#acamprosate

[smashing-yng-man]

I've done it all - attended Alcoholics Anonymous twice a day, five days a week. Memorized the fourth edition of the "Big Book" from cover to cover. Admitted myself into two different rehabs, staying 60 days each time.

What has ultimately kept me sober from drinking is confiding in my therapist and taking a combination of Acamprosate and Naltrexone twice a day to curb alcohol cravings.

I drank heavily for nearly two decades, and frankly have the experience and genetic predisposition to confirm that addiction is not a choice.

But sobriety and self-care are.

#addiction #alcoholism #drinking #recovery #sobriety #rehab #mental health #mental illness #alcohol dependency #alcohol withdrawal #sober living #self care #naltrexone #vivitrol #camoral #acamprosate #alcoholics anonymous #alcohol use disorder #substance abuse #self medicating

[mcatmemoranda]

I'm listening to episode 292 of Frany Speaking About Family Medicine - Reducing the Risk of Alcohol-Associated Liver Disease

14 grams of alcohol is a standard drink. That's 5 oz of wine, 12 oz of beer, or 1.5 oz 80-proof liquor. More than 7 drinks in 1 week or more than 3 in one day is excessive drinking for women. More than 14 drinks in one week or more than 4 drinks in one day is excessive drinking for men. Basically, women should drink 1 or no alcoholic beverages daily and men should drink no more than 2 drinks daily.

Alcohol use disorder = continued use despite harm. There are 11 criteria* for EtOH use disorder; the pt must meet 2 of the criteria in an 12-month period. It leads to clinically significant impairment or distress.

Ask about the pt's motivation to quit or cut back on his/her drinking to help guide treatment. Ask if the pt has ever experienced any symptoms of alcohol withdrawal (headache, palpitations, tremors, hallucinations) to help determine whether the pt is a candidate for output vs. inpatient withdrawal. For pts who have experienced seizures, hallucinations, DT, if they have a CIWA score of more than 15, are medically complex, or are pregnant, they should be inpatient for withdrawal treatment.

-4 to 6 out of the 11 criteria = moderate alcohol use disorder.

-6 or more out of 11 criteria = severe alcohol use disorder; recommend medical and psychosocial treatment

Naltrexone is a good first line treatment as long as the pt isn't taking opioids. It comes in oral and IM forms. It reduces cravings for alcohol.

Acamprosate is another option, but pts need to achieve abstinence before starting it and it's dosed TID.

Disulfiram, gabapentin, topiramate, and baclofen are other drugs that can be used to treat EtOH use disorder.

*the 11 criteria for AUD:

-You drank more, or longer, than you meant to

-Craved alcohol badly

-Tried or wanted to drink less, but couldn’t

-Gave up or cut back on activities you used to enjoy, so you could drink instead

-Spent a lot of time drinking or recovering from a hangover

-Repeatedly placed yourself in risky situations during or after drinking

-Had problems at home, work, or school because of drinking or hangovers

-Continued to drink even when it negatively affected your personal and professional relationships

-Kept drinking even though it made you feel anxious or sad

-Had to drink more to feel the desired effect, or felt much less of an effect from your usual number of beverages

-Experienced shaking, restlessness, anxiousness, nausea, or other withdrawal signs when the effects of your drinks wore off

#EtOH #alcohol use disorder #alcohol #standard drink #naltrexone #acamprosate #frankly speaking

[pharmaffiliatesanalytics]

CAS No : 3687-18-1 | Product Name : Acamprosate Calcium - Impurity A (Freebase) | Chemical Name : Homotaurine | Pharmaffiliates

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#Product Name : Acamprosate Calcium - Impurity A (Freebase) #CAS No : 3687-18-1 #Chemical Name : Homotaurine #PA 28 15010

[myosotisa]

Like Real People Do - e.m.

Part 1/2 - Why were you digging?

ǁ  summary: 30 days into your stay at the Betty Ford Center for Rehabilitation, Eddie Munson gets brought in against his will. While in the middle of trying to figure out your own issues, you find yourself being followed around by a detoxing rockstar who won't take a hint and get lost.

ǁ  tags: angst, hurt/comfort, heavy themes. depictions of inpatient rehab in the 90s. implied fem!Reader, no pronouns used, no y/n. strangers to reluctant acquaintances to lovers.

ǁ  content warning: both parts will contain mentions of drug use, struggling with addiction, self worth, society's view on drug users, grief, and death by drug overdose. brief mention of domestic violence and drug assisted disordered eating. please consume thoughtfully and if you have any questions before reading, feel free to message me.

ǁ  word count: 7k

ǁ  Part 2 ǁ  Read on AO3 ǁ

The lock on your door clunks open at exactly 8am every morning. A glaring alarm that your new day is about to start whether you want it to or not.

At 8:15, one of the workers on staff is barely knocking before pushing in to make sure you and your roommate will be ready for breakfast at 8:30 sharp.

At 8:30, you’re standing in line with everyone else to get your morning meds. Amoxaphine for depression. Atenolol for high blood pressure. Methadone for opioid withdrawal. Acamprosate for alcohol withdrawal.

A little paper cup of water to wash them all down, your mouth presented to prove you did actually swallow them, and then a verbal pat on the back before sending you over to the breakfast line.

A styrofoam plate of scrambled eggs and toast with jam on a plastic tray, balanced carefully with a cup of whatever juice they decided to buy this week. Carefully set down on one of the small tables by the window where you’ll sit and eat alone – appreciating the quiet and serenity for the few moments a day you get it before you’re shoved off to the next task.

The same thing for the past 28 days since you were deposited in the Betty Ford Center. You’d gone from euphoric, cold, and totally out of it to anxious, shaky, unable to sleep, and just fucking miserable. And while some days were getting easier and others seemed more difficult than ever, at least you had gotten into the routine of inpatient rehab. At least you knew to expect the same thing everyday. At least you were prepared to deal with what the external world threw at you.

Until you weren’t.

The moment the doors to the main hall are thrown open – impacting the opposing walls with a slam –  you get an overwhelming feeling that something is about to change. Something big.

“Hey fucker! Hey! Get your meat hands off me, lughead.”

Most of the heads in the room turn toward the source of the yelling, a parade of 5 coming through the double doors. Two you know, the medical director Mr. Ford and one of the doctors Dr. Lincoln. They both look annoyed and uncomfortable as they walk ahead of a set of 3 men. 

Flanked on either side by a buff orderly, getting borderline dragged across the floor, is a man you’ve never seen. His long, messy waves whip wildly around his head as he lets out expletives and pulls against the sharp hold on his biceps. His voice is ragged and slurred as he makes nonsensical arguments towards the two men leading him away. He’s in regular clothes – outside clothes – with torn jeans and metal chains hanging off his hips, ripped sleeves showing off his tattooed arms, and large rings on every finger.

Someone new?

Having gotten their eyeful, half the room goes back to pushing around their breakfasts with plastic cutlery while the other half continues to watch with amusement. A new person only comes through every 15 days or so, and this was only the second since you’d arrived. The first one, a meek boy named Thomas, had been admitted so quietly that he all of the sudden appeared one day in group, already through the worst of the detox, before you had ever even heard of him.

It makes you wonder if more inpatient admissions are like that or like this.

You wish you could remember yours.

In a whirl of movement, the man rips his arms free and flies backwards with a stumble. Had he been more coordinated, and probably more sober, than he is, he might have made a decent break for it. As he is, he’s barely able to turn toward the doors they came through before the men are grabbing him again from behind, hooking their arms around his to now actually drag him down the hallway toward the hospital wing.

The heels of his black boots drag against the beige tile floor as he slumps in their grip, eyelids fluttering slightly before he manages to bring back enough energy to yell another, “Fuck you!” at his captors.

