Brain Science and Updates From the Field

A Different Look at Addiction Recovery

Monday, September 08, 2014

Innovative Injectable treats addiction by target brain's receptors

There is no magic pill for addiction, but an innovative treatment method that can eliminate the effects of alcohol and opiates has been an effective tool in the box for those struggling with substance abuse.

Wendy McCullough, director of Stairways Behavioral Health’s Forensic Clinic has witnessed first-hand the positive outcomes Vivitrol, a monthly injectable, can yield in recovering addicts.

“We’ve had good results with it,” McCullough. “The big thing is that it is not a narcotic, so it’s not addictive and it can be given by anyone who can write prescriptions.”

Vivitrol, the trade name for Naltrexone, is an extended-release injection given each month that acts as a blocker by attaching to receptors in the brain, blocking the euphoric feelings associated with opiates and alcohol.

Vivitrol blocks receptors in the brain associated with opioids (above) and alcohol.

In contrast to methadone and buprenorphine (Suboxone), which have been the standard agonist treatments used during recovery, Vivotrol is an antagonist, meaning it blocks the brain’s neurotransmitters. Methadone and buprenorphine, which are opiates, meanwhile, activate the effects of neurotransmitters naturally found in the brain.

Stairways has used Vivitrol with clients for more than two years and has seen its effectiveness on multiple occasions.

Part of the drug’s appeal, noted McCullough, lay in its practicality. Vivitrol gives substance abuse treatment providers and those in treatment an alternative to methadone and buprenorphine, which must be taken daily under the supervision at certified clinics or, in the case of buprenorphine, at home, which can lead to street sales.

Another attractive quality of Vivitrol is its extended-release feature, which can reduce the urge to get high by eliminating the need to take a daily pill. If a dosage of one of the daily drugs is missed, McCullough noted, addicts are susceptible to relapse because they would then be able to feel the effects of the substance they abuse.

“If I wanted to go use heroin tonight, I could stop using Suboxone two days in advance and get high,” McCullough said. “You can’t do that with Vivitrol.”

While oral naltrexone has been a trusted method used to treat substance abuse for nearly 30 years, intramuscular injections of Vivotrol are a relatively new development, having been approved by the Food and Drug Administration in 2010.

An ongoing concern since its introduction has been its steep price tag. Monthly injections sit in the $800-1,200 range, but unlike other treatment options, Vivitrol is now eligible to be covered by insurance.

 “Some people say it is expensive, McCullough said. “But when you factor in that most insurance pays for it, whereas it does not Suboxone, it really isn’t that much more than the other methods of treatment.”

McCullough recalled an instance several years ago when the drug was not yet covered by insurance, when a clients’ parents paid out of pocket for the monthly injections.

Stairways clients undergo a comprehensive process prior to being put on Vivitrol: blood tests are collected to detect the possible presence of liver enzymes and a chart is kept to monitor triggers and urges. McCullough said that the 20 to 25 clients taking Vivitrol at any given time who also undergo treatment in the form of stress and medication management in coordination with their monthly regimen have generally responded well.

“The people we have on it like it,” she said. “They seem more apt to stay on it. They seem not to be using.”

Though Vivitrol has produced positive results in many, McCullough did acknowledge that monthly injectables are not necessarily a fit for all in recovery.

“We realize it isn’t for everybody and not everyone wants to use it.”

Finding A Better Balance

Wednesday, July 30, 2014

Stairways program on cutting edge of biofeedback technology

An ACT team staff member uses an interactive computer game associated with the HeartMath InnerBalance application.

Math has long been the source of aggravation for countless individuals. However, thanks to an innovative and interactive biofeedback smartphone application, Stairways’ Assertive Community Treatment team (ACT) is using math to reduce stress.

Since February, the ACT team has been utilizing HeartMath Inner Balance, an iPhone app that seeks to reduce tension by improving one’s heart rate and breathing.

ACT has integrated the tool’s use in its work with clients as well as staff members, ACT physician Jennifer Pasternack, Ph.D, said.

“We’re using it for ourselves for stress,” she said. “Our clients are also using them for stress but it’s good for many of them who have had trauma as well.”

InnerBalance works by using an earlobe-clip that monitors one’s heart rate variability (HRV) — the changes in one’s heart rhythm that often reflect their present emotions. The HRV is then visually represented onscreen as a flowing wave, while the user is encouraged to breath in a slower, calmer manner by following along with a breath-pacing tool.

Sam Trychin, Ph.D., an Erie psychologist and consultant to Stairways Behavioral Health, introduced InnerBalance to Stairways after he had used the tool for more than five years, he said.

“Psychology influences physiology,” Trychin said. “And the inverse is true. Changing your breathing along with greater thoughts of appreciation can have a direct impact on your heart rate that you are able to see on the spot.”

Calmer, deeper breathing along with more appreciative feelings, Trychin says, results in fewer drastic fluctuations on the HRV meter. As this improved balance is achieved, “coherence”— the relationship between your HRV and a relaxed emotional state — increases as well, which, in turn, reduces the psychological and physiological symptoms of stress.

InnerBalance has yielded positive results for people suffering from mental illness as well as physical pain. For example, Veterans Affairs medical centers across the country have introduced the tool to veterans suffering from post-traumatic stress disorder.

At Stairways, Bernadette Valentinetti, a mental health professional in ACT, said she likes to incorporate the app into therapy as a way to visually show clients how their stress and heart rate directly correlate. With some clients, Valentinetti makes use of InnerBalance computer games that sync with breathing and heart rate variability to simulate adventure settings, such as being in a tropical garden or on a rainbow.

“I have a client that has a lot of anxiety and this is one way for her to regulate that,” Valentinetti said. “It’s a way for them to increase coherence without having to think of it as a deep-breathing exercise.”

ACT’s use of InnerBalance hasn’t been just limited to therapy with clients, however. The team’s staff also uses it immediately before meetings as a means to increase coherence and mitigate stress.

“It fits in well with our philosophy in that there’s not much of a difference between us and our clients,” she said. “Coping mechanisms are coping mechanisms and we all have stress whether we have a mental disorder or not.”

Pasternack, who initiated the app’s use after beginning to use it herself in December, said she has seen a difference in her own life.

“I feel I’m much calmer and more able to handle stress when it does arise,” she said.

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