take deep breaths, stretch or meditate. Try to eat healthy, well-balanced meals, exercise regularly, get plenty of sleep and avoid alcohol and drugs.
    • Make time to unwind and remind yourself that strong feelings will fade. Take breaks from watching, reading, or listening to news stories. It can be upsetting to hear about the crisis and see images repeatedly. Try to do some other activities you enjoy to return to your normal life.
    • Connect with others. Share your concerns and how you are feeling with a friend or family member. Maintain healthy relationships.
    • Maintain a sense of hope and positive thinking.

    Share the facts about COVID-19 and the actual risk to others. People who have returned from areas of ongoing spread more than 14 days ago and do not have symptoms of COVID-19 do not put others at risk.

    What are quarantine and social distancing?

    • Quarantine separates and restricts the movement of people who were exposed to a contagious disease to see if they become sick.
    • Social distancing means remaining out of places where people meet or gather, avoiding local public transportation (e.g., bus, subway, taxi, rideshare), and maintaining distance (approximately 6 feet or 2 meters) from others.

    Sharing accurate information can help calm fears in others and allow you to connect with them.

    Learn more about taking care of your emotional health.

    For parents:

    Children react, in part, on what they see from the adults around them. When parents and caregivers deal with the COVID-19 calmly and confidently, they can provide the best support for their children. Parents can be more reassuring to others around them, especially children, if they are better prepared.

    Not all children respond to stress in the same way. Some common changes to watch for in children:

    • Excessive crying and irritation
    • Returning to behaviors they have outgrown (e.g., toileting accidents or bedwetting)
    • Excessive worry or sadness
    • Unhealthy eating or sleeping habits
    • Irritability and “acting out” behaviors
    • Poor school performance or avoiding school
    • Difficulty with attention and concentration
    • Avoidance of activities enjoyed in the past
    • Unexplained headaches or body pain
    • Use of alcohol, tobacco, or other drugs

    There are many things you can do to support your child:

    • Take time to talk with your child about the COVID-19 outbreak. Answer questions and share facts about COVID-19 in a way that your child can understand.
    • Reassure your child that they are safe. Let them know if is ok if they feel upset. Share with them how you deal with your own stress so that they can learn how to cope from you.
    • Limit your child’s exposure to media coverage of the event. Children may misinterpret what they hear and can be frightened about something they do not understand.
    • Help your child to have a sense of structure. Once it is safe to return to school or child care, help them return to their regular activity.
    • Be a role model; take breaks, get plenty of sleep, exercise, and eat well. Connect with your friends and family members and rely on your social support system.

    Learn more about helping children cope.

    For responders:

    Responding to COVID-19 can take an emotional toll on you. There are things you can do to reduce secondary traumatic stress (STS) reactions:

    • Acknowledge that STS can impact anyone helping families after a traumatic event.
    • Learn the symptoms including physical (fatigue, illness) and mental (fear, withdrawal, guilt).
    • Allow time for you and your family to recover from responding to the outbreak.
    • Create a menu of personal self-care activities that you enjoy, such as spending time with friends and family, exercising, or reading a book.
    • Take a break from media coverage of COVID-19.
    • Ask for help if you feel overwhelmed or concerned that COVID-19 is affecting your ability to care for your family and patients as you did before the outbreak.

    For people who have been released from quarantine:

    Being separated from others if a health care provider thinks you may have been exposed to COVID-19 can be stressful, even if you do not get sick. Some typical reactions after being released from COVID-19 quarantine can include:

    • Mixed emotions, including relief after quarantine
    • Fear and worry about your own health status and that of your loved ones who may have been exposed to COVID-19
    • Stress from the experience of monitoring yourself, or being monitored by others for signs and symptoms of COVID-19
    • Sadness, anger, or frustration because friends or loved ones have unfounded fears of contracting the disease from contact with you, even though you have been determined not to be contagious
    • Guilt about not being able to perform normal work or parenting duties during quarantine
    • Other emotional or mental health changes

    Children may also feel upset or have other strong emotions if they, or someone they know, has been released from quarantine. You can help your child cope.

    Learn more tips for taking care of yourself during emergency response.

  2. Buprenorphine Treatment for Opiate Addiction and Pain

    Carolina Behavioral Care (CBC) offers a full array of clinical services around buprenorphine treatment for opiate addiction. With the high level of concern nationally over opiate addiction, we thought it worthwhile to address the landscape of treatment options. As a result over the last five years, we have developed buprenorphine treatment under the leadership of Robert Fleury, M.D. For both detoxification from opiates as well as abstinence-focused maintenance, buprenorphine (Suboxone, Subutex, Zubsolv, Bunavail brand names) has become an excellent option. This drug has also emerged as a treatment for chronic pain, especially for those patients who have difficulty controlling their use of opiates. We have many patients, who have come to us because of difficulty with opiate use, report a reduction in pain symptoms comparable to opiates.  

