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Treating addiction

With the opioid epidemic dominating headlines, a look at a Squamish rehab facility, how a local survived and some promising treatments
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Nirmala Raniga on the steps of one of the homes of the Chopra Addiction and Wellness Center.

Surrounded by dense Paradise Valley forest, walking trails and gardens, the two immaculate, modern houses sitting on 10 acres look like ideal places to recuperate.

Inside the addiction and wellness centre, a hot organic, vegetarian lunch is prepared – handcrafted pizza and fresh greens on the day The Chief visited.

The 16-bed, 24-hours-a-day, seven-days-a-week rehab facility, the Chopra Addiction and Wellness Center, has been operating since 2010 when the famous guru Deepak Chopra partnered with the Squamish facility formerly known as Paradise Valley Wellness Centre. It is the only such treatment facility Chopra has partnered with in this way.

"What makes Chopra Addiction and Wellness Center unique is our focus on promoting balance and integration of body, mind, spirit, community, and environment," reads an email from the facility's founder, Nirmala Raniga.

The no-smoking facility boasts master-level therapists, a physician that is licensed to provide opioid substitution therapy, a consulting psychiatrist, nursing staff, a nutritionist, art therapist, massage and acupuncture practitioners, yoga and meditation. In addition to substance use issues, the centre treats other addictive behaviours – gambling and sex addiction, for example – as well as anxiety and post-traumatic stress disorder.

Men and women stay in gender-specific houses.

Detox is not available, but referrals are available.

Currently, the facility is going through the process to be licensed by Vancouver Coastal Health, Raniga said.

Outgoing Mayor Patricia Heintzman lives near the centre and recalls the concern of some neighbours when it first opened: 60 people came to an information meeting when it was proposed.

“It has been great,” she said on Monday morning. “It is quiet. It is peaceful.”

[The centre has an extensive website – go to www.chopratreatmentcenter.com to learn more.]

The average duration of a client's stay in residence is four to six weeks, according to Raniga, who has been involved in recovery work for 30 years.

The centre offers a no-charge, community bed for a Squamish resident who can't afford the fee.

"Beds that go to Squamish Nation, because we are on their land, and then anyone who has been a resident of Squamish for six months… can access our services," Raniga said.

The typical patient, however, will pay about $22,000 plus GST for a four-week stay, or about $730 per day.

The centre offers a 12-week continuing care incentive plan for those who paid for four weeks, weekly follow-ups for all clients for 12 weeks after they leave, as well as weekly phone calls for three months. Staff encourages clients to reach out for support anytime after they leave.

Raniga said it would be ideal for everyone who needs it to have access to the centre.

"My wish is that the government was able to provide these things," she said, adding, ideally, licenced facilities would be covered for those who need the treatment.

"That is what I have been hoping for the last 30 years," she said.

Raniga and all of the experts The Chief spoke to for this story agreed on one thing – the stigma around addiction is not helping anyone.

"If a person shares with their family or friends or workplace, are they being judged? That is the biggest thing – that judgment."

People need to understand that everyone will face challenges in life, Rangia said.

"We need to understand that if someone is using alcohol or drugs or abusive behaviours, they are really trying to cope with their feelings or suppress their feelings," she said. "If you come from a place of compassion and non-judgment, we make pathways for all people to heal."

Shame is a barrier to healing, she said.

"You believe stories about yourself that aren't necessarily true," she said. "Addiction, depression, anxiety – happen in isolation. We want them to be a part of a community."

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In addition to substance use issues, the centre treats other addictive behaviours – gambling and sex addiction, for example – as well as anxiety and post-traumatic stress disorder.

From those who have lived it

Squamish advocate Laurence Gauthier speaks openly about his history with substances to raise awareness and make things a little better for others who are struggling, he says.

For him, popular culture played into his move to substances.

"It really comes down to movies, music, magazines… being cool is the gateway drug," he said, adding cigarettes and beer were his first drugs. Eventually, he tried almost every drug there is, he acknowledged.

The culture of "old" Squamish – a remote forestry town – was and is very testosterone driven, according to Gauthier.

"Don't talk about your feelings. If something is wrong with you, you dust it off and rip harder," he said. Drugs lull their takers into a sense of control and make the person think they have things all figured out, he added.

There can be an extreme cost of not dealing with feelings.

 "Over the last year I have lost 10 of my bros who I grew up with in Squamish," he said.

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Laurence Gauthier - YouTube

The hardest thing for Gauthier to kick was opioids, he said. Medical staff gave them to him when he was severely injured in a logging accident.

"Then you miss a doctor's appointment because you are so whacked out – you are a zombie – and then if you are cut off of it, you have no choice but to hit the streets." Gauthier has been off of opioids for more than 18 months, and he still feels withdrawal symptoms and cravings.

When he gets low over his current fight with WCB, for example, his mind still tells him to do drugs, he said.

One thing those who were addicted battle is people not believing them when they are living healthier lives, he said.

He has lost weight, so some friends and family assume he is using destructively again, he said, which is frustrating and leads some in recovery to relapse.

It is essential for people to realize that you don't have to be a so-called "drug addict" for life, he said.

