Ondansetron & Opiate Treatment

Scientists at the School of Medicine have discovered that a commonly available non-addictive drug can prevent symptoms of withdrawal from opioids with little likelihood of serious side effects. The drug, ondansetron, which is already approved to treat nausea and vomiting, appears to avoid some of the problems that accompany existing treatments for addiction to these powerful painkillers, the scientists said.

Opioids encompass a diverse array of prescription and illegal drugs, including codeine, morphine and heroin. In 2007, about 12.5 million Americans aged 12 and older used prescription pain medications for non-medical purposes, according to the National Survey on Drug Use and Health, administered by the federal government’s Substance Abuse and Mental Health Services Administration.

“Opioid abuse is rising at a faster rate than any other type of illicit drug use, yet only about a quarter of those dependent on opioids seek treatment,” said Larry Chu, MD, assistant professor of anesthesia and lead author of the study that was published online Feb. 17 in the Journal of Pharmacogenetics and Genomics. “One barrier to treatment is that when you abruptly stop taking the drugs, there is a constellation of symptoms associated with withdrawal.” Chu described opioid withdrawal as a “bad flu,” characterized by agitation, insomnia, diarrhea, nausea and vomiting.

Current methods of treatment are not completely effective, according to Chu. One drug used for withdrawal, clonidine, requires close medical supervision as it can cause severe side effects, while two others, methadone and buprenorphine, don’t provide a satisfactory solution because they act through the same mechanism as the abused drugs. “It’s like replacing one drug with another,” said co-investigator Gary Peltz, MD, PhD, professor of anesthesia.

“What we need is a magic bullet,” said Chu. “Something that treats the symptoms of withdrawal, does not lead to addiction and can be taken at home.”

The researchers’ investigation led them to the drug ondansetron, after they determined that it would block certain receptors involved in withdrawal symptoms.

The scientists were able to make this connection thanks to their having a good animal model for opioid dependence. Mice given morphine for several days develop the mouse equivalent of addiction. Researchers then stop providing morphine to trigger withdrawal symptoms. Strikingly, these mice, when placed into a plastic cylinder, will start to jump into the air. One can measure how dependent these mice are by counting how many times they jump. Like humans, dependent mice also become very sensitive to pain when they stop receiving morphine.

But the responses vary among the laboratory animals. There are “different flavors of mice,” explained Peltz. “Some strains of mice are more likely to become dependent on opioids.” By comparing the withdrawal symptoms and genomes of these different strains, it’s possible to figure out which genes play a major role in addiction.

To accomplish this feat, Peltz and his colleagues used a powerful computational “haplotype-based” genetic mapping method that he had recently developed, which can sample a large portion of the genome within just a few hours. This method pinpoints genes responsible for the variation in withdrawal symptoms across these strains of mice.

The analysis revealed an unambiguous result: One particular gene determined the severity of withdrawal. That gene codes for the 5-HT3 receptor, a protein that responds to the brain-signaling chemical serotonin.

To confirm these results, the researchers injected the dependent mice with ondansetron, a drug that specifically blocks 5-HT3 receptors. The drug significantly reduced the jumping behavior of mice as well as pain sensitivity—two signs of addiction.

The scientists were able to jump from “from mouse to man” by sheer luck: It turns out that ondansetron is already on the market for the treatment of pain and nausea. As a result, they were able to immediately use this drug, approved by the Food and Drug Administration, in eight healthy, non-opioid-dependent humans. In one session, they received only a single large dose of morphine, and in another session that was separated by at least week, they took ondansetron in combination with morphine. They were then given questionnaires to assess their withdrawal symptoms.

Similar to mice, humans treated with ondansetron before or while receiving morphine showed a significant reduction in withdrawal signs compared when they received morphine but not ondansetron. “A major accomplishment of this study was to take lab findings and translate them to humans,” said principal investigator J. David Clark, MD, PhD, professor of anesthesia at the School of Medicine and the Palo Alto Veterans Affairs Health Care System.

Chu plans on conducting a clinical study to confirm the effectiveness of another ondansetron-like drug in treating opioid withdrawal symptoms in a larger group of healthy humans. And the research team will continue to test the effectiveness of ondansetron in treating opioid addiction.

The scientists warned that ondansetron will not by itself resolve the problems that arise with continued use of these painkillers. Addiction is a long-term, complex process, involving both physical and psychological factors that lead to compulsive drug use. “This is not a cure for addiction,” said Clark. “It’s naïve to think that any one receptor is a panacea for treatment. Treating the withdrawal component is only one way of alleviating the suffering. With luck and determination, we can identify additional targets and put together a comprehensive treatment program.”

Collaborators on this study included De-Yong Liang, PhD, the study’s co-lead author, previously a research associate in the Department of Anesthesia and currently a research associate at the Palo Alto Institute for Research and Education; Xiangqi Li, MD, a life science research assistant in the department; Nicole D’Arcy, a medical student; Peyman Sahbaie, MD, a research associate at the institute; and Guochun Liao, PhD, of the pharmaceutical company Hoffman-La Roche. This work was supported by grants to Clark from the National Institutes of Health and the National Institute on Drug Abuse, and grants to Chu from the NIH and the National Institute of General Medical Sciences.

The researchers are working with the Stanford University Office of Technology Licensing to seek a patent for the use of ondansetron and related medicines in the treatment of drug addiction.

Opiate Dependence & Medication Assisted Treatment (MAT)

“I wish that all families would at least consider investigating medication-assisted treatment and reading about what’s out there,” says Alicia Murray, DO, Board Certified Addiction Psychiatrist. “I think, unfortunately, there is still stigma about medications. But what we want people to see is that we’re actually changing the functioning of the patient.”

Essentially, medication-assisted treatment (MAT) can help get a patient back on track to meeting the demands of life – getting into a healthy routine, showing up for work and being the sibling, spouse or parent that they once were. “If we can change that with medication-assisted treatment and with counseling,” says Murray, “that’s so valuable.”

