Benefits of Art Therapy

Our souls respond to art, even if we don't believe we're creative in any way. Because of this, art therapy is often a good holistic approach for maintaining sobriety. It allows you to experience emotion, relay perceptions, find peace, and explore new ideas.

The human relationship with art is integrated into our very being. Think of any ancient culture, and you know it through the pottery, paintings, architecture, writings, and other media left behind. We have a primal connection to the aspiration of beauty, and it does us good to be in the seat of creation for a while. 

You don't have to be the next Kahlo, Bernstein, Morrison, or Chihuly to benefit from art therapy. Simply permit yourself the time to create without fear or filters.

The Definition of Art Therapy

Using art as a deliberate form of therapy started in the 1940s. Many official organizations exist around the world to help license professionals in the practice. The Art Therapy Credentials Board (ATCB) defines it as "using art media, the creative process, and the resulting artwork as a therapeutic and healing process."

Healing after substance abuse often requires a multi-layered plan. The physical aspect is usually taken care of through detoxification and other medical care. The mental and emotional components are sometimes addressed through a variety of techniques such as cognitive behavioral therapy; talk therapy with a group or counselor; exercise and other forms of recreation; eye movement desensitization and reprocessing, also known as EMDR; and many other methods. Art therapy is another tool to help people move toward better wellness.

This technique is often used in addiction treatment because it offers someone the chance to:

• Restore or improve wellbeing
• Develop better self-awareness and healthier self-esteem
• Experience emotions through a safe, nonjudgmental approach
• Understand and resolve emotional conflicts
• Reduce anxiety
• Improve social skills

ATCB professionals stress that participating in this therapy isn't simply for the sake of creating art: it's to expand whole person wellness. Process matters more than product. Learning to enjoy the process is an extra bonus.

The Benefits of Art Therapy

Participants in art therapy may use any number of creative outlets and mediums to help move through certain issues, such as:

• A traumatic event, either experienced or witnessed
• Reconciling past addiction behavior
• A mental health condition

For individuals recovering from substance abuse, an art therapist may suggest creating something that reveals how they feel about themselves or a certain event. This clinical approach won't evaluate how someone paints or draws as much as it explores what tangible representation reveals about an emotion.

Art therapy is particularly helpful for encouraging people to acknowledge negative emotions and find meaningful ways to work through them. This recognition leads to a better understanding that sadness, anger, grief, and other feelings are part of being human. Understanding a wide range of emotions opens the door to managing them effectively.

Participants may also learn more about being mindful in the present moment and what that looks or feels like. This is a beneficial technique for controlling reactions to triggers and learning how to pause.

Expression through art is also another tool that helps change behavior. For example:

• Sketching out a problem may be a way to resolve it, because it's out of your head and placed in front of you, where the answers are clearer.
• Using free movement, with or without music, as a method to release nervous pent-up energy allows for an acceptance of why this is necessary from time to time.
• Creating a collage of people, places, experiences, and moments you're grateful for reaffirms this through visual representation when you're feeling down.
• Writing a letter to someone who hurt or betrayed you, but never sending it, permits you to safely explore the emotions involving this person, and learn constructive ways to let go.

Creative therapeutic applications like these and many others are direct yet non-verbal ways to:

• Reduce the psychological distress that may have prompted addictive behavior
• Develop greater resilience to handle external stressors
• Identify boundaries, when to establish them, and when to let them go
• Alleviate anxiety or depression
• Communicate fears and insecurities
• Deal with concerns about addiction and recovery
• Accept a difficult decision or situation

There are many clinical techniques your certified art therapist may use. These include active imagination, which is more free association to aspects of the recovery process; Gestalt method, which uses the art as a starting point to prompt deeper discussion; and third-hand approach, during which the therapist helps someone create art but gives the individual total control over the end result.

Take What You Learn into Daily Life

So, while art therapy isn't always about the art, you may discover it's the perfect conduit to allow more joy and stability in your life. As you develop new habits for maintaining sobriety, look around your community for opportunities for creative self-expression.

For example, in the Tucson area, there are many artistic outlets, including:

• The All Souls Procession. Initially created by artist Susan Johnson after the death of her father, it's "a sanctuary for community members from all walks of life to express their grief and loss in a celebration of creative energy and rejoicing of life." The annual event is a lively mix of dance, aerial arts, workshops, installations, and more. It's organized by Many Mouths One Stomach, a non-profit arts collective, and always welcomes new artists and volunteers.
• The Sonoran Glass School. Work with delicate yet resilient glass as a metaphor for forming new life from raw material. Various classes in torch work, glass blowing, kiln-fusing, and more.
• The Drawing Studio. "Where art meets life" is its motto. Multiple classes throughout the year invite you to try your hand at a variety of options.

