May 17, 2012

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A Look At Sunrise Ft. Lauderdale, Our New South Florida Facility

May 16, 2012 By Leave a Comment

Today I was able to stop in at the Open House for our new facility at 2331 N.E. 53 St., in Ft. Lauderdale.  I snapped a few pictures, and I thought you all might like to see how it looks.  We expect to begin receiving clients in mid to late June.

Click the thumbnails for larger images.

 

Happy Mother’s Day From Sunrise!

May 12, 2012 By Leave a Comment

We have an exciting week coming up at Sunrise Detox.  On Tuesday and Wednesday we have the Open House at our Ft. Lauderdale facility.  It’s located in northeast Ft. Lauderdale, near Federal Highway, convenient to Ft. Lauderdale-Hollywood International Airport and about 30 minutes from the Miami airport.  This new location will allow us to serve facilities in Broward and Miami-Dade Counties more efficiently, and the additional beds in our system will substantially increase the number of folks we’re able to help.

During the same period, we’re having a site visit from the Joint Commission (formerly JCAHO) at Lake Worth.  The Commission is the accrediting body for medical facilities, and we  expect re-accreditation this year with no problems.  Nonetheless, site visits are a busy time for staff, especially given the simultaneous Open House. Everyone will be relieved when the excitement is over and we can get back into our routine of helping our clients without distractions.

And, of course, tomorrow is Mother’s Day. If you’re a Mom, congratulations, and we hope you have a wonderful day! 

Whether our moms were our staunchest support, or maybe not so much, they’re the reason we’re here.  If we’re in recovery — or trying to get there — we must be OK with that.  Let’s be thankful for her, regardless of what our relationships were like.  She did the best she could, the same as we are — one day at a time.

Why Can’t I Drink Or Smoke A Little Weed? I Was A Pill Addict!

May 9, 2012 By Leave a Comment

Professionals refer to “addiction,” or “addictive disease,” rather than to heroin addiction, cocaine addiction, etc. The fact of the matter, little understood by the world at large, is that we don’t become addicted to drugs, but to the effects that they have on our brains — specifically on the pleasure center. The pleasure center is located in the sub-cortical region of the brain which means, among other things, that we can’t control it directly.  (That’s why “Just Say No” is a cruel joke.)

US Dept. of Transportation (dot.gov)

Drugs short-circuit the process by either stimulating the production of these neurotransmitters, or by mimicking their actions.  Drugs allow us to control the production of the good feelings. Since we are pre-programmed to seek those feelings, we tend to do it quite a lot. Over time, actual physical changes take place in our brains in order to accommodate the unnatural levels of chemicals.

This occurs in several ways, but we’ll simplify it by saying that our neurons grow additional receptor sites to deal with the surplus. This means, in turn, that we need more of the drug’s effects to reach the levels that give us pleasure. This tolerance is one of the first signs of developing addiction. Eventually we reach a point where we need the stimulation in order to function anything like normally, and we’re hooked for sure.

When we go “cold turkey,” the sudden absence of chemicals causes the syndromes that we call acute withdrawal. The length of the acute phase lasts anywhere from a few days to several weeks, depending on the drug. Simple drugs, like alcohol, have the shortest acute phases, while those that metabolize into other active compounds can take much longer. Methadone is an excellent example.  It has not only a longer but more severe acute withdrawal than other opiates. The symptoms of withdrawal, generally speaking, are the reverse of whatever effects the drugs had. Opioids, for example, calm us and slow the action of our digestive tract, and the withdrawal symptoms are the jitters, nausea, diarrhea and the creepy-crawlies, among others.

Those extra receptor sites slowly become dormant and stop pestering us for stimulation, but the main thing to remember is that while the body and brain recover from the changes, the changes do not necessarily go away, and if they do, it is usually over a period of years.

If we use drugs or alcohol in early recovery, we will interfere with the progression to normalcy. Any extra stimulation, whether by the drug of choice or another, can have this effect; we don’t have to get drunk or high. The neurotransmitters involved are the same combination, and using any mood-altering drug can lead back to an active addiction.  At the very least, it will prolong the recovery process.

Even after our brains are back as close to normal as they’re going to get, exposure to drugs can reactivate those dormant receptor sites, and start the cravings all over again.  This is true of marijuana and booze, as well as other drugs, since they all work by stimulating the reward center.  In addition, drugs tend to make us more likely to do stupid things, like use more drugs. 

So we can obviously drink or use cannabis if we wish.  As addicts are so fond of pointing out, “It’s my life!”*  However, if we do so even in small amounts, we are likely to end up deep in addiction again.

*How bogus is that?  Like we have no effect on anyone but ourselves.  Addict thinking.

Newly Sober? PAWS Still Has You In Its Claws!

May 4, 2012 By 2 Comments

We all know that most relapses occur in the first few months after we get clean and sober.  Many of them are related to Post-acute Withdrawal Syndrome.  We talked about PAWS in a previous post, but I wanted to go into it more specifically here.

Although there are differences in the way they act, all addictive drugs function by either stimulating or imitating the chemicals of the brain’s reward system — giving us too much of a good thing.

In an attempt to return our brain chemistry to normal (homeostasis), the brain builds more receptor sites for those particular neurotransmitters.  This allows it to deal with