Workplace injuries happen everyday, and more often than not, the injured worker will be prescribed an opioid as a way to help ease the pain and lasting issues associated with the immediate injury. Whether the ultimate treatment for the injury involves surgery, physical therapy, or another treatment, medical professionals often turn to opioids like Vicodin or Oxycodone to placate the injured worker’s reported pain.
Risk of Opioid Dependence
As well as they may work to reduce pain levels, the unfortunate truth about opioids is that they are highly addictive, and they have been shown to increase pain sensitivity, called Opioid-induced hyperalgesia (OIH), which creates a vicious cycle of increased pain, increased dosage, increased tolerance and increased risk of dependence and overdose. Several studies, including one in JAMA, show that as many as one-third of workers who begin using opioids for a workplace injury become addicted to them — which can hinder both the treatment and recovery for the injury, as well as their timetable to return to work and living a productive life.
One report from the CDC found that among adults (non-cancer patients) who received a prescription for opioids, the likelihood of chronic opioid use started after just three days of the medication, and increased with each additional day of medication supplied. The most dramatic increase among these patients was seen after the fifth day of taking opioids, and the highest probability of continued opioid use at 1 and 3 years was seen among patients who were prescribed long-acting opioids like Fentanyl or Morphine.
Increased Time Off Work
The research is strong enough that some medical groups have begun recommending against prescribing opioids for less severe injuries, as developing an addiction after a workplace injury has become a growing concern in industries around the world. Although some medical communities may see opioids as the best (or only) option for getting injured workers back to work — particularly for injuries that can’t be resolved with surgery and will likely linger for an extended period of time — opioid use triples a worker’s time spent on disability, on average.
Considering that the time spent on disability doesn’t even factor in other possible side effects of becoming dependent on opioids, the risks associated with the popular painkillers can make them a dangerous choice for anyone suffering from a workplace injury. Although they may seem necessary for a physician who has “tried everything”, finding an alternative source of pain relief could spare employees, employers, and workers compensation carriers all over the world from the weeks, months, or even years of suffering that opioids can lead to.
There are evidence-based alternative treatments for pain that focus on changing one’s beliefs and removing fear around pain – altering the pain experience. An effective and integrated pain recovery program, like Roots Chronic Pain Recovery, utilizes approaches including mindfulness, cognitive behavioral therapy, psychoeducation, EMDR, and art therapy, and integrates yoga, tai chi, physical therapy, family therapy, and other modalities.
“The goal is to get people moving again”, says Dr. Michael Aquino, PT, DPT, “The less people move out of fear of further injury, the more pain they will experience.”
Roots Chronic Pain Recovery has developed a mind-body approach to treat chronic pain and opioid dependency. With personalized treatment and an interdisciplinary team, we can help you regain control of your body – and your life.
EMDR has received some notable attention recently thanks to its effectiveness in treating trauma. There is a lot of information available online and in academic literature of the therapy, so we put together this article as an overview of EMDR to help you understand what it is and how it works.
So what exactly is EMDR and how does it work?
EMDR stands for Eye Movement Desensitization and Reprocessing, and it involves 8 phases including the use of eye movement, or bilateral stimulation, which appears to be similar to what occurs naturally during dreaming or REM (rapid eye movement) sleep. As we wrote about in past blogs, when a person experiences a traumatic event, their brain goes into defense mode and changes its function.
One of these functions includes the hippocampus, which usually works to store memories in a neat filing system that allows us to easily and accurately recall these memories. When faced with a threat, the hippocampus takes on the role of pumping cortisol throughout the body so that we don’t feel pain, and puts the memory storage on the back burner. So it’s no wonder it’s incredibly difficult to recall a traumatic event, or we recall it inaccurately by filling in the blanks later on.
EMDR allows us to go deep into the brain and file these memories with the appropriate meanings and emotions attached to them. According to the EMDR International Association, the goal of EMDR is to:
“Process completely the experiences that are causing problems, and to include new ones that are needed for full health… That means that what is useful to you from an experience will be learned, and stored with appropriate emotions in your brain, and be able to guide you in positive ways in the future. The inappropriate emotions, beliefs, and body sensations will be discarded… The goal of EMDR therapy is to leave you with the emotions, understanding, and perspectives that will lead to healthy and useful behaviors and interactions.”
One of the leading experts on developmental trauma and author of The Body Keeps the Score, Dr. Bessel van der Kolk recalls the experience he had using EMDR on a patient when he realized the power of the therapy. Watch below:
What are the 8 phases of EMDR?
Phase 1: The first phase is a history-taking session(s). The therapist assesses the client’s readiness and develops a treatment plan. Client and therapist identify possible targets for EMDR processing.