The opioid epidemic is terrifying, especially so for the family of someone already struggling with prescription pills or heroin use. It’s so important to consider any and all options for helping your child recover from their opioid dependence.

Part of the reason it’s so hard to overcome an opioid addiction is because it rewires your brain to focus almost exclusively on the drug over anything else, and produces extreme cravings and withdrawal symptoms as a result. By helping to reduce those feelings of cravings and withdrawal, medication-assisted treatment can help the brain to stop thinking constantly about the drug and focus on returning to a healthier life.

Medication-assisted treatment is often misunderstood. Many traditional treatment programs and step-based supports may tell you that MAT is simply substituting one addictive drug for another. However, taking medication for opioid addiction is like taking medication for any other chronic disease, such as diabetes or asthma. When it is used according to the doctor’s instructions and in conjunction with therapy, the medication will not create a new addiction, and can help.

“MAT medications are most effective when they are used in conjunction with therapy and recovery work. We would never recommend medication over other forms of treatment. We would recommend it in addition to it.”

Common medications used to treat opioid addiction are:

  • Naltrexone (Vivitrol)
  • Buprenorphine (Suboxone)
  • Ondansetron

Naltrexone, known by its brand-name Vivitrol, is administered by a doctor monthly through an injection. Naltrexone is an opioid antagonist. Antagonists attach themselves to opioid receptors in the brain and prevent other opioids such as heroin or painkillers from exerting the effects of the drug. It has no abuse potential. Vivitrol is an injectable form of naltrexone and is effective for 30 days. Even if a person wants to use, if they have naltrexone or Vivitrol in their system, they cannot. It is a form of insurance against relaspe that is vital to treatment.

Buprenorphine, known by its brand-name Suboxone, is an oral tablet or film dissolved under the tongue or in the mouth prescribed by a doctor in an office-based setting. It is taken daily and can be dispensed at a physician’s office or taken at home. Buprenorphine is a partial agonist. Partial agonists attach to the opioid receptors in the brain and activate them, but not to the full degree as agonists. If used against the doctor’s instructions, it has the potential to be abused.

Scientists at the Stanford School of Medicine have discovered that a commonly available non-addictive drug can prevent symptoms of withdrawal from opioids with little likelihood of serious side effects. The drug, ondansetron, which is already approved to treat nausea and vomiting, appears to avoid some of the problems that accompany existing treatments for addiction to these powerful painkillers, the scientists said.


There is no “one size fits all” approach to medication-assisted treatment, or even recovery. Recovery is individual. The most important thing to do is to consider all of your options.

Harm Reduction and Medical Marijuana

(CNN)Harm reduction is a strategy for treating addiction that begins with acceptance. A friendlier, less disciplined sister of abstinence, this philosophy aims to reduce the overall level of drug use among people who are unable or simply unwilling to stop. What should naturally follow is a decrease in the many negative consequences of drug use.

In other words: progress, not perfection, as advocates of Alcoholics Anonymous often say.
Most European countries and Canada have embraced the idea of harm reduction, designing policies that help people with drug problems to live better, healthier lives rather than to punish them.
On the front lines of addiction in the United States, some addiction specialists have also begun to work toward this end.
Joe Schrank, program director and founder of High Sobriety, is one of them. He says his Los Angeles-based treatment center uses medicinal cannabis as a detox and maintenance protocol for people who have more severe addictions, although it’s effectiveness is not scientifically proven.
“So it’s a harm-reduction theory,” he said. “With cannabis, there is no known lethal dose; it can be helpful for certain conditions.”
“Some say it’s hypocritical because, you know, you’re supposed to go to rehab to get off drugs,” said Schrank, who recently celebrated 20 years of sobriety from alcohol and all drugs. “And cessation of drug use can be a goal for some people, but pacing is also important.” Some patients want to gradually move into abstinence, weaning themselves off drugs over time. Others want to maintain sobriety from a drug by using a less harsh drug, such as cannabis.
 Others, including Todd Stumbo, CEO of Blue Ridge Mountain Recovery Center in Georgia, do not favor using marijuana as treatment for addiction.
“I’m all about adding interventions and therapeutic techniques that have proven to be significantly profound in the changes to somebody’s life and treatment. Unfortunately, I don’t know that there’s evidence to substantiate that marijuana’s had that effect,” says Stumbo. “Our take is abstinence based and we use every tool or intervention we can that’s been proven effective in the past.”
Still, harm reduction is gaining acceptance in the wider field of addiction specialists in the U.S.
“In principle, what we have aimed for many years is to find interventions that would lead to complete abstinence,” said Dr. Nora Volkow, director of the National Institute on Drug Abuse. Practically, though, that has been very difficult to achieve with relapsing addictions.
“One of the things is, we don’t have any evidence-based medication that has proven to be efficacious for the treatment of cocaine addiction,” Volkow said. “So we currently have no medicine to intervene, and it can be a very severe addiction and actually quite dangerous.”
Dangerous because it gives users a high that literally alters the brain. Medical consequences of cocaine addiction include seizure, stroke and bleeding within the brain.
“We have started to explore the extent to which interventions that can decrease the amount of drug consumed can have benefits to the individual,” Volkow said, adding that she’d make this same argument for opioids and heroin. “It would be valuable to decrease the amount of drug consumed.”
Schrank is clear on the value of simply reducing drug use.
“We think of addiction as this light switch you can turn on and off,” he said. “What we’re learning is that for some people, it’s similar to scuba diving: You can only come up 20 feet so often or you get very, very sick. When people stop immediately and that abruptly, it really makes them vulnerable.”
Schrank, who readily concedes there are possible health and addiction risks with marijuana, says he offers his cannabis detox and maintenance protocol to people addicted to crack cocaine as well as those trying to kick opioids. Through the years, he says, he’s treated about 50 people with this technique and expects to see “more people wanting to try to have a voice in their recovery rather than just plug into systems telling them what to do.”
Marijuana “can really help people with pain management and other health issues, or it can help them be safer,” Schrank said.
Reversing heroin’s damage

Yasmin Hurd, director of the Addiction Institute at Mount Sinai School of Medicine, says generally, cannabidiol is the more important compound when it comes to marijuana as a treatment for addiction. It is one of the two primary cannabinoids, along with Δ9-tetrahydrocannabinol (THC), found in the cannabis plant. In terms of the wider scope of medical marijuana research, this is the “same cannabidiol being looked at for the kids with epilepsy,” Hurd said.

