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medication assisted treatment for addiction
There is a big move in addictions treatment to utilize medications in an attempt to improve success rates in keeping people sober. The following are selections pulled from wikipedia on the most common medications for MAT (medication assisted treatment). Clinical literature and my own experience show that MATs can be a nice adjunct to counseling and social and spiritual supports but are not a replacement for a genuine recovery experience. There are approved MATs for alcohol and opiates with both agonists (activate receptor sites in a similar but safer way then the drug) and antagonists (block receptor sites). For alcohol there is also antabuse which prevents the usual breakdown of alcohol and massively increases the chemicals related to hangover resulting in an immediate negative experience upon consumption. There are significant side effects and contraindications with all of these approaches and everyone in the treatment field or who struggles with addiction would be well advised to do some homework on possible medication options.
Medication Assisted Treatment Medicines (from Wikipedia)
Acamprosate (brand name: Campral):Acamprosate is thought to stabilize the chemical balance in the brain that would otherwise be disrupted by alcoholism, possibly by blocking glutamatergic N-methyl-D-aspartate receptors, while gamma-aminobutyric acid (GABA) type A receptors are activated. Alcohol inhibits activity of biochemical receptors called N-methyl-D-aspartate receptors, or NMDARs, so that chronic alcohol consumption leads to the overproduction (upregulation) of these receptors . Thus, sudden alcohol abstinence causes these excessive numbers of NMDARs to be more active than normal and to produce the symptoms of delirium tremens and excitotoxic neuronal death.[9] Withdrawal from alcohol induces a surge in release of excitatory neurotransmitters like glutamate, which activates NMDARs.[10] Acamprosate reduces this glutamate surge.[11] The drug also protects cultured cells in excitotoxicity induced by ethanol withdrawal.[12] and by glutamate exposure combined with ethanol withdrawal.[13]In addition to its apparent ability to help patients refrain from drinking, some evidence suggests that acamprosate is neuroprotective (that is, it protects neurons from damage and death caused by effects of alcohol withdrawal and possibly other insults). Reports indicate that acamprosate only works with a combination of attending support groups and abstinence from alcohol.[3] Certain serious side effects include allergic reactions, irregular heartbeats, and low or high blood pressure, while less serious side effects include headaches, insomnia, and impotence.[4] Acamprosate should not be taken by people with kidney problems or allergies to the drug. FDA concluded: “Campral proved superior to placebo in maintaining abstinence (keeping patients off alcohol consumption), as indicated by a greater percentage of acamprosate-treated subjects being assessed as continuously abstinent throughout treatment. Campral is not addicting and was generally well-tolerated in clinical trials. The most common adverse events reported for patients taking Campral included headache, diarrhea, flatulence, and nausea.”
Buprenorphine (Subutex, Temgesic, or Suboxone [buprenorphine:naloxone 4:1 preparation] – sublingual tablets – Buprenex – for injection – and Norspan – transdermal patch) is a semi-synthetic opioid that is used to treat opioid addiction in higher dosages (>2 mg) and to control moderate pain in non-opioid tolerant individuals in lower dosages (~200 µg).
Disulfiram is a drug used to support the treatment of chronic alcoholism by producing an acute sensitivity to alcohol. Trade names for disulfiram in different countries are Antabuse and Antabus manufactured by Odyssey Pharmaceuticals. Disulfiram is also being studied as a treatment for cocaine dependence, as it prevents the breakdown of dopamine (a neurotransmitter whose release is stimulated by cocaine); the excess dopamine results in increased anxiety, higher blood pressure, restlessness and other unpleasant symptoms. Under normal metabolism, alcohol is broken down in the liver by the enzyme alcohol dehydrogenase to acetaldehyde, which is then converted by the enzyme acetaldehyde dehydrogenase to the harmless acetic acid. Disulfiram blocks this reaction at the intermediate stage by blocking the enzyme acetaldehyde dehydrogenase. After alcohol intake under the influence of disulfiram, the concentration of acetaldehyde in the blood may be 5 to 10 times higher than that found during metabolism of the same amount of alcohol alone. As acetaldehyde is one of the major causes of the symptoms of a “hangover” this produces immediate and severe negative reaction to alcohol intake. Some 5–10 minutes after alcohol intake, the patient may experience the effects of a severe hangover for a period of 30 minutes up to several hours. Symptoms include flushing of the skin, accelerated heart rate, shortness of breath, nausea, vomiting, throbbing headache, visual disturbance, mental confusion, postural fainting, and circulatory collapse. Disulfiram should not be taken if alcohol has been consumed in the last 12 hours. There is no tolerance to disulfiram: the longer it is taken, the stronger its effects. As disulfiram is absorbed slowly through the digestive tract and eliminated slowly by the body the effects may last for up to two weeks after the initial intake; consequently, medical ethics dictate that patients must be fully informed about the disulfiram-alcohol reaction.[4] A recent nine-year study found that incorporation of supervised disulfiram and a related compound calcium carbimide into a comprehensive treatment program resulted in an abstinence rate of over 50%.
