Suboxone Assisted Treatment
501 (c) (3) Non-Profit Organization
If I have the belief that I can do it, I will surely acquire the capacity to do it, even if I may not have it at the beginning.
Greetings to all of you. It's 2008...Can you believe it? We all did survive even though at times we did wonder. It is time to put it all behind us but the lessons we learned. Some of you made changes in your life for the better and I'm certainly proud of all of you. If you started on Suboxone and have maintained your Sobriety then we would love to hear from you. If you feel you can, then please send us your "Success Story." We have started publishing some as you can see and we would love for yours to be included. You can never understand how much your story inspires others.
If you started on Suboxone last year, but relapsed, you too, deserve praise. You made the decision and believe me it is the key. Your actions will follow your will. I have a Japanese Proverb to share with all of you.
"Fall seven times, stand up eight!"
I'm hoping all of you had a wonderful Christmas and a "Happy New year." We stayed open all through the Holiday Season just in case anyone needed us. We gave you our word in the beginning, "You are never alone." We strive to live up to those words. We know Christmas can be an enjoyable time for many, but for some of us with no family and friends, it can be more than one can bear.
It's not easy either for many of us with "substance-abuse" problems. It can defintely be a temptation to many of us and we have extra people on call if you need support and encouragement.I can say we only received a small percentage of calls with the majority of them coming in on New Year's Day. I am sure you can guess where they were coming from (?)
It told us some of you managed to celebrate "New year's Eve" and found yourself incarcerated. It is certainly not the place you want to spend "New Year's Day. I reached the conclusion after talking to you ...most of you have no idea of what your rights are. I decided it is a subject we should pursue because "Knowledge is Power!"
FLEX YOUR RIGHTS QUIZ
Think you know your rights during police encounters?
Answer these eight short questions, and see how prepared you are.
1) The Patriot Act increases police power during traffic stops.
There are many reasons to be concerned about the PATRIOT Act, but it doesn’t give new powers to regular cops. Anti-terrorism legislation gives federal agents broad powers to investigate potential terrorist activities, but it doesn’t apply to the local cops in our neighborhoods or the state police patrolling our highways. If you’re accused of terrorism, you’ve got big problems, but we promise you won’t be sent to Guantanamo Bay for refusing a consent search.
2) ) Undercover officers must admit they’re police when asked.
This wildly inaccurate and pervasive myth has gotten many people in trouble. In reality, police are allowed to lie about all sorts of things if it helps them to make arrests. Watch COPS a few times and you’ll see how often people think they’re protecting themselves by asking this silly question.
3) During a traffic stop, police may automatically perform a weapons pat-down.
Pat-downs have become a matter of routine in some departments, but the truth is police must have reasonable suspicion to believe you're armed before patting you down. It doesn't take much evidence for a judge to uphold a pat-down, but remember that your lawyer can challenge a pat-down that happens for no reason.
Just say "No" to warrantless searches. Warning: If a police officer asks your permission to search, you are under no obligation to consent. The only reason he's asking you is because he doesn't have enough evidence to search without your consent. If you consent to a search request you give up one of the most important constitutional rights you have—your Fourth Amendment protection against unreasonable searches and seizures.
4) Fourth Amendment protections still apply if you’re a minor.
The Fourth Amendment applies to all citizens, including minors. Nonetheless, young people face greater challenges when attempting to exercise their rights. It takes knowledge and confidence to stand up to adults, especially police who are trained to intimidate.
Additionally, young people don’t usually own property, so their privacy is reduced by the fact that adults often control the spaces they use. Parents might consent to a home search, just as the principal might permit locker searches at school. These conditions sometimes limit, but do not cancel out, the Fourth Amendment rights of minors.
5) Officers have to read you your rights when you're arrested, or you can’t be charged.
Many people believe that an officer must automatically read a person his or her Miranda rights as part of performing an arrest, either immediately before or immediately after an arrest is made. This is a myth.
The truth is that the only time an officer must read a person his or her Miranda rights is when: (1) the person has been taken into custody, and (2) the officer is about to question the person about a crime. Even when they do read you your rights, they leave out lots of important information. If you find yourself in legal trouble, keep your mouth shut and get a lawyer.
6) Refusing a search gives police a legal basis to detain you.