Just before they disappear behind another set of locked down double doors, the two of you make eye contact. From this distance, you can still see how bloodshot his eyes are – deep brown ringed by red toned white. They are steadily falling closed with each blink as he most likely loses the fight against some kind of sedative. But somehow, with what must be the last moments of consciousness he has left, he sees you watching him. The corner of his mouth tilts up in a lazy smirk. And he winks.

The motherfucker winks at you right as his head lulls to the side before falling forward and the group of 5 disappears.

Something new indeed.

You don’t see the stranger again until 6 days later.

New admissions normally spend anywhere from 3 days to a week and a half in the hospital wing after arriving. IV fluids, heavy meds, and a more prepared medical staff to deal with the worst of the detox period. Depending on what you were on, how recently you took it compared to when you arrived, and the length of your addiction makes a huge difference in how much time you spend there before being sent back to the rest of the floor.

4 days is average, which is the amount of time you spent in the hospital wing before being put into room 102 with Melissa Redding. Teen beauty queen of the Betty Ford Center who got hooked on meth after a consultant for the pageant used it to help her lose weight.

The center had a neat little tradition of having your roommate show you around on the first day. For you, that had meant busy bee Melissa whispering in your ear in and outs of who was who and all of the drama entailed even though you didn’t care in the slightest. That continued through the rest of the day as she showed you around the main hall, gave you a tour of the garden during your mandated 1 hour of outside time, and into the Therapy House.

While she had initially been excited to have a roommate, she very quickly learned you would not be the entertainment she wanted. So she went back to gossiping with Kathy the housewife, who was in for a bad habit of using too much Adderall to get through the day with her kids. Leaving you to your own devices.

It was better that way.

You’re already in your seat by the window with breakfast by the time the stranger stumbles in after Howard, the gruff old man whose family sent him here for drinking too much (drinks the same amount as any other man his age, but who are you to judge?). He gets right into the med line, now half diminished due to their late arrival, and doesn’t seem to pay any attention to the stranger as he wanders away.

Guess he decided that wasn’t his job.

Tall, dark, and lanky looks like he’s been through the ringer. Skin pallor and clammy, hair pulled into a bird’s nest of a bun on the back of his head with the top and bangs matted flat with what you assume is sweat, hands fussing in front of him like if he doesn’t move as many muscles as possible at once he’ll explode. There are deep purple bags under his wide eyes as he approaches one of the other windows in the space, 30 feet away from where you’re sitting. 

He looks over the frame like he’s trying to find a way out, coming back with nothing before heading to the next window, closer to you. His appearance and behavior make you think of a wet rat trying to claw its way up the side of a bathtub – unable to grip onto anything and getting sent back down into the water again every time he tries to climb.

Hoping not to catch his attention, you direct your gaze down, focusing back on your under salted eggs and grape jam. Between the lack of seasoning and the juice of the week being some kind of weird pineapple mix, you’re left wanting even more so than usual over your bare bones breakfast.

Despite your half assed attempt to be invisible, the single chair across from you at your table is pulled out, flipped around, and then settled into by the stranger. In your shock, you look up at him before you can second guess the reaction.

“I saw you, I remember,” his voice is deeper than you thought, raspy at the edges with exhaustion and hardship. His gaze flicks rapidly from the table, your food, your face, the rest of the room, his hands. Everywhere at once it seems. “The day they brought me in.”

“Yup,” you confirm with an awkward nod of acknowledgement before looking back at your food.

Please leave, please leave, please leave.

“I’m Eddie. Eddie Munson.”

Looking back up at him, he has a bit more life in his face. Something that looks a little bit like hope.

“Okay.”

His face falls.

“You… Doesn’t ring any bells? Eddie Munson, guitarist, Corroded Coffin, biggest rock-metal band of the 90s?” The longer he goes, his wet eyes widen, making him look like a pleading animal looking for food scraps. When you show absolutely no recognition for anything he’s saying, he brings his hands together, fingers moving to twist at rings that no longer sit there. When he doesn’t find them, his leg starts to bounce under the table and his palms start tapping on the top of the chair at his chest.

“If you’re looking for celebrity worship, I’m sure Melissa or Kathy would be happy to provide.” You inform him, hoping he will lose interest and go searching for them to give him the attention he seems to be looking for. You go back to spreading jam on your slightly burnt toast.

He doesn’t take the bait. “How, uh, how long have you been here?”

Taking a long inhale through your nose and out through your mouth, you set your plastic knife back down. “A month.”

His hisses out air through his teeth, eyes searching over the rest of the room, like he’s waiting for something bad to happen. “How long do people normally stay locked up in here?”

Ah. 

“I dunno. A couple months? I’m not exactly some kind of authority here. You should go ask–”

“Has anyone ever broken out?”

Though you’re not sure why you’re surprised, you still struggle with the question. He makes eye contact with you again and the look in his eye is different now. Smaller.

He’s scared.

“I don’t know. I don’t think so.”

He scoffs, using his hand at his chin to crack his neck in either direction, looking unsatisfied with your answer. “Come on, like nobody has ever tried to get out? You’ve never tried?”

A weight presses down on your chest. “No, I haven’t.”

“Yeah right, I’m sure that there’s some–”

“Mr. Munson!”

An orderly stalks toward the table, looking crabby and annoyed this early in the day. Eddie looks about ready to bolt after their bark but somehow remains seated until they arrive. “I’m sure Howard didn’t inform you, but first thing in the morning you’re supposed to come up to the nurse window to receive your medication.” They present their arm back to where the now empty med line stands, everyone else settled into seats with their breakfasts. “After you’ve taken your medication, you can grab some breakfast and…” They make eye contact with you that you’re quick to avoid. “Converse with whoever you want.”

“See, your mistake was that I don’t need any medication, so I don’t need to wait in line.” His voice is slowly raising in volume, drawing more and more attention as he goes. “In fact, I’m not even supposed to be here!”

“Mr. Munson, please lower your voice, you’ll disturb the other residents.”

“Fuck the other residents,” he slams his palms down on your table, almost knocking off your plastic cup of juice when it rocks and you jolt back from the show of aggression. All eyes in the room are on him now, and by extension, you. Other residents, other orderlies, nurses, the kitchen staff.

Too many eyes.

While the attention makes you want to crawl into a hole and die, it seems to please Eddie. He pushes up off of his chair and makes a show of arguing with the annoyed orderly all the way over to the nurse’s station. All eyes in the room follow him and his suddenly animated features, looking like he has gained 10x more energy than when he walked in. You use the distraction to your advantage.

By the time Eddie has had medication forced down his throat, a plate of shitty eggs deposited in his hands, and he turns around to look at your table again, you’re nowhere to be found.

He finds you again in the garden before group therapy.

You’re tucked away in a painted white, wrought iron chair that’s bolted to the ground next to a tall shrub. It’s still in the gated off outdoor area, but mostly hidden from view. The orderlies know to find you there if they need you because that’s where you always are – sitting on that single chair in the sunshine with a paperback book on your lap. Today it’s Good Omens: The Nice and Accurate Prophecies of Agnes Nutter, Witch.

When a body blocks the sun over your book, your first assumption is that it’s an orderly coming to tell you it’s time to head to Therapy House. But it seems too early for that, and you’re normally a pretty good judge of time (at least, in here), so when an unfamiliar voice clears its throat in front of you, you huff a breath before you raise your head to acknowledge him.

“Is that seat taken?” He asks with a grin, motioning to the empty table bolted to the ground beside your chair. It’s obviously a rhetorical question – maybe to get you to smile or laugh. You do neither and give him a flat look.