THC, she says, binds to cannabinoid receptors in our brains (as do the natural cannabinoids our bodies produce), and it is the stimulation of those receptors that brings a “high.” By comparison, cannabidiol has very weak effects in this regard and negatively modulates that receptor, instead.
Yet cannabidiol reverses some of the brain changes that occur with heroin use, Hurd says, based on her own studies of the compound.
 For instance, heroin harms the glutamate transmitter system, which is important for decision-making, cognition and even reward, explains Hurd.
“We found that (cannabidiol) reversed the impairments caused by heroin, for example, on the glutamatergic receptors,” Hurd said. Similarly, cannabidiol reversed damage to the cannabinoid receptors themselves caused by heroin, while activating the serotonin system: the neurotransmitter system believed to affect mood and a common target for makers of anti-anxiety and antidepressant medications.
More generally, cannabidiol positively influences our biological systems that are linked to the negative components of addiction, such as anxiety and inhibitory control, Hurd suggests.
“We still haven’t figured out how it works,” Hurd said. She notes that although cannabidiol is believed to be a “treatment to consider for opioid addiction and other drugs,” there aren’t a lot of data, especially with regard to its potential effects for cocaine addiction.
Adding to the data is a recent study, funded in part by a company applying to the Canadian government for a license to produce medical cannabis, exploring one possible harm reduction plan: swapping crack cocaine for marijuana.
Studying crack users

Crack cocaine is said to be a low-end incarnation of a rich man’s drug. Cocaine, an expensive stimulant made from the leaves of the coca plant native to South America, can be processed to make a cheap crystal rock or “crack.” The name refers to the crackling sound the rock makes when heated so its vapors can be inhaled through a pipe, but many users prefer to mix crack with vinegar to form a liquid that can be injected. This form becomes much higher-risk to users who are likely to share needles.

To explore whether smoking marijuana might reduce crack use, researchers led by M-J Milloy, an infectious disease epidemiologist and research scientist at the BC Centre for Excellence in HIV/AIDS, recruited drug users living within the greater Vancouver area of British Columbia.
Milloy and his colleagues measured and analyzed how frequently 124 drug users smoked or injected crack before, during and after a period of cannabis use, based on their own self-reports.
Crack use did not decrease during the period when participants intentionally self-medicated with cannabis, compared with the time before trying marijuana
Afterward, crack use decreased significantly, with participants reporting using it on average about half as often as before the intervention.
“We certainly have no illusions that this is the final word on the matter. Indeed, I think what it really is, it may be a first step,” Milloy said of his study, which was recently published in the journal Addictive Behaviors. “So what we hope is that further study will let us know if it is in fact an effective substitution treatment for crack cocaine use disorder. To that end, we are putting together a clinical trial, which we hope will better test the hypothesis that cannabis could be useful to people who are suffering from this disorder.”
Although the Vancouver study did not investigate the brain science to explain how marijuana might have this effect, Milloy and his co-authors say that emerging data “provide biological plausibility” for the findings.
They reference animal studies demonstrating that THC and cannabidiol may help eliminate cocaine-craving and heroin-seeking behaviors. One study in rodents showed cannabidiol to disrupt the reconsolidation of cocaine- and opioid-related memory, while findings from human trials suggest that high doses of cannabidiol effectively decreased cravings and anxiety among heroin-dependent people.
Volkow believes the Vancouver study result, showing that smoking marijuana reduced use of cocaine (though without producing abstinence), is an “interesting finding that cannot be ignored.”

‘Be yelled at for 30 days’

Generally, she says, not a lot of study has been done in the area of swapping cannabis for cocaine, and she emphasizes the need to determine whether the result can be replicated and studied even more extensively “under a clinical trial-type design, so you can actually document that cannabinoids can decrease consumption of cocaine.”
“There have been a couple of papers that have reported actually some beneficial effects of marijuana smoking and the use of other drugs, but there also was one other paper that reported the opposite,” Volkow said.
That paper found, “an increase instead of a reduction in the severity of cocaine withdrawal symptoms,” and concluded, “worse detoxification treatment response.”
To remedy the lack of scientific evidence, the National Institute of Drug Abuse is funding projects investigating synthetic THC for treatment of substance use disorder and providing grants for other projects testing cannabidiol for the treatment of methamphetamine use disorder and relapse prevention. The institute is also looking at the endocannabinoid system as a potential therapy for alcohol use disorder and opioid withdrawal.
“The paradigm as it is now is, wait until it’s a crisis and then be yelled at for 30 days, and then you’re never supposed to do it again,” Schrank said.
Abstinence is “a hard thing for people to do, and I don’t know that we give people enough space to grow and develop,” he said. “Most people coming off crack or heroin would want the insulation of some kind of feeling change.”
Although most people in the treatment world would say an addicted client who swapped harder drugs for pot has a relapse and not recovery, Schrank said, “to me, if somebody was using heroin and now they’re using cannabis, that’s a major victory.”
“If you smoke the wrong rock of crack, your heart stops,” he said. “It’s very, very, very dangerous.”
“I’ve had so many clients who were in treatment and seemingly doing well, and then they dropped dead,” Schrank said. “If rehab worked so well, why is the success rate like 5%? We’re definitely doing something wrong.”

