Marin Drug Recovery Updates

Paul Pribuss was recently featured in an article in the Marin IJ newspaper. The coverage focused on his work with substance abuse, couples and his volunteer participation at San Quentin state prison. To read the whole article and view the photos open the attached link

http://www.marinij.com/lifestyles/ci_11276719

The state of the economy is unpredictable at best and for the typical addict this becomes a recipe for relapse. In my personnel and well as professional experience I find the two main causes of relapse to be Matters of the Heart and equally important Matters of the Pocket. What specifically does this include? The “heart matters” comprise loss and pain associated with our primary interpersonal relationships as well as that of close family and social members. “Pocket Issues” refer to situations involving money, plain and simple. Surprisingly, the issue of money often includes success as well as failure.

In today’s economy there are many triggers, which will take our sobriety and recovery to task. We are all aware of someone who has been laid off or fired. We all have experience with people who have lost 30% -50% of their portfolio. We all know someone who has lost an extensive amount of their business. Could that some one be you?

So many of us place a great deal of value in our work, our income and our net worth. These are the standards by which the world judges us and provides us with a means to survive. Work and career is what gives many of us a reason to get up every morning, a sense of purpose and a reason to exist. It is our means of contributing to life and a method of leaving some mark on the world. Loss of these attributes elicits fear, hurt, disgrace, embarrassment, humiliation, and an inability to function in life. If these are realized our life is compromised and the associated pain seems too much to endure. The best answer could easily be “to use”.

Let’s take a look at the world of Oxycontin, Oxycondone, street name OC (many of the tablets have the letters O and C imprinted on them). Why is it becoming the fastest-growing street “drug of choice” for young adults? If it were a problem, why would our respected medical profession prescribe it? If it’s being used illegally why is it available on the Web? How can it be so destructive if it is manufactured by responsible pharmaceutical corporations and not in some basement meth lab? These questions have validity and tend to confuse us as participants subject to peer pressure, addicts suffering from opiate withdrawal, parents and citizens. Is there a viable plan for therapy and subsequent recovery from Oxycontin addiction?

Oxycodone is an opioid analgesic, or pain medication, synthesized from thebaine (a minor constituent of opium, producing stimulatory rather than depressant effects). It is also sold in a sustained-release form in the U.S. by Purdue Pharma under the trade name OxyContin (the name is actually short for Oxycodone continuous release) as well as generic equivalents. It was developed in 1916 in Germany and its chemical name is derived from codeine — the chemical structures are very similar. In the United States, oxycodone is a Schedule II controlled substance. This mandates control by the DEA, strict administration of prescriptions, maximum 30-day allowance and no refills allowed on the initial prescription. It was first introduced to the U.S. market in May 1939 and is the active ingredient in a number of pain medications commonly prescribed for the relief of moderate to heavy pain. A partial list of these medications are referred to as Oxycodone, Oxycontin, Percocet, Tylox and Percodan.


Addiction to opiates usually originates in a controlled medical setting. Typically the patient has a back or neck injury and the pain is overwhelming. The doctor originally prescribes Vicodin and the pain goes away, temporarily. Tolerance to the med develops and more and more is needed to reduce the pain. Often meds are substituted, combined, added to, and increased until a problem becomes apparent. The problem is addiction! The medical profession is aware of the abuse/addiction and they become reluctant to continue prescribing. The patient becomes desperate and seeks the assistance of multiple doctors. This cycle can’t continue indefinitely and illegal or street drugs become the option.

The “young adult” route to opiate addiction is somewhat different in origin but bears the same results. The story has become a cliché regarding the kid who feels lost and just wants to fit in. The teen experience is difficult for most and “adaptation” is seemingly mandatory. Yet it isn’t only the outcast or odd one who chooses the drug route. There are an equal number of examples of valedictorians, star athletes and overachievers also finding solace in drug addiction. Yes, it does start innocently, with “gateway” drugs, e.g., cigarettes, alcohol, and marijuana. The plot varies and the influencing factors are difficult to categorize. Many teens experiment with a variety of drugs and develop a normal pattern of acceptable usage into their adulthood. There is a middle group who seem to exceed experimentation and try any drug available. The pattern continues into adulthood, usually focusing on an individual drug. Such users would be described as problematic. While their lives function with impairment they are not addicted.

Addiction is the final stage or group, and Oxycontin/OC gets people addicted fast. As an opiate it is quickly tolerated (more is required for the same result) and getting “strung out” (physiologically addicted) can easily occur in one week. The misconceptions surrounding the drug are paramount: Many believe it is manufactured safely by pharmaceutical corporations, prescribed by family doctors, regulated and controlled by the federal government, pure and unadulterated, devoid of any criminal or underground element.
When a participant “joneses” (develops a physical craving, enters withdrawal) addiction takes its most devastating form. Illegal activity, inappropriate sexual practices, loss of self-respect and that of others, lying, avoidance of friends and family, and run-ins with police are some of the indicators of decline. Many who get to this point want to do the right thing, but the triggers, the group they run with, the affluence of our Western lifestyle and the easy access to OC repeatedly draws them back in. It sounds like a Hollywood movie line, but quite accurately they’re “in too deep.” They are at their weakest, yet trying to make the most important and difficult decision of their life.


Peruse some of the following stats and make your own decision regarding the severity of this current epidemic. They were funded by NIDA and conducted by the University of Michigan's Institute for Social Research in 2007. My guess is that OxyContin addiction is getting worse.