Naltrexone is an opioid receptor antagonist used primarily in the management of alcohol dependence and opioid dependence. It is marketed in generic form as its hydrochloride salt, naltrexone hydrochloride, and marketed under the trade names Revia and Depade. In some countries including the United States, an extended-release formulation is marketed under the trade name Vivitrol. Also in the US, Methylnaltrexone Bromide, a closely related drug, is marketed as Relistor, for the treatment of opioid induced constipation. Naltrxone should not be confused with naloxone (which is used in emergency cases of overdose rather than for longer-term dependence control) nor nalorphine. Both nalorphine and naloxone are full antagonists and will treat an opioid overdose, but naltrexone is longer-acting than naloxone (although neither is an irreversible antagonist like naloxazone), making naloxone a better emergency antidote. Its use in alcohol (ethanol) dependence has been studied and has been shown to be effective [1]. Its mechanism of action in this indication is not fully understood, but as an opioid-receptor antagonist it’s likely to be due[citation needed] to the modulation of the dopaminergic mesolimbic pathway which is hypothesised to be a major center of the reward associated with addiction (being one of the primary centers for risk-reward analysis in the brain, and a tertiary “pleasure center”) that all major drugs of abuse are believed to activate. The standard regimen is one 50 mg tablet per day. Initial problems of nausea usually disappear after a few days, and other side effects (e.g., heightened liver enzymes) are rare. Drug interactions are not significant, besides the obvious antagonism of opioid analgesics. Naltrexone has two effects on alcohol consumption.[8] The first is to reduce craving while naltrexone is being taken. The second, referred to as the Sinclair Method, occurs when naltrexone is taken in conjunction with normal drinking, and this reduces craving over time. The first effect persists only while the naltrexone is being taken, but the second persists as long as the alcoholic does not drink without first taking naltrexone. In alcohol dependence, naltrexone is considered a safe medication. Control of liver values prior to initiation of treatment is recommended. There has been some controversy regarding the use of opioid-receptor antagonists, such as naltrexone, in the long-term management of opioid dependence due to the effect of these agents in sensitising the opioid receptors. That is, after therapy, the opioid receptors continue to have increased sensitivity for a period during which the patient is at increased risk of opioid overdose. This effect reinforces the necessity of monitoring of therapy and provision of patient support measures by medical practitioners. Naltrexone can induce early morning erections in patients who suffer from psychogenic erectile dysfunction. The exact pathway of this effect is unknown. Priapism has been reported in two individuals receiving Vivitrol. Naltrexone has been shown to be effective in the reversal of sexual satiety and exhaustion in male rats.[22]The Chicago Stop Smoking Research Project at the University of Chicago studied whether naltrexone could be used as an aid to quit smoking. The researchers discovered that Naltrexone improved smoking cessation rates in women by fifty percent, but showed no improvement for men.[23] Some studies suggest that self-injurious behaviors present in developmentally disabled and autistic people can sometimes be remedied with naltrexone.[25] In these cases, it is believed that the self-injury is being done to release beta-endorphin, which binds to the same receptors as heroin and morphine.[26] By removing the “rush” generated by self-injury, the behavior may stop. Naltrexone helps patients overcome urges to abuse opiates by blocking the drugs’ euphoric effects. While some patients do well with the oral formulation, there is a drawback in that it must be taken daily, and a patient whose craving becomes overwhelming can obtain opiate euphoria simply by skipping a dose before resuming abuse. There are indications that naltrexone might be beneficial in the treatment of impulse control disorders such as kleptomania (compulsive stealing), trichotillomania, or pathological gambling.[28] Clinical trials are ongoing regarding the use of naltrexone in combination with another drug, bupropion, as a weight loss therapy.[29]
Alcohol Dependence and Anti-Depressants
In 2002, Dr. Fulton T. Crews, Bowles Center director, and Bowles Center research associate Dr. Kim Nixon were the first to report that alcohol, during intoxication, has a detrimental effect on the formation of new neurons in the adult rat hippocampus. This brain region is important for learning and memory – in animals and humans – and is linked to psychiatric disorders, particularly depression.
“When used in excess, alcohol damages brain structure and function. Alcoholics have impairments in the ability to reason, plan or remember,” said Crews, also professor of pharmacology and psychiatry in UNC’s School of Medicine. “A variety of psychological tests show alcoholics have a difficulty in ability to understand negative consequences.”
In the new study, senior co-author Crews and co-author Nixon found inhibition of neurogenesis, or brain cell development, during alcohol dependency, followed by a pronounced increase in new neuron formation in the hippocampus within four-to-five weeks of abstinence. This included a twofold burst in brain cell proliferation at day seven of abstinence.
“And when they stop drinking, you can show in a period of weeks, months, years, the brain grows back, there’s a return of metabolic activity, and cognitive tests show a return of function,” Crews said.
“Pharmacological agents such as antidepressants and behaviors such as running, increased physical activity and learning experiences apparently help regulate the process of neurogenesis,” he added. “Our research suggests they could be considered in the treatment of chronic alcohol dependency.”
Holiday Letter 2010
Its been another event filled year here on Leslie Lane. Not all pleasant or easy but each day an opportunity to grow, learn, and be more engaged in the world around us.
