Empowering Residents to Find (and Speak) Their Truth


Sierra Tucson Patient Advocates John Flagle and Jan York

The Patient Advocates help foster healthy recovery behaviors

At Sierra Tucson, the Patient Advocates serve as the liaison between residents and staff. Patient Advocates communicate resident concerns to appropriate staff members. The team, consisting of one male and one female Patient Advocate, is open seven days a week to reinforce an environment that is focused on resident-centered care.

What Is a Patient Advocate?

  1. Self-Advocacy – A Patient Advocate supports residents by empowering them to become effective self-advocates. At Sierra Tucson, our job is not to rescue residents from despair; our job is to teach residents essential life skills in recovery. We want each individual to learn how to become his or her own spokesperson, then practice speaking his or her truth during treatment. Self-advocacy allows residents to “flex” their recovery muscles, and the Patient Advocate serves as a trusted staff member with whom they can be transparent.
  2. Cultural Sensitivity – Patient Advocates help to support cross-cultural beliefs and practices by listening and responding to residents’ religious, spiritual, and cultural needs throughout the year. For instance, residents may receive visits by members of the clergy, or the Patient Advocate may coordinate a trip to a nearby synagogue, temple, or church. Special dietary modifications are also organized through the Patient Advocate Office, and certain religious items such as Bibles, prayer books, kiddush cups, and Shabbat candles are provided upon request.
  3. Communication, Collaboration & Confidentiality – Information that is shared between a resident and Patient Advocate is confidential. Although our Patient Advocates are an extension of Sierra Tucson, they want residents to feel safe and comfortable when disclosing information that is often personal to them. They maintain their trust and confidence with integrity. When appropriate and/or necessary, they collaborate with other staff members to ensure residents’ needs are met in a timely manner.
  4. Assessment – The Patient Advocates are responsible for conducting mid-term surveys with our residents. These surveys disclose how the resident feels about his or her treatment experience two weeks after admission. Once the survey is completed, it is reviewed by the Patient Advocates, who address any concerns the resident may be having with the resident. The mid-term survey is then disseminated to Sierra Tucson’s Quality Manager for further investigation and clinical outcomes studies.
  5. Community – The Patient Advocates at Sierra Tucson work hard to establish a sense of community among our residents. From weekly all-community meetings to resident traditions, to outings and fun events on campus, they are committed to creating a feeling of togetherness. Before coming to Sierra Tucson, many of our residents were deep in the throes of their disease – often isolated from the outside world. Patient Advocates help to break down those barriers of isolation by reconnecting residents with others and self. Ultimately, it is their goal to foster healthy recovery skills early on, making the transition from treatment to the “real world” as seamless as possible.

“Residents tell us that we provide a safe environment for them to express their needs and concerns, and that they feel heard.”
-Jan York, Patient Advocate at Sierra Tucson

Revealing the Reality of Perinatal Women and Substance Use

Perinatal Woman and Substance Use

Valerie M. Kading, DNP, PMHNP-BC

By Valerie M. Kading, DNP, PMHNP-BC
Chief Medical Operations Officer

Women of childbearing years represent approximately 1 out of every 4 individuals globally. In 2015, 1.6 billion women aged 15 to 44 years represented approximately 45% of the total female population (U.S. Census Bureau, 2015). The number of women of childbearing years has been projected to increase by over 0.4 billion between 2002 and 2050 (U.S. Census Bureau, 2015). In 2012, there were nearly 63 million women in the United States aged 15 to 44. Of these women of childbearing years, 6% became pregnant, resulting in 3.9 million births (U.S. Census Bureau, 2012). The total population of women aged 15 to 44 in the United Kingdom in 2014 was 22.5 million with a total of 695,000 births (Office for National Statistics, 2014). Women of childbearing years who represent a significant portion of the population and pregnancy, both intended and unintended, should be considered when addressing the health of this population.

Substance use and overdose-related deaths are a public health crisis and women represent a significant portion of this population. An alarming 30% of individuals addicted to substances are women of childbearing years aged 15 to 44. The National Survey on Drug Use and Health (NSDUH) from 2015 shows that approximately 5% of pregnant women in the United States report using illicit substances within the past month, compared to 10% of non-pregnant women (SAMHSA, 2015). Alcohol use among pregnant women was 16.4% compared to 53.2% of non-pregnant women. These results, while promising, may be conservative due to stigma and fear of reporting, and may not have included women who did not know they were pregnant. NSDUH data also suggests that substance use decreases during pregnancy but resumes after pregnancy and beyond.