Opportunities at Cottonwood Tucson

The inpatient rehabilitation schedule at Cottonwood Tucson includes various forms of holistic approaches designed to help you develop recovery methods that work for you, including art therapy. Review a typical patient schedule to learn more. 

By Tracey L. Kelley

Yoga for Recovery: Interview with Emily Mattimoe

Emily Mattimoe, MS, CTRS, is the coordinator of recreation therapy services at Cottonwood Tucson. She explores how leisure and recreational activities can be coping mechanisms for sobriety and how these methods help add joy to the recovery process. 

Yoga is a vital component of the holistic recreational approach at Cottonwood Tucson. "Treatment isn't just about getting counseling—it's about the whole experience. We truly believe in this idea that it's the entire body, mind, and spirit that are affected when it comes to recovery," Mattimoe says. "Many times when people come to us, they're not only having problems with depression, anxiety, and addiction, they're also dealing with somatic experiences. Their bodies are hurting."

Yoga movement and its focus on universal wellness are often considered forms of somatic therapy. Soma is Greek for "living body." This approach examines the connection between body and mind and uses both physical techniques as well as cognitive or behavioral therapy to release underlying causes for many co-occurring conditions people might face when suffering with addiction.

"A lot of times, they're disconnected from their spiritual selves. They're so focused on trying to be functional in life," Mattimoe says. "One of the pieces that Cottonwood does well is we're able to meet residents where they're at, and then maybe pull in the physical aspect and the spiritual aspect and explore how those connections can be such a key element of recovery."

How does yoga practice help with this? "Many times, we don't want to feel emotions, or we don't want to experience what's happening in our bodies because it's so painful. So, what happens is people hold those emotions or trauma in their bodies," Mattimoe says. "It's our job as professionals to really help them move all of that through their bodies, then bring some language to it. Afterward, when they feel safe, start touching on those pieces that might be stuffed down." 

The Importance of Participatory Medicine

Cottonwood Tucson presents residents with the theory of participatory medicine that includes not only physical movement, but emotional movement. It's a form of internal empowerment that Mattimoe says is crucial to the concept of recovery.

"People come in here thinking something external is going to heal them. They're going to have medication-assisted therapies, or 'I haven't able to do it for myself, but this therapist is going to fix me.' Through participatory medicine, we teach them how to have the mindfulness to be better healers for themselves," she says. "People aren't going to be in the Cottonwood bubble for the rest of their lives. Things are going to happen in the real world, but they can use yoga as a mindfulness practice to develop a tolerance for discomfort. For example, 'I can hold this pose for another 30 seconds, it's okay, I don't have to move my foot or react right now.' Someone learns they don't have to disconnect from that experience. They can be a little uncomfortable, but still be safe."

The concepts of ownership and agency are critical to successful recovery. Mattimoe says people often learn through yoga what matters most to them about the process of healing, and not that they're doing it for their parents or the cute guy back home. Honoring yourself and being present for yourself are primary messages conveyed through yoga that most people haven't heard before.

"It's an ability to understand that we have more impact on ourselves than anyone else does. Some people come in and feel victimized, often for very valid reasons," Mattimoe says. "It's our goal to walk them through that feeling of being a victim toward the feeling of 'I can make changes. I can be an empowering person for myself. I have this toolbox that other people help me put together, yet I'm the person who chooses what tool to use, where I use it, and for how long.'"

Yoga, she says, helps reinforce embrace ownership and agency through the power of choice. "Do I want to hold this pose for another breath, put my hand on a block, or can I push the edge a little more? It's all about choices and listening to ourselves as to what we truly need," she says. "Does this feel safe? Does this feel comfortable? Is this too much? Is this too little? We just become more aware of where we are in space, and make choices accordingly."

The Cottonwood Approach to Yoga

Cottonwood Tucson provides new residents first with a lecture that leads to a yoga practice. The staff intends to help break down any barriers regarding yoga so people can learn about the pieces that are important. Many people have never done yoga, think they can't do it, or have a concept of it that doesn't align with what they know. Mattimoe believes one of the best things the staff can do is to help people feel safer and more comfortable while encouraging them to speak up about particular boundaries.