Exercising your rights can never be used as evidence to justify a search or detention. In fact, the opposite is true. If an officer were to admit in court that he/she was suspicious solely because you refused a search, it could actually help your case. On the other hand, consenting to a search makes it nearly impossible to legally challenge any evidence that police might find on you. If you refuse a search and the officer threatens you, ask if you're free to go.
7) Drug checkpoints are unconstitutional.
The Supreme Court has ruled that random checkpoints for the purpose of finding illegal drugs are unconstitutional. However, police sometimes put up signs warning drivers of up-coming drug checkpoints and instead pull over people who make illegal u-turns or discard contraband out the window. If you see a sign saying “Drug Checkpoint Ahead”, just keep driving and don’t panic. If there’s a rest area following the sign, DO NOT pull into it. If you do, you’ll find yourself surrounded by drug-sniffing dogs.
Police Departments, especially in the Mid-west, have been pushing their luck with this tactic, so if you encounter anything resembling an actual drug checkpoint, please contact that state’s ACLU Chapter. Similarly, if you’re arrested as a result of a real or fake “drug checkpoint”, you must contact an attorney to explore your legal options.
8) You can be arrested for refusing to identify yourself to a police officer.
This one’s tricky. As a general principle, citizens who are minding their own business are not obligated to "show their papers" to police. In fact, there is no law requiring citizens to carry identification of any kind.
Unfortunately, in Hiibel v. Sixth Judicial District Court of Nevada, the Supreme Court upheld state laws requiring citizens to disclose their identity to police when officers have reasonable suspicion to believe criminal activity may be taking place. Commonly known as 'stop and identify' statutes, these laws permit police to arrest criminal suspects who refuse to identify themselves.
Regardless of your state's law, keep in mind that police can never compel you to identify yourself without reasonable suspicion to believe you're involved in criminal activity. Rather than asking the officer if he/she has reasonable suspicion, test it yourself by asking if you're free to go.
If the officer says you’re free to go, leave immediately and refrain from answering any additional questions. If the officer detains you, you'll have to decide whether refusing to disclose your identity is worth the risk of arrest.
How many of you could answer these? If you couldn't then it is about time you think about learning because it could prevent you from finding yourself incarcerated and in need of help on New Year's Day.
Brain-Boosting Drugs Could Soon Become The Smart Choice
During a quiet moment in the pub over Christmas, a friend of mine leaned over and whispered in my ear. "Do you know where I can get my hands on some smart pills?"
Like me, the friend - who works for an engineering firm - had heard the rumours about modafinil, one of a powerful new breed of brain-boosting drugs that enhance concentration, memory and mental aptitude. Medicines which were designed to treat brain injury, dementia and ADHD are now becoming popular pick-me ups. Businessmen take them to beat jet lag, academics pop them to sharpen their minds and shift workers take them to stay alert.
Online you can find web chat rooms full of glowing testimonies from users, but as the popularity of smart pills spirals, experts are warning that, with no real knowledge of long-term health risks, users are making themselves guinea pigs. In a recent commentary in the journal Nature, Professor Barbara Sahakian and Dr Sharon Morein-Zamir called for a national debate on "cognitive enhancers" and their potential impact on society. Are smart pills "unfair", they ask, and should we do anything to regulate them?
To address their questions, we should begin by looking at currently available cognitive enhancers. Perhaps the nearest thing we have to the ideal "smart pill" is modafinil, a drug designed to treat narcolepsy, which is reportedly being used by businessmen and others to overcome tiredness.
"We know that a number of our scientific colleagues in the US and the UK already use modafinil to counteract the effects of jetlag, to enhance productivity or mental energy, or to deal with demanding and important intellectual challenges" says Sahakian.
Recent paparazzi shots revealed a packet of a brand of modafinil - Provigil - in Britney Spears's handbag.
Although there are side effects - headaches and nausea - they appear to be mild. One survey found that as many as 10% of students at American universities are using Ritalin and Adderall - ADHD drugs - to improve their performance.
Ritalin helps hyperactive children to focus on one thing at a time, but when used in otherwise healthy adults it makes them feel more alert and full of energy - unsurprising when you find out that the active ingredient is amphetamine. However, its side effects include sleeplessness, loss of appetite and in rare cases, hallucinations.
Other so-called smart pills include Aricept (donepezil), an Alzheimer's drug, which studies found could improve the memory of fighter pilots learning new moves on a flight simulator. Finally and potentially the most powerful of all are ampakines, a new untested class of drug designed to boost memory and improve alertness, without giving users the dreaded caffeine shakes.