“Actually, I’m saving it for someone.”

This seems to delight him even more, eyebrows raising and eyes getting some more life in them as he takes a seat on the table anyway. “Well I’ll keep it nice and warm for them until they show up.” He pulls his facility-issued navy sweatpants covered legs up to cross under him, effectively draping his knee over your arm.

Accepting your fate to not get rid of him, you open your book again to where you left off. 

“Best not to speculate, really,” said Aziraphale. “You can’t second-guess ineffability, I always say. There’s Right, and there’s Wrong. If you do Wrong when you’re told to do Right, you deserve to be punished.”

“I checked the perimeter of the garden,” his voice is lowered, as if someone would overhear him, “looking for weak spots.”

You hum an acknowledgement, keeping your eyes on your book as you reply in a sarcastic monotone, “Because that’s definitely not suspicious.”

He waves you off out of the corner of your eye, beginning a light tap of his hands against his knees. Even with the medication. He either needs a higher dose or he’s hyperactive at baseline. “They probably just thought I was giving myself a little tour or something, I don’t know. I don’t really care if it’s suspicious, actually. All I know is there’s like… Nothing. At all.”

“Shocker.”

Continuing to ignore your lackluster responses, a bopping of his head joins the beat of his palms. You attempt to reread the same paragraph over and over to try and comprehend it through his talking and fidgeting, failing time after time. “Not even like a locked gate or anything. And the fence itself is too high to get over with no footholds, unless you got something to stand on to grab the top and pull yourself over. Yeah…” 

“Oh!” The sudden volume of his voice makes you jerk away from him again, not expecting the sharp change. “What about your chair, is it loose?” One long fingered hand grips the backrest between your shoulder blades and the other the chair arm closest to him, attempting to give it a shake. “Maybe we could get the bolts out and use it to climb the fence.” He only succeeds in making an annoying rattling sound and jostling you back and forth.

“Fuck, Eddie, will you –” Using the paper cover of your book, you smack at his forearm a few times, causing him to quickly withdraw and hold his hands up in front of his chest like he’s worried your attack will continue. “Fucking, stop it.”

“Geez, sorry,” he mutters, looking slightly sheepish but still not exactly apologetic. “What’s your name, by the way? I forgot to ask.”

“Seems a little too late to ask now, don’t you think?” You turn the page of your book to make it look like you’re making progress despite the fact that you haven’t been able to finish a sentence since Eddie sat down beside you. Anything to help you look less interested in his attempted escape and, therefore, him.

An amused snort leaves his nose, tapping hands turning to a hold on his knees to let him lean back without falling off the table. “Well you are just a ray of sunshine,” he snarks back, looking more amused than annoyed. “Anyone ever told you that before?”

Finally lifting your head to give him a placating and overly artificial smile, you meet his eyes to make sure he can see your insincerity when you say, “Only every day.”

And while he opens his mouth to probably throw back another sarcastic retort, he’s interrupted by the “relaxing” (read: fucking annoying) gong by the Therapy House going off, signaling it’s time to head inside. You snap your book shut and push off your chair without a word to join the rest of the group outside in the unenthusiastic shuffle toward the birch wood doors. Another set of slip-on shoes, a matching pair to yours, sidles up beside where your own drag through the dirt path.

“So what happens now?” He asks, leaning a little bit closer to you as he speaks again, like the two of you are conspiring together on something. Based on your interactions so far, maybe he thinks you are.

“Therapy,” is your sharp reply. And, as if finally understanding he probably isn’t going to get much more information, he shuts up and just walks beside you toward the two story building off of the main facility.

All 12 of you wander through the doors in your similar outfits – sweatpants, t-shirts, and hoodies in shades of blue, grey, and black. Crossing from dirt and stone pathways onto the pristine wood floors of the Therapy House that’s awash with sunlight. As many windows as possible in all directions and a huge circular skylight above leaves the whole room bright and airy.

There are 13 metal folding chairs set up in a circle beneath the skylight, 1 more than yesterday, and the one directly across from the door is already occupied.

Mrs. Penelope Windsor is the head of therapy at the Betty Ford Center for Rehabilitation and wears that title with the utmost pride. She’s put together, ambitious, intelligent, and damn good at her job. Not to mention attractive, with her long legs crossed under her black pencil skirt, her crimson red button up blouse showing just enough collarbone to still be ‘professional’, and the long brunette braid draped over her shoulder. Her black heels are patent leather and perfectly shiny along with the matching briefcase sitting beside her chair. She stands out sharply from the white walls and birch wood floors of the Therapy House – but she commands your attention that way. A focal point in a room of white and tan and beige nothingness.

And the moment you walk through the doors with Eddie beside you, you feel her hazel eyes on you like a fucking hawk.

You avoid making eye contact, as per usual, and settle into the seat you’ve been using since the first day you came here. To your displeasure, Eddie immediately grabs the seat to your right, flipping it around to sit backwards in it, folding his arms over the back with a certain lazy confidence.

Tony, who normally sits there, hovers uncomfortably for a moment behind before scuttling over to the only remaining chair between Mrs. Windsor and Melissa.

As soon as he’s seated, heavy and tense silence settles over the room while the rest of you wait for Penelope to greet the group. You could hear a pin drop in the room in these moments, everyone shifting uncomfortably in the quiet as she takes a few moments to look over the group before her.

Almost like she enjoys making us all squirm under her authority.

Her sharp eyes settle on Eddie, her face as passive as always. He does very little to react to her stare but takes it as a sort of challenge – staring right back where most would shy away. The corner of her mouth lifts almost imperceptibly, like she appreciates the challenge.

The silent standoff is broken as Thomas’ wooden cane clatters to the floor beside his chair from where it had been leaning. He immediately turns bright red from the collar of his black t-shirt all the way to the tips of his ears. “Shit – Wait, oh, shoot, sorry!” Scooping it up in shaky hands, he is quick to tuck it between his knees, white knuckle fisting the handle in his embarrassment.

“That’s quite alright, Thomas,” is Penelope’s serene reply, a gentle smile directed his way before she addresses the group. “Good afternoon, everyone. Welcome back to our group session for today.”

No one says a word as she takes another uncomfortable moment to scan the group before doubling back to land on Eddie. “I see we have a new member of our group today. My name is Mrs. Windsor and I’m the head therapist here at the Betty Ford Center, but you’re more than welcome to call me Penelope. Could you introduce yourself for us, please?”

“Eddie Munson, guitarist, Corroded Coffin.” He answers cooly, and you watch his eyes do a quick scan to see if anyone shows any recognition. When there are a few reactions, his smile grows into one of satisfaction before he returns his gaze to Penelope. “Am I supposed to say what they locked me up for now or somethin’?” It comes out in a teasing lit, like he is trying to make a joke of it all.

No one laughs.

She takes it in stride. “You’re more than welcome to share what you’re struggling with, if you’d like.”

His shoulders rise slightly, like a cat going on the defensive. “Okay, first of all, I’m not struggling with anything. I’m not even supposed to be here. I keep telling them if they just let me call my manager we could get this whole thing cleared up so I can get the fuck out of here and back to my life.”

“Your manager…” She leans over, plucking a file from her briefcase and unfolding it on her lap. “Mr. Scott?” She looks up through her eyelashes for confirmation.

He settles again, looking slightly relieved. “Yeah, Jonathan Scott, Razor & Tie.”

“Mhmm…” She looks back at the file, flipping a page up in what looks to be a show. Like she already knows what she’s supposedly ‘looking’ for. “It says here Mr. Scott is the person who applied for your stay in our center and is the sign off as your legal guardian while you’re completing your treatment.” She lightly closes the file, sitting up straight again to look at him. “Did you know that Eddie?”