"If someone is willing and open to it, we like to have a conversation about how can we help with any barriers. For example, if someone's fear is 'I have trauma, and I don't want the teacher to touch me in yoga class,'—it's important to vocalize that, because it's a great place to start. And then we can ask 'How do you have control over that, what can you do to address it?' 'Well, I can ask the teacher not to touch me.' And then we assure them the instructors will respect them and this choice."

Yoga instructors at Cottonwood Tucson are often multi-disciplined in other wellness components, such as counseling, behavioral therapy, and nutrition. They design yoga sessions based on the people in the class, allowing for individual experiences to guide the flow. Teachers often need to be considerate of how different participants have triggers that involve everything from someone standing behind them to trust of strangers, but it's also important for individuals to find their voices and be open about what they need.

"This is so huge. It's part of the goals we have of them being here: being able to share honestly what they're feeling and what's happening with them without shame, without judgement," Mattimoe says. "So many times, we feel things are happening to us. Our staff wants to validate that this is their opportunity to have some buy-in. They've been feeling out of control, maybe due to depression, isolation, and trauma, or to using. We want to help them regain control."

Mattimoe notes that addiction creates chaos. Yoga, she says, is the opposite: it fosters a space of stillness, of calm. "Chaos is often the way we distract ourselves from what's happening. With yoga, we build a foundation to face all of that," she said. "People may not have any idea yet what it's doing for them, but we can hopefully help make small adjustments that have a huge impact." 

What Allows You to Succeed

The professionals at Cottonwood believe communication is fundamental to many aspects of life during treatment and beyond. Through the variety of holistic practices offered at the facility, people develop the mindfulness to acknowledge their experiences, work through them, and step on the path to a more healthy life with the ability to make their voices heard. To learn how this approach may help you, please contact us today.

By Tracey L. Kelley

Understanding Process Addictions

As addiction science evolves, the medical community continues to find support for the claim that addiction is a chronic brain disease. In the past decade, numerous studies have reinforced direct causation of drugs and alcohol on the brain's reward center, neural pathways, memory, cognitive function, and motivation.

Further research by the American Society of Addiction Medicine includes process addictions—also sometimes referred to as urge-driven disorders or behavioral addictions—in the current understanding of how the brain is affected by artificial stimuli.

Non-substance-related disorders are hotly disputed, even though the American Psychiatric Association (APA) included some of them in its most recent edition of The Diagnostic and Statistical Manual of Mental Disorders (DSM). In the current American healthcare system, an official designation listed in the DSM allows rehab facilities and health practitioners to provide a universal standard of care and treatment within coverage options recognized by insurance companies.

The updated version, DSM–5, references the following process addictions:

• Eating Disorders, including binge eating, anorexia nervosa, bulimia nervosa, and other related conditions
• Gambling Disorder, recognized as a quantifiable behavioral addiction disorder
• Internet Gaming Disorder, closely related to Gaming Disorder, now listed as a condition "warranting more clinical research and experience before it might be considered for inclusion in the main book as a formal disorder"

There are other notable urge-driven disorders, including but not limited to:

• Hypersexual activity
• Compulsive shopping
• Exercise addiction
• Internet and/or social media addiction
• Compulsive pornography viewing
• Food addiction

However, not all of these are currently recognized by the DSM–5. This doesn't make them less valid—especially if they're co-occurring conditions to substance abuse. It just means the APA has yet to conclusively affirm them as disorders.

What Science Indicates

According to studies cited by the National Institutes of Health, researchers believe "all entities capable of stimulating a person can be addictive, and whenever a habit changes to an obligation, it can be considered an addiction."

Medical experts at the APA, the Institute of Medicine, and the American Medical Association adhere to a definitive explanation of addiction that evidence indicates is a brain disease. The Addiction Recovery Guide details the explanation: “It’s the uncontrollable, compulsive drug craving, seeking, and use, even in the face of negative health and social consequences. Addiction is a condition caused by persistent changes in brain structure and function. Both developing and recovering from it depend on biology, behavior, and social context.”

As the experts point out, a person can become compulsively dependent on or obsessed with anything due to chemical changes in the brain, now reliant on artificial stimuli to the pleasure and reward center. This is what makes behavioral disorders different than, say, someone frequently engaging in certain hobbies or activities. While the physical signs of addiction aren't often present with behavioral disorders, the mental symptoms may closely resemble substance addiction.

The polarized thoughts regarding process addictions seem to relate to how an individual's particular habits can be classified as behavioral disorders. Some professionals identify process addictions by the compulsivity factor, similar to obsessive-compulsive disorder, which is recognized by the APA. This rationale is linked to the alteration of the brain's structure and function.