Perinatal and Substance Use_VKVarious risk factors exist for illicit substance use, including family history of drug addiction, history of addiction to any drug (including tobacco), history of psychiatric or psychological illness, and history of childhood trauma (SAMHSA, 2015). Research suggests that 55% to 99% of women who abused substances had a significant trauma history (Najavits et al., 1997). Other risk factors include involvement in an intimate relationship with a partner who abuses substances. Protective factors include marriage and partner support.

Women are more likely than men to experience co-occurring substance use and mental health disorders. It is estimated that 72% of women diagnosed with alcohol use disorder (AUD) have a co-occurring psychiatric illness, and 86% diagnosed with alcohol dependence have a co-occurring psychiatric illness (Kessler et al., 1997). Anxiety disorders, depression, PTSD, and eating disorders are the most common co-occurring psychiatric illnesses among women (Agrawal et al., 2005). Individualized treatment targeting co-occurring illnesses is critical to addressing the health of the woman during the perinatal period.

Management of a pregnancy in a substance-abusing woman can be complex and involve psychosocial, medical, and addiction considerations. The perinatal period is a critical transitional time in a woman’s life where healthcare providers must address concerns about substance use and mental health issues. Perinatal depression is estimated to affect approximately 10% to 15% of women worldwide and is considered the most significant risk factor for postpartum depression (Agency for Healthcare Research & Quality, 2015; Melville, Gavin, Guo, Fan & Katon, 2010; WHO, 2012b). A systematic review revealed that postpartum depression symptoms were present in 19.7% to 46% of postpartum women who abused substances and those with a history of substance use (Chapman & Wu, 2013). In a sample of 125 women, one-third of opiate-addicted mothers screened positive for major depression, and almost half experienced postpartum depression 6 weeks post-delivery (Holbrook & Kaltenbach, 2012). Perinatal women experiencing depression may be at a higher risk for substance use as a means to self-medicate. Addressing substance use and co-occurring mental health concerns is imperative for a positive outcome for the mother, unborn child, and family.

Substance use during pregnancy has been associated with negative outcomes for the woman and baby, including increased morbidity and mortality for the woman and her child. Pregnant women abusing substances are less likely to obtain consistent obstetric care and have poor medical follow up. Obstetric complications associated with opiate dependence include miscarriage, preterm labor and postpartum hemorrhage. Adverse outcomes for the fetus include stillbirth, prematurity, intrauterine growth retardation (IUGR), and neonatal abstinence syndrome. In a sample of 247 subjects, cocaine and heroin use were both positively associated with IUGR, preterm delivery, and low birth weight (Pinto et al., 2010).

Perinatal and Substance Use imgHealth care providers are at an optimal position to screen for substance use among perinatal women. Women with histories of psychiatric or substance use should raise concern and trigger focused assessment on substance use. Screening for the use of substances should occur routinely in obstetric/gynecology, primary care, and psychiatric practices to immediately capture substance use among perinatal women and result in referral for treatment. Evidence-based substance use screening tools for perinatal women include ASSIST, CRAFFT, Substance Use Risk Profile-Pregnancy Scale, T-ACE, TICS and TWEAK (Goodman & Wolff, 2013). These screening tools range in sensitivity from 50% to 91% and are validated for prenatal and pregnant women (Goodman & Wolff, 2013).

Valerie M. Kading, DNP, PMHNP-BC, serves as the chief medical operations officer at Sierra Tucson, focusing on enhancing medical system operations and management to facilitate exceptional patient care. Prior to joining Sierra Tucson, Dr. Kading practiced as a board-certified psychiatric mental health nurse practitioner for10 years in a community mental health clinic, working with patients with various mood disorders and co-occurring substance use diagnoses. Dr. Kading specializes in working with perinatal women experiencing psychiatric illness, and continues to be clinically involved with this special population through the Tucson Postpartum Depression Coalition. She is a member of Phi Kappa Phi, Arizona Nurses Association, American Nurses Association, and the American Academy of Nurse Practitioners. Dr. Kading is passionate about her roles at Sierra Tucson, as a psychiatric nurse practitioner and an administrator, and provides compassionate attention to the wellbeing and positive outcomes of residents and their families.