    Buprenorphine works to treat opiate addiction and chronic pain through its effect on the same brain receptor where opiates work. It is technically an opiate partial agonist and has its effect by binding to the opiate brain receptors. Both craving and chronic pain are controlled through the interaction at these receptors. Buprenorphine is not addicting like opiates because tolerance does not develop. However, withdrawal will occur if stopped without medical supervision. The goal of buprenorphine is to control craving so the patient has no desire to take opiates. Because of the genetics of addiction, some patients may take buprenorphine for the long term. But the goal clinically is always to regulate the patient’s cravings on the least amount of the drug possible. Over time, patients work towards reducing buprenorphine use, and many patients stop it completely with good stability of abstinence.  

    CBC offers medically assisted treatment (MAT) at our Durham, Hillsborough and Pinehurst, N.C., locations. A distinct advantage of buprenorphine over other forms of opiate addiction treatment is that it can be prescribed at a physician’s office. At the time of this post, CBC has eight certified buprenorphine prescribers.  

    Clinical Procedures for Safe Buprenorphine Treatment in Durham, N.C., and the Triangle area

    For patients requesting help with their addiction, there are several stages of care to address. Initially, a complete substance abuse assessment is performed with one of our prescribers.  This includes a psychiatric assessment as well to identify any co-morbid psychiatric issues such as depression or anxiety. Additionally, a basic medical evaluation is performed. CBC has in-house lab services to assess potential metabolic or infectious disease problems. We also perform urine drug testing to identify any substance which might affect recovery. If the patient requires detoxification from opiates or any other drug of abuse, the CBC staff will develop a tailored detoxification regimen for the patient. This is greatly facilitated through our in-house pharmacy. All dosing requirements are developed  in collaboration with the CBC pharmacist. Patients need to be off all opiates for at least 24 hours before beginning buprenorphine. Those patients who have been actively using opiates have to be in active withdrawal for the safe administration of buprenorphine.

    The next phase of treatment is called induction. In this phase, buprenorphine is started while in the office, and if detoxification has been managed correctly, withdrawal symptoms will usually subside within a few hours. The CBC staff will monitor the patient’s vital signs during induction to be sure there are no significant side effects before returning home. Routinely the patient’s medication level is adjusted over the course of the first month with the goal of achieving control of opiate craving. Additionally the patient will receive a substance abuse counseling assessment with treatment focused on changes in the patient’s psychosocial life to support recovery. Involvement in AA or NA is recommended.  

    Maintenance treatment is achieved through the ongoing relationship with the prescriber. Monthly visits with the prescriber are required to monitor craving and to make adjustments of the buprenorphine as needed. Since CBC prescribers also have psychiatric credentials, they can address any co-morbid psychiatric problems that exist. The role of the substance abuse counselor is also important during each phase of treatment to set realistic recovery goals and address healthy changes in lifestyle.  

    Buprenorphine comes in several preparations. Most patients take a form that includes naltrexone. These brands include Suboxone, Zubsolv, and Bunavail. Naltrexone is a medicine which also reduces cravings. It has been added to buprenorphine to specifically block possible euphoric symptoms if a patient were to abuse the drug by taking it intravenously. Buprenorphine alone (Subutex) is recommended during pregnancy, and the staff at CBC has extensive experience working with women during pregnancy.  

    In-House Buprenorphine Treatment in Durham and Hillsborough

    The CBC in-house pharmacy is particularly helpful when a patient starts buprenorphine treatment. Most insurance companies have a preferred form of the medication, and the CBC pharmacist will complete all precertification requirements so the patient can start treatment immediately. Our pharmacists also monitor dosing of all medications and ensures that refills are available so that the patient will always have their medications.  This is especially important with buprenorphine treatment because withdrawal will occur if doses are missed. This collaboration between the prescriber and the pharmacist is critical to the success of the treatment. CBC has full-time pharmacy staff at all three sites.

    CBC welcomes requests for treatment directly from patients as well as from the medical community at large. To schedule an appointment or make a referral, contact our Call Center at (844) 534-7208 Monday through Friday from 8 a.m. to 5 p.m.

  • Pinehurst office

    289 Olmsted Blvd Pinehurst, NC 28374

    910-295-6007

  • Hillsborough office

    209 Millstone Drive Hillsborough, NC 27278

    919-245-5400

  • Durham office

    4102 Ben Franklin Blvd Durham, NC 27704

    919-972-7700

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Dr. David Cowherd, MD, FACC - Pinehurst Medical Clinic

Carolina Behavioral Care has been my number one choice for my psychiatric referrals for the past 20 years. Their level of professionalism is unsurpassed and I have never been disappointed.

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