Question: I'm not hearing from my good friend who was just court ordered into a free California drug rehab facility for a year. I'm trying to discover what full time residents are and aren't allowed to do. He's angry with me but not enough to stop all communication....but I really don't know this for certain. I'm having difficulty getting any info out of the main office running the facility/home he's staying at as far as his freedoms are concerned, if he's allowed to go somewhere within reason. If there's a curfew it says to me that he is. How are these freedoms monitored? Can he visit other people who are in his program? Can he use a public telephone while he's away from the house? What are typical rules/regulations at state run houses for full time residents? I basically understand his daily curriculum but on Sundays I believe he has a free day. What's he allowed to do on those days? Does he have access to a phone or computer? I don't want to feel angry he's ignoring me only to discover he has no way to contact me other than writing me letters. On the other hand I don't want him eventually blaming his silence on "rules" when the truth was he just didn't want to talk to me. I cannot discover these answers anywhere. I hate to keep calling their main office and asking more questions when they're not very forthcoming to begin with. I miss my friend very much. Any information you can provide will be greatly appreciated. Thank you.

Katie Brooks Says...:

Hey there, 

I'm so sorry, but every facility is different.  It has been my experience that there is a detox period where no contact is allowed and then after patients are able to use the phone.  Without knowledge of where this facility is, what it's name is, or how much time he is supposed to stay it is really hard to answer your question.  I know it's hard to be without your friend, but he is obviously going through a lot of pain.  He may not be contacting you for that very reason.  Just give it some time, let him contact you, and trust what he says to be true.  It sounds like he needs a friend right now and you could provide that for him.  If you have any further questions or need more support you can reach me at GoodTherapySanDiego.Com.

Good luck to you!

Question: If a mom takes norcos while breastfeeding all the time will the baby get addicted to opiates? If the baby is already addicted to opiates what is the best way for this baby to stop being addicted without having to go through bad withdrawal pains. If the mom slowly lowers the amount she takes over a month or two months until she is not taking any anymore will the baby slowly get off the opiates without feeling the withdrawal pains? I am asking for a friend of mine who relapsed after she had her baby and she is too scared to tell her doctor because she thinks they will probably take her daughter away from her. She doesn’t know what to do and she is so upset about it.

Katie Brooks Says...:

Hello there-

I'm really sorry that your friend and baby are going through
this.  Unfortunately, it is out of the scope of my practice to consult on
the titration for pharmaceuticals.  It is really important for the baby
that your friend seeks medical support though. It would be so much worse if
something bad were to happen to her or the baby.  Sometimes there is no
way around being truthful even if you know there are serious consequences. If
you could explain to your friend that this act of bravery could save her baby’s
life, she might think of telling the truth in a different way.  The consequences of not telling far out weigh
the consequences of the truth.  

Best
wishes to you and your friend.  Please
contact me if you have any further questions at GoodTherapySanDiego.Com.

Question: Will a doctor prescribe marinol for someone who has difficult marijuana withdrawal issues. I read about this but my doctor said she couldn’t prescribe a controlled substance like that for marijuana withdrawal. Do you know if some doctors will prescribe this? I know you can't comment on specifics...but in general, have you ever heard of doctors using this in America?

Katie Brooks Says...:

Hi there-

What
an amazing thing you are doing for yourself.  Good for you!
 Unfortunately, I cannot give advice on medication, but I urge you to try
to withdrawal on your own.  You may experience symptoms such as:
 cravings, moods swings, insomnia, headaches, and sleep disturbance.  The intensity of the symptoms will most likely depend on the amount you smoked, and for how long.  Stay in contact with you doctor and make an
appointment if you feel unsafe, but you should be just fine.  If there are
any symptoms, they will last up to two weeks to a few months, decreasing in
intensity the longer you are abstinent.  Hopefully, you will only
experience cravings and the physical symptoms won't be too rough on you.  If you
use another controlled substance to taper off an addicted substance you risk
becoming addicted again, therefore, risking another withdrawal.  In
my opinion, this is not worth the trouble.  My advice is to see a
therapist for help coping with withdrawal and resisting cravings, as well as
staying in close contact with your doctor.  If you have any further
questions you can contact me at goodtherapysandiego.com.  

Good
luck!!!!