Does that sound tempting? Most of us can imagine a situation at work where we would benefit from a little cognitive enhancement. And is that really such a crime?
"People have all sorts of natural advantages - some are cleverer, stronger or more beautiful than others," says Michael Gazzaniga, president of the Cognitive Neuroscience Institute in America. "If we can boost our abilities to make up for the ones Mother Nature didn't give us, what is wrong with that?"
After all, as the Nature authors point out: "Most readers would not consider that having a double shot of espresso or a soft drink containing caffeine would confer an unfair advantage at work. So does it matter if it is delivered as a pill or a drink?"
Indeed, they argue that there are situations in which the use of drugs to improve concentration or planning "may be tolerated, if not encouraged", such as by "air-traffic controllers, surgeons and nurses who work long shifts, airport-security screeners, or by soldiers in active combat".
However, they are quick to point out the flipside. "Universities may have to decide whether to ban drug use altogether, or to tolerate it in some situations - whether to enable all-night study sessions or to boost alertness during lectures," they say.
Their biggest concern is for children. The long-term effects of many cognitive enhancers on the developing brains is still unknown.
So what form should any regulation take? Should they only be available on prescription?
"We believe it would be difficult to stop the spread in use of cognitive enhancers given a global market in pharmaceuticals with increasingly easy online access. They call on scientists, doctors and policy-makers to "provide easy access to information about the advantages and dangers of using cognitive-enhancing drugs and set out clear guide-lines for their future use."
A softer approach is possible, they say, because at present, cognitive enhancers are "relatively safe" and yield "only moderate effects".
But, with increasingly sophisticated and even genetically-tailored treatments, truly smart drugs with dangerous large effects on cognition will become feasible.
"Fears have been raised of an overworked 24/7 society pushed to the limits of human endurance, or of direct and indirect coercion into taking such drugs," they say.
"If other colleagues at work, or children at your child's school, are taking cognitive-enhancing drugs, will you feel pressure to take them yourself?"
For many, this is no longer a theoretical question. Is it for you? What is your decision and would you share with us how you arrived at it? Please all feedback would be appreciated.
Source: James Morgan, Reporter UK, The Herald
“Addiction is not simply a lot of drug use; it is a disease of the brain that is expressed through behavior.”
Laughter is the best medicine.
Emergency Antidote, Direct To Addicts
After 11 years as an addict, Mr. Kinzly cleaned up, began working with needle exchange programs and became a research associate at the Yale School of Public Health. Then came the relapse and the overdose that nearly killed him.
“We were watching TV — I think it was the Red Sox beating the Yankees,” Mr. Kinzly, 47, recalled of the evening in 2005 when he passed out in a colleague’s apartment. “Because of our work he knew what to do. He dialed 911 and then injected the naloxone.”
Taken in high enough doses, heroin and other opioids suppress the brain’s regulation of breathing and other life-sustaining functions. Naloxone is a chemical that blocks the brain-cell receptors otherwise activated by heroin, acting in minutes to restore normal breathing.
Since its approval by the Food and Drug Administration in 1971, naloxone has become a standard treatment for overdoses, used almost exclusively by emergency medical workers. But it has lately become a tool for state and cities struggling to reduce stubbornly high death rates among opiate users. By distributing the drug and syringes to addicts and training them and their partners in preventing, recognizing and treating overdoses, the programs take credit for reversing more than 1,000 overdoses.
“From a public health perspective, it’s a no-brainer,” said Dan O’Connell, director of the H.I.V. prevention division in the New York State Health Department, which supports 20 naloxone programs, all but one in New York City. “For someone who is experiencing an overdose, naloxone can be the difference between life and death.”
But federal drug officials say distributing naloxone directly to addicts may do more harm than good.
“It is not based on good scientific data,” said Dr. Bertha Madras, deputy director for demand reduction at the White House Office of National Drug Control Policy. “It’s based on what some people would consider the right thing to do. But the studies supporting it are so sparse it’s painful.”
She pointed to a survey in 2003 of addicts in San Francisco. published in The Journal of Urban Health, in which 35 percent said they might feel comfortable using more heroin if they had naloxone on hand, and 62 percent said they might also feel less inclined to call 911.
“These were their attitudes,” Dr. Madras said. “I’m taking the stand that in the absence of scientific evidence we don’t engage in policies that would bring more harm than benefit.”