A Physical Approach to Pain Treatment

Anthony Henderson, DPT

Anthony Henderson, DPT

By Anthony Henderson, DPT
Doctor of Physical Therapy

Physical therapy is designed not only to treat physical limitations, but also to ensure improved pain over a longer period of time, overall functional mobility with a high success rate for treatment, and a 72-percent reduction in the medical cost of treatment within the first year. However, physical therapy can be one of the most challenging methods for treating pain due to the rigorous work required, as compared to other treatments which may involve a more passive, quick-fix approach that can seem appealing for immediate pain relief. Due to this rigorous physical demand, patients often struggle to comply with a home exercise program and attend physical therapy appointments. At Sierra Tucson, physical therapy conveniently takes place on site and thus, vastly improves compliance.

Another challenge people often experience with physical therapy is a lack of one-on-one time with the physical therapist. Instead, more time is spent “handing off” the patient to physical therapy assistants and physical therapy technicians. Consequently, the individual may feel undervalued and unheard. At Sierra Tucson, each patient is granted 60 minutes during each visit with the same physical therapist. The treatment plan may be modified by the attending physical therapist to ensure treatment appropriateness, and adjustments are made as needed.

A Patient-Centered Approach

We use a pain-directed, interdisciplinary, professional team approach. Our Pain Recovery Program includes health care providers who work directly with each individual, offering a variety of interventions and strategies for self-management. Our comprehensive treatment focuses on a thorough assessment, communication within disciplines, education, and follow-up. We believe pain should never be the only focus assessed – it is important to take a holistic approach when shaping one’s overall treatment.

The Treatment Team

Physician Assistants
Nurse Practitioners
Physical Therapists
Recreational Therapists
Support Staff
Significant Others (family, friends, neighbors)

In a typical healthcare environment, there may be a primary care provider, a physical therapist, a counselor, and other specialists on staff. While they communicate occasionally, they seldom meet face-to-face as a team to discuss the well-being of every patient. Sierra Tucson’s interdisciplinary treatment team for the Pain Recovery Program meets regularly to review each individual’s treatment and care. We assess goals that have been set, the progress that has been made, difficulties and challenges, and next steps. Based on the patient’s progress, we are able to determine which team members may need to alter their approach and other areas that might require additional attention, as well as personally communicate with the patient.

Our goal at Sierra Tucson is to provide individuals with a well-balanced approach to treatment. Each team member complements the team as a whole. The patient is our priority – we respect his or her values and needs, coordinate and integrate appropriate care, provide emotional support, and involve his or her family and loved ones. We empower patients to take an active role in their recovery.

Physical therapy is designed to treat physical limitations and ensure improved pain. We believe in a well-balanced, holistic approach to treatment. Call today.

The Opioid Epidemic: Prevention, Recognition & Treatment

Teresa Jackson, MD, Director of Sierra Tucson's Addictions / Co-occurring Disorders Program

Teresa L. Jackson, MD

By Teresa L. Jackson, MD
Director of Addiction Recovery Program

Prince, Michael Jackson, Heath Ledger, Whitney Houston, Amy Winehouse, Philip Seymour Hoffman, John Belushi, River Phoenix, Janis Joplin…the list goes on and on. It’s shocking to hear when a famous rock star or actor has died of a drug overdose.

What’s more disturbing…

  • 91 people die each day in the United States from an opioid overdose.
  • 33,000 people died from an opioid overdose in 2015. Half of these deaths were from prescription opioids.
  • Drug overdoses are the leading cause of accidental death in the United States, ahead of motor vehicle deaths and firearms (deaths).

In the last 15 years, the number of prescriptions for opioid pain medications has quadrupled. Prescription opiates like methadone, oxycodone (Percocet), and hydrocodone (Norco and Vicodin) are the leading cause of prescription opioid deaths. The United States uses 99 percent of the world’s hydrocdone. The majority of people that use heroin started with an opiate pill. Sadly, heroin is readily available and less expensive. We are in the midst of an opioid addiction and overdose epidemic in the United States.