Phase 2: During the second phase of treatment, the therapist ensures that the client has several different ways of handling emotional distress. The therapist may teach the client a variety of imagery and stress reduction techniques the client can use during and between sessions. A goal of EMDR therapy is to produce rapid and effective change while the client maintains equilibrium during and between sessions.
Phases 3-6: In phases three to six, a target is identified and processed using EMDR therapy procedures. These involve the client identifying three things:
1. The vivid visual image related to the memory
2. A negative belief about self
3. Related emotions and body sensations.
In addition, the client identifies a positive belief. The therapist helps the client rate the positive belief as well as the intensity of the negative emotions. After this, the client is instructed to focus on the image, negative thought, and body sensations while simultaneously engaging in EMDR processing using sets of bilateral stimulation. These sets may include eye movements, taps, or tones.
Phase 7: In phase seven, closure, the therapist asks the client to keep a log during the week. The log should document any related material that may arise. It serves to remind the client of the self-calming activities that were mastered in phase two.
Phase 8: The next session begins with phase eight. Phase eight consists of examining the progress made thus far. The EMDR treatment processes all related historical events, current incidents that elicit distress, and future events that will require different responses.
Does it actually work?
At least 20 positive controlled outcome studies have been done on EMDR therapy. According to the EMDR Institute, which hosts a comprehensive list of EMDR-related research, some of the studies show that 84%-90% of single-trauma victims no longer have post-traumatic stress disorder after only three 90-minute sessions. Another study, funded by the HMO Kaiser Permanente, found that 100% of the single-trauma victims and 77% of multiple trauma victims no longer were diagnosed with PTSD after only six, 50-minute sessions.
EMDR International Association reports on the same topic, “Clients often report improvement in other associated symptoms such as anxiety. The current treatment guidelines of the American Psychiatric Association and the International Society for Traumatic Stress Studies designate EMDR as an effective treatment for post traumatic stress. EMDR was also found effective by the U.S. Department of Veterans Affairs and Department of Defense, the United Kingdom Department of Health, the Israeli National Council for Mental Health, and many other international health and governmental agencies. Research has also shown that EMDR can be an efficient and rapid treatment” (www.emdria.org).
Who does EMDR?
Only Masters-level or Doctoral-level professionals–therapists, nurses and doctors–who have gone through approved EMDR training can provide EMDR to people. Roots Through Recovery is proud to have two clinicians on our team that are trained and certified to provide EMDR. Clients who have undergone EMDR therapy for trauma have seen great improvement in their management of traumatic experiences, and how that plays a role in their addictions and mental health.
Roots Through Recovery opened its doors in January 2017 and in the last four months, the program has grown to include daytime partial hospitalization and morning intensive outpatient to meet the various needs of our clients. There has been a lot of interest in recent weeks for an evening intensive outpatient program for the working professionals in Long Beach and the South Bay.
In response to this growing need, Roots Through Recovery is excited to announce the start of its evening IOP program beginning the week of May 15th!
CALL NOW (562) 473-0827
Much like our daytime programs, the evening IOP program will focus on addressing underlying trauma and mental health needs of community members who are coping with alcohol or drug addiction. Our compassionate and highly trained therapists provide trauma-informed care in small groups and individual therapy.
Travis will discuss how to navigate the behavioral healthcare treatment system and touch on topics like levels of care, accreditation, and referral brokering.
He’ll also provide insights into understanding insurance types and policies, including NC and PA Medicaid, Medicare, and private or commercial insurance.
A Mindful Emergence provides an in-depth and informative look into addiction recovery, trauma relief, and compassionate self-care.
Travis Herman is the National Representative for Pyramid Healthcare and has extensive experience in the helping industry. Travis is a graduate of UNC-Asheville and started his behavioral health career in 2008. His first job involved working with people with severe and persistent mental health struggles. Additional experience includes Substance Use treatment for adolescents, adults in the criminal justice system, and has worked on Community Support, and Assertive Community Treatment teams.
This work experience, and passion for customer service, provides Travis wit
h the unique experience and ability to identify needs in our community, build relationships with stake holders, and collaborate on how best to serve those seeking treatment for mental health and substance use struggles.
Most people who work in recovery or are in recovery themselves, or both, would agree that social connections are important for long-term recovery from addiction. The level of external support individuals have is often referred to as Social Capital or Recovery Capital, which for the purpose of this article, we are defining as:
The abundance of positive social relationships and connections, specifically across the domains of social supports, spirituality, life meaning, and involvement in a recovery community.