Similar concerns were expressed by Dr. H. Westley Clark, director of the Center for Substance Abuse Treatment, a federal agency that finances treatment programs. “Our position is that naloxone should be administered by licensed health care professionals,” Dr. Clark said.
Nevertheless, the direct-to-addicts model has spread rapidly since Chicago introduced it in the late 1990s. Baltimore, New York and San Francisco soon adopted the model, and Boston, Philadelphia, Connecticut, Minnesota, New Mexico, Rhode Island and Wisconsin have more recently joined the trend.
“The program here has been extremely successful,” said Richard W. Matens, assistant commissioner of health for chronic disease prevention in Baltimore.
Overdose deaths there in 2005 were at their lowest level in more than a decade, and Mr. Matens gives at least some credit to the naloxone distribution.
The worrisome findings of the San Francisco survey have not been borne out by more recent studies of actual programs that include training in prevention and treatment.
A study in 2005 of San Francisco’s pilot program found that of 20 overdoses witnessed by trained addicts, 19 victims received CPR or naloxone from the trainee, and all 20 survived. Knowledge about managing overdoses increased, and heroin use decreased.
“Research has shown none of the concerns about naloxone distribution to be true,” said Dr. Sandro Galea, a researcher at the University of Michigan who has written two studies of programs in New York. “It probably is one of the few interventions that truly can reduce the deaths from opioids overdoses.”
Dr. Herbert Kleber, who had Dr. Madras’s position in the White House under President George H. W. Bush and now directs the Columbia University substance abuse division, said although he wished the evidence supporting naloxone distribution were stronger, “In terms of lives saved, it’s probably the kind of intervention where there’s a likelihood of more good than harm.”
In New York City, the 863 overdose deaths in 2005 made up the fourth leading cause of death among people younger than 65, according to Dr. Thomas R. Frieden, commissioner of health and mental hygiene.
“We want people off drugs,” he said. “But until they get off, we’d like them to stay alive. That means not getting H.I.V. and not dying of overdose.”
Existing programs focus on reaching urban heroin addicts, but naloxone is equally effective at reversing overdoses from other opioids like OxyContin and methadone.
With overdose death rates from such drugs increasing sharply, officials in Wilkes County, N.C., are working on a program to dispense a naloxone nasal spray to users leaving hospital emergency rooms, detoxification centers and jails.
The program, Project Lazarus, received approval from the state medical board in November.
Lazarus, biblically speaking, is one who was raised from the dead, and that is essentially what naloxone does for these people,” said the director of the program, the Rev. Fred Brason II.
Dr. Sharon Stancliff, medical director of the Harm Reduction Coalition, which operates naloxone distribution and training in New York and San Francisco, conceded that the scientific case was not ironclad.
“Right now,” Dr. Stancliff said, “we’re at the point where we know it’s safe. We’re not seeing any bad outcomes.
“And we know it’s feasible. We’re just beginning to get really good evidence that it’s associated with a significant reduction in
Mark Kinzly, who is back in recovery after relapsing in 2005, says he has all the evidence he needs.
“This weekend I will go see my 9-year-old son play Pop Warner football,” he said. “I am extremely grateful that the medication was available, and as a result I get to raise my child.”
Resource: DAN HURLEY New York Yimes 11 December 2007
Transfer From Methadone To Suboxone
Patients receiving methadone may seek transfer to buprenorphine treatment. There are a large number of clinical scenarios that would cause a patient receiving methadone to seek a transfer to buprenorphine. It is incumbent upon the physician to weigh the clinical issues carefully prior to agreeing to assist in the transfer. If a patient is stable on methadone, it is generally not advisable to agree to transfer to buprenorphine without a careful evaluation of the factors motivating the desire to transfer. However, if in the physician’s medical judgment, buprenorphine treatment is appropriate and the patient is well-informed of the risks and benefits, transfer may be a reasonable option.
Among the potential benefits of transfer to buprenorphine include lower risk of overdose or sedation, less severe withdrawal if a dose is missed, the capacity to obtain medication at a local pharmacy and the option of treatment in a doctor’s office.
A number of factors might motivate a patient's request to transfer from methadone. These include:
(a)a desire to no longer receive their treatment from an opioid treatment program,
(b)perceived stigma associated with receiving methadone,
(c)concerned about having methadone in the house,
(d)a desire to travel frequently for work,
(e)concern about having a large number of methadone bottles in their possession when traveling,
(f)concern about losing methadone bottles without the possibility of replacement,
(g)less need for the required counseling/medication dispensing/urine collection in regulated opioid treatment programs,
(h)and/or living a long distance from a treatment program.