The best way to prevent opioid overdose deaths is to improve opioid prescribing, reduce exposure to opioids, prevent abuse, and stop addiction. Prescribing physicians must carefully regulate opiate prescriptions. Preventing abuse of prescription opiates is a combined effort between physician, pharmacies, patients, and family members. It is very important to keep all controlled substances in a secure location. Never share your prescription and always destroy the medication when it is no longer needed. Pharmacies often accept medications. In addition, they can be discarded in cat litter or coffee grounds.

Early recognition and treatment of addiction to opiates can save lives. Medication-assisted treatment (MAT) combines the use of medication with counseling and behavioral therapies. Unfortunately, behavioral interventions alone have a poor success rate in opioid addiction, with a relapse rate that is greater than 80 percent. The addition of medication to behavioral intervention greatly increases the outcomes. FDA-approved medication such as buprenorphine (Suboxone, Subutex), methadone, and naltrexone improve the success rate and decrease the associated risks of opiate addiction, including HIV, Hepatitis C, and overdose. Extensive literature and systematic reviews show that maintenance treatment with either methadone or buprenorphine is associated with retention in treatment, reduction in illicit opiate use, decreased craving, and improved social function.

Often, patients express concern about seemingly trading one drug for another. Abstinence is always an option; however, MAT allows the brain to heal from opiate dependence. The patient can concentrate on recovery without ongoing withdrawal symptoms and cravings. The brain gradually heals from opiate dependence and the medication can be slowly tapered. One of the most common fears for patients is withdrawal. The Surgeon General and government are responding to this epidemic by increasing funding for the treatment of addiction, including MAT. In addition, life-saving medications that can reverse an opioid overdose are now available to patients who are prescribed opiates and for the loved ones of patients addicted to opiates. Naloxone (Narcan) can reverse an opiate overdose. The nasal spray is easy to use and more readily available now.

Early treatment for opioid addiction saves lives. If you are concerned about a loved one’s use of prescribed opiate pain medication or use of illicit opiates such as heroin, please seek professional help. The combined use of medication, counseling, and behavioral therapies may save his or her life.

MAT: A Case Study

Jane is a 34-year-old woman addicted to heroin. She started using oxycodone in college on the weekends. She began working after college and married a man that also used oxycodone. After a miscarriage and the death of her father, Jane’s use escalated to daily use of up to 600 milligrams of oxycodone. She was spending $600 daily on oxycodone. Her drug dealer introduced her to heroin. Her use of heroin escalated to 2 grams per day. She tried stopping on her own and could not. She tried two detox programs and immediately returned to using. She was overwhelmed with anxiety and cravings without heroin. Upon admission, she was prescribed Suboxone® to help with withdrawal symptoms. Within 24 hours of her admission, her withdrawal symptoms were gone and she was feeling well and participating in groups and activities. Because Jane had been using for many years and relapsed several times after trying to stop on her own and detox, she is candidate for MAT. She was discharged on Suboxone maintenance therapy for at least six months. Suboxone®, in addition to Intensive Outpatient Treatment (IOP) and relapse prevention meetings, is the reason Jane is drug-free today and enjoying life.

Ready for Change: How the Admissions Team Supports Referring Professionals

Blake Master

Blake Master

By Blake Master
Director of Admissions

With direct efforts from behavioral health professionals who refer to Sierra Tucson, over 1,600 lives were touched in 2017. That’s 1,600 people making a change in order to feel better, improve, and thrive for years to come. It is not only these individuals who are taking a leap of faith when seeking treatment, but also their referring doctors, therapists, and counselors who are joining them on their journey. Having professionals feel prepared for this process is as important as having the residents feel comfortable and ready to begin. Sierra Tucson has refined the admissions process for healthcare professionals who reach out directly to our facility.

If you are a referring professional who is making a phone call to Sierra Tucson, you will be greeted by an admissions coordinator. He or she will gather clinical information regarding your client and walk you through our simple, two-step admission process. That’s it. In less than 90 minutes, your client will be ready to begin individualized treatment at Sierra Tucson.