Being outside in nature has been healing for Gauthier.

"When you are stuck at home you see Facebook and your friends doing things… you don't see the bad parts of people's lives," he said.

He also echoed something Raniga said about the disconnection that exists for many today.

"People are finding an escape or people are finding a feeling of belonging and those [drugs] are the quickest places to go." 

He isn't particularly supportive of treatment centres, however.

"They are a business too," he said. "The reality is, [those who are addicted] need love and they need to talk about it without feeling guilty."

B.C.'s Leslie McBain, the co-founder of the advocacy network Moms Stop the Harm, said that relatives of those with addiction need to work to maintain their relationship. The group, therefore, doesn't support coercing relatives into care.

"Given the situation – a parent and a child and the child is already doing risky behaviour or is addicted – that relationship is probably already pretty fragile and so to put that incredibly important relationship at risk by forcing a kid into care, there may be more harm than good from that," she said.

McBain, whose only child, Jordan Miller, died from a drug overdose in 2014, also acknowledges the flip side of that coin – it is essential people stay safe.

"If the family doesn't feel safe around the behaviour of the loved one… we have to stay safe."

Regarding choosing a treatment facility, McBain said the availability of aftercare is critical.

Moms Stop the Harm is not supportive of only offering abstinence as an option.

"A lot of treatment centres require that the person be abstinent for a certain length of time before they enter, which is ridiculous," she said. "They are saying, ‘You have to go into withdrawal and be sick for a week before you get here.' What is the point of that?" McBain said. "A lot of people who are addicted can't do that. So, it is counterproductive."

Centres that provide counselling and the ability for the person to taper or go on medically assisted treatment are preferable for many, she said.

 As also noted by Raniga, fentanyl has changed the dynamics for everyone.

"If we didn't have fentanyl, if we just had regular old garden variety heroin, that has been around for many, many years – except for a few times when there were some really bad drugs on the street – then people who go into treatment and then relapse, would probably not die," she said. "People who are trying for recovering from opioids [can] relapse six to seven times before they recover. The thing to do is keep them alive."

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Mark Haden, a public health professor at the University of British Columbia. - Facebook photo

Future advances in treatment

Mark Haden, a public health professor at the University of British Columbia, said one tool for helping people transition off of opioids that offers hope is ibogaine, a naturally occurring psychoactive substance found in plants. It is legal in Canada and Mexico, but not in the U.S. It can be taken during detox.

"There's something about the biology of resetting the brain’s receptor sites for opioid addiction," he said. "It is hard to understand why it works so effectively, but so far it is the most promising treatment for opioid addiction that I have ever seen."

He thinks, eventually, the best practice will be for people who come into treatment addicted to opioids to be stabilized on something like morphine and then started on ibogaine.

There are challenges with the ibogaine in that it is very long acting, meaning it requires medical oversight for about a week.

"You have to prepare people. You have to really set them up for the experience," he said. "The cost isn't purchasing the ibogaine. The cost is in managing where you have to intensely work with people over a week-long period."

There seems to be an elevated risk of cardiovascular death while on ibogaine, but given those who have been abusing substances have often been doing so long enough to do damage to their hearts and aren't living a healthy lifestyle, that isn't surprising and doesn't mean it isn't useful.

"It seems to be effective for heroin treatment, and you have to put it in a context. There's a huge death toll out there. It is about relative risks versus relative benefits.

"It appears that the relative benefits are higher than the relative risks."

While there is a lot of attention in the academic literature to ibogaine that shows there's nothing else like it, there haven't been the clinical trials for it yet that would turn it into a medicine – probably because that takes millions of dollars, Haden said.

"It seems to have something to do with the receptor sites. You go in with this huge heroin withdrawal, and you start taking it, and your withdrawal goes away," he said.

His website, markhaden.com, has plenty of resources, including videos, for parents and individuals dealing with problematic substance use.

 

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Organic, vegetarian meals are part of the care at the Chopra Addiction and Wellness Center.

A typical day at the Chopra  centre 

Wake – Light breakfast

7 to 8 a.m. – Yoga

8 to 8:30 a.m. – Meditation

8:30 to 9:15 a.m. – Breakfast

9:20 to 9:40 a.m. – Mindfulness walk

10 to 11:30 a.m. – Group Therapy

11:30 to noon – Reflection time

Noon to 1 p.m. – Lunch

1 to 1:50 p.m. – Chopra Curriculum: Addiction Discussion Session

1:50 to 2 p.m. – Break

2 to 3 p.m. – Chopra Curriculum: Mind, Body, Spirit Discussion Session

3 to 3:30 p.m. – Snack

3:30 to 4:30 p.m. – Yoga/physical fitness

4:30 to 5 p.m. – Meditation

5 to 5:30 p.m. – Integration Time

5:30 to 6:30 p.m. – Dinner

6:30 to 10 p.m. – CHOICES

•All activities facilitated by a Wellness Staff Member: AA Meeting ----- Chopra Book Selection: Freedom From Addiction ----- Swimming -----12 Step Work Offered ----- Journal/Gym ...... Gratitude Circle

10 p.m. – Retire for the night

 

 

 

 

 

 

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