We rung in the new year quietly at home. Began the trend of 2010 of not going to social events even if I had said I was going. Even planning in advance couldn’t get me out of the house to socialize this year. But when I got out of the house I got out of the house. In March John, Shadow & Smokey came through picked me up and we drove on down to FLA. We went all the way to the bottom camping at Big Cypress National Wildlife Refuge, moving on to the Everglades, and day tripping down into the Florida Keys. We hit some national forest in the north and some beach on the Florida Pan Handle. It was a great trip and made the oil spill more poignant having just seen the area. Again my biggest impression was the incredibly rich biodiverse Everglades with the near desert like monoculture of our present day agriculture. Night and day the incredible shrinking of life. We are all criminals and murderers. I still bought oranges.
I got home from vaca with a bit of a stiff neck which evolved into intense back and neck pain which was ultimately diagnosed as a pinched nerve from some bulging discs (C-4 & C-5 i think). Physical therapy adjustments seemed to do the trick and haven’t had too much problems with it. It was scary at the time, made me thankful to have two arms that work.
Work-wise the beginning of the year was fruitful. I enjoyed my role of trying to foster a Dual Recovery Anonymous meeting. I also continued working with the Missouri Cadre for Co-Occurring Excellence and enjoyed a strategic planning retreat at a really cool resort. Saw a bluebird thanks to the new license plates (they’re our state bird). Ultimately resigned my leadership position with the Cadre, too much happening at the agency.
In May we celebrated the end of Lost. Until then we had a house full every Tuesday to watch, same as last year. We didn’t do costumes, theme food, or Dharma stuff because we did all that for the season premiere party. We just watched TV together. In retrospect I thought Lost ended pretty good, not perfect but good enough.
Myrtle died this year. That was sad as hell. We dug her a deep hole and planted some Greek Myrtle. She was a beautiful dog, quite a character for her only three years. Dad took some solace in Oni, but to be frank she was a piss poor primary dog. slept all day, pissed on the furniture. mostly my bed and the couch. one night she pissed my bed pretty good and i was headed to bed late and suddenly had to go sleep on the futon in the living room where dad was trying to watch a movie. i grumped some and he took her to the humane society. We followed her on the internet she was in foster care with second chance. Just looked for her and couldn’t find her picture, hope she got adopted.
June was interesting because I seized an opportunity when the agency burned through its contract prior to the end of the fiscal year (huge huge budget cuts once the federal support to state stimulus was used up) and i was granted a few weeks off without pay at my request. gardened up a storm and did some ozark adventure. went to johnson’s shut ins, elephant rocks, all that stuff. had some nice camping with Oni.
2010 was also a year for making new friends in far off places. We had some exchange students from Taiwan who were observing the batterer intervention program i worked at my part time job over for a couple of barbecues. Took them to the Devil’s Ice Box (a local cave) and down to the Lake of the Ozarks for outlet mall shopping with John when he was visiting (saw a lot of John in 2010). They’re enthusiasm was infectious. Also spent a lot of time with Amy’s friend Belen who visited for the summer from Spain. Took her to Jefferson City to see the monuments and we broke into a Catholic Church. Very cool seeing the familiar from fresh perspectives and breaking things down to communicate with very smart women but whom English is a second language. Learned a lot about myself and my world.
Speaking of Amy, I was flattered to be asked to officiate she and Michael’s wedding. It went very well and was a charming affair. The only down side was the AC was on the fritz and I sweated like a pig. Drenched my shirt clean through.
Dad had some health issues early in the year. A lot of unexplained weight loss. Turned out to be celiac disease forcing us to go gluten free. We’ve made a lot of adjustment. Bread is probably the thing Dad misses the most. There’s just no adequate substitute. Corn tortillas come the closest. For me its been good. We eat a lot less processed food. Buy stuff a lot more in its natural condition. No more hamburger helper.
In July work picked up when I switched from doing the co-occurring stuff to being the senior counselor. With state cut backs its been a bit of a mad scramble. We’re trying to make some changes and it seems to be getting doable. Very engaging overall, love my education groups, love being a part of people making good changes in their lives. Not a hint of boredom yet.
Myrtle’s death and Oni’s eviction left a dog shaped hole but only for a couple few weeks. Dad saw an add in the free classifieds and picked Fido up at 4 months. He’s half Bichon Frise (the little teddy bear looking poodle dogs) and half Cocker Spaniel or Cockechon, although he was advertised in the paper as a Cockapoo and that is what Dad will tell you the dog is.
Fido’s first road trip was back to the homeland to meet everyone at the family reunion. He got a little car sick but enjoyed meeting all the people and dogs. He’s continued to liven up the house and we like to walk the piece of the Bear Creek Trail by us.
The Big Muddy was high most of the summer so didn’t float a lot. Did float at the flooded out Overton Bottoms and enjoyed the heck out of canoeing through the woods. Whoop, the brownies need checking…… Not too bad for gluten free.
The Fall was pretty uneventful. Brought a bigger and homemade compost bin on line, thanks Dad and ended up with a pretty decent garden harvest. Brenda, Heather, and John made it out for Thanksgiving which we did up right with all local made from scratch dishes including our pasture raised bird. Ended up using a lot of my holiday energy to pull that off so we are taking a minimalist approach to Christmas. It will be our first Christmas at Leslie Lane breaking the last five or six years of spending the holiday camping or in a hotel.