UCLA researchers identify a potentially effective treatment for methamphetamine addiction

UCLA researchers identify a potentially effective treatment for methamphetamine addiction

A new study by UCLA researchers has found that Naltrexone, a drug used to treat alcoholism, may also be a promising treatment for addiction to methamphetamine.

“The results were about as good as you could hope for,” said Lara Ray, a UCLA associate professor of psychology, director of the UCLA Addictions Laboratory and lead author of the new study.

The study, published in the journal Neuropsychopharmacology, was the first in the U.S. to evaluate Naltrexone for treating methamphetamine addiction. Researchers analyzed 22 men and eight women who use methamphetamine an average of three to four days a week.

During a four-day hospital stay, each person was each given either Naltrexone — 25 milligrams the first two days, 50 milligrams on days three and four — or a placebo daily. Ten days later, the subjects were readmitted to the hospital for four more days; those who had taken Naltrexone earlier were given placebos, and vice versa.

On the last day of each hospital visit, all participants were given intravenous doses of methamphetamine. Three hours later, the researchers asked how they felt and how much they wanted more of the drug.

The scientists found that Naltrexone significantly reduced the subjects’ craving for methamphetamine, and that it made them less aroused by methamphetamine: Subjects’ heart rates and pulse readings both were significantly higher when they were given the placebo than when they took Naltrexone. In addition, participants taking Naltrexone had lower heart rates and pulses when they were presented with their drug paraphernalia than those who were given placebos.

Ray said the results indicated that Naltrexone reduced the rewarding effects of the drug — those taking Naltrexone did not find methamphetamine to be as pleasurable and were much less likely to want more of it.

Naltrexone was well tolerated and had very minimal side effects. The researchers found that men and women both were helped by taking Naltrexone, although the positive effect on men was slightly smaller. It made no difference whether the participants were given Naltrexone during their first hospital stay or their second.

Naltrexone works by blocking opioid receptors in the brain. Ray said that in previous studies, people undergoing treatment for alcoholism reported getting less of a “high” from drinking when they take Naltrexone.

Ray, whose research team studies the causes of drug and alcohol addiction and possible treatments, plans to examine whether Naltrexone would be more effective in combination with other pharmaceuticals and at different doses. Her research is funded by the National Institute on Drug Abuse and UCLA’s Clinical and Translational Science Institute.

Twenty-five of the participants also underwent functional magnetic resonance imaging, or fMRI, brain scans in UCLA’s Center for Cognitive Neuroscience. Ray and UCLA graduate student Kelly Courtney, a co-author of the Neuropsychoparmacology paper, are analyzing that data.

Methamphetamine use disorder is a serious psychiatric condition that can cause psychosis and brain damage, and for which no FDA-approved medication exists. An estimated 12 million Americans have used methamphetamine, nearly 400,000 of whom are addicted to it, according to recent estimates.

Although the new study is promising, it needs to be backed up by clinical trials, said Ray, who is also a member of the UCLA Brain Research Institute. The next step in evaluating Naltrexone’s effectiveness for treating people addicted to methamphetamine is already underway: the National Institute on Drug Abuse is sponsoring clinical trials.


Other UCLA co-authors of the new study include Edythe London, the Thomas P. and Katherine K. Pike Chair of Addiction Studies; Karen Miotto, a clinical professor in the department of psychiatry and biobehavioral sciences at the Semel Institute for Neuroscience and Human Behavior; Steven Shoptaw, professor in the departments of family medicine and psychiatry and biobehavioral sciences; and Keith Heinzerling, an associate professor of family medicine at the David Geffen School of Medicine.

Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.

Pharmacogenetic Testing (PGT)

Assisted Recovery Center of America is pleased to provide treatment that includes the latest advances in science and medicine for the treatment of behavioral health issues.  One such advance, known as pharmacogenetic (PGT) testing, employs a saliva test to help clinicians prescribe the optimal medication and dosage for any given behavioral health disorder, including addiction and mental health issues. Since the decoding of the human genome in 2001, substantial advances have been made in the field of genomic medicine.  ARCA now offers PGT testing


Humans respond to medications differently, with some being more effective than others. Medications are often prescribed in a process of elimination. For example, less than 30 percent of patients respond adequately to their initial anti-depressant, with 25 percent still experiencing unresolved issues with their current medication according to the National Institute of Mental Health (NIMH).



Using PGT testing to ascertain the optimal prescription for a patient not only saves both parties time and money by minimizing trial and error, but can identify possible drug to drug interactions, saving the patient unnecessary pain and adverse effects on their general and mental health. Some of the benefits of the PGT include the following:


  • Individualizes the treatment of pain during the withdrawal process by   providing objective information to help clinicians in their selection of drug and dosage
  • Minimizes the trial and error involved in finding the optimal prescription, helping the patient recover more quickly and painlessly
  • Identifies possible drug to drug interactions
  • Allows the exploration of the clinical impact of genetic variations
  • Provides evidence-based information in easy-to-read guideline format, including a primer on pharmacogenetics, metabolism diagrams, generic/brand prescription drug lists and gene-specific inhibitors and inducers


Although PGT testing is built off of decades of research conducted by the human genome project, the process itself is extremely straightforward. Clinicians have the option of selecting either their specific medication of interest from or from the respective class medications.  The report generated provides a clinical interpretation of the proper drug and dosage for the particular situation.


Assisted Recovery understands that it can take years of trials to find the right medication for a specific person, which is why we employ PGT testing through Millennium Labs. The testing process is simple and painless, requiring nothing more than a swab of saliva. Patients’ DNA profiles are not saved and all samples are destroyed after testing, ensuring the utmost confidentiality. By identifying the optimal medication for each individual case, we are able to not only provide fast and effective treatment, but avoid the risk of interactions and other adverse effects that can arise.