“No,” he answers, voice suddenly unsure, eyebrows drawing together on his forehead and shoulders falling. “No, I didn’t.”

“Well then,” her smile is nothing but satisfied when she slips the papers back into her briefcase. “It seems there’s nothing to be cleared up here after all. And I’m sure we’re all very excited to get to know you over the next few weeks, Eddie.”

Challenge won.

When he doesn’t respond, she moves on. “Now, Kathy, it looks like your nails are doing better…”

You tune out the rest of her interaction, focusing on the man beside you. He has his head slightly hung down, eyes on his hands as he holds one wide and uses the opposite thumb to rub along his palm. There’s an air about him – closer to one you saw this morning. Confused. Lost. Scared.

You almost feel sorry for the guy.

Two hours later, you’re in one of the ‘office lofts’ of Therapy House, a 5x5 closed room with a loveseat for you and an armchair for your therapist. After group is over, there are rotations of 1 on 1 therapy with one of the various counselors on staff, herding each of you into tiny rooms for an hour at a time. At the beginning of your stay, you had somehow lucked out to being assigned to Queen Penelope herself.

She sits across from you with her holier-than-thou attitude and a spiral notebook clutched in her well-manicured hands – filled with notes about you that you’re not supposed to see. In the sunken down cushions of the loveseat, you end up sitting below her eyeline even if you tried to sit up straight. So you don’t try – tucking your legs under you and crossing your arms under your chest.

As per usual, she starts the session with a few moments of horrifying silence. Almost as a dare to get you to talk first just to break it.

You never have.

“So, how are you feeling today?”

“Fine. Same as always.”

She clicks her pen, like she’s already prepared to start taking notes off that one sentence. “Indeed. Everyday is always ‘fine’, isn’t it?”

Eddie must have made you more snippy than usual, because you’re already ready to turn on her. “What point are you trying to make, exactly?”

“Everyday, every time anyone asks, the answer is always ‘fine.’ Fine is a noncommittal answer that means nothing.” She leans back in her chair, cool and collected as always. “Fine is the answer you give when you’re avoiding the answer.”

It takes everything in you not to roll your eyes at her. “Okay, what is my answer supposed to be then?”

“The truth, preferably.”

Wow, thanks, that’s helpful.

When you don’t respond with a new answer, she moves on. “Are you still having nightmares? Flashbacks?”

A shiver crawls up your spine, creeping toward the cold sweat that starts to build at the nape of your neck on instinct. “Sometimes.”

Liar.

“How often, would you say? For the nightmares?”

Clammy hands press into the fabric of your grey sweatpants. “Maybe once a week.”

Liar.

She scribbles something down in her notepad. “And the flashbacks?”

A vision of cold, blue tipped fingers reaching out toward you from the dark comes to the forefront of your mind before you blink it away. “Less than that, I think.”

Liar!

“And are they all still about her?”

The cold from those blue tipped fingers permeates through your body, settling into your bones in a chill that never seems to leave you anymore. “Not all of them.”

LIAR. LIAR. LIAR. LI–

“Actually, can we talk about something else?” Your request comes out quicker than you’d like, giving a show of desperation as you adjust in your seat. “Please,” you add as an afterthought.

Her gaze is sharp as ever and calculated in her perusal of you for another few moments, but she concedes. “Alright. What would you like to talk about then?”

When you flounder for an answer, mouth opening and shutting uselessly, she offers an alternative of her own. “I saw you walk in with the new guy today. Eddie, right? Did you talk to him at all?”

You let out a huff, eyes directing down to where your wandering fingers have landed on a piece of loose thread on your pants. “More like sat there while he talked at me.”

“He didn’t give you a chance to talk or you never took it?”

“I don’t exactly have anything I want to talk to him about,” is your cold response, once again looking up to make eye contact with her.

“You know, it wouldn’t actually hurt to try to connect with someone again. Maybe open up to a new friend?”

This time you’re not able to withhold your eye roll. “Junkie rockstar is not exactly the kind of friend I’m looking to make.”

“That’s a bit of a hurtful representation, don’t you think?” She is writing another note as she speaks, eyes looking between you and her page. “How would you feel if someone didn’t want to interact with you because you’re a ‘junkie’?”

Your gaze flicks back down to the thread between your fingers as you mumble, “They wouldn’t exactly be wrong.”

“Do you think you’re a bad person because of your drug use?”

I think I’m a bad person for a lot of reasons.

“It doesn’t exactly give you a glowing perception in the eyes of the public,” you answer defensively.

“That may be true. So you did something that was frowned upon by the general public, making it ‘bad’ or ‘wrong’.” She adds in the air quotes, even though her tone was enough to warrant the assumption that she was being facetious. “What about all of the good things you’ve done? Is there some kind of threshold for the amount of ‘bad’ things a person needs to have done in comparison to the good ones to brand them as a ‘bad’ person?”

“I don’t know, maybe.”

Her eyes flit over to the book beside you, resting on the cushion with the cover Good Omens facing up, before returning to you. “I think, personally, that it’s possible to have done bad things without it making you a bad person. It doesn’t make you a good person either, mind you. Because there’s also no such thing as a person who is wholly good either.” She folds her hands over her lap like she always does when she thinks she’s about to say something really profound.

“Good and bad are just malleable descriptions we give to things. People are not simply good or simply bad. People are just… People. Where good, bad, and everything in between coexist.”

Then why do I feel like this?

Eddie plops down in front of you at breakfast looking slightly less like a wet rat than he has so far.

"Good morning, sunshine." And he grins, way too fucking chipper for being 2 weeks into detoxing.

"Don't call me that."

"Whatever you say, sunshine," he repeats with the same grin, like he's glad you don't like it. "I have a plan for us to get out of here."

Get out? A plan? Us? You don't even know where to start with that. "Ah. No wonder you look like it's Christmas morning."

"I'm going to take that as a compliment." With a noncommittal 'mmfh', you go back to pushing around your over salted scrambled eggs. "Aren't you going to ask what my plan is?"

"No."

"Well, since you asked," he ignores you and leans over the table, once again lowering his voice to a soft murmur. "One of the night nurses is a fan of my band."

He pauses there, like he's looking for some kind of response. You offer up a completely lackluster, "Congrats."

"Sooo, maybe I can butter her up. Promise her VIP tickets or backstage passes or something. Bribe her to get us out."

Stabbing into a chunk of egg hard enough to almost pierce through the styrofoam beneath, you mumble, "Good luck with that."

He points his fork at you, eyes narrowing in a glare. "You don't think it will work."

"I don't care if it works," you sigh as you bring a hand up to rub at the sudden tension in your temple. "What do you think is gonna happen when you get out, huh? They're just gonna say 'Well, he got out of rehab, guess that's it then!' Your manager is just gonna have you delivered right back here."

"Then I get a new manager." Another flat look is leveled in his direction. "Seriously, I can figure it out once I get out of here. And if you're gonna be this negative about it, then maybe I won't take you with me," he says it like a threat, looking smug as he sips at his not-quite-pineapple juice.

"Good."

His plastic cup hits the table fast enough that a bit sloshes out and onto the vinyl cover. "What do you mean 'good'? You're telling me you don't want to get out of here?"

It's like he's finally hearing you for the first time. "Yes, that is what I'm telling you."

"As if." He scoffs, shoving a chunk of scramble egg in his mouth before continuing to talk through chewing it. "Nobody wants to be in here getting pumped full of happy meds and talking about our feelings with the Ice Queen."

A part of you actually wants to be amused at the term Ice Queen, but you're quick to beat it down. "Yeah, well, maybe I do."