Now, what happens while your client is in treatment? To ensure fluidity of care, Sierra Tucson will update you, the referring professional, weekly while your client is in treatment at our facility. We understand and respect that professionals have a history with the individual whom they referred, and the clinical information they  provide helps us deliver precise care. This weekly contact will continually happen until discharge. Sierra Tucson also understands that the upcoming change of treatment environment can be stressful for the individual and all parties involved. As your client’s treatment experience comes closer to completion, we make this process as smooth as possible for all involved.

Sierra Tucson has a three-pronged approach to its continuum of care. First, we communicate with the resident’s treatment team to assist with the individualized continuing care plan, which may include stepping down to a lower level of care (i.e., PHP, IOP, extended care, sober living, or continuing care with the referring professional). Second, the resident will be enrolled in Connect365, our year-long continuing care service offered at no additional cost; the individual will engage in weekly communication with his or her recovery coach for one year post-discharge to help with the transition from treatment to life in recovery. Finally, the resident will have all of the offerings that come with being a Sierra Tucson alum, including support groups offered throughout the country, workshops, social activities, and the annual Alumni Retreat.

Our primary goal is client success. Pending the appropriate releases, we believe that communication and working collaboratively with treatment professionals help create a supportive environment that aids in the resident’s healing journey.

“The intake department at Sierra Tucson is extremely effective and efficient. I can usually expect an email response to our inquiries within 90 seconds from two separate intake specialists. They are quick to run verification of benefits, and great on the phone with our clients and their family members. If we ever want something done quickly, we know that Sierra Tucson is the first place to call.”
– From an outpatient professional group in Newport, CA


Alumna Shares Her Gratitude

Thank you so much to everyone at Sierra Tucson, especially my counselor, Phil Mitchell.

Since completing treatment, I have finished both of my masters’ degrees (MSW and MPH), have a job as a study coordinator and smoking cessation counselor, and have started yoga teacher training.

Let the journey continue – it truly is a miracle!

With unending gratitude,

Jessica W.
Philadelphia, PA

Miracles All Around

Jaime Vinck, MC, LPC, NCC, CEIP

Jaime Vinck, MC, LPC, NCC, CEIP

By Jaime Vinck, MC, LPC, NCC, CEIP
Chief Executive Officer

Happy New Year from beautiful and sunny Tucson, Arizona! As I reflect on the past 365 days, it is humbling to consider that we have helped more than 1,600 individuals find hope and healing. Prior to Sierra Tucson, each of those individuals were cared for by at least three people, conservatively speaking, who likely breathed a huge sigh of relief when their loved one agreed to treatment. In that case, another 4,800 lives were positively impacted by the work of our talented team of professionals in 2017.

Every day when we read or listen to the news about the world around us, we are overwhelmed with abhorrent behavior, drug epidemics, tragic overdoses, and suicides of public and not-so-public figures, to name a few. Unfortunately, the good news is often overshadowed by the negative, more scandalous news.

For me, it is helpful to think about the many miracles taking place right here at Sierra Tucson. In 2018, I choose to focus on the positive and affirm those I care about. I am going to be gentle with myself; celebrate the grace that has been given to me without even asking; and embrace the wisdom that has emanated from my pain. No marathons, no diets, no other punishing behaviors—a simple celebration of daily gratitude is my only resolution.

In the next year, Sierra Tucson will continue to be a thought leader in the treatment of substance use and mood disorders. We will celebrate with our residents as they begin their healing journey, and we will support them in the 365 days following treatment via Connect365 – our signature continuing care service. Thanks to Sierra Tucson Alumni Relations, the support continues for a lifetime.

Here’s some good news we can savor in 2018: Sierra Tucson is committed to clinical excellence and compassionate care – yesterday, today, and tomorrow. May you enjoy a happy and healthy New Year!

For information about our residential treatment programs, please call our Admissions Coordinators at (800) 842-4487.

Residential Therapists: Providing Comfort and Care During the Holidays

Residential Therapists keep residents safe

Gabrielle Shoun, MS, LASAC

By Gabrielle Shoun, MS, LASAC
Manager of Residential Therapists at Sierra Tucson

Taking that first step through the doors of a treatment center is often one of the most overwhelming experiences a person can endure, particularly during the holiday season. So many unknowns consume the minds of all those involved. “What kind of support will I have?” “How will I cope with being away from home?” “What will my loved one be doing all day?”

