Description of Clinic Services
Addicition & Psychotherapy Services is an outpatient facility designed for patients with opiate/opioid dependence who can function and work while in treatment and who have the ability to improve without the structure of a residential treatment center. If possible, all aspects of the patient's psychological-psychiatric problems are addressed. Significant others are encouraged to participate in treatment. The primary goal of the clinic is to move patients from a dysfunctional abuse/addiction pattern to a managed physical dependence without any drug abuse behavior, and at the appropriate time, to a completely drug-free state.
Synthetic narcotics (methadone, Suboxone) are used in treatment because of their proven effectiveness in reducing drug abuse behavior. Methadone concentrate and Suboxone are usually taken daily.
When taken in appropriate dosage, synthetic narcotics do not interfere with normal functioning, judgment, performance of complex tasks and psychological treatment. For opioid dependence treatment, methadone or Suboxone (buprenorphine) maintenance, combined with psychological-rehabilitative treatment, is far superior to conventional chemical dependency treatment.
Suboxone (buprenorphine) treatment (maintenance; rapid or three to six-month medical withdrawal/detox) is offered to appropriate patients, based on medical evaluation and treatment plan. Buprenorphine is less potent than methadone but psychologically more addicting and much more expensive. It is safer in overdose and regulations on buprenorphine are less restrictive. The size of habit is critical in determining qualification for buprenorphine treatment.
Methadone maintenance; rapid or six-month withdrawal, with daily dosage adjustments, as indicated
Highly qualified staff provide integrated pharmacological/medical, case management, psychological/psychiatric, and rehabilitative services, including:
Evaluation: evaluation of chemical abuse, psychiatric and medical history, physical examination; laboratory evaluations; determination of qualification for services and/or referral; (special laboratory tests as indicated, available at Clinical Pathology Laboratory at moderate fee)
Individual, couple, and family counseling
Extensive group teaching by highly qualified staff, open to significant others, close relatives and friends of clients, and to former clients who completed treatment and are drug-free
Cognitive therapy and relapse prevention; education on a broad range of issues related to addiction, health, psychology and treatment approaches; relaxation, meditation, self-hypnosis, guided imagery, and pain management; yoga; spirituality; women's groups; parenting; grief; and other special focus groups
Access to a wide range of educational videos on health, psychiatric disorders and chemical dependency
Assistance in management of pain in established patients; consultation with patient's physician(s)
Psychiatric care: cognitive-behavioral and pharmacological treatment of mood and anxiety disorders, as well as other psychiatric disorders; Eye Movement Desensitization and Reprocessing (EMDR) for treatment of PTSD and other conditions
Auricular (ear) acupuncture for withdrawal, craving, and anxiety
Detoxification from other drugs while on methadone or buprenorphine
Counseling support and prescriptions of medications, as indicated, for medical withdrawal from methadone or buprenorphine.
Information for Individuals Seeking Admission
New clients are admitted to the clinic on Monday, Tuesday, Wednesday, and Thursday mornings only between 6:00 - 7:00am on a first-come first-served basis. Recent readmission and transfer clients may be admitted on Fridays. An individual seeking admission must be in some mild withdrawal when they arrive at the clinic. We recommend not using opiates for 12-24 hours prior to arrival. Also, early arrival is recommended because the clinic only accepts a limited number of new clients on a given morning. Intake and initial adjustment takes several hours as it includes evaluation and observation of the client. Some clients benefit from multiple dosages if the initial dosage is inadequate to suppress withdrawal.
Admission to the clinic is not guaranteed and is dependent on the doctor's evaluation of the individual's addiction and the appropriateness of methadone treatment. Again, potential admissions are strongly recommended not to use any heroin or other opiates for 24 hours prior to their initial evaluation as staff must be able to document signs of withdrawal. In addition, it is not safe to start methadone if the client is still under the influence of opiates.
What to bring with you to be admitted:
l The initial evaluation currently costs $120 for methadone and $150 for buprenorphine (Subutex) and must be paid in cash or money order on the morning of the admission. Former clients who wish to be readmitted to the clinic, as well as transfer clients, are eligible for a reduced initial evaluation fee.
l A valid Texas state issued driver's license (certain other forms of photo identification may be accepted, such as passports or Texas state prison ID cards).
l Any medical or prescription records relating to the individual's history of addiction, including prescriptions or pills currently used.
l If you have no valid Texas-issued state ID, please bring in an ID from another state, expired ID(s), other picture ID(s), Social Security card, birth certificate, any recent medical records, TDC papers, etc.