Katie Brooks, LCSW

Question: I am a cocaine addict and I am a daily heavy drinker. I do not think I am an alcoholic but I think I am physically addicted to alcohol. I tried to stop on my own last month and I had to stop when the shaking got so bad I realized I was in danger. I tried to wean myself off alcohol but this was hopeless. I am on a waiting list at the county medical detox and I am supposed to go in next week. They are strongly recommending that I do their intensive outpatient program after. I am not sure if I can stay clean on my own. I can manage to stop drinking but I cannot stay off cocaine and then when I do cocaine I always drink. I do not have health insurance so I would have to find some free rehab somewhere like maybe at the Salvation Army. Do you recommend that I do the intensive outpatient program or the free rehab?

Katie Brooks Says...:

Hi there-

I understand your dilemma.  The detox
process is just the first step in your recovery.  You will definitely need
an after care program.  The Salvation Army is highly religious and there
are some requirements to the program that you should make sure you could commit
to.  If you are highly religious or do not mind being counseled in this
way, then I recommend saving some money.  On the other hand, if you are
not religious this might be a distraction for you.  

An Intensive Outpatient Program will be
expensive, but you will most likely get evidenced based treatments from highly
skilled professionals.  It sounds to me like you have a serious and
life-threatening addiction to both cocaine and alcohol.  I think that your
life will be a wonderful worthwhile investment.  Substance abuse treatment
can be very effective if done correctly, but it takes patience and persistence.
 Make some time to get sober... you won't regret it!  If you have any
further questions please contact me at goodtherapysandiego.com.

Question: For privacy reasons I would prefer not to have an insurance record of my drug addiction treatment. I would like a 28 day rehab program. I do not need anything fancy but I would like quality care and I would like to get into a program within a couple of weeks to coincide with downtime at work (so no waiting lists). What is the minimum I should expect to pay for this. Is $8000 going to be enough to find what I need? Can you recommend any programs, preferably in California but nearby states are also OK?

Katie Brooks Says...:

Hi-

Historically 28 day programs are cheaper than 90 day, so you should be fine with $8000. Due to the lack of knowledge that I have about your addiction/ condition, I am not able refer you to a specific facility.  However, you can inquire about program at www.rehab.com.

Another great way to find resources is to dial 211.  Good Luck!

Here are two that I personally refer to:

Sharp
McDonald Center 

7989 Linda
Vista Road

San Diego, CA 92111

1-800-734-3477  (flexible night programs)

Sharp
Mesa Vista

7850 Vista Hill
Ave.

San Diego, CA 92123

858-278-4110

Question: I am addicted to Tramadol. I am trying to taper down. I am down to 300 mgs a day. I used to be doing 800 mgs a day which is twice the recommended daily max and well into the seizure risk zone so I dodged a bullet in never having a bad effect over the last 5 years that I was taking them I guess. I was always taking the instant release IR 50s. I am trying to taper down by 5% a week. I know this is slow but seriously any faster than this and I really feel messed up. Last week I couldn’t get the 50 ir capsules and I picked up some 100 mg extended release tablets instead. This is the first time I ever tried. The ers are supposed to last for 24 hours and the irs are only about 6 hours or so. The experience was quite different. The irs definitely give a better buzz and warm happy feeling but the ers give me a much more stable, generally feeling OK feeling all the time (but I am always sort of waiting for that feeling of them kicking in…and it never really comes). I was thinking that I might be better off tapering off the more stable ers rather than the more up and down irs? Does this make sense? Also because the ers don’t give me a buzz and I guess this is something I need to learn to live without if I am going to be able to live without tramadol at all at some point. But I am having trouble finding out if you can cut an er table in half without then dumping all the drug into your system at once (once you have ruined the exterior coating). Can you recommend a way to taper using the ers?

Katie Brooks Says...:

Good for you for taking this
step!!!!  Unfortunately, it is out of the scope of my practice to give
advice on tapering medication.  Hopefully you are working with a
psychiatrist or a physician.  If not, I highly suggest tapering down under
the supervision of a physician. 

As you know, it can be very dangerous for
your system.  It sounds to me like you should eliminate the IRs because
they give you a "buzz".  This might have been an error in your
question, but in your description you mentioned tapering off the ERs.  You seem to be addicted to the buzz of the
IRs, and therefore, it would be a logical step to work towards tapering down on
that specific medication.