He takes a big bite out of his stiff toast next, crumbs flying with the force of it. "I think," he pauses to swallow the bite before pointing the toast at you this time. "That you have Stockholm Syndrome. And have accepted defeat in your captivity."

"Whatever you say, Munson."

You should've known better than to assume it would end there.

After breakfast, all of you scatter throughout the main hall to do various things to fill your time. As usual, you sit down on a chair by the window so you can continue your book. You're quickly approaching the climax of the narrative, when the four horsemen begin their ride toward the end of the world.

Eddie has set up shop at a table nearby, bent over the top that's scattered with papers that are all covered in drawings of various mythical creatures. He's currently scratching away at a sketch of a three headed Hydra, mouths roaring fire toward the sky.

You'd never tell him this of course, but you have to admit that they are pretty good.

It's 30 minutes of blissful silence with plenty of progress made in your book until he starts talking again.

"Do you actually not want to get out of here?"

You exhale through your nose sharply, annoyed that you're being forced to continue this conversation. Closing your book with your thumb tucked in to save your page, you turn your upper body toward him. "Is that really so hard to believe?"

"Yeah, actually, it is. What are you even in here for anyway? Like what 'problem' do they think you have?"

"None of your fucking business," is your extremely grumpy reply, settling back into your chair and opening your book again in hopes he'll drop it.

"Well, whatever it is, it's not worth sitting in this glorified prison for months on end, I can tell you that much."

Something about the way he's talking really starts to grate on your nerves, making you want to fight more than you want to ignore him. "I'm sorry, would you rather be in actual prison?"

This makes his face drop, a muscle in his jaw rolling with tension. "What the fuck is that supposed to mean?"

"It means that coke and meth are illegal, in case you forgot. And can actually get you arrested." Your tone is condescending, tinged with venom. "So maybe you should be grateful to be in this 'glorified prison' instead of a real one."

"Grateful?" He lets out a fake laugh, looking at you in disbelief. "Yeah, let me just try to be grateful to have my every move watched and my entire day planned for me like I'm in a fucking daycare."

An orderly walks in through the double doors to the garden, propping them open in an invitation to move outside for the hour. You're quick to rise, tucking your bookmark into your spot and muttering a dismissive, "Whatever," as you pass.

You're barely off the stone path and into the grass towards your seat when he comes barrelling out after you.

"Hey, I'm not done."

"Listen," you continue forward, talking over your shoulder at him as he marches after you, "I get you're still in denial and everything. But it's not my job to make you accept that you're here for a reason. So why don't you just leave me alone."

A hand grips your shoulder, forcing you to turn toward him. The sun is behind his head from this angle, leaving him silhouetted in light and you standing in his shadow in the grass.

"And what exactly do you think the reason I'm here is?"

"I don't know," you push his hand off your shoulder, tucking your book in against your stomach. "Why don't you ask yourself that question?"

"I'm here against my will because a fucking corporate prick thinks I need 'fixing'," his voice comes out as a hiss through his clenched teeth. His hands tighten into fists at his sides. "Everybody thinks we need to be 'fixed'."

"Maybe we fucking do, Eddie! Did you ever consider that?"

Out of the corner of your eye, you see your argument getting some attention from other patients and an orderly standing watch, but you're too caught up in your anger to care.

You jolt in surprise when Eddie's hands grip your shoulders, forcing your attention on him. "Are you even fucking listening to yourself?!"

"Eddie, let go of me."

His hands only tighten, his wide eyes going wild. "They fucking infected you with their bullshit doctrine of what society thinks is right and wrong, but it's not true."

You try to pull away from him but his grip just turns bruising in response, fingertips digging into your skin painfully. Fear takes hold, tears starting to push at the back of your eyes as you plead, "Please, Eddie, you're hurting me–"

"They're hurting you!" He's borderline yelling in your face now, emphasizing his next point by shaking you where you stand. "Don't you fucking get it? They're the ones hurting you by making you think there's something wrong with you!"

An orderly appears beside him and grips his shoulder, ordering a tense, "Let her go."

This seems to shock him as his hands release you mid-shake, sending you backwards onto your ass. You make impact with a yelp, the tailbone pain enough to force the tears that were threats before to start to spill down your cheeks. You're sure that if your hands weren't pressed to the ground behind you, they'd be trembling.

Heels click along stones on the approach, heated and quick. "What the hell is going on here?" Penelope Windsor asks sharply, barely faltering as her heels meet grass and dirt.

You look up at Eddie with tears in your eyes, shocked and terrified.

He looks down, as pale as a ghost, the orderly's hand still on his shoulder as he stares at his own like they don't belong to him.

"Are you alright?" Penelope asks when she kneels to the ground beside you, fancy slacks of her pantsuit in the dirt. A gentle hand hovers over your shoulders, concern evident in the way she looks you over.

Swallowing hard around the lump in your throat, you break away from your stare at Eddie to glance at her and then the ground. "I'm fine."

"I…" Eddie's voice sounds small, scared. "I'm so sorry, I don't know what happened. I didn't mean to–"

"Come on." Penelope is calm as she interrupts him, more caring and gentle than you've ever heard her. "Let's go get you cleaned up."

You manage a nod before you allow her to help you to your feet and put a protective arm around your back as she leads you over toward the Therapy House.

Eddie stands there with the orderly, hands shaking and tears forming in the corners of his eyes as he watches you go. Hoping you'll look back. That you'll tell him it's okay, that you'll forgive him. Tell him that you will be okay.

You don't look back.

Once you've disappeared behind those birch doors, the orderly finally lets him go. Walks back over to the main hall without another word – leaving Eddie alone to his panic and shame while he stares at your copy of Good Omens from where it sits half open and abandoned in the grass.

Your chair is empty in group that day.

-

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thanks for reading!! please reblog if you liked it and let me know what you think, feedback means everything!! read part 2 here

#eddie munson x reader #eddie munson x you #eddie munson angst #eddie munson hurt/comfort #eddie munson fanfiction #eddie munson fanfic #eddie munson fic #eddie munson x female reader #rockstar!eddie munson #stranger things fanfic #stranger things fic #stranger things fanfiction #myos ideas #myo4munson

[i-am-thornqueen]

I know drug names are sometimes ridiculous (sulfamethoxazole-trimethoprim anyone? or any drug with the suffix -mab) but I encountered the best misspelling of a drug today and I will never be able to look at this drug's name without thinking of this misspelling.

The drug is acamprosate and it is typically prescribed "acamprosate 666 mg PO TID" (orally three times a day).

On the order, it was written as 'acumprostate.'

A. Cum. Prostate.

When I tell you I had to contain myself. I was training a new pharmacist. My eye was twitching from the effort not to say anything other than 'oh dear, they misspelled the order, but that's okay, we know what they meant.' I wanted to call it a Freudian slip so bad! But I didn't it! I kept all the inappropriate comments inside! I earned my keep as a professional on this day!

But still.

A. Cum. Prostate.

A. Cum. Prostate.

A more perfect misspelled drug does not exist.

#pharmacy stuff

[swasthasuchan]

Acamprosate Pharmacology   Acamprosate About Acamprosate Sulfonic Acids and Derivatives, for management of chronic alcoholism (drug depenance) and maintain balance. Mechanism of Action of Acamprosate Acamprosate may interact with glutamate and GABA neurotransmitter systems centrally, and has led to the hypothesis that acamprosate restores the balance. It seems to inhibit NMDA receptors…

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[treatmentangel]

Overcoming Alcohol Addiction Treatment Options in Dallas

Alcohol addiction is a pervasive issue that affects individuals and families across the globe. In Dallas, Texas, the prevalence of alcohol abuse underscores the urgent need for effective treatment options. Fortunately, Dallas boasts a range of resources and facilities dedicated to helping individuals overcome alcohol addiction and reclaim their lives.