Basic Treatment Information / Considerations for Clients Seeking Treatment
Severe addiction is a catastrophic disorder which requires intense long-term treatment comparable to any chronic medical-surgical or psychiatric condition. Patients addicted to opiates almost always relapse if rapidly withdrawn (detoxified). Outcomes are much better if treatment includes opioid maintenance for at least eighteen months. The conclusion of treatment would ideally include a slow medical withdrawal, accompanied by intense rehabilitative services, including education and therapy groups, as offered at this clinic.
Starting treatment at this clinic may be one of the most important decisions in your life. Make sure you stay with the treatment.
If you are pregnant, do not withdraw or use opiate medications other than methadone. Methadone treatment is safe during pregnancy. Withdrawal and the use of illicit drugs are much worse for the embryo/fetus than methadone. When pregnant it is particularly important to avoid alcohol, cigarettes or smoking, or the use of any illicit drugs. Our clinic offers education and support for pregnant patients.
Methadone and buprenorphine prevent physical withdrawal and decrease craving, drug abuse behaviors, and relapse. Treatment maintains your physical opioid dependence but alleviates ("cures") the psychological addiction. Abuse thinking may continue but addiction thinking and behaviors cease. Methadone works as a slow-release medication and lasts about three times longer than heroin. It maintains a normal mental state, without "highs" and withdrawal symptoms. If abruptly discontinued, withdrawal starts after 2-3 days, is less intense than heroin withdrawal, and lasts about three weeks (it is safe to miss one or two days of treatment). Buprenorphine is similar to methadone but last even longer. Withdrawal is delayed, less intense and longer lasting. As with alcohol and benzodiazepine withdrawal, clients may experience sleep disturbance for months after withdrawal. Follow-up treatment is provided by this clinic to address the issues arising from slow withdrawal. This problem may be addressed with antidepressant medications.
Methadone is not toxic. In other words, it does not lead to any tissue damage. It does not hurt bones, teeth or the liver and can safely be taken for decades.
As with all opiate/opioid medications, women on methadone may not have menses but can still become pregnant.
Patients who have developed an opiate addiction cannot safely use alcohol, tranquilizers and other potentially addicting medications. (However, abrupt discontinuation of opioids, alcohol tranquilizers or sleeping pills is dangerous.) Alcohol use while on methadone reduces the effectiveness of methadone. Methadone seems to decrease alcohol craving, and during treatment, clients may have a false sense that they can easily control their alcohol consumption. During and after medical withdrawal, any alcohol use readily leads to alcoholism or relapse.
Many patients have both chronic pain and an addiction to morphine, Dilaudid, Vicodin, Percodan, Oxycontin, or other opiate pain-relieving pills. Abuse and addiction often develop when patients receive pain medications which they also use for pleasant feelings such as relaxation, stress relief, and intoxication. In therapeutic opiate use, the medication helps the patient function and has minimal or no negative effects. In contrast, in addiction the drug seeking and the drug effects interfere with normal functioning. This clinic deals with the pain issues of our opiate addicted patients, and we often consult with other specialists as part of our services.
Many opiate addicts have anxiety, depressed mood, sleep disturbance, or other psychological issues. Such problems need attention along with chemical abuse treatment. As part of our program services, we treat psychological problems with counseling, appropriate medications, and by teaching self-help skills in groups. Appointments with the psychiatrist for evaluation and prescription of appropriate medications are also included.
Some medications interact with methadone and buprenorphine. Patients should inform treatment staff of any prescription, over-the-counter and herbal medications they use and any treatment received for medical, dental, surgical and psychological conditions. Patients are advised to inform their pharmacist that they are prescribed methadone or buprenorphine, as well as any other medications they are on. They should inform their physician(s) that, while on methadone or buprenorphine, they cannot take pain medications such as Talwin, Stadol, Nubain, Suboxone/buprenex (for methadone patients) because these lead to withdrawal symptoms and worsen pain. Buprenorphine patients cannot take any narcotic medications. They may possibly increase buprenorphine dose to the maximum effective level. Increased methadone and i.m. Toradol are optimal medications for severe pain while on methadone. Morphine, Dilaudid and other high potency opiates/opioids are less effective. Demerol seems a poor choice. Patients must never use theantagonist naltrexone (Revea, formerly called Trexan). Naltrexone is sometimes used for alcoholism.
One monthly Saturday "MD group" is held from 9:00am - 10:00am. Dates for these groups are posted on the board in the clinic lobby.
Next dates: May 20th, 2017
Ear acupuncture is offered Monday-Friday at 6:30am, 8:30am and 12:30pm.
*Dr. Heinz Aeschbach is availible on Monday "MD groups".