On Christmas Eve we are going to Outback and perhaps go see True Grit. Christmas morning I’m working. I got permission to show A Charlie Brown Christmas for my ed group and I plan talking about cultivating our inner Linus. Dad is making a ham for the big day and I’m having a former homeless guy over for dinner. Its his birthday and he doesn’t have anyone and a guest will make it all the more festive. Boxing Day we plan on spending with Amy and Michael for more ham and such. Bought a Norfolk Pine and decked it out as the holiday tree as part of my adding more houseplants to the mix. Also picked up a nice Christmas cactus.
The new years is then upon us and i am gearing up for a major new resolution. Details TBA. Hope your holidays are filled with peace and joy light and love.
thanksgiving menu
After a 5 day holiday its time to wake up tomorrow and return to regular life. The 9 1/2 hour horror show that is the typical monday these days. Its a good time to sum up and most of that summing up is cooking.
I really started the weekend before by making corn bread and chicken stock. The corn bread I doubled the recipe on the corn bread box and added the left over grits from breakfast. That made them moist and good but it didn’t really dry out as much as I would have liked . I cut it up into squares a couple of days before Thanksgiving but should have done it the day I made it. I tossed it in the oven a couple of times on a low temp to dry it out further.
The stock I made out of neck and back & organs of a local chicken that i simmered with a couple of bay leaves for 4 hours. I kept it in the fridge and scooped off the condensed fat. I also added the broth from any veggies i cooked during the week. I had intended to use it in the dressing but when the cooking got into a team sport plans changed.
The day before I pulled one of the pumpkins off the front porch and pealed and chopped and seasoned and cooked all the flesh. I used a lot of fresh ground spices, nutmeg, cinnamon stick, anise star, all spice, and fresh ginger. I figured letting it sit over night the spices would mix and instill themselves in the pumpkin. I ended up underspicing by a considerable degree. I probably didn’t fully realize just how much pumpkin i was dealing with. I also baked some pumpkin seeds with salt and a little lime, they were delicious. I left a few for the compost i’ve had good luck with volunteer pumpkins.
I also brined the turkey. I put in the cooler with 2 gallons of water a cup of sugar and a cup of kosher salt. the turkey i had ordered a couple weeks ago from some local farmers and then picked up on Tuesday at Cafe Berlin. I got the biggest one they had 17 lbs. more because i wanted to ensure i got a female more than i wanted a giant bird. I had to put it in the cooler on its side and it ended up bruised on one side. There was a little talk on facebook about brining and its done to both clean it and tenderize the meat. When you buy it in the grocery store its already packed in salt water.
The day of I started cooking a little before 7. I rinsed off the turkey and patted it dry. I rubbed it inside and out with olive oil and stuffed it with 2 local pears, 3 big cloves of garlic, and a white onion. I baked it at 425 for an hour and then backed it off to 325. Pretty much according to the directions from the farmers. I baked it upside down both to keep the breast meat moist and because it was too big for the roaster pan.
While it was baking Brenda put the neck and organs boiling with a half of a pack of celery. I added maybe 4 tbsps fresh picked white sage and maybe 2 of oregano plus a bay leaf and we boiled that for about 3 hours. Someone turned up the fire or I would have let it go 4. Brenda combined that with the cornbread and some more fresh sage and I roasted some fresh chest nuts and diced them in and that was it.
Early on in the day i made pie crusts. I found a gluten free recipe on line. folded in shortening into rice flour. i was regretting not getting lard, supposed to make crusts flakier. I made one the same way with wheat flour it wasn’t any good. I baked them for about 20 minutes with the turkey. two i did with pumpkin. added some egg, brown sugar, and condensed milk. My sister Betty had sent a quart of minced meat from my grandma trapp’s recipe so i made a minced meat pie as well. it was excellent. one of the better gluten free deserts i’ve had.she had also sent down some gluten free cranberry bread. we broke that out with coffee in lieu of breakfast since we were having a giant meal early.
Then got the stove top stuff ready. Cubed up some red potatoes from the market for mashed taters. Made them pretty classic with whole milk and butter and fresh ground pepper. Brenda made gravy out of turkey drippings, corn starch and I pulled up a horeradish and cleaned it up. Freshly grated it was good. Don’t think I’m going to prepare it just keep it fresh in the freezer and grate as needed, just like I do my ginger.
We also did butternut squash also mashed with brown sugar, butter, and roasted walnuts. The sweet potatoes i did in small cubes cooked on the stove top in the water from the pumpkins. I grated in extra star anise and fresh ginger and added butter and Springfield honey. they were a little mushy from scaling up the recipe.