Alternatively, the patient may not be doing well on methadone, continuing to use opiates, stimulants (cocaine or methamphetamines) or benzodiazepines and wishing to leave the structure of an opioid treatment program. Finally, it is possible that a patient may be buying methadone on the street and is now seeking legitimate treatment.
When a patient is seeking transfer from methadone to buprenorphine, it is advisable to determine if the request is based on realistic expectations. It is important for the prospective patient to know that, in an effort to lower the patient’s level of opioid physical dependence, it is advised that most patients taper their dose of methadone prior to transferring to buprenorphine.
Unfortunately, for some patients, the transfer process may be associated with a period of discomfort, both from tapering methadone and from starting buprenorphine. Individuals on moderate to high-doses of methadone, over 60-100 mg, may not be able to taper without discomfort and a risk of relapse. As the methadone dose is lowered, if the patient begins to experience withdrawal that interferes with their functioning or leads to relapse, he/she can be advised that transfer at a later time may be advisable.
If the buprenorphine practitioner is not associated with the patient’s methadone clinic, it will be important to work with the methadone physician and treatment team to coordinate the taper and the timing of the transfer. One should work with the methadone clinic staff to insure continuity of care and a smooth transition, and know that if the transfer fails, that the patient may return to methadone treatment. In some cases, the methadone clinic staff may oppose the patient’s transfer. The buprenorphine prescriber should be cautious about being perceived as forcing the transfer, yet encourage the patient to advocate on their own behalf if needed and appropriate.
Level of evidence: Low -observational studies and a limited nuber of randomized studies.
Studies of transfer from methadone to buprenorphine are limited (Levin, Fishman, et al 1997; Breen, Harris et al 2003; Law, FD et al. 1997; Clark, Lintzeris et al, CPDD 2006) but offer helpful insights into the transfer process on both inpatient and outpatient settings. It is advisable for the patient to arrange a few days off from work, to go through the transfer.
As with any induction, the patient must be essentially free of opioid full agonists before taking the first dose of buprenorphine. It is not necessary to start with buprenorphine mono then transfer to buprenorphine/naloxone a few days later. The minimal absorbtion of naloxone is not likely to cause a precipitated withdrawal if the patient is in adequate withdrawal when they receive their first dose of buprenorphine.
With the long-acting agonist methadone, the timing of the first dose of buprenorphine may be perhaps more difficult to determine than when starting someone who is using a short acting-opiate. Methadone undergoes significant storage in body tissue, especially the liver, so the length of time until withdrawal is experienced is dependent upon factors such as hepatic function, dose of methadone, duration of methadone, etc. While a patient may know how long it takes for them to go into withdrawal while using heroin, they may not have ever missed a methadone dose and so be unaware of the timing of withdrawal symptoms.
Higher methadone doses and a shorter timeframe between last methadone dose, are clinical concerns in the methadone to buprenorphine transfer process. Generally it is advisable to taper a patient to 20—30 mg methadone, and maintain that dose for a week or more. Buprenorphine may be started 36-72 hours after the last methadone dose, but it is advisable to observe for objective signs of withdrawal (Clinical Opiate Withdrawal Scale of 13-15) and not rely only on time lapsed since the last methadone dose.
The key to a smooth transition is not the length of time since the last methadone dose, but rather how much objective withdrawal the patient is in when they come for their first buprenorphine dose. Both the doctor and the patient may be surprised to learn that it may take much longer than 36 hours to begin methadone withdrawal.
Clonidine, anxiolytics, including benzodiazepines, non-steroidal anti-inflammatory agents may be used judiciously to assist the withdrawal process, and continued during the induction as well. Withdrawal anxiety will be one of the more common concerns.
Alternatively a patient may taper to the dose at which they report discomfort, and if withdrawal signs are observed by the practitioner, the patient can then be started on buprenorphine with results similar to a taper to 30 mg methadone. (Breen, Harris, Lintzeris 2003)
A recent study from Australia, conducted on an inpatient unit with doses of buprenorphine that are not available in the U.S., presented at the College on the Problems of Drug Dependence (2006 Clark, Lintzeris) evaluated 3 induction schedules-low (0.8 mg qid on day 1 increasing to 32 mg by day 5; standard (4 mg day1, increasing to 32 mg at day 5) or high (32 mg day 1 and maintain through day 5). The authors conclude that the high and low dose induction proved more tolerable than the standard induction.