Setting Goals


Four Rules of Changing Old Habits


William James, the pioneer psychologist and pragmatist, established four rules for breaking old habits and forming new ones. They are:

1. Old habits are destroyed by forming new ones. In forming a new habit, launch yourself with as strong and decided an initiative as possible. You must be convinced of the necessity of replacing the old with the new, sincere in your conviction; and you must make the strongest effort you can summon up.

2. Never suffer an exemption to occur in the formation of a new habit. To allow an exception to occur, to repeat an indulgence just once, is to strengthen the destructive habit pattern and to sabotage the constructive one. You are trying to eliminate the old pattern by disuse; to use it just once is to restore its original strength.

3. Seek the first possible opportunity to act upon a new resolution. Any delay is in itself a demonstration that the sincere conviction of a needed change is absent. Delay is an excuse; the time to start is NOW!

4. Keep the faculty of effort alive in you by little gratuitous exercises daily. You must be constantly aware that you are forming a new habit pattern in order to be able to fight off the unexpected pressure that would hurl you back upon the old. Mere abstention from some action is not enough; there must be positive action.

Understanding Your Values

Now that you understand the importance of setting some new positive goals, it’s time to spend some time thinking about what’s really most important to you in your life. Understanding your own personal values will help you to set your own priorities, and determine what to do first, what to do next, and so forth.

Much of the key to understanding your current priorities may lie in the reasons why you decided to quit drinking in the first place. Perhaps your reason for quitting was primarily health related, perhaps because of deteriorating personal relationships, or perhaps to avoid serious legal or financial consequences.

You’ll also want to spend some time thinking about who you really are, and who you would like to be. Perhaps financial security and material possessions are of utmost importance to you… or perhaps you are more interested in creative endeavors, spiritual growth, or in having plenty of time to spend with your loved ones.

Though your values in life are important and will help guide you in the right direction, it’s not as important WHAT you do now, as that you DO SOMETHING. You can always re-evaluate and make adjustments as you go along.

Let’s Get Busy

The first step in setting your personal goals is to consider what you want to achieve over the course of your lifetime. This will give you the overall perspective that shapes all other aspects of your decision making. Remember that setting long-term goals does not mean that you have to do everything all at once. So consider setting some long-term goals in each of the following categories:

  • ArtisticCreativity and artistic self-expression can be among the most satisfying of all the possible leisure-time activities. Painting, writing a novel, learning to play a musical instrument, carving or woodworking… the possibilities are endless.

  • AttitudeMany of us can benefit from changing some our negative thinking. Especially if you are still carrying around some guilty feelings over past behavior while drinking. What can you do to develop a more positive attitude about life?

  • CareerMost of us are faced with the reality of having to work for a living. Some are even lucky enough to enjoy their work, while others are content to bring home a paycheck in order to support other interests. What’s important to you?

  • EducationOne of the best ways to keep life interesting, and your mind active and healthy, is to always be involved in the process of learning something new. Even if you’ve finished your Ph.D., your education is never completed.

  • FamilyRepairing and restoring your relationship with your loved ones is among the first priorities of a happy sober lifestyle. Make a concerted effort to spend more quality time with them. It’s highly unlikely that you will someday look back over your life, and wish you’d spent more time at the office.

  • FinancialA certain amount of financial security is a desirable goal for everyone. Beyond that, you decide how important money is to you. Will you be happy in a small house with a white picket fence, or do you want the big house on the hill with the Ferrari in the driveway, and the bank account to match?

  • Physical HealthMaintaining or improving your physical health will pay big dividends in your efforts to remain sober. When you feel good physically, you feel better emotionally (and vice-versa). A program of physical exercise, good nutrition, and getting enough sleep will help put you in a positive upward spin, instead of the old, self-destructive cycle.

  • PleasureCan you even remember what you used to do for fun, before you started drinking? Many people can’t. Learning how to have fun again, without alcohol, is one of the most important things you have to do. The world is full of fun, exciting things to do, that don’t necessarily involve drinking. Get out and try some of them, and find out what you do enjoy. You didn’t get sober to sit at home on the sofa, and you won’t stay sober for long if you do.

  • Public ServiceGiving unselfishly of yourself can be an extremely rewarding experience. Opportunities to volunteer your time and talents are plentiful. Give it a try… you may be pleasantly surprised at how much you’ll get in return.

  • SocialDo most of your social activities with friends revolve around drinking? How are you going to change that, without giving up all of your friends? Are there some acquaintances that you may have to give up, because of their drinking? What other social activities can you participate in, that don’t involve drinking?

This list is a good place to start, but you may think of some other categories of your own, in which you would like to set some goals.

Setting SMART Goals

Now that you’ve considered some of the different categories in which you might want to set some goals, lets turn our discussion to the process itself. In order to insure that your efforts are successful, here are some general guidelines to follow when setting your goals.

SMART is an acronym which stands (in this instance) for goals which are:

  • Specific

  • Measurable

  • Achievable

  • Realistic (and)

  • Timed

Perhaps these terms will be best illustrated by working a practical example, and discussing it as we go along. We’ll start out with a specific category, which we’ll call “My Recovery”. (See the sample Goal Setting Worksheet which is provided at the end of this chapter.) This is a broad, overall category which will encompass all of your other, more specific categories.

We’ll start by entering the name of the category in the blank at the top of the form, in this case, “My Recovery”. Next, we move to defining our objective within this category, by setting our “Long Range Goal,” and putting it down in the blank provided.

You might be tempted at this point to write down something simple, such as “Abstinence” as your Long Range Goal, but first, let’s examine whether-or-not that really meets our five SMART criteria. In this instance, we’ll define it as meaning “Abstinence from Alcohol”, but some may wish to make it more SPECIFIC to include the words “Abstinence from Alcohol and Other Drugs.” But is even that specific enough? Isn’t the real goal something larger than that… something having to do with not missing our alcohol? So we may want to rephrase this to include “To be happy in abstinence.”

