From not enough to too much

LIHU‘E — The type of treatment an addict pursues often reflects

the willingness to overcome the addiction with support, experts

say.

Editor’s note: This is the third of a multi-part series about prescription drug abuse on Kaua‘i. Visit www.thegardenisland.com to view previous parts.

LIHU‘E — The type of treatment an addict pursues often reflects the willingness to overcome the addiction with support, experts say.

Prescription pill abuse — just as alcohol, marijuana and illicit drugs — is part of everyday life for some Kaua‘i residents. But it can be more difficult than others to recognize as a brain disorder to treat before it advances.

“People never start out to become an addict and it’s not on the top-10 list of things to be when we’re grown up, but people do,” said Dr. Gerald McKenna, who provides pain management programs, chemical dependency assessments, addiction therapy, intervention and psychiatric care at McKenna Recovery Center on Kaua‘i.

After working in prescription addiction for nearly four decades, he said it is a cyclical problem. New medications are over-prescribed until a crisis calls for alternative measures, he said. There are also lifestyle factors and a false perception that prescription medicines will do no harm.

Pain medication is the new epidemic of prescription addiction, McKenna said. The fear of addiction meant opiates were used sparingly for post-surgery or broken bones. Today they are prescribed more liberally for pain once thought tolerable or treatable with non-opiates.

“That under-treatment of pain has morphed into an over-treatment of pain,” McKenna said.

Prescribing opiate analgesics requires an appropriate determination for the basis of pain, he said. Judicious treatment uses smaller amounts of a combination of drugs to achieve the desired effect without risking the overuse of any one drug.

McKenna said his clinic and other doctors have been using Suboxone for over five years to treat opiate dependencies. It is now considered a non-addictive treatment of chronic pain.

Dr. Krishna Kumar, a board-certified psychiatrist and a Distinguished Life Fellow of the American Psychiatric Association, the organization’s highest honor, has practiced on Kaua‘i for the past 20 years. Before moving here, he practiced for 15 years on O‘ahu.

Commonly misused narcotic medications when properly prescribed take into account the likelihood of addiction, Kumar said. This is addressed with tests and in consort with the physician and family.

As a patient develops a tolerance to severe pain medications they become dependent from more frequent or stronger dosages. This level of opiate intoxication results in dementia or psychotic disorders, but he said they take more opiates to avoid serious physical withdrawals.

If the medications are mixed with alcohol and other drugs, Kumar said the patient experiences an intensified delirium and would need to be hospitalized to survive.

When the patient has a coexisting depression or anxiety disorder Kumar said they usually go along with the addiction risk regimen. He said they are more willing to decrease the dosage to avoid dependency.

Patients with existing personality or pain disorders tend to have less motivation to make the changes, he added. A pattern of behavior to watch for may start with anger when the physician suggests an alternative medication.

Addiction leads to bad choices as well. The patient may go “doctor shopping” off-Island or even steal their physician’s prescription signature.

Avoiding addiction has a better success rate with pre- and post-medication toxicology reports, an MRI and other exams to show physiological changes in the body. Kumar said this is evidence on which to base a decision on dosage.

The diagnosis of a pain disorder should be done in consultation with the patient’s physician and mental health professional to determine the level of pain management, the likelihood of depression, or a personality disorder, Kumar said.

“Professionals have to collaborate frequently,” he said, to include individual, family and group counseling, monitoring, and Alcohol Anonymous or Narcotics Anonymous meetings. It is all part of setting the parameters for an intensive rehabilitation program.”

Inpatient care facilities needed

Inpatient or residential treatment is available in Honolulu, the Big Island and Maui, but not on Kaua‘i.

As a plan for an adolescent treatment center on the Garden Isle progresses, McKenna and Kumar said they also support an adult residential treatment center.

“Yes, there is a need for an intensive outpatient program, and a drug dependency and alcohol and prescription drug dependency and residential treatment program as well,” Kumar said.

The Salvation Army of Hawai‘i and the Pacific Islands has a residential treatment center on O‘ahu, based on needs of individualized treatment plans. It also has a one-week detoxification facility and outpatient program.

The County of Kaua‘i is considering an in-residence facility for youth who are addicted. With the siting in Lihu‘e only recently announced, the center would not be operational until at least 2014 if approved and funded.

The state’s three primary youth in-residence programs include the Bobby Benson Center on O‘ahu, the Aloha House on the Big Island and Marimed Foundation on Maui. There are also therapeutic foster homes with professional parents trained to support addicted youth in their own homes.

Kaua‘i Family Guidance Center in Lihu‘e is a good starting point for youth referrals, officials said.

Insurance and waiting lists are typical issues with in-resident programs. When money is no object, there are private facilities on-Island.