Sierra Tucson is proud to offer an exceptionally unique team of 19 masters-level therapists whose role is to address concerns like these and assist in comforting residents, which, in turn, provides comfort to their loved ones.

The residential therapists, or RTs, work from 7 a.m.–midnight, seven days a week, and are responsible for the coordination and facilitation of didactic lectures, psycho-educational groups, and individual sessions. These activities help in keeping residents engaged throughout the day and provide an opportunity for them to develop and hone their recovery skills from the moment they wake up until the time they go to bed. RTs utilize this time to establish a rapport so the residents always have a familiar face to seek out should they require additional care and support or need to process information they gathered in their groups.

Residential therapists assist in crisis management, for instance, if a resident receives difficult news, is contemplating leaving treatment against medical advice (AMA), or experienced a particularly intense session. RTs utilize evidence-based practices such as cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT), and incorporate various grounding skills to meet residents’ needs. The treatment team may request to have an RT check on an individual at night as well. From the beginning of treatment until completion, residents know their needs are of the utmost importance, even after their primary therapist leaves for the day.

The unwavering and continuous support of Sierra Tucson’s residential therapists provides a strong structure in which residents can foster healthy connections and process any feelings and emotions that arise, no matter the time of day.

Throughout the holiday season, families can rest assured that their loved ones will be surrounded by a skilled team of clinicians who provide additional support during the treatment process and guide residents on the path of recovery.

Gabrielle Shoun, MS, LASAC, manager of residential therapists (RTs) at Sierra Tucson, explains the important role Sierra Tucson’s RTs play in providing residents with the comfort and care they need. Watch now.

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Tips for Navigating Drinking Pressures During the Holidays

holiday drinking pressuresThis time of year can be especially difficult for recovering alcoholics and addicts who may become triggered by the overwhelming emotions brought on by the season. Between anxiety-provoking family dynamics, challenging in-laws, and pressure to attend social gatherings, the holidays can be stressful.

Studies show that depression, drunk-driving accidents, suicide, and even domestic violence increase from Thanksgiving to New Year’s Day. Many of these instances are linked to alcohol and drug abuse – from individuals who are using substances to cope with holiday stress.

Fortunately for recovering alcoholics and addicts, there are several ‘tools’ to survive the season in a healthy, recovery-friendly way. Here are some helpful tips on avoiding temptations at holiday parties, staying on track during holiday travels, and enjoying all that the season has to offer.

Attending Holiday Parties

  • Have an escape plan Arrive to a holiday event in your own vehicle, which will allow you to leave immediately if you’re feeling uncomfortable.
  • Beware of food/drinks that may contain alcohol Even a trace of alcohol can trigger cravings. Watch out for holiday favorites such as eggnog and rum cake.
  • Manage your own drinks – Bring your own beverage and make sure to fill your own cup, so there is no pressure to accept a drink that someone innocently offers you.
  • Choose your events wisely – If negative influences are going to be in attendance or the party is held in an environment that might trigger unpleasant memories, it’s best to avoid the event altogether.
  • Have a response ready – Even if you decline an alcoholic beverage, there’s a chance someone will be persistent. You can simply state that you are committed to a healthier lifestyle.

Traveling During the Holidays

  •  Attend sobriety meetings and support groups – There are meetings and groups in many parts of the world, making it easier to stay the course and connect with others in recovery.
  • Have a sober friend “on call” – Make sure you have someone with whom you can communicate who understands your struggles and can talk you through a tempting situation.
  • Take care of yourself – Make sure you get plenty of rest, appropriate exercise, and proper nutrition.
  • Plan healthy activities – Take the reins and plan an activity where you will feel empowered—one that is not centered on drinking.
  • Be honest – It’s OK to let family and friends know you need a timeout. Use the quality time spent with loved ones during the holidays to tell them you are struggling, and talk with them about how they can best support you.

It’s important to reinforce your sobriety goals regularly. Acknowledge your triggers and refresh your recovery toolbox. Remind yourself about how good it feels to wake up clean and sober, and how far you have come.

Sierra Tucson’s Addiction Recovery Program combines integrative and experiential therapies with evidence-based practices to provide a full range of treatment methods. If you or a loved one is struggling, call our Admissions Coordinators at (800) 842-4487.

Talk About Your Medicines Month

safe use of opioid medicationWhat do Heath Ledger, Anna Nicole Smith, and Chris Farley have in common? They were celebrities whose lives suddenly ended from drug overdose. Sadly, all three tragedies were directly linked to abuse of prescription medications. While the abuse of many illicit schedule controlled substances has steadily declined in the general population, the misuse of opioids (substances found in almost every prescription pain reliever) has increased drastically. According to the United Nations Office on Drugs and Crime (UNODC), it is estimated that between 26.4 million and 36 million people abuse opioids worldwide.[1] What’s more, the Substance Abuse and Mental Health Services Administration (SAMHSA) estimated that 2.1 million people in the United States suffered from substance use disorders related to prescription opioid pain relievers in 2012, while an estimated 467,000 were addicted to heroin.[2]

According to the American Society of Addiction Medicine (ASAM), opioid addiction is driving the overdose epidemic, with more than 20,000 overdose deaths in the U.S. in 2015. Fortunately, there are ways to prevent opioid-related fatalities. Knowing how to safely use, store, and dispose of medications can help put a halt to this epidemic. Individuals will have a greater awareness of the negative outcomes, thus helping to reduce the risk of accidental overdose.

Safe Usage

Opioids, which send pain-blocking signals to the brain, are found in prescription pain relievers such as hydrocodone, codeine, and morphine. For chronic pain sufferers and cancer patients, these medications are highly beneficial as they play a key role in treating long-lasting pain. However, when not used as prescribed, abusing opioids can negatively impact your health.

Unbeknownst to many, everyday pain relievers such as Tylenol and Advil can cause severe damage to vital organs or even fatality, if used incorrectly. Whether it be a pain medication containing opioids prescribed by a doctor, or an over-the-counter substance, one should adhere to label instructions or doctor’s orders to prevent abuse and make consumption as safe as possible. Ultimately, pain relievers can be very helpful, but the slightest abuse of a medication can be life-threatening.

If you’re unsure about a medication, contact your doctor or pharmacist before use. Here are a few ways to safely use medications:

  • Always ask about side effects and how you might react if you are taking other medications or vitamins.
  • Be certain you understand how and when to take the medication.
  • Make sure you know the prescribed duration of treatment and ask if you should finish the prescription even if you aren’t experiencing pain.
  • Schedule an appointment with your doctor for a review of your medications. Put everything (including vitamins and over-the-counter medications) into a secure bag and bring it with you to your appointment. The doctor should inform you of any medications that could cause a negative reaction when taken together.

Proper Storage

Not only is proper storage vital to safety, but where you store your medicine can also affect how well it works. Always keep medications out of reach from children and in a locked cabinet. Improper storage can lead to misuse/abuse by another individual, deteriorate the drug’s effectiveness, or even cause you harm. Heat, light, air, and moisture can alter medication, making it less potent or causing it to expire before the expiration date. It is important to keep medicine in its original container. When in doubt, ask your pharmacist for specific storage instructions.

When it’s time to dispose of your medications:

  • Transfer unused medicines to authorized collectors. You can find a DEA-authorized collector in your area.
  • You can discard most medicines in the household trash by following these steps:
  • Mix medicines (uncrushed) in dirt, used coffee grounds, or cat litter.
  • Place mixture in sealed plastic bag.
  • Throw bag in household trash and be sure to scratch out all personal information from prescription bottles or packaging.

Signs and Symptoms of Abuse

The signs and symptoms of opioid abuse can depend on many factors and may include the following:

Behavioral symptoms:

  • Withdrawal from family and friends
  • Expressions of unprovoked anger
  • Dramatic changes in clothing, weight, and personal hygiene
  • Inability to plan or follow through with plans
  • Obsession with acquiring and using drugs
  • Lying about whereabouts

Physical symptoms:

  • Impaired motor coordination
  • Shallow breathing and slowed heart rate
  • Dilated pupils

Cognitive symptoms:

  • Memory problems
  • Excessive sleepiness

Knowledge Is Power

The best way to prevent opioid overdose is to improve prescribing, reduce exposure, and stop abuse. With a combined use of counseling and behavioral therapies, the Addiction Recovery Program and Pain Recovery Program at Sierra Tucson offer comprehensive residential treatment for those struggling with opioid addiction. A multidisciplinary team of professionals provides an individualized plan to meet the specific needs of each resident. If you or your loved one is abusing prescribed pain medications and/or opiates, please contact our Admissions Coordinators at (800) 842-4487. We can help.

[1] UNODC, World Drug Report 2012. http://www.unodc.org/unodc/en/data-and-analysis/WDR-2012.html

[2] Substance Abuse and Mental Health Services Administration, Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-46, HHS Publication No. (SMA) 13-4795. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2013.

Addressing an Unmet Need in Depression

Michelle Chacon, RN

Michelle Chacon, RN

By Michelle Chacon, RN
Certified TMS Clinical Operator, Sierra Tucson

Major depressive disorder (MDD) is one of the most common mental conditions in the world, affecting millions of individuals. It is estimated that approximately 4 million patients do not benefit from standard treatments for depression, even after repeated treatment attempts. In the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) – the largest collaborative study to date on depression treatment and outcomes – researchers found the odds of achieving remission from depression diminish significantly with each failed antidepressant trial. Statistically, there is only about a 7 percent chance of remission by the time an individual is being treated with his or her fourth antidepressant medication regime. In addition, the likelihood of the patient discontinuing treatment due to side effects increases with each new course of medication. While these are some rather discouraging statistics, patients whose depression has not responded to first-line treatment have reason to be hopeful.

Transcranial magnetic stimulation (TMS) is a safe and proven treatment for major depressive disorder indicated for adult patients who have failed to respond to antidepressant medication. Cleared by the Food and Drug Administration (FDA) in 2008 for treatment of MDD, TMS is a form of neuromodulation that is non-invasive, non-systemic, and requires no anesthesia or sedation. It stimulates nerve cells in the brain by delivering highly focused, MRI-strength magnetic field pulses that lead to activation of cortical and deep brain structures known to be involved in mood regulation. The treatment is administered daily for 4-6 weeks and each session takes less than an hour to complete. The procedure can normalize and restore balance in areas of abnormal or decreased activity, resulting in a significant reduction of symptoms or complete remission from depression – all without the typical side effects caused by antidepressants.

Sierra Tucson pioneered the concept of TMS therapy in the residential treatment setting in February 2016. Since then, we have treated over 120 patients and administered more than 1,600 TMS sessions. Sierra Tucson’s therapeutic environment sets it apart from other outpatient providers of TMS therapy. Patients are engaged daily in process groups, therapeutic recreational activities, and integrative services, in addition to having the benefit of 24-hour staff care. Typically, an individual who undergoes TMS treatment for depression attends an outpatient facility, every day, for 4-6 weeks. Navigating 20 to 30 appointments around work, school, or family obligations may seem daunting to many people. Some individuals may not have the benefit of a local TMS provider, and Sierra Tucson represents an opportunity for them to try this groundbreaking treatment that had been previously inaccessible. For those who have decided to take the next step and enter residential treatment, the majority of TMS sessions can be completed during their stay at Sierra Tucson.

Who Benefits from TMS Therapy for Depression?

  • Diagnosis of MDD with no psychotic features
  • Medication failures, such as but not limited to:
    • Treatment-resistant depression
    • Those who have considered or are considering ECT for depression
  • Marginally functional, for example:
    • Someone who goes to work every day, but is essentially just “going through the motions.” He or she does not spend all day in bed but likely has the desire to do so.
  • Motivated for treatment and willing to commit to 20-30 treatment sessions

As Sierra Tucson’s TMS clinical operator, I witness firsthand the remarkable healing and hope that TMS patients experience. As they return for TMS treatment sessions each day, I gradually see the light return to their eyes. They become more active; conversation with others becomes easier; and there is a renewed interest in what’s going on around them. They begin to re-engage with a life they had once given up on, and reconnect with people and loved ones from whom they retreated during their depressive episode. Helping patients recover from depression is the focus of my career. It challenges me in ways I never imagined, and I am committed to making a difference every day.

For more information about Sierra Tucson’s comprehensive residential treatment, please call our Admissions Coordinators at
(800) 842-4487.