Secondly, the word Abstinence does meet the criteria of MEASURABLE, since having even one drink is a violation of abstinence. Thirdly, Abstinence is ACHIEVABLE, since we know others before us have done it (though we also know that it won’t always be easy). Fourth, Abstinence is REALISTIC, since it may in fact be more likely than yet another attempt at moderation (or controlled drinking.)

And lastly, let’s consider our 5th criteria, TIMED. Have you completely accepted the idea of giving up the alcohol for the rest of your life? If so, great, include that in your goal. But if not, and the idea of never having another drink for the rest of your life seems unimaginable and UNREALISTIC to you at this point, then set a period of time that you feel you can live with, such as one year, and set that as your goal.

Putting it all together, we’ve arrived at our SMART-modified Long Range Goal, which now reads something like “To be happy in abstinence from alcohol for life.” We’ve already written it in for you. If your goal is something different from that, take one of the blank Goal Setting Worksheets, and write it in the appropriate space.

Once you have clearly defined what your goal really is, it’s easier to figure out how to go about achieving it without going astray. You do that by breaking down your overall goals into smaller, Short Term Goals, and then breaking those down into even smaller, bite-sized pieces which we call Tasks (or Things-to-Do). Tasks are simply small goals which can be accomplished in 5 minutes to an hour’s time, which move you in the direction of your larger goals.

You’ve already made some decisions about your Short Term Goals within the “My Recovery” category, because you’ve already enrolled in the Assisted Recovery Program, and started working it. So you’ve already got your first Short Term Goal, which is to “Complete the ARCA Program”. Write it down.

Now you’re ready to break that down into the individual tasks that you will have to complete in order to successfully complete the program. We’ve already written them in for you on the sample “My Recovery” Worksheet, though you may want to revise it in accordance with your own Initial Treatment Plan, or the goals you’ve set for yourself.

We’ve written in the sample, the following tasks:

  • Take my Naltrexone EVERYDAY (without fail) for the full 6 months.

  • Allow (person’s name) to monitor that I’m taking my medication.

  • Attend ARCA group meetings at least once a week for the first year.

  • Attend one-on-one counseling sessions as scheduled.

  • Complete all homework as assigned.

On the second line under Short Term Goals, we’ve written in for your second goal, that you promise to yourself to try to “Maintain an attitude of being ‘In Recovery’ for a minimum of the first full year.” You may find that you will want to continue this attitude (and the work that goes with it) for a lot longer than that, but the length of time that you will want to continue working at your recovery, is really up to you.

Maintaining your attitude of recovery means doing the work that’s involved, and on the tasks list side of the worksheet, we’ve written in the following suggestions:

  • Reading a variety of Recovery related books and other materials.

  • Developing a sober support system, making new friends who are recovering.

  • Trying out a variety of activities and finding some you enjoy doing sober.

  • Working on rebuilding and restoring any relationships we may have damaged while drinking (where appropriate).

  • Looking for opportunities to “be of service” to others less fortunate than ourselves, and especially to others who are still suffering from active addiction to alcohol, if there are ways in which we can be of help.

You may be thinking that some of these things overlap with some of the things you’ve already thought about to include in some of the other specific categories. That’s fine. Better to have your goals written down twice than not at all.

You may have also thought of some other things that you want to include here, that are part of your own personal program of recovery. That’s fine too… in fact, its GREAT… so feel free to write them down, and add them to your list. And remember too, we’re merely explaining the Goal Setting Process here… not trying to force any goals on you, that you’re not completely ready to accept as your own goals. These have been offered as suggestions and ideas… not hard and fast rules.

Now you’re ready to move on and set some goals in some or all of the other suggested categories. Try to remember to set goals over which you have as much control as possible. You don’t want to become discouraged early on, because you set goals which included too many factors which were beyond your control. Try to set goals based upon improvements in personal performance, rather than strictly on outcomes. (For example, set a goal to increase your sales by 10% next month, rather than to become the top salesperson in your division next month.) And remember when going through the different categories: just because you set a goal doesn’t mean you have to start working on achieving it immediately. Write down everything you can think of that you’d like to accomplish… you can always revise later on if you change your mind about something.

Prioritizing your Goals – What to Do First

Now that you have set some specific goals within some or all of the individual categories, and broken them down into smaller goals and tasks that you will have to accomplish to move in the desired direction, you’ll have to make some decisions about which things you need to work on the most. You do this by reviewing your Goal Setting Worksheets, and by moving some of the tasks from your worksheets to the “Things to Do This Week” list. We’ve provided you with a blank form which you can copy for future use, and another sample form, on which we’ve already moved some of the items from the previous “My Recovery” worksheet.

In addition to a place to write down items for each specific day of the week, there is a place for items you want to remember to do Everyday, such as “Take my Naltrexone.” Be sure to write down anything in this space that you want to make into a positive new habit.

If you sometimes forget to brush your teeth or take your vitamins, write it down here.

Next, go through the “My Recovery” worksheet, and you should end up with a list very similar to the example we’ve provided. Now finish the process by moving some of the tasks from your other Category Worksheets onto your “Things to Do This Week” list.

Remember that at this early stage in your recovery you need to stay busy, so move lots of tasks onto the list. Don’t worry: if you don’t get around to doing them all this week, you can always decide to try again next week by moving it to your next weeks list, or you can decide that it’s not a high priority right now, and that you’ll get around to doing it later on. It will still be there on your Tasks list to remind you to get back to it later.

Repeat this process at the end of each week. Go over last week’s “Things to Do This Week” list, and move to next week any items you didn’t get to, which you want to try again next week. If you had 30 items on your list and you checked off 25 of them, it should make you feel pretty good about yourself, for having accomplished so much towards achieving your goals. On the other hand, if you only checked 5 things off your list… better resolve to try a little harder next week.

As you work this process week after week, you will soon begin to see that you’re actually beginning to accomplish some of your goals. There’s a wonderful feeling of satisfaction you get out of working towards your goals, and then finally achieving some of them. In some ways it’s very similar to that feeling of happiness that we used to get out of the “quick fix” of alcohol, but with two distinct advantages: it doesn’t wear off as fast, and you won’t wake up the next day with a hangover.