Brenda and Heather brought a Panerra cheese bread and we chunked it up and toasted with butter and garlic powder. Did a relish tray with my dill and bread & butter pickles, black and green olives. I opened a chilled can of whole cranberries, fluffed with a fork and it was dinner. I was most appreciative of the teamwork. Everyone jumped in to help which made it really nice and allowed us to eat a couple hours earlier.
foundational moles
We’re debating moles here on Leslie Lane. My attitude has been live and let live. They aerate the soil which my clay pit desperately needs and don’t do anything but cosmetic damage. I am not going for a vast expanse of monoculture grass so the tracks haven’t really bothered me. Its not really noticeable curbside but its been a growing problem. This fall a bunch of tunnels have appeared near the house, i’m guessing to take advantage of the warmer soil. Dad claims they’ll wreck the foundation. I am dubious but dad is right enough it led me to an internet search. Couldn’t find any indications they do any damage except cosmetic damage to lawns. They’re tunnels appear to collect nuisances as when you eliminate them new critters move in, other moles, mice, wasps & hornets and such. I’m not thrilled with my ever growing system of mole tunnels but killing the little bastards seems extreme and likely to invite new invaders to move into the vacuum. So for now i will share the yard with my myopic friends. If they become problematic or i learn something that changes my mind i’ll invest in a mole trap. With my already extant tunnel system i can expect it to be a reoccurring issue.
from computer fast to thanksgiving feast
its been a little minute since i’ve posted anything. i was without a computer. i broke my power cord in the same place that i broke the last one so i decided i needed to change my computer usage and it took me a few weeks to get my desk moved and set up in the spare room so i could try to move most of my computing and all of my plugged in computer time in the office. but what i found was i kind of enjoyed not playing on the computer. freed up some time which i promptly wasted reading novels, re-read snowcrash and the diamond age both just as good a second thoughtful time through. floated the lemine river the last 12 miles before the the 2 miles before the mouth of the missouri. loverly it was. saw a beautiful bald eagle, piliated woodpecker and great hawk and great blue heron sitings. floating is a misnomer though as if we would have allowed for current we would probably still be there. there were places were the leaves had fallen and they just stayed there, very beautiful. patches of color but mostly bare so you could see through the woods like you can in winter. some pretty bluffs. nice big easy river. not a lot of motor boats on a cool fall day. dad finished the new compost bin. its a lot bigger a square plywood box framed with two by fours and a plywood bin. today at lunch i raked leaves and layered them in with the house coffee and scraps and started shoveling in the top layers of my compost that’s been going. i think there’s probably a fair bit finished down below and i’m gonna mix it in to make the leaves go faster. should have enough capacity to hold all of my fall plant material at once. i want to use the compost to turn up a couple of beds hopefully of spinach, lettuce, and kale. still need to harvest the horseradish but its still green so i’m letting it grow. i bought alcohol to process the witch hazel tincture, european style not distilled like i’ve always used. i’m waiting for it to lose the rest of its leaves and i’m going to prune off suckers. also have a pretty darn local thanksgiving feast in the works. brenda and heather are driving down bless their hearts. i ordered a pasture raised bobtail white, next year i’m going to heritage, but i’m excited nonetheless, littler than a factory bird but realer and there’s only going to be four or so. plus i’m gonna do mashed taters, red if there’s some left. i’m going to hit the market first thing. i’m also doing sweet potatoes cubed and cooked in a little water in the cast iron skillet with spinach, fresh chopped ginger, freshly ground star anise & nutmeg (my bastardization of a recipe i had at Jack’s Steakhouse on HT3’s b-day dinner [a very cool affair with live piano, a beef mushroom wine soup, a wine soaked local streak, the sweet potatoes, and a baked alaska for two{suitable for four}]). and butternut squash with brown sugar, butter and roasted nuts (not pecans this year’s don’t come out for two more weeks.) cornbread dressing with fresh roasted chestnuts and the nasty bits of the turkey (neck and organs [i love my family]). some type of cranberry dish, maybe just the canned kind (not the tube though). also will have the homemade bread & butter pickles that get better and better as they sit. got a bottle of a nice italian red. taking the day before to cook. sightseeing and an AA meeting on black friday, the first day of winter market with brenda and heather (those pecans i mentioned and a breakfast burrito) and then see them off with two days of weekend to clean up and deal with leftovers and relax before the grind. life is sweet. i am blessed and looking forward to a full holiday season at my own home for the first time in my life. greetings to the national christmas tree which is winding around wyoming enroute to columbia to spend the night at the holiday inn. sorry i won’t get across town to get you a commemorative ornament. know that i love you just the same.
fall gardening
I’ve gotten to do a bit of gardening after work yesterday and some this morning, nice fall stuff. Back by Myrtle’s greek myrtle grave blanket I extended the bed to the west to put in some tulips and daffodils with crocus on the front. Its by the bird feeder so i thought dad would enjoy the crocuses when he feeds the birds this spring. I had first extended that bed to the south and put in a row of daylilies i had gotten from the market. So I pulled out one that needed to be split out of the bed i inherited that’s no shaded by the neighbor’s privacy fence. I figured they’d do better in the sunnier locale and the hill of crab grass could someday be a hill of daylilies. I also figure in three years or so the myrtle will have spread and I can move them when they need to split again.