One of the primary approaches to treating alcohol addiction in Dallas is through residential rehabilitation programs. These programs provide a structured environment where individuals can receive intensive treatment and support away from the triggers and stressors of everyday life. Residential rehab typically involves detoxification, counseling, therapy, and skill-building exercises aimed at addressing the underlying causes of addiction and developing coping mechanisms for relapse prevention.

In addition to residential rehab, outpatient treatment programs offer flexibility for individuals who cannot commit to a full-time residential program. Outpatient programs provide many of the same services as residential rehab, including counseling, therapy, and support groups, but allow participants to continue living at home and attending work or school while receiving treatment. This flexibility can be particularly beneficial for individuals with responsibilities they cannot leave behind.

Behavioral therapy is a cornerstone of alcohol addiction treatment in Dallas. Therapeutic approaches such as cognitive-behavioral therapy (CBT), motivational interviewing (MI), and dialectical behavior therapy (DBT) are commonly used to help individuals identify and change unhealthy thought patterns and behaviors related to alcohol use. These therapies equip individuals with the skills and strategies they need to manage cravings, cope with stress, and navigate social situations without relying on alcohol.

Medication-assisted treatment (MAT) may also be prescribed to help individuals manage alcohol cravings and withdrawal symptoms. Medications such as naltrexone, acamprosate, and disulfiram can reduce the pleasurable effects of alcohol, alleviate withdrawal symptoms, and deter relapse. When combined with therapy and counseling, MAT can significantly improve treatment outcomes and support long-term recovery.

Peer support groups, such as Alcoholics Anonymous (AA) and SMART Recovery, play a vital role in the recovery process for many individuals in Dallas. These groups provide a supportive community of individuals who understand the challenges of addiction and offer encouragement, guidance, and accountability. Attending regular meetings allows individuals to share their experiences, learn from others, and cultivate a sense of belonging that is essential for sustained sobriety.

Holistic approaches to alcohol addiction treatment are also gaining traction in Dallas. These approaches recognize the interconnectedness of the mind, body, and spirit and emphasize practices such as mindfulness, meditation, yoga, and nutrition to promote overall well-being and support recovery. By addressing the physical, emotional, and spiritual aspects of addiction, holistic therapies empower individuals to heal on a deeper level and cultivate a lifestyle that supports sobriety.

Alcohol addiction treatment in Dallas encompasses a variety of approaches tailored to the individual needs and preferences of each person seeking help. From residential rehabilitation programs to outpatient treatment, behavioral therapy, medication-assisted treatment, peer support groups, and holistic therapies, there are numerous options available to support individuals on their journey to recovery. By accessing these resources and committing to the recovery process, individuals can overcome alcohol addiction and build a fulfilling life free from the grip of alcohol.

For more info:-

alcohol addiction treatment Dallas

san diego alcohol addiction rehabs

san diego heroin treatment centers

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Nasha mukti Kolkata

"Nasha Mukti" is a term in Hindi that translates to "freedom from addiction" or "addiction liberation" in English. It refers to the process of overcoming addiction to substances such as alcohol, drugs, or tobacco. Nasha Mukti encompasses various approaches and interventions aimed at helping individuals break free from the cycle of addiction and lead healthier, substance-free lives. Here are some common elements of Nasha Mukti programs kolkata:

Detoxification: Detoxification, or detox, is often the first step in Nasha Mukti programs. It involves the removal of addictive substances from the body while managing withdrawal symptoms safely and comfortably. Medical supervision may be necessary, especially for severe withdrawal symptoms.

Counseling and Therapy: Counseling and therapy play a crucial role in Nasha Mukti programs by addressing the psychological and emotional aspects of addiction. Individual counseling, group therapy, and family therapy sessions help individuals understand the root causes of their addiction, develop coping skills, and learn strategies for relapse prevention.

Behavioral Therapies: Behavioral therapies such as cognitive-behavioral therapy (CBT), motivational interviewing, and contingency management are commonly used in Nasha Mukti programs. These therapies help individuals identify and change unhealthy thought patterns and behaviors associated with addiction.

Medication-Assisted Treatment (MAT): For certain types of addiction, medication may be prescribed as part of Nasha Mukti programs to help reduce cravings, alleviate withdrawal symptoms, and support long-term recovery. Medications such as methadone, buprenorphine, naltrexone, and acamprosate may be used under medical supervision.

Peer Support Groups: Peer support groups like Alcoholics Anonymous (AA), Narcotics Anonymous (NA), and SMART Recovery provide valuable support and encouragement for individuals in recovery. These groups offer a safe and non-judgmental environment for sharing experiences, receiving support, and learning from others who have overcome addiction.

Holistic Approaches: Some Nasha Mukti programs incorporate holistic therapies and practices such as yoga, meditation, art therapy, and mindfulness-based techniques. These approaches address the physical, emotional, and spiritual aspects of addiction recovery, promoting overall well-being and resilience.

Aftercare Planning: Successful Nasha Mukti programs include aftercare planning to support individuals as they transition back to their daily lives after completing treatment. Aftercare may involve ongoing therapy, support group participation, sober living arrangements, vocational training, and relapse prevention strategies.

Nasha Mukti programs can vary in duration, intensity, and treatment approaches depending on individual needs and preferences. It's important for individuals struggling with addiction to seek professional help from qualified healthcare providers or addiction specialists to begin their journey toward recovery.

[centrallondontraumatreatment]

Navigating Addiction Treatment: A Professional Perspective on Recovery Strategies

Introduction: Addiction is a complex and chronic condition characterized by compulsive substance use despite harmful consequences. It affects individuals from all walks of life, posing significant challenges to their health, relationships, and overall well-being. However, with the advent of evidence-based treatment approaches, recovery from addiction is not only achievable but also sustainable. This article aims to provide a professional overview of addiction treatment strategies, encompassing pharmacotherapy, psychotherapy, behavioral interventions, and holistic approaches to foster comprehensive recovery.

Understanding Addiction: At its core, addiction represents a neurobiological disorder, involving alterations in brain structure and function that perpetuate compulsive substance-seeking behaviors. Whether stemming from substance abuse or behavioral dependencies, such as gambling or gaming, addiction undermines individuals' ability to exert control over their impulses, leading to detrimental outcomes. Recognizing addiction as a chronic condition necessitates a multi-dimensional treatment approach addressing its biological, psychological, and social determinants.

Find more Info here – Central London anxiety treatment

Pharmacotherapy: Pharmacotherapy assumes a pivotal role in addiction treatment, particularly in mitigating withdrawal symptoms, curbing cravings, and preventing relapse. Medications such as methadone, buprenorphine, and naltrexone have demonstrated efficacy in managing opioid addiction by modulating brain receptors involved in the addictive process. Similarly, medications like disulfiram, acamprosate, and naltrexone have been instrumental in treating alcohol use disorder by altering neurotransmitter activity to reduce alcohol cravings and aversive reactions.

Furthermore, pharmacological interventions for nicotine addiction, stimulant use disorders, and other substance dependencies continue to evolve, underscoring the importance of individualized treatment plans guided by comprehensive assessments and ongoing monitoring.

Psychotherapy: Psychotherapy, or talk therapy, serves as a cornerstone in addiction treatment, offering individuals the opportunity to explore underlying issues contributing to their addictive behaviors and develop coping mechanisms for sustained recovery. Cognitive-behavioral therapy (CBT) stands out as a highly effective therapeutic modality, empowering individuals to identify and modify maladaptive thought patterns and behaviors driving their addiction.