Individuals coping with substance use or dependence are often treated as patients with an acute illness, as one would be treated in the ER or urgent care:
which research proves is not an effective approach to achieving sustainable recovery. Alexandre Laudet, PhD., Director of the Center for the Study of Addictions and Recovery (C-STAR) at the National Development and Research Institutes suggests that if one considers addiction to be a chronic condition, a conjecture increasingly accepted in the field, then being in remission (recovery) should be thought about in terms of a long-term process that unfolds over time, rather than a time-limited ‘event’.
The theory of recovery capital suggests that the more abundant our recovery capital, the greater the likelihood we will remain in recovery. We see the value of this connection to community at the very core of sober living environments and groups like Alcoholics Anonymous, an international fellowship of more than 2 million men and women with an alcohol dependence, and their associated groups including Narcotics Anonymous and Cocaine Anonymous. Not surprisingly, we see poorer outcomes and frequent relapse in those who leave treatment, even long-term treatment, without a social network to support them in recovery.
Longitudinal studies, like that of Dr. Laudet’s, exemplify the critical value of social and recovery capital at the various stages of recovery, allowing us to most effectively incorporate these practices into assessment, treatment planning and discharge planning. Whether you’re a staunch supporter of 12-step recovery, a believer in the value of psychotherapy or biomedical treatments, or have embraced the combination of these approaches, it is becoming increasingly more difficult to deny the impact of connections and social support in long-term recovery, both positive and negative.
Taking into consideration the number of connections isn’t enough to determine the impact they will have on an individual in recovery; rather, we must account for the value of each connection, or perceived value. The complex web below shows that our social and peer connections differ in impact based largely on perception. For example, communication can be seen as a sign of caring and concern–a component of emotional support–and therefore, helpful to recovery. In contrast, criticism (a form of communication) may be perceived as unsupportive and therefore harmful to recovery, regardless of intention.
What if having a large, closely-knit social and peer network was detrimental to recovery? The role of social networks and peer support in recovery has been studied for quite some time; and although the research overwhelmingly sways in the direction of the positive impact social networks play in our recovery, a recent NPR article about the increase in opioid abuse in rural communities–in sharp contrast–points to social networks as a main contributor.
The story follows Melissa Morris, whose story of addiction started like many others–with a prescription to Percocet, an opioid pain killer. She got hooked, and when the Percocet stopped getting her high, Morris then started injecting Oxycontin. After that, she got her hands on Fentanyl patches, a highly addictive and potent opioid, and would chew on them instead of applying them to skin as the package directed. When the prescriptions stopped coming, she turned to a cheap and easy option: heroin. Morris’ story is much like what we are seeing across the country, and especially in rural communities.
The CDC reports three out of four new heroin users report abusing prescription opioids prior to trying heroin.
In the U.S., heroin-related deaths more than tripled between 2010 and 2015, with 12,989 heroin deaths in 2015.
According to the U.S. Centers for Disease Control and Prevention, opioids were involved in more than 33,000 deaths in 2015 — four times as many opioid-involved deaths as in 2000.
A recent University of Michigan study found the rates of babies born with symptoms of withdrawal from opioids rising much faster in rural areas than urban ones.
So what role do social networks play in the opioid epidemic? The publication about rural Colorado, titled “Rural Colorado’s Opioid Connections Might Hold Clues To Better Treatment”, in addition to limited access to alternative treatments for pain like physical therapy, found in speaking with individuals struggling with opioid addiction that these communities saw an increase in misuse and dependence because rural residents know and interact with roughly double the number of people an average urban resident does. Counterintuitively maybe, this “small town” social network provides members of rural communities twice the number of opportunities to access drugs, according to Kirk Dombrowski, a sociologist at the University of Nebraska-Lincoln.
“So some of those social factors of being in a small town can definitely contribute,” Dombrowski says.
Melissa Morris of Sterling, Colorado. Credit: Luke Runyon/Harvest Public Media
But, like Dr. Laudet’s findings, the Colorado resident Melissa Morris describes how the size of your social network doesn’t define the risk, but rather, the value of the network is often at play. She says that close social ties in her town may have contributed to the spread of opioids there as those bonds can spread drug use quickly, however they can reduce the spread of drugs in other ways. Morris, who is now on Suboxone to help her with her opioid addiction, recently recruited two opioid-dependent friends to the clinic she goes to weekly for treatment.
“I used to sell them pill and heroin,” says Morris, who is now helping these friends get clean. “And so I do have hope. I’ve seen those success stories.”
This consideration of the value, and perceived value, of social networks has great implications for the field of addiction research and treatment. Often times, providers ensure clients broaden their social network and surround themselves with “positive influences”, but as treatment providers, it should be a regular practice to give individuals in recovery the tools needed to regularly take an inventory. We should assess the impact individuals have (are they helpful or harmful?) often as this can frequently change, as our once drug dealers can enter treatment and have a positive impact on our recovery.