The Scott Recovery Retreat on Kaua‘i has sister centers in Los Angeles and Europe. It offers a tailored boutique style addiction treatment program in a private, luxurious facility with experts flown in from around the country.

Kat Conway, director, said Hawai‘i law requires private centers to complete an addiction assessment report just as the public clinics. It is conducted for the Department of Health, Alcohol and Drug Abuse Division.

More brain studies have been conducted in the last 30 years than in all of history. Traditional therapy, cognitive behavioral therapy and 12-step programs are all scientifically proven to work, Conway said.

“It takes work to recover and for many prescription drug addicts it takes trained professionals in the field of addiction who can design a treatment track that includes the latest holistic scientifically proven cutting-edge therapies,” Conway said.

Holistic care

Dr. Leia Melead, a naturopathic doctor and licensed acupuncturist, operates the Kaua‘i Natural Medicine & Acupuncture Center. She said the best way to help addicts is to create a healing setting and remove them from environmental triggers to begin the process of recovery.

Not everyone can afford the luxury of a spa setting, Melead said, but the most important factor is the patient’s willingness to stop using drugs. Addicts are sometimes brought in by friends or family members. If they are still in denial they won’t usually come back.

An attitude to succeed fuels their therapy and helps acupuncture, she said, adding that a multitude of modalities of traditional Chinese medicine have proven effective.

Another issue is when the patient sometimes expects a one-time appointment to be a cure. Melead said the treatment plan requires repeat appointments and following advice on nutrition and lifestyle changes.

“The patient has to be willing to want to change,”Melead said. “That is difficult when they have an addiction.”

As a student of TCM in Portland, Melead worked at an addiction center run by acupuncturists. She said when people stick to a regimen of three treatments per week they saw results.

The treatment includes the Homunculus (little man) acupuncture of the ear, where lines of meridian move the body’s “Qi” energy to the major organs. Not all acupuncturists treat this way but Melead said therapies involving the head, neck, fingers and feet work well in combination with full-body acupuncture.

“This is an integral part of detoxification when used for addiction treatment,” Melead said.

Addictions can include tobacco and alcohol, recreational and prescription drugs or even sugar. A habit, compulsion or physical addiction will create imbalance, Melead said.

Acupuncture is nearly 5,000 years old and opened up to the west over the past 40 years. Addiction to opiates was an ancient issue in China and there is much to learn from the ancient medical texts now being translated for the west, Melead said.

When Lei talks about imbalance, yin and yang or the elements of the earth, she said it’s not easy for the western mind to understand a diagnosis. She explains illness and addiction through terms of Qi stagnation and balancing energy flow.

Outpatient care

Addiction treatment services include assessments and diagnosis, interventions and counseling, medical and psychiatric services, outpatient and social services. Treatment may be voluntary or sometimes a required component of probation through the criminal justice system.

Narcotics Anonymous is a required component of many treatment programs. Its 12-step program succeeds with support groups to help maintain abstinence from alcohol and drugs.

NA members believe that addiction is treatable, but not curable to where they could ever control using a substance again. The path of staying clean and maintaining physical, mental and spiritual health helps addicts reform, improve themselves and their family relationships.

NA Kaua‘i meets nearly every day of the week at various places around the island. Call 828-1674 or www.na-hawaii.org.

The Salvation Army of Hawai‘i and the Pacific Islands offers structured outpatient programs with classes and support.

The Kaua‘i Salvation Army centers in Hanapepe (335-5441) and Lihu‘e (245-2571) offer free services and assistance, a shelter and children’s program, counseling and a pastor.

Child and Family Service in Lihu‘e (245-5914) is a substance abuse outreach program with early intervention and treatment for pregnant and parenting women. Its Baby Safe program accepts infants for drug and alcohol screening.

Hina Mauka Recovery Center in Lihu‘e (245-8883, hinamauka.org) offers evaluation, treatment and referral services to individuals and families dealing with substance abuse. Its Teen C.A.R.E. school based outpatient treatment offers services for adolescents at school.

Codependents Anonymous (245-5870, coda.org) is an support system for people with friends or loved-ones that are addicts. There are meetings, information services, and a 12-step fellowship.

Kaua‘i Veterans Center in Lihu‘e is a good starting point for programs or referrals. Call 246-1163 or visit kauaiveteranscenter.com.

The 24-hour Hawai‘i Department of Health Access Line is 800-753-6879. Call for general information about health, mental health and addiction.

A complete directory of substance abuse treatment programs is compiled by the Regional Alcohol & Drug Awareness Resource of the Network Center of Prevention Resource Center, Hawai‘i at drugfreehawaii.org.

• Tom LaVenture, staff writer, can be reached at 245-3681 (ext. 224) or by emailing tlaventure@ thegardenisland.com.