Motivational interviewing (MI) provides another valuable framework for facilitating behavior change by enhancing individuals' intrinsic motivation to engage in treatment and adopt healthier lifestyles. Additionally, dialectical behavior therapy (DBT), contingency management, and family therapy offer specialized interventions tailored to address specific needs and challenges encountered in the recovery journey.

Behavioral Interventions: Behavioral interventions complement pharmacotherapy and psychotherapy by targeting environmental and contextual factors that influence addictive behaviors. Interventions such as contingency management, which utilizes incentives to reinforce abstinence, and community reinforcement approaches, which promote positive social connections and alternative sources of reinforcement, have demonstrated efficacy in facilitating long-term recovery outcomes.

Moreover, relapse prevention strategies equip individuals with skills to identify triggers, manage cravings, and cope with high-risk situations without resorting to substance use. By fostering resilience and self-efficacy, these interventions empower individuals to navigate the challenges of recovery with confidence and fortitude.

Holistic Approaches: In recognition of addiction's profound impact on physical, emotional, and spiritual well-being, holistic approaches to treatment have gained prominence in recent years. Integrative therapies such as mindfulness meditation, yoga, art therapy, and acupuncture offer individuals avenues for self-expression, stress reduction, and self-awareness, promoting holistic healing and inner transformation.

Furthermore, holistic treatment models emphasize the importance of addressing co-occurring mental health disorders, trauma, and social determinants of health to facilitate sustained recovery and enhance overall quality of life.

Conclusion: In conclusion, addiction treatment represents a multifaceted endeavor requiring a comprehensive and integrated approach to address its complex etiology and manifestations. Through the synergistic application of pharmacotherapy, psychotherapy, behavioral interventions, and holistic modalities, individuals can embark on a journey of recovery marked by resilience, empowerment, and transformation. Central to this process is the collaborative engagement of individuals with skilled professionals in crafting personalized treatment plans aligned with their unique needs and aspirations. By embracing a holistic framework of care, we can pave the way for enduring recovery and renewed hope in the face of addiction's formidable challenges.

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[calidarehab]

Understanding Alcohol Addiction: Symptoms, Treatments, and Seeking Help

Alcohol addiction, also known as alcoholism or alcohol use disorder, is a chronic and debilitating condition characterized by an inability to control alcohol consumption despite its negative consequences on one's health, relationships, and overall well-being. As a prevalent issue worldwide, it's crucial to recognize the symptoms of alcohol addiction, understand the available treatments, and seek professional help when needed. In this blog, we'll explore alcohol addiction in-depth and shed light on how individuals struggling with this condition can find support.

Symptoms of Alcohol Addiction:

Cravings: Individuals with alcohol addiction often experience intense cravings for alcohol, leading to compulsive drinking behavior.

Loss of Control: Despite attempts to cut down or stop drinking, those with alcohol addiction find themselves unable to control their alcohol consumption.

Tolerance: Over time, individuals may develop a tolerance to alcohol, requiring larger amounts to achieve the desired effects.

Withdrawal Symptoms: When not drinking, individuals may experience withdrawal symptoms such as tremors, nausea, anxiety, and sweating.

Neglecting Responsibilities: Alcohol addiction can lead to neglect of responsibilities at work, school, or home, as well as strained relationships with family and friends.

Continued Use Despite Consequences: Despite experiencing negative consequences such as health problems, legal issues, or relationship difficulties, individuals with alcohol addiction continue to drink.

Treatments for Alcohol Addiction:

Detoxification: The first step in treating alcohol addiction is often detoxification, during which individuals undergo withdrawal under medical supervision to safely eliminate alcohol from their bodies.

Behavioral Therapies: Cognitive-behavioral therapy (CBT), motivational interviewing, and contingency management are among the behavioral therapies used to address underlying issues and develop coping strategies to prevent relapse.

Medications: Medications such as naltrexone, acamprosate, and disulfiram may be prescribed to help reduce cravings, alleviate withdrawal symptoms, or create adverse reactions to alcohol.

Support Groups: Participation in support groups such as Alcoholics Anonymous (AA) or SMART Recovery can provide individuals with alcohol addiction with peer support, accountability, and encouragement on their journey to recovery.

Dual Diagnosis Treatment: Many individuals with alcohol addiction also struggle with co-occurring mental health disorders such as depression or anxiety. Dual diagnosis treatment addresses both conditions simultaneously to promote holistic healing.

Seeking Help at Calida Rehab Center:

For individuals seeking alcohol addiction treatment near Mumbai, Calida Rehab Center offers comprehensive and personalized care in a supportive and compassionate environment. With a team of experienced professionals specializing in addiction treatment, Calida Rehab Center provides evidence-based therapies, holistic approaches, and individualized treatment plans tailored to each client's unique needs. Through detoxification, therapy sessions, group support, and aftercare planning, Calida Rehab Center equips individuals with the tools and resources they need to overcome alcohol addiction and embark on the path to lasting recovery. If you or someone you know is struggling with alcohol addiction, don't hesitate to reach out for help. Calida Rehab Center is here to support you every step of the way.

[mcatmemoranda]

Decompensated cirrhosis

Albumin, INR, and platelets tell you about decompensated cirrhosis

Get MELD score (tells you about prognosis) and Child Pugh score (estimates cirrhosis severity). MELD-Na is a new version of the MELD score that is better than the MELD and includes Na+; it's based on whether pt goes for dialysis twice weekly, Cr, bilirubin, INR, and sodium. MELD-NA tells you the severity of end stage liver disease. Pts who present with bleeding varices or ascites have decompensated cirrhosis and worse prognosis. So calculate the MELD score to educate the pt about his/her prognosis. Child-Pugh is based on total bilirubin, albumin, INR, Ascites, Encephalopathy.

Maddrey's discriminant function suggests which patients with alcoholic hepatitis have a poor prognosis and would benefit from steroids. It's based on PT and total bilirubin.

Cirrhosis is decompensated if the pt has varices or ascites.

Pts who present with bleeding have 50% mortality in 6 months.

All cirrhotics should get an EGD to evaluate for presence of varices.

In pts with ascites, calculate the SAAG score, which tells you whether the ascites is due to portal HTN.

Patients with SAAG greater than or equal to 1.1 gm/dL is considered as having high SAAG, indicating the presence of portal hypertension, while those with SAAG less than 1.1 gm/dL are considered as having low SAAG, indicating the absence of portal hypertension.

This is an example of a GI note for a pt who came in with decompensated cirrhosis:

Pt is a ----- w/ a PMH of hepatitis C, EtOH abuse, tobacco use, and IVDU who was admitted for acute decompensated liver cirrhosis w/ascites. 1. Acute decompensated liver cirrhosis w/ascites New diagnosis of liver cirrhosis likely 2/2 EtOH/hepatitis C. MELD score = 21, indicating 19.6% estimated 3-month mortality. Notable symptoms include scleral icterus and abdominal ascites. Low concern for SBP in the absence of fever, leukocytosis, or peritonitis. Initial labs include hemoglobin 14.5, platelet count 113, INR 1.6, PTT 29.2, total bilirubin 8.3, AST 125, ALT 58, albumin 2.7, total protein 9.3. No evidence of anemia. Parsaesophageal varices suggested on CT imaging require eventual EGD for further evaluation.

Ceruloplasmin and AFP normal. Iron studies and alpha-1 antitrypsin indicative of inflammation. Additional labs pending. 4L ascitic fluid removed during 9/7 paracentesis. PMN less than 250, which is not indicative of SBP. Ascites albumin pending for SAAG calculation. RUQ U/S demonstrates slowed portal vein flow, though no evidence of masses or thrombosis.