So get busy, and GO FOR YOUR GOALS!


Alcohol and Depression


l as her family whose personal suffering was every bit as awful as Terry’s. One of the most moving interviews ever given was by former U.S. Senator and Democratic candidate for President of the United States, George McGovern. He spoke eloquently about his daughter Terry, who suffered from both alcoholism and major depression. He gave a detailed account of all that he, his wife and many others did to help Terry recover, only to be shocked and saddened late one December evening when a police officer and minister came to his home to tell the McGovern’s that Terry was dead. She had gotten drunk, passed out in the cold and froze to death.

In a book he wrote to tell this story, simply titled Terry (1997), Senator McGovern provides a heart wrenching description of the life and tragic death of his beloved daughter. He wrote that Terry “was dealt a double cruel hand: the dual tragedy of suffering from depression and alcoholism. This book provides insight on the experiences of Terry as well. The book shows how alcoholism when combined with depression leads to tragedy and a sense of helplessness.

Addiction and depression are common co-existing conditions. A study conducted by the National Institute on Health reported that almost one-third of individuals with depression had a co-existing substance use disorder at some point in their lives (Regier et al, 1990). The National Co-morbidity Study found that men with alcohol dependence had rates
of depression three times higher than the general population; alcohol
dependent women had four times the rates of depression (Kessler et al, 1997).

People with addiction and depression often have other mental illness diagnoses including bipolar, anxiety, personality or other addictive disorders. Women often develop the mood disorder first while men frequently develop the addiction first. For many, these disorders become linked over time with symptoms of each worsening the other. These conditions are often chronic and must be managed over the long run.

Children of alcoholics or opiate addicts are at increased risk for substance abuse, conduct problems, anxiety disorders and mood disorders. Parental substance abuse underlies many family problems such as divorce, spouse abuse, child abuse and neglect, welfare
dependence and criminal behaviors (Daley & Miller, 2001). Children of depressed mothers are at increased risk for a psychiatric disorder; the prevalence of “multi-problem” children is over eight times higher among families with a depressed parent (Yapko, 1999).


Treatment should be “integrated” and go beyond symptom reduction by helping the person engage in a structured recovery process. Professional treatment and involvement in recovery for example at Assisted Recovery can make a significant positive impact on clients and their families in managing mental illness and addiction while improving the quality of life.


There are many effective treatments for mental illnesses for example depression, including cognitive behavioral therapy (CBT), rational emotive behavioral therapy (REBT), motivational interviewing (MI) which may be combined with modern anti-depressant medications. Treatment should be provided in facilities which are able to deal with co-existing conditions. Assisted Recovery for example is fully licensed by the State of Arizona as a behavioral health provider.


There are also many effective treatments for addiction including the above mentioned behavioral therapies and the use of safe, approved, effective medications that level the playing field to enable the therapy to be more effective. Medical science now recognizes that brain biochemistry controls both mental disorders such as depression and addictive disorders such as alcohol and opiate dependence. Assisted Recovery has been providing what is known as “Pharma-co-therapy” since 1997, combining behavioral therapy with effective medications to assist an individual in the process of recovery. The use of anti-alcohol medications such as naltrexone, Vivitrol® which is injectable naltrexone, ondansetron, and Campral® and the anti-opiate medication Suboxone® will revolutionize addiction science and the treatment of people suffering terribly from mental illness and addiction.


Addiction and mental illness are common co-occurring disorders which have numerous and very serious adverse effects which makes recovery utilizing traditional methods all but impossible. Best practice calls for an integrated approach which addresses both the mood and addictive disorders.




Binge Drinking


Binge drinking and excessive alcohol consumption are responsible for roughly 10 percent of deaths among working age adults, according to a new study by the Center for Disease Control and Prevention. The study, carried out between 2006 and 2010, found that alcohol abuse kills nearly 88,000 Americans every year, and accounts for over one in ten years of potential life lost among working-age adults in the United States. All in all, excessive drinking is responsible for one in 10 deaths among working age adults in the country, more than half of which were specifically tied to binge drinking.

Nationwide, those 88,000 alcohol-attributable deaths per year amount to roughly 27.9 per 100,000 American adults. But that number actually varies quite a bit by stateas you can see from the map above. In New Mexico, the death rate due to excessive drinking is 51.2, which is easily the highest in the U.S. In New Jersey, the state with the lowest reading, the death rate is nearer to 19 per 100,000 residents. Alaska notched the second highest reading, with 41.1 alcohol-related deaths per 100,000 residents; Hawaii notched the second lowest, with 20.8; and Washington D.C.’s 34.7 rate is well above the national average.

America’s drinking problem poses more than merely a health risk—it costs the country more than $220 billion each year.

Alcohol abuse is currently the fourth leading preventable cause of death in the United States. And it’s hardly limited to those of legal drinking age. A surprisingly high percentage of high school students indulge not only in underage drinking, but underage binge drinking, and hundreds of thousands of underage drinkers are hospitalized each year. The CDC, in response to its findings, recommends a more widespread implementation of a number of interventions, including the raising of alcohol taxes, and forced limit on alcohol outlet density.





Assisted Recovery is an evidence based treatment program that has been treating individuals suffering from alcohol and substance dependence since 1997. We treat any behavioral problem including gambling and smoking cessation. The treatment environment is safe, caring and non-judgmental. ARCA meets the criteria for providing “best practice” treatment as defined by the United States Substance Abuse and Mental Health Services Administration.


Advances in the understanding of addictions have led to the development of highly effective medications and therapies that allow long-term recovery in the patient’s normal home environment with little or no disruption of work, family or school.


We have a caring, highly trained professional team that provides state-of-the-art individualized treatment, utilizing Cognitive Behavioral Therapy, Rational Emotive Behavioral Therapy and Motivational Interviewing. The treatment team is directed by a licensed doctoral level psychologist.