In addition, it was advised to wait as long as possible after the last dose of methadone to perform the buprenorphine induction. Because of the difficulties in tapering a stably maintained patient's methadone dose, several studies have tried to induce patients at higher doses, such as 60mg, or 70mg. The results suggest that although it is uncomfortable, it may be possible, and not completely contraindicated (2005 Glasper,2003 Grenwald).
It may not be possible to admit a patient on high-dose methadone (over 40 mg) to an inpatient service, nor to taper methadone to 30 mg. After obtaining a COWS of 15, it appears advisable to start at 2 mg, and continue to dose until the patient is comfortable up to 32 mg on day 1. If withdrawal is precipitated, management with ancillary medications is advisable. Discomfort may persist for up to 96 hours.
It may be helpful to maintain contact with the patient and provide reassurance and telephone consultation up to 3 times daily for the first few days. This can be an intensive process for the physician as well as the patient so it may be inadvisable to start the transfer late in the week. After 3-5 days, the patient will be stable and comfortable, but it may be necessary to add medications to assist with some of the discomforts associated with the withdrawal/transfer process.
The patient may lose patience with the discomfort and want to return to methadone. The clinician will need to work with the patient either to accomplish this, or to encourage them to wait a bit longer, provide additional therapeutic support and/or increase ancillary medications.
Lintzeris, N., Clark, N., Muhleisen, P. & Ritter, A. Australian National Clinical Guidelines and Procedures for the use of Buprenorphine in the treatment of Heroin Dependence. (2001).
Law, F.D. et al. The feasibility of abrupt methadone-buprenorphine transfer in British opiate addicts in an outpatient setting. Addiction Biology 2, 191–200 (1997).
Breen, C.L. et al. Cessation of methadone maintenance treatment using buprenorphine: transfer from methadone to buprenorphine and subsequent buprenorphine reductions. Drug Alcohol Depend 71, 49-55. (2003).
Levin,F.,Fischman, M et al. A Protocol to Switch High-Dose Methadone-Maintained Subjects to Buprenorphine: American Journal on Addictions V.6, Number 2, Spring 1997
Johnson, R.E., Strain, E.C. & Amass, L. Buprenorphine: how to use it right. Drug Alcohol Depend 70, S59-77. (2003).
Clark, N, Lintzeris, N et al. Transferring from high doses of methadone to buprenorphine: a randomized trial of three different buprenorphine schedules. Presented at College on the Problems of Drug Dependence, Scottsdale, June 2006
Glasper, A., L. Reed, et al. (2005). "Induction of patient with moderately severe methadone dependence onto buprenorphine." Addict Biol 10(2): 149-55.
Greenwald, M., K. Schuh, et al. (2003). "Transferring methadone-maintained outpatient to the buprenorphine sublingual tablet: a preliminary study." Am J Addict 12(4): 365-74.
Autumn is gone and Winter has definitely arrived. It was 6 degrees when I awoke this morning. The wind chill factor made it even lower. I shiver to think. It doesn't usually get as cold in Georgia.
A"New Year" has arrived and I proclaim it is going to be the best ever for me. I'm asking all of you to make the same "Declaration" as I did. You can do anything you set your mind to do. I believe it is time we start making the needed changes in our lives. Think of today as the "First Day Of The Rest Of Your Life." You have been given a second chance and you have the ability inside of you to accomplish whatever you desire.
I'm asking you to activate your will? Speak aloud what your "New Year's Resolutions" are when you first awake in the morning and let it be the last words you speak at night before going to sleep. Keep your mind on what it is you want to achieve and do not let your thoughts wander aimlessly around in your head.
Work toward your goals each day and even if you slip, and most of you will from time to time, just keep on striving toward your goals. You have not failed until you give up on yourself and quit. I know all of you reading this are winners. Start acting like one. Remember, knowledge is power.
We are here for you. You are no longer alone. We stay open twenty-fours every day of the year. You are welcome to call us at any time. We are here to answer any questions you have, to assist you in any way we can, to give you support and encouragement and most of all just to be your friend. If you can't afford to give us a call then send us an e-mail and leave a number we can call you at and the best time to call. We will call you any time you need us at our expense - now what is your excuse? We are waiting to hear from you...