Detractors point to longitudinal studies that indicate process addictions are more of a "transient, limited behavioral problem" which won't persist. It eventually dissolves over time, mostly due to people taking stock of their lives and choosing to modify certain habits.

Reasons for Process Addictions

The absolute causes of process addictions are unclear. However, there seems to be a correlation between dysregulation, especially in response to trauma, and urge-driven disorders.

Dysregulation is a condition that impairs psychological, metabolic, or physiological process regulation. For example, a teenager who is frequently bullied may immerse herself in video games as a means to control her environment. Or, someone who was physically abused as a child may use the thrill and perks of gambling to create an inflated sense of worth.

Further, while the APA doesn't recognize an addictive personality as a psychiatric diagnosis, there are often certain characteristics common among people who suffer from process addiction:

• Increasing dopamine, the "pleasure chemical," by acting on impulsive tendencies or engaging in risky activities or behaviors
• Co-occurring conditions such as substance abuse, anxiety, depression, or borderline personality disorder
• Nonconformity, which includes a loss or gain of social structure, excessive narcissism, or defiance of authority

Key protective factors such as an established sense of purpose, positive relationships, good self-control, community involvement, and others often help to balance the urge to participate in particular behaviors. But, since many process addictions are often initially viewed as harmless activities, the crisis of the behavior might not be noticeable until there's a real problem.

Symptoms of Process Addiction

It's important to note that with the definition of addiction as a brain disease, not everyone who uses drugs or alcohol becomes addicted, just as someone who goes on a shopping spree after receiving an employment bonus isn’t automatically a compulsive shopper.

Process addiction may be present if someone displays the following symptoms:

• Acting on compulsive impulse to continue the behavior
• Obsessing about the need to engage in an activity
• Developing a tolerance to negative aspects of the behavior, no matter how difficult
• Losing control over participation, such as how much to do it or for how long
• Hiding the behavior or denying there's a problem
• Experiencing adverse reactions when unable to engage in the activity
• Finding it difficult to control or refusing to stop the behavior
• Continuing with the activity or behavior even if it causes harm 

Treating the Whole Person

At Cottonwood Tucson, we believe addiction of any type starts with chemical changes in the brain. Our team of experts seeks to help clients understand the root causes of these issues and advance through recovery in healthy, meaningful ways.

We provide personalized holistic behavioral therapy options for people wanting treatment for process addictions. Contact us today to see how we can help you or a loved one.

By Tracey L. Kelley

Why Substance Abuse Affects Nutrition

The statistics regarding America's lack of nutrition are rather astounding. Consider the following:

• Dietary guidelines for 2015-2020 released by the Office of Disease Prevention and Health Promotion indicate that 117 million Americans—approximately half of all adults in the nation—have at least one preventable chronic condition related to inadequate diet and lack of exercise.
• The average American consumes nearly four times the recommended daily intake of sugar—a whopping 22 teaspoons of added sugar, not accounting for amounts found in foods such as condiments, cereal, and yogurt. Extra sugar does more than harm your teeth: it contributes to high blood pressure and cholesterol; causes fatigue; and may even contribute to worsening depression.
• Recent study findings from the National Institutes of Health reveal that Americans have a higher risk of dying from cardiometabolic diseases—type 2 diabetes, stroke, and heart disease—if their diets are heavy with unprocessed red meat, processed meats, sugar-sweetened beverages, and sodium. What's more, it's not enough to avoid or eliminate these foods; people must also increase daily intake of more healthy options such as fruits, vegetables, nuts and seeds, seafood omega-3 fats, and whole grains. The researchers' analysis indicates almost half of deaths due to cardiometabolic diseases had a direct correlation to these dietary factors.

If you're in recovery from substance abuse, you're also rebuilding the structure of your nutrition. It's important to start the process in treatment and slowly adapt to better habits.

The Relationship Between Substance Abuse and Nutrition

While you may have a friend or a loved one who can eat sloppy burgers and a mess of fries seemingly without consequence, that fact is all of us operate more efficiently with whole food fueling our bodies and minds.

Scientists and physicians are taking a closer look at what they call "nutritional psychiatry" and are evaluating how what we eat affects our thinking and functioning. Whole foods rich with antioxidants, minerals, and vitamins provide nourishment to the brain. "Live" foods also protect the brain from oxidative stress caused by the waste produced when you use oxygen. Oxidation damages cells and heightens inflammation.