That left me with two myrtles left from the too big clump i dug up. I threw them in containers, through the grass in the compost and gave everything a drink. I guess that was friday. Saturday i did three groups all of which were cool but somewhat intense and i was cashed after six hard days. It was dark before I got any gumption back and that got spent watching football with dad and eric. go mizzou. could hear the cheers from the stadium. It also allowed me to definitively id the source of the snatches of marching band music i wonder if i hear and that weird metronome that kind of vibrates through you. nice to know the ominous thump has an external source.
So flowers in lieu of float. I dug up a small bed north of the myrtle bed and put in the two daylilies. Considered breaking up another goodly sized clump in the shade and make a matching row but i also wanted to get some other things done, like relax. I put in tulip clumps between them, thought they might come up through the expanding myrtle some day, we’ll see.
brought in mom’s ficus. which involves a lot of moving stuff and sweeping. it really grew this summer, just getting heavy. i’ll need to work out before next year. rearranged, cooked and ate. now dad and i are going to watch timecrimes.
Sunday i had planned to float the Lemine with several friends but one canceled do too back injury and i pulled the plug on the remainder of the 3.
Camping in the Rolla District
Finally got our Fall camping trip in. It was a little on the cool side Dad likes the lows in the 50s but was also pretty motivated to get Fido out in the woods so he said it would be a go with an expected low of 49. We drove down Saturday in typical Dad fashion about 45 minutes before we had planned to leave. That way I still got to go to the market. We had decided to get dinner in Rolla so we wouldn’t have to cook but I grabbed some hot dogs from the local beef guy and we’ve been sitting on a bag of marshmallows for a while.
We drove down to Rolla got on 44 West and got off at the J exit. We also stopped at a tourist trap because we weren’t hungry enough for dinner so I could get some hot dog buns and I grabbed a jar of Amish style pickled eggs, which turned out to be really good. We took J down to M and then left on forest service road 1208. We followed it the required two miles from blacktop for dispersed camping. There was a spot where the road turns to trail that would have worked but it wasn’t an existing spot. We ended up driving back about a half mile where there was a cleared area by the road where they had done some logging and we camped there. Built a fire pit in a low spot. Since no one had ever camped there but they had logged there there was ample wood extremely close.
Took Fido for a hike and we found a sandy area where wild turkeys wallowed in the sand. We also saw lots of asters mostly the purple but some blue ones too. Fido enjoyed being free in the woods quite a bit. He did not want to get back in the truck when we left on Sunday. Can’t say I blame him.
We roasted weenies and I toasted some marshmallows and we sat around the campfire. I slept out by the fire to enjoy the stars. When the wind it would whistle through the pines. When it was softer it would rattle the dry leaves much like Aspen. There was some Fall color but peek seems a couple weeks back. We hope to get back then if the lows stay high.
It was a nice spot for Fall camping. Its low and tends toward wet. Oh and I forgot to mention the chiggers. Got et up pretty good, probably from sleeping on the ground though it was in the dirt and not in the grass. But they mostly got my legs and they like stretchy waste bands and stuff and i only had my thermal long johns on at night.
complaint free me
Last week was long and challenging. I’m working around a couple people’s work schedule and just working more in general. I went in last weekend and got caught up a bit which felt good the first part of the week when i could knock out some little things because i didn’t have the constantly existing backlog. Last session Wednesday I fell behind and then never got a chance to get caught back up. Jamming all day every day and falling a bit more behind. I’m not complaining just painting a context for where i was at friday afternoon when a co-worker asked if she could incorporate acomplaintfreeworld.org bracelets in her group. How it works is you where a bracelet and every time you complain you move it to the other arm. You do that until it stays on one wrist for 21 days. She said its 21 days because scientists say that’s how long it takes to form a habit. I questioned that. Sounds more like folk wisdom. She likes the gratitude angle and I do too. I asked her if gratitude has a downside. If it does we didn’t know it. I discussed venting, and she offered a venting exception, which I pooh poohed. Venting has a dark side, the rehearsal for a blow out. It keeps negative emotions alive when sometimes they just need to pass I told her. I said there has to be a way of letting off steam without complaining and I put it on. I said I would probably have to wear it for years. She said she ordered a 100 for when it wears out. It was late in the day and served as a nice reminder. I would’ve complained twice before leaving work if I hadn’t been wearing it. The bracelet was working. After work started to putter around the yard, beautiful day and a lot of projects to do. learned dad hadn’t eaten yet except for some candy. so i didn’t garden but got right on supper. i was already complaining and switching the bracelet. Dad had talked about cooking together because he had gotten all the stuff for walnut crusted chicken breast and a broccoli side dish out of Wednesdays Columbia Tribune. I washed the dishes and Dad talked about his day. Amy had come over with Olive Oil to play with Fido and Dad told me the blow by blow. Olive stayed over while Amy went to the dentist. she brought a box of tea and a bag of starbucks house blend. I’m pretty thankful for Amy. Comes over twice a week and hangs out with the popster for puppy play dates. I read through the recipes and decided to chop up everything then start the water for the pasta. i was chopping the walnuts when dad came to cook to. said i should crush the walnuts with a pop bottle. I told him advice wasn’t help and swapped the bracelet. i said i would just cook. the chicken called for