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What to Expect When You Come In
NaltrexZone™ treats patients for addiction. This is made clear in all marketing materials. Marketing consists primarily of word of mouth, the internet and occasionally specific ads. No other treatment is offered as the NaltrexZones™ are addiction treatment centers and referred to as such invariably. Therefore, patients presenting to the NaltrexZones™ for treatment come for treatment of their addiction. They are essentially self referred after self diagnosis.
The term addiction is used as it is the common vernacular. More specific terminology is avoided in order to enhance communications. Specifically, DSMIVR criteria, which are most useful when physicians communicate either for research purposes or with insurance companies, is not utilized since NaltrexZones™ are not engaged in research and insurance companies are not billed.
When patients present to a NaltrexZone™, they are presenting for what they understand is their addiction. Therefore, the chief complaint (CC) is addiction. Patients are self selected for this problem and it is noted on the chart.
A brief and directed history is obtained. This history is brief and directed on the first visit due to the fact that these patients of necessity present somewhere along the spectrum of withdrawal to intoxication. Their attention spans are limited.
Facts necessary for detoxification are ascertained. Specifically the duration of the present use, pertinent use of interactive drugs, type and amount being used and mode of administration.
Additionally, a brief history of exposure to the most important treatment modalities, continuing self-help or 12 step recovery groups, is obtained. This subject is touched on repeatedly during the first and subsequent visits despite the intoxication-withdrawal spectrum problem. This is due to the fact that it has been shown that such brief interventions are beneficial. This has been shown by Drs. Judith and Edward Bernstein, and published as Brief Encounters Can Provide Motivation To Stop Drug Abuse, published in Drug and Alcohol Dependence, January, 2005.
A directed physical is performed. The physical is directed toward those signs, the medically objective findings, indicative of where the individual is along the spectrum of withdrawal through intoxication.
It is ascertained whether the patient is awake, alert, and oriented in the three spheres of person, place and time. This is done with the understanding that the patient is in some way influenced by the uncontrollable propensity to use mood altering drugs continuously. The skin is observed for jaundice as this may indicate that detoxification alone at this time may not be appropriate. The skin is also routinely observed for diaphoresis, piloerection, and lesions due to excoriation from histamine release. Pupils are observed primarily as a gauge of whether the patient is in withdrawal, dilated, or intoxicated, constriction and ptosis. Regularity of the heart rhythm is ascertained due to the fact that some concomitant drug use may produce arrhythmias. Specifically, "speed balling", or concurrent use of cocaine and heroin. The lungs may be affected by the mode of administration and concomitant drug use also.
When patients have received naltrexone administration by naltrexone pellet implantation the site is examined for signs of infection or rejection.
The above information results in an assessment or diagnoses where a determination is arrived at regarding where the patient is along the spectrum of withdrawal through intoxication.
The treatment plan will initially consist of medications to alleviate withdrawal symptoms as much as possible. There is NO comfortable detoxification. All detoxifications come with some degree of discomfort.
The basis of detoxification is withdrawal of the opiate agonist and stabilization for a short period of time on a partial agonist. This will lead to decrease in severity of withdrawal symptoms. The partial agonist drug of choice for this purpose is Buprenorphine.
The Buprenorphine is permitted under the Drug Abuse and Treatment Act 2000 (DATA 2000). Buprenorphine may be provided by physicians who have completed the required course, passed an examination, and been granted a waiver by the Drug Enforcement Administration (DEA) as indicated on their DEA licenses.
Following detoxification is the maintenance of an abstinence state and continuation of the recovery process.
The recovery process may involve continuation of anti-craving antagonist therapy as well as cognitive behavior therapy (CBT). NaltrexZones™ utilize naltrexone compounded into a pellet form and Twelve Step programs for these purposes.
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