If you really
want to be free of Tramadol, or any other medication for that matter, I suggest
tapering down on any medication that you are using for recreational
purposes rather than the intended use.  For instance, Tramadol is a pain
reliever and should be relieving physical pain.  If you are using it to
eliminate negative emotion, to enhance your mood, or you are taking more than
originally prescribed, then you are abusing it.  It works this way for all
prescribed medication.  Think about its intended purpose and stick to it.
 If you have trouble tapering off or find yourself substituting with
another addictive substance contact a therapist to guide you through substance abuse treatment. If you have any questions
or would like to make a phone appointment you can reach me at
goodtherapysandiego.com.

Good luck to
you! 

Warmest Wishes, 

Katie Brooks, LCSW

Question: Do you know much about L-Theanine. It’s supposed to be this supplement that induces alpha waves in the brain and makes you feel calm and not anxious and from what I heard it helps reduce anxiety and irritability and insomnia that come when you quit marijuana. I am a long time smoker, frequent quitter and unfortunately equally frequent relapser so I know what to expect when I try to quit again by Mother’s day. It seems safe enough but I can’t get much solid info on whether it actually makes a difference for weed withdrawal. Do you know?

Katie Brooks Says...:

Hello there!

I am sure that the detoxification that you are experiencing is
very uncomfortable.  Unfortunately, it is
out of my scope of practice to advise on medication or supplements.

Visit
your primary physician or a psychiatrist if you have questions pertaining to
effectiveness and side effects.  

In order to reduce anxiety and agitation:

1. Make sure you are getting enough sleep.  Go to bed at
   the same time every evening and wake up at the same time every morning.
    Use your bed only for sleep and do not watch TV in bed.  In
   addition, try not to eat right before bed.
2. Try to eat healthy foods.  Stay away from excess sugar,
   alcohol and caffeine.
3. Make sure your house and workspace are clean and
   organized.  A cluttered space can
   sometimes cause a cluttered mind.
4. Try to reduce the stress in your schedule while you’re
   detoxing.  Take lots of time for rest and relaxation.
5. Surround yourself with supportive positive people who do not
   trigger negative emotion.  You will need support.  Sometimes talking
   to a good friend or family member can really help.
6. Try listening to guided visualizations or meditate daily.
7. EXERCISE!  Get that
   excess energy out.  Get outside and either run or walk vigorously.  The fresh air and sunlight will help.  Otherwise, yoga can be great for reducing
   anxiety.
8. Focus on where the
   anxiety is in your body.  If it is in your chest, focus on the anxiety in
   your chest until the anxiety dissipates or changes.  Whenever your attention
   wanders, bring it back to the place in your body where the physical feeling is.
   Doing this for five or ten minutes can reduce, if not eliminate, the anxiety.
9. Help someone
   else in order to distract yourself. 
   Distract yourself with anything that deters your thoughts from negative
   thinking.
10. Try to think
    positively about your anxiety.  Reframe negative statements like, "I
    can't handle this" to "This will pass or "I am handling this and
    can get through this".
11. Do the
    opposite of what your body wants to do.  If you want to hide, go out and
    be social.  If you want to anxiously eat, go out and exercise.
     Sometimes doing the opposite of what are emotions are driving us to do
    can change the emotion completely.
12. Make sure your
    environment is positive.  Try to avoid scary movies with a lot of negative
    imagery.  If the news is upsetting; don't watch it.
13. Progressively relax your body from your feet
    to your head.  Take a deep breath in and
    as your exhale shift your focus to each body part.  Let the stress melt from your muscles.  Look up progressive relaxation for full
    instructions.
14. Practice mindful breathing.  Take a deep breath in and as you exhale count
    the exhalations.  Continue this exercise
    for 10-20 minutes.  If you attention
    wanders gently bring it back to counting exhalations.
15. If you notice that your breathing feels
    shallow and constricted try to elongate your inhalations and exhalations.  Breathing into your belly rather than your
    chest can reduce the anxious feelings.

If these methods do not
work psychotherapy is very effective for the reduction of anxiety.

Find a
therapist that practices Dialectical Behavior Therapy, Cognitive Behavioral Therapy or mindfulness techniques.  You can read
more about it or call me for a phone consultation at GoodTherapySanDiego.com.
 Hopefully these tips were helpful.

Good luck!

Katie Brooks, LCSW