chicken breasts pounded down to 1/2 ” thick. salt and fresh ground pepper on them. then you dip them in egg white and roll them in corn meal with cayenne. back in the egg white and then roll them in chopped walnuts. fry in olive oil until done. the broccoli dish called for boiling some pasta for 5 minutes, add broccoli, finish boiling pour off all but 1/4 cup add 2 tbsp olive oil and a clove diced garlic. the chicken took a lot longer than i anticipated and my rice pasta fell apart. sliced some maters, a black plum, yellow teardrop, what was supposed to be a green zebra but they keep turning orange (orange zebra?), and a store bought with some cottage cheese. Dad was trying to tell me about amy and michael’s date night, i told him i was busy, he said what, i yelled i was busy, 2 complicated dishes after a long complicated day i could not listen too. i couldn’t move the bracelet my hands were gooked up with chicken gook i totally lost my composure. i took a breath decided to complain again so it was on the right wrist and just get ‘er done. supper was excellent, the chicken really out of this world. the broccoli was tasty as well even dripping in gloppy rice scum. dad was complimentary. said he could see where i was coming from. it was really sweet. saturday though i got going rehashing friday night to sarah and harry. made my point about venting. there wasn’t anything unresolved, we talked about it fine, i was heard, it was acknowledged. the next day gripe was resentment pure and simple, with no need. a few more incidental complaints then i hit a stride. today complaint free, even though dad told me “quit complaining” when i was telling him he shouldn’t be buying the dog junk food treats. that was just telling him my view on our shared beast even if he knew and even if i’d said it before. mostly though i’ve just been a bit more positive. It’d be easy to take out my frustrations on dad, he’s around, it can be frustrating as i start to pick up even more of the upkeep of the house. but it wouldn’t be right. it wouldn’t be what i am about. i am looking forward to hitting day 3 tomorrow and being more grateful and less resentful.
OCD – notes
http://www.medscape.com/viewarticle/447413_6
Spitznagel compared orbitofrontal and dorsolateral patterns of frontal lobe dysfunction implicated in subjects with OCD and schizotypy respectively, in subjects with either condition and in a mixed group with OCD and schizotypy. Results confirmed orbitofrontal type problems, such as difficulty changing cognitive set, in the OCD group only.
Cavedini[48*] on the other hand reported decision-making impaired in OCD compared to controls and panic subjects, with impairment predictive of a poorer pharmacological response for OCD. Jurado[49*] assessed memory for temporal order as well as a ‘feeling-of-doing’ judgement, finding these impaired in OCD; in a second study incidental memory for frequency was impaired in OCD.[50*]
Another interesting aspect of memory is negative priming, whereby ignoring a particular stimulus can hamper subsequent attended processing of the same stimulus. Negative priming is reduced in OCD, consistent with reduced inhibitory function. This is further explored in a study comparing schizophrenia, OCD and controls, which demonstrated differences in negative priming in OCD subtypes of checkers versus non-checkers, with differences varying with response-stimulus interval. A related tack is that of directed forgetting, based on evidence that OCD patients show impaired ability to forget negative material, with limited further support from a study comparing OCD and anxious controls.
hus Pelissier[58*] examined inductive and deductive reasoning in a small comparison of OCD, generalized anxiety disorder and non-anxious controls. OCD subjects showed differences on some tasks in probabilistic reasoning and greater conviction, echoing some of the cognitive distortions found in OCD.
http://www.brainphysics.com/refractory.php
Very few patients with obsessive-compulsive disorder (OCD) ever experience a complete remission of symptoms. Often a clinician stops working with the patient, or the patient stops working with the clinician, once symptoms have been reduced to tolerable levels. Although symptoms may have only reduced by a third, if the person is able to function, this may be considered “good enough.”
Treatment resistant OCD is generally defined by two adequate attempts with SRIs. SRIs stand for a class of medication called antidepressants. They include tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs). True treatment-refractory OCD can only be determined if a person has tried, at a minimum, three different SSRIs at a maximum dosage for at least 3 to 6 months each (with the TCA clomipramine being one of them). They must have also undergone behavioral therapy while on a therapeutic dose of an SSRI, and lastly, have received at least two atypical anti-psychotics as augmenters while receiving behavioral therapy and taking the SSRIs.The researchers found that the factors associated with refractoriness of OCD were more severe of symptoms, chronic course of illness, lack of a partner, being unemployed, low economic status, presence of obsessive-compulsive symptoms of sexual or religious content, and greater family accommodation of the OC symptoms. However, this was but one small study, and future studies are warranted to verify these findings.
Opiates: Researchers have postulated that the opiod system in the brain plays some role in the OCD circuitry. Several research studies indicate that opiates (like morphine) may be promising treatment for OCD alone or combined with SSRIs.
Cognitive-behavioral therapy: It is imperative that proper behavior therapy is attempted before being labeled treatment refractory. As stated, most OCD sufferers have not received an adequate trial of behavioral therapy, which is ultimately the most effective way to beat OCD long-term. While behavioral therapy and medication both have very similar results, up to 80 percent of OCD sufferers relapse when off medication.
http://www.brainphysics.com/therapy.php
At one time, obsessive-compulsive disorder (OCD) was thought of as a “neurotic” disorder. Sigmund Freud, the father of psychotherapy, devoted considerable attention to OCD, and believed that OCD existed on a spectrum ranging from obsessive-compulsive personality to psychosis.