NIDA: National Institute on Drug Abuse
Abuse of prescription drugs is particularly problematic among adolescents.
• NIDA’s 2007 Monitoring the Future
(MTF) survey found continued high rates of nonmedical use of the prescription pain relievers Vicodin and OxyContin in each grade. In 2007, many 12th grade students reported nonmedical use of Vicodin and OxyContin during the past year––9.6% and 5.2%, respectively (figure).
• And while the nonmedical use of some stimulants (i.e., methamphetamine) decreased among 12th-graders between 2006 and 2007, levels reported remain high. For the past year nonmedical use of amphetamines, 7.5% of 12th-graders reported abuse; for Ritalin, 3.8% reported abuse; and for methamphetamine, 1.7% reported abuse. It is generally believed that the broad availability of prescription drugs (e.g., via the medicine cabinet, the Internet, and physicians) and misperceptions about their safety make prescription medications particularly prone to abuse. Among those who abuse prescription drugs, high rates of other risky behaviors, including abuse of other drugs and alcohol, have also been reported.

For more information on drug and alcohol addiction therapy, visit the Marin Drug Recovery website

The Slippery Slope of Drug Usage, Pt 2 of 4
A Typical Picture of Drug and Alcohol Addiction by Paul Pribuss MFT

There is another group who discover the drug has enhanced their lives in a variety of questionable ways, which they previously had difficulty achieving. With drug usage they become more popular and fit in with a desirable social group, find a method of rebelling, become less self conscious, take on a false bravado, self medicate depression, lose one’s inhibition, and the list continues on. Typically there is a great degree of fun and excitement associated with early drug use, but as involvement expands a problem or two will start to occur. These problems are easily overlooked or denied and considered “part of the territory”. We start to believe others don’t understand us, families are over involved in our lives, and it becomes easier to avoid scrutiny and isolate, find associates who have similar or worse patterns of use, and in truth continue in our addictive path. What started out to be “a little fun” has now taken a habitual turn. We try to convince ourselves we can control the habit and stop whenever we choose, but when tested, find the pattern more entrenched than anticipated. We may be able to take a brief respite from our use but find we revert back to the old ways in a short amount of time with the same or greater intensity.

What does a life look like, teetering on the verge of addiction? Once again, the view can take on a wide variety of images. On the upper range of the scale an addict is able to ignore the issue because they have friends, family and associates who seem to have a greater problem. Their external world (job/school, marriage/family, material possessions) may not have substantially deteriorated and this becomes the rational to continue on. On closer inspection the deterioration is far greater than acknowledged or realized. Their internal world is in shambles and true quality of life is negligible. At the bottom end of the scale the deterioration is impossible to ignore and has occurred repeatedly. This stage is as bad as I can only imagine and typically involves legal involvement, perceived mental illness, homelessness, loss of most material possessions and alienation from not only family but also any meaningful human contact. Is one stage worse than another? Not really, because the pain and suffering is the real determinate and who can claim superiority or inferiority in this regard?

What transpires in an addict’s life to bring about change? The list or circumstances is endless. Who knows why one person will suffer to the point of jail, psych ward, homelessness and total devastation while another, who is seemingly healthy, decides change is imperative? People in the field of recovery refer to a “moment of clarity” and/or a “miraculous intervention”. These can be difficult terms to accept and often an impediment to accepting help. I like the 12-step phrase “sick and tired of being sick and tired”, which speaks to my experience. I don’t believe it is necessary to lose everything before change can take place, yet realize everybody has to walk their individual path. A family intervention, legal issue, threatened or realized divorce, lost job, financial problems, are all situations the addict chooses to change. There is no one “right way” or “sufficient reason” to get sober!

How do people address their addictions? Again the possibilities as well the results are vast. Typically an addict starts to understand the drug is causing some problem in their life and they feel some urgency to change. Initially, controlled using, cutting back, some reduction in the current pattern, seems to be a logical concept. This is an individual pursuit and promises, agreements and written contracts are established. It becomes apparent this isn’t as easy as it seems and there occur some concessions, changing of the rules and failure before it is time to seek some form of professional help.

This is an article about drug and alcohol addiction therapy by Marin Drug Recovery

The Slippery Slope of Drug Usage, Pt 1 of 4
A Typical Picture of Drug and Alcohol Addiction by Paul Pribuss MFT

Chemical dependence has been studied and treated for hundreds of years with varying degrees of success, dating back to the Neolithic period. (cir. 10,000 B.C) There are a variety of modern theories and programs to treat the addiction process, many claiming a high degree of success. Some of these programs do achieve results while others seem to have a great amount of recidivism. What would distinguish one process from another? Why would a person suffering from addiction chose plan A over plan B? These questions continue to vex many addicts and their long-suffering families to the point of indecision and confusion.

What is the bottom line regarding addiction and recovery? My belief at Marin Drug Recovery is that the initial goal is clearly to get clean or sober. Whatever works in this regard is good-enough. The method can vary from “cold turkey” detox in a jail cell to a private suite with gourmet food in a recovery/spa type center. Sometimes we aren’t able to chose or afford our preferred method of getting clean. Additionally the event or circumstances, which precipitate sobriety, can also vary. A judge may sentence one to a 12 step or recovery program. One’s spouse or employer may insist upon abstinence to continue with the relationship. Family members can initiate an intervention, resulting in sobriety. Again, whatever works is good-enough. If the choice or circumstances were left up to the individual, waiting for the correct timing, well that might never happen, resulting in excessive and needless suffering.

People become addicted to drugs and alcohol in a variety of manners, yet there are some basic concepts similar for most people. Typically a young person will start to experiment with an easily accessible drug, usually alcohol or pot. There is a certain amount of curiosity as well as peer pressure involved in the initial phase. Many people at this stage discover the effects of the drug are somewhat detrimental to their current life and decide the experiment is over. They frequently return to the drug in an appropriate manner, using it socially, in what is described as “normal” use.