Another important aspect of nutritional psychiatry is understanding gut health. Surprisingly, one of the most powerful neurotransmitters activated in your brain first starts in your gastrointestinal tract—serotonin. Serotonin helps inhibit pain, control appetite and sleep, and regulate moods. In an article for Harvard Health Publishing, physician Eva Selhub details just how many neurons are in your digestive system, and what happens when poor eating habits make it harder for "good" bacteria to absorb fundamental nutrients, ward off toxins from "bad" bacteria, and keep the neural pathways between the gut and brain clear.

For someone suffering from substance abuse, these signals are crossed. Maintaining a proper diet is difficult when:

• Alcohol and drugs contribute to an increasing depletion of essential vitamins and minerals, which compromises multiple mind and body functions.
• Mental health issues may complicate substance use and interfere with healthy habits.
• Repeated use of illicit substances doesn't usually permit frequent grocery shopping and preparing nutritious meals.
• Addictive substances may increase or decrease appetite, causing extreme fluctuations with calorie consumption, metabolism, and nutrient processing. 

Quite often, people entering treatment for substance abuse are malnourished. This may be apparent in a variety of ways, such as slow-healing wounds; kidney and liver complications; immune system disorders; and anxiety and insomnia. Additionally, for people dealing with alcoholism—a high caloric carbohydrate due to the sugar content—they often crave other unhealthy carbs, sugar, and salt.

This compounds nutritional deficiencies.

In addition to the health conditions many Americans face due to a poor diet, malnourished people also frequently experience:

• A compromised immune system, leading to further infection or illness
• Acid reflux, abdominal pain, and bowel tissue decay
• Hepatitis, HIV/AIDS, and other infectious diseases
• Higher stress and agitation
• Prenatal issues

Medical detoxification and a comprehensive whole foods eating plan help people move forward with nutritional wellness.

Overcoming Dietary Issues Related to Substance Abuse

Nutrition experts stress that proper hydration and a slow correction of micro- and macronutrient deficiencies help individuals in recovery reduce malnutrition and junk food withdrawal.

That's right—some people suffer withdrawal symptoms when they initially eliminate foods that are high in processing, fat, simple carbohydrates, salt, and sugar. For example, similar to certain addictive drugs, junk food often spikes dopamine, located in the pleasure center of the brain. To quit cold turkey triggers a number of problems, including headaches, irritability, anxiety, mood swings, insomnia, dehydration, constipation, and other health issues.

Today's Dietician recommends patients go through a form of medical nutrition therapy in stages, which may include:

• Healing the body after medical detoxification with calorically-balanced meals, increased hydration, managed sleep, and stress-relieving techniques
• Improving aspects of nourishment with the introduction of nutrient-dense foods
• Assessing mood imbalances and behaviors to create stability through diet modifications such as regulating insulin, increasing amino acids, and adding omega 3-6-9 compounds
• Helping clients understand the differences between hunger cues, substance cravings, and uncovered emotions
• Recognizing the potential for co-occurring disorders such as binge eating and taking dietary and psychological prevention measures

Nutritional Care at Cottonwood Tucson

The professionals at Cottonwood use nutrition as a primary component of addiction detox, along with individualized medication protocol, counseling, and holistic practices such as yoga, Tai Chi, equine therapy, and meditation.

Our behavioral health dieticians develop nutritional plans for residents that promote clear thinking with stable, confident, and happy moods. They also collaborate with Cottonwood chefs and culinary staff to create menus supportive of the neurobiological needs of all patients.

By Tracey L. Kelley

The Epidemic of Painkiller Addiction

In 2015, Harvard Medical School reported that "four times as many prescription painkillers are provided each year now compared with the 1990s." In 2017, the U.S. Department of Health and Human Services (HHS) implemented a public health emergency, and developed a campaign to focus on specifically reducing opioid dependency. In its research, HHS cited the following statistics from the Centers for Disease Control and Prevention:

• In 2016, approximately 115 people died each day in the U.S. from opioid overdoses.
• In that same year, reports indicated the number of deaths from fentanyl and prescription/illegal opiates was five times greater than in 1999.
• Also in 2016, more than 63,000 deaths occurred—over 65 percent were due to opioids.

Why People Abuse Painkillers

The Substance Abuse and Mental Health Services Administration (SAMHSA) reported in July 2017 that prescription drug misuse is second only to marijuana as the most commonly-used illegal drug.