His treatment of choice was psychoanalytic therapy for OCD, and this was the accepted treatment of the disorder for many decades. Because this approach was met with no success, OCD was considered a rare and intractable disorder.
People who suffer from OCD usually have at least some insight into their behaviors, making the ultimate goal of insight less useful; insight alone is not enough to “cure” OCD.
We now understand that OCD has, in large part, a biological causation (meaning, for example, that OCD behavior is not simply caused by a bad relationship with your mother), and it tends to run in families. Because of the failure of traditional psychological treatments for OCD, cognitive-behavioral treatments are now used in the treatment of the disorder, with very high rates of success.
Mild cases of OCD can be treated with self-help techniques. The book Brain Lock: Free Yourself from Obsessive Compulsive Behavior
The goal of CBT is two-fold: to change thoughts and behaviors. Changes in thoughts and behaviors then lead to changes in feelings. The cognitive portion involves the identification and analysis of irrational thoughts, which are then challenged. In the behavioral portion, the therapist and client work together to change the compulsive behaviors. This typically includes techniques such as Exposure and Ritual Prevention, also called Exposure and Response Prevention (ERP or EXRP), psychoeducation (learning about OCD and how symptoms are maintained), relaxation techniques, and many others.
Exposure and Ritual Prevention is successful 80 percent of the time in significantly reducing obsessions and compulsion, making it the most effective and well-researched treatment for OCD. A person suffering from OCD feels obsessions, which cause extreme anxiety, and is then driven to perform compulsions, which momentarily relieve the anxiety. The goal of EXRP is to expose the OCD sufferer directly to their anxiety-causing obsessions, and then prevent them from performing a ritualistic compulsion to relieve the anxiety. EXRP is a hierarchical process. The therapist has the patient rank their fears from most distressing to least distressing. After the fears are ranked, the patient will then be exposed to each fear as they are ready, starting with the easiest item. The therapist does not force the client do anything the client does not want to do, so great care is taken to be sure the client is ready for the next step. The OCD patient eventually learns that the obsessions are not harmful and the anxiety diminishes on its own over time.
Because even the thought of confronting ones fears can prevent many patients from seeking CBT for OCD, many wonder if it is possible to bypass the behavioral portion of the therapy. Cognitive therapy alone can be helpful if a patient is unable to participate in the behavioral exercises, but the behavioral part of the treatment is the real key to success. Research seems to indicate that cognitive-behavioral therapy for OCD is better than cognitive therapy alone.
The therapist will typically assign daily homework and take periodic ratings of symptoms to be sure the patient is improving. The therapist will push the patient somewhat, because ultimately most people need someone to drive them at least a little for effective treatment, but not more than they can handle. It is a difficult process, but very effective and rewarding. EXRP treatment can be accomplished in seventeen 90-minutes sessions, twice per week.
CBT is also effective for most anxiety disorders and many OC spectrum disorders. Learn more about CBT for OCD…
weeding and wild onion pottage
It was a beautiful sunday here in como. What I love most about fall here is how spring like it becomes with little delicate shoots coming up that this yankee always associates with spring. its a bit of hope as the days get shorter and the nights get colder. My lettuce is doing surprisingly well considering how dog trampled it is. One of Fido’s set piece runs goes right through the middle of all three rows. One of the two surviving chards looks like its going to do something protected by the okra, which continues to produce. I wish I would have thrown plastic over the main bed its gonna be cold tonight. Mom’s ficus is outside too, Dad talked me down from rearranging the living room and bringing it in today. Its gonna warm up tomorrow night he says. I had other things to do and didn’t get in the garden until late. the sunny part was in the beds along the privacy fence. my best find was about 10 little coreopsis coming up in a place i’ve never gotten anything to grow. the daylillies i planted are doing well, the ones that came with a place have boomed back and i think i am going to split a clump maybe two and move into a sunnier spot, maybe by myrtle’s myrtle. a hillside of lillies seems lovely. the ragwort continues to spread and i dead headed the rose tulips the only thing blooming in the backyard besides the rose of sharon flanking the hidden gate. I had seriously turned the compost yesterday so it cleaned it up to get a nice tier of plant stuff and had a bit of a mix of green and brown. considered raking but will wait until the redbud completely loses it. Outfront a couple of asters are booming the periwinkle blue ones and a vibrant purple one. I’m gonna move the purple one in the spring it was crowded got weedy and fell over. Its a crazy purple clump hanging over the corner of my driveway. quirky but not what i was going for. while i was weeding i noted the wild onions which i thought (correctly) would be excellent for pottage. I took most of a cup of lentils, 1/3 cup white rice, 2/3 cup brown rice, 1/2 cup of olive oil, 1/3 tsp salt, and almost 3 cups water, plus a couple of bay leaves from the mom’s tree of the guy at MO Wildflowers Nursery and maybe 3 tbsp wild onion greens. did it in the rice cooker, very good but a bit el dente for dad i think. He was mute on the meal but ate it. Next time 3 1/2 cups water and i think it will be it.
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