ARCA’s experienced physicians utilize medications that are all FDA approved and have been proven to be highly effective, safe and fast acting. They are not addicting, or have very low abuse and are radically different from older, far more well known medications like Antabuse and methadone. The medications include naltrexone, Vivitrol® (injectable naltrexone time released for 30 days), Campral®, ondansetron, Suboxone®, Chantix® and topiramate. It must be emphasized that these medications are tools, not cures. They compliment the therapy provided by the treatment team.


Assisted Recovery has available full psychological testing and evaluation to assist in understanding the issues affecting recovery and having a full, happy life. The ARCA team includes a Arizona State certified Hypnotherapist as a adjunct to treatment.




The use of medications is a critical component of the recovery process. They effectively and safely level the playing field so that the individual can focus on the truly difficult part of recovery, which is, simply put, learning how to be happy in life without alcohol and or drugs. Naltrexone, which was first approved in 1994, will within 20 minutes suppress the craving or the thought process to drink. Suboxone® aids individuals addicted to opiates (heroin, pain pills) to detox safely and without getting sick, in a reasonable amount of time. ARCA physicians have years of expertise in the use of these medications.



ARCA will supervise the medical home detox for clients in a manner to provide relief from the physical withdrawal symptoms, anxiety and depression. The detox medications provide protection from potentially serious events, for example seizures. We will seamlessly start clients on anti-craving medications which help to block the desire for alcohol or drugs.




Alcohol and substance dependence are destructive and potentially deadly addictions that impact not only the dependent individual but also devastate their family, friends and their work place.


Dependence on alcohol and drugs often creates a sense of shame, guilt and fear causing individuals to hide their problem. It is often with shock when a spouse, parent or loved one learns of the crisis. The initial shock can quickly turn to anger and disappointment. The question becomes, what can be done to help. What are the treatment options?

Should an expensive program in California, Minnesota or Missouri be contacted? Is affordable treatment available? The answer is to call ARCA for effective, evidence based treatment.



The Assisted Recovery treatment team believes that individuals suffering from alcohol, substance and other behavioral dependency issues should have viable treatment options, other than a traditional 12 step approach. ARCA believes that each individual should thoroughly research treatment options, including 12 step based programs before making the decision as to what is the most appropriate treatment.


The treatment professionals at ARCA will never tell a patient that he or she is hopeless or powerless over alcohol or substance dependence. In fact treatment at ARCA is based on the opposite that individuals still have the power and motivation to change their lives for the positive by eliminating destructive addictive behavior.



Addictive disorders impact the patient and their families in multiple ways. Measuring success is not just helping patients get off of the alcohol or drugs. The ARCA treatment team measures success by looking at several parameters, including sobriety, family and social relationships, work and educational functioning, and the development of recovery support systems.






Study: Public Feels More Negative Toward People With Drug Addiction Than Those With Mental Illness


People are significantly more likely to have negative attitudes toward those suffering from drug addiction than those with mental illness, and don’t support insurance, housing, and employment policies that benefit those dependent on drugs, new Johns Hopkins Bloomberg School of Public Health research suggests.

A report on the findings, which appears in the October issue of the journal Psychiatric Services, suggests that society seems not to know whether to regard substance abuse as a treatable medical condition akin to diabetes or heart disease, or as a personal failing to be overcome.

“While drug addiction and mental illness are both chronic, treatable health conditions, the American public is more likely to think of addiction as a moral failing than a medical condition,” says study leader Colleen L. Barry, PhD, MPP, an associate professor in the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health. “In recent years, it has become more socially acceptable to talk publicly about one’s struggles with mental illness. But with addiction, the feeling is that the addict is a bad or weak person, especially because much drug use is illegal.”

Between Oct. 30 and Dec. 2, 2013, Barry and her colleagues surveyed a nationally representative sample of 709 participants about their attitudes toward either mental illness or drug addition. The questions centered on stigma, discrimination, treatment and public policy.

Not only did they find that respondents had significantly more negative opinions about those with drug addiction than those with mental illness, the researchers found much higher levels of public opposition to policies that might help drug addicts in their recovery.

Only 22 percent of respondents said they would be willing to work closely on a job with a person with drug addiction compared to 62 percent who said they would be willing to work with someone with mental illness. Sixty-four percent said that employers should be able to deny employment to people with a drug addiction compared to 25 percent with a mental illness. Forty-three percent were opposed to giving individuals addicted to drugs equivalent health insurance benefits to the public at-large, while only 21 percent were opposed to giving the same benefits to those with mental illness.

Respondents agreed on one question: Roughly three in 10 believe that recovery from either mental illness or drug addiction is impossible.

The researchers say that the stories of drug addiction portrayed in the media are often of street drug users in bad economic conditions rather than of those in the suburbs who have become addicted to prescription painkillers after struggling with chronic pain. Drug addicts who fail treatment are seen as “falling off the wagon,” as opposed to people grappling with a chronic health condition that is hard to bring under control, they say. Missing, they say, are inspiring stories of people who, with effective treatment, are able to overcome addiction and live drug-free for many years.

Barry says once it would have been taboo for people to casually discuss the antidepressants they are taking, which is often the norm today. That kind of frank talk can do wonders in shaping public opinion, she says.

“The more shame associated with drug addiction, the less likely we as a community will be in a position to change attitudes and get people the help they need,” says another study author, Beth McGinty, PhD, MS, an assistant professor in the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health. “If you can educate the public that these are treatable conditions, we will see higher levels of support for policy changes that benefit people with mental illness and drug addiction.”

Stigma, Discrimination, Treatment Effectiveness, and Policy: Public Views About Drug Addiction and Mental Illness” was written by Colleen L. Barry, PhD, MPP; Emma E. McGinty, PHD, MS; Bernice A. Pescosolido, PhD; and Howard H. Goldman, MD, PhD.