-acute hepatitis panel, ANA (anti-Nuclear Antibody), ASMA (Anti-Smooth Muscle Antibody), AMA (antimitochondrial), SPEP (Serum Protein Electrophoresis) pending -less than 2 g daily sodium restriction -ascites fluid analysis w/ cell count, albumin, and protein for calculation of SAAG -ammonia level pending -confirm vaccination status of HAV, HBV, influenza, Pneumovax, Prevnar -avoid NSAIDs + counsel for alcohol cessation -steroids for EtOH liver disease contraindicated due unclear hepatitis C status -MRI abdomen for evaluation of portal vein thrombosis/masses -100 mg spironolactone + 40mg lasix qd

2. EtOH use Hx of significant alcohol use over the past 6 years w/o reported hospitalization. Reported taper from 3-4 glasses of vodka daily to several ounces daily; last drink 3 days ago. No withdrawal symptoms at this time. EtOH level less than 3 on admission. Suspected primary etiology of liver cirrhosis.

-management of potential withdrawal symptoms per primary team (CIWA protocol without ativan) -cessation counseling strongly recommended in setting of liver cirrhosis -potential options for medication assisted therapy include acamprosate, naltrexone, baclofen, or gabapentin -nutrition therapy including multivitamin, thiamine, and folate -recommend nutrition consult

3. Hepatitis C Reported hx of hepatitis C not previously treated, unknown genotype. Last seen by GI prior to COVID.

-HCV viral load + genotype pending -outpatient GI f/u for further management

4. Paraesophageal varices on CT Confirm CT findings w/ EGD prior to considering initiation of beta-blocker. -outpatient EGD, unless concern for GI bleed or masses seen on abdominal MRI

5. Family hx of colon cancer

Sister diagnosed w/colon cancer. Pt has not had colonoscopy to date. -outpatient colonoscopy recommended

#cirrhosis #decompensated cirrhosis #liver failure #SAAG

[ubaid214]

Unraveling Addiction: Evidence-Based Practices in Alcohol Abuse Treatment

Alcohol substance abuse is a pervasive issue that affects millions of individuals worldwide. The journey to recovery from alcohol addiction can be complex and challenging, requiring a combination of medical intervention, psychological support, and lifestyle changes. In this article, we delve into the various aspects of alcohol substance abuse treatment, exploring effective strategies, evidence-based approaches, and the importance of holistic care in promoting long-term sobriety. DV court ordered treatment near me

Understanding Alcohol Substance Abuse: Alcohol substance abuse involves the compulsive consumption of alcohol despite negative consequences on physical health, mental well-being, and social relationships. It often manifests as a progressive disorder, starting with occasional binge drinking and escalating into chronic alcohol dependency. Factors contributing to alcohol abuse include genetic predisposition, environmental influences, and underlying mental health conditions.

The Treatment Process: Effective treatment for alcohol substance abuse typically begins with an assessment by a healthcare professional to determine the severity of addiction and any co-occurring disorders. The treatment process may involve several components, including:

Detoxification: In cases of severe alcohol dependency, medical detoxification may be necessary to safely manage withdrawal symptoms. This process is supervised by medical professionals and may involve the administration of medications to alleviate discomfort and reduce the risk of complications.

Therapy and Counseling: Behavioral therapies, such as cognitive-behavioral therapy (CBT), motivational interviewing, and dialectical behavior therapy (DBT), are integral components of alcohol abuse treatment. These approaches help individuals understand the root causes of their addiction, develop coping skills to manage cravings and triggers, and address co-occurring mental health issues.

Medication-Assisted Treatment (MAT): Certain medications, such as naltrexone, acamprosate, and disulfiram, may be prescribed as part of a comprehensive treatment plan to reduce cravings, prevent relapse, and support recovery. MAT is often combined with therapy and counseling for optimal results.

Support Groups: Participating in support groups like Alcoholics Anonymous (AA) or SMART Recovery provides individuals with a sense of community, peer support, and accountability during their recovery journey. These groups offer a platform for sharing experiences, receiving encouragement, and learning from others who have overcome similar challenges.

Lifestyle Changes: Adopting a healthy lifestyle is crucial for sustaining sobriety in the long term. This may involve establishing a structured daily routine, engaging in regular exercise, practicing stress-reduction techniques, and cultivating supportive relationships with family and friends.

Holistic Approach to Recovery: In addition to addressing the physical and psychological aspects of alcohol substance abuse, a holistic approach to recovery emphasizes the importance of treating the individual as a whole person, taking into account their unique needs, values, and goals. This may involve incorporating complementary therapies such as yoga, mindfulness meditation, art therapy, and nutritional counseling to promote overall well-being and enhance the effectiveness of traditional treatment modalities.

Challenges and Roadblocks: Despite the availability of effective treatments for alcohol substance abuse, recovery is not always linear, and individuals may encounter setbacks along the way. Common challenges include cravings, relapse triggers, social pressure, and co-occurring mental health issues. It's essential for individuals in recovery to develop resilience, seek support when needed, and remain committed to their sobriety goals.

Conclusion: Alcohol substance abuse treatment is a multifaceted process that requires a combination of medical, psychological, and social interventions to address the complex nature of addiction. By incorporating evidence-based practices, holistic approaches, and ongoing support, individuals struggling with alcohol dependency can embark on a journey of recovery, reclaiming their health, happiness, and sense of purpose in life. Remember, seeking help is the first step towards a brighter, alcohol-free future.

[googledanielgreer]

Is Alcohol Rehab the Right Choice for You?

Alcohol rehab, short for alcohol rehabilitation, refers to the process of helping individuals who are struggling with alcohol addiction or alcohol use disorder to overcome their dependency on alcohol and achieve sobriety. Rehab programs are designed to address the physical, psychological, and social aspects of alcohol addiction. Here are some key components typically involved in alcohol rehab:

Assessment and Evaluation: Before starting a rehab program, individuals undergo a thorough assessment to determine the severity of their alcohol use disorder, as well as any co-occurring mental health issues. This helps create a personalized treatment plan.

Detoxification (Detox): For individuals with a physical dependence on alcohol, the first step may involve a medically supervised detoxification process to safely manage withdrawal symptoms. This phase aims to cleanse the body of alcohol.

Inpatient or Outpatient Treatment: Rehab programs can be either inpatient (residential) or outpatient. Inpatient programs involve residing at a treatment facility for a specified period, often providing a more immersive and structured environment. Outpatient programs allow individuals to receive treatment while living at home.

Counseling and Therapy: Various forms of counseling and therapy are crucial components of alcohol rehab. Cognitive-behavioral therapy (CBT), motivational enhancement therapy (MET), and family therapy are commonly used to address underlying issues, triggers, and develop coping strategies.

Support Groups: Participation in support groups, such as Alcoholics Anonymous (AA) or SMART Recovery, is a common element of alcohol rehab. These groups provide a supportive community of individuals who share similar struggles.

Medication-Assisted Treatment (MAT): In some cases, medications may be prescribed to help individuals manage cravings and reduce the risk of relapse. Medications like disulfiram, naltrexone, and acamprosate are examples.

Aftercare Planning: Planning for life after rehab is essential. Aftercare programs may include ongoing counseling, support group participation, and other resources to help individuals maintain their sobriety in the long term.

Holistic Approaches: Some rehab programs incorporate holistic approaches such as yoga, meditation, art therapy, and nutrition to address the overall well-being of individuals in recovery.

It's important to note that successful recovery often requires a combination of these elements, and the duration of a rehab program can vary based on individual needs and circumstances. Seeking professional help and support from qualified healthcare providers is crucial for effective alcohol rehabilitation. If you or someone you know is struggling with alcohol addiction, reaching out to a healthcare professional or addiction treatment center is recommended.

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