SAMHSA indicated that more than 90 percent of Americans surveyed in 2015 used prescribed pain relievers in the previous year. Of that number:

• Nearly 64 percent misused these medications in order to alleviate pain.
• Approximately 6 percent misused tranquilizers issued by medical professionals, usually to relax or to sleep more efficiently.

In some respects, prescribers are responsible for controlling access to painkillers. Their scope of knowledge regarding painkiller alternatives is more extensive than what the average person might know, especially when it involves medication.

But when patients approach healthcare providers with complaints of pain, it's difficult for medical professionals to evaluate, as each individual's perception of pain—particularly chronic pain—is subjective. There's no universal aspect of measurement that can be applied.

Because every person has different pain receptors, various prescription medications may be offered to help reduce the severity of symptoms.

Some recommended drugs—such as anti-inflammatories or NSAIDs more powerful than over-the-counter varieties—have what's called a "ceiling effect" where an increased dose doesn't provide greater pain relief. With different types of opioids—narcotic analgesics such as Percocet, hydrocodone, Tylenol with codeine, methadone, OxyContin, Lortab, fentanyl, and others—some people develop a tolerance to a certain dose, even if pain hasn't subsided, so dosing is increased without limitation. This is the start of addiction.

Additionally, some physicians think we have a "prescription culture." Researcher Marcia Meldrum of the University of California studied the history of pain care applications and shared her findings in a variety of medical journals. “Too many people see drugs as the answer to not only pain, but to improve their lives," she's quoted as saying in the Canadian Medical Association Journal. "If the solution also means they may become somewhat dependent on a drug, they probably think, 'Well, that would be better than this.'"

Consequently, many medical professionals seek to alleviate symptomatic problems with painkillers, even when causation isn't clearly identified.

Overprescribing Painkillers May Contribute to Epidemic Increase

Unfortunately, the medical community isn't completely without fault in the painkiller epidemic, and more lawsuits are coming to light. Here are just a few:

• In March 2018, NBC News reported five physicians accepted bribes to prescribe more fentanyl than medically necessary.
• A story in Rheumatology News discussed the details of several lawsuits brought against physicians for excessive prescribing of painkillers—including a Oklahoma doctor who "prescribed three million doses over five years," often in combination with anti-anxiety medication and muscle relaxers.
• Another March 2018 story from CNN outlined the particular conflicts with the "pay to prescribe" incentive systems of some pharmaceutical companies. For example, one lawsuit described how a doctor would only prescribe a certain manufacturer's drug to patients, regardless of how serious side effects impacted them, and how much money he received as a result. The Drug Enforcement Administration investigated this doctor and discovered he prescribed buprenorphine, another type of opiate, "for non-legitimate medical reasons" and received bonuses from the drug company.
• Fortune magazine revealed in a June 2018 feature that the HHS and the Department of Justice issued charges in a massive class action lawsuit against 601 defendants—including physicians, nurses, clinics, and pharmacies—because of a reported $2 billion in healthcare fraud involving opioids.
• Owners of Purdue Pharma—the manufacturer of OxyContin—and many of the company's board members and executives are embroiled in a multi-district case worth billions of dollars with other painkiller drug manufacturers and distributors. The primary reason for the lawsuit: "an illegal business model leading to addiction and deception to enrich a few while leaving a path of devastation and destruction in its wake."

What's Being Done Now

The Washington Post reported in August 2017 that as of that time, 17 states had enacted rules to limit the number of painkillers doctors can prescribe. Some restrictions were by number of days allowed for a prescription; others by type of drug and dosage.

Arizona is one of those states. Effective April 2018, state lawmakers:

• Limited initial opioid prescriptions to a five-day supply, unless post-surgical—then a 14-day supply is allowed in most circumstances
• Restricted dosage of initial opioid prescriptions to under 90 MME per day, or morphine milligram equivalents
• Required that schedule II opioids—which are many of the narcotic analgesics mentions above—can no longer be prescribed without a doctor's visit, with extremely few exceptions
• Mandated that pharmacies dispense schedule II drugs with red caps and labels warning of "potential addiction"

Additionally, in 2019, a gradual rollout throughout the state enforces mandatory electronic prescription tracking for schedule II opioids.

For full details about changes to protect Arizona residents, review the Turning the Tide Controlled Prescription Monitoring Program. You can also follow real time statistics on the painkiller epidemic on a special site updated by the Arizona Department of Health Services.

Comprehensive Care at Cottonwood Tucson

If you or someone you love is struggling with painkiller addiction, please reach out to our staff right away. We can be reached at 888-727-0441 or you can fill out our contact form.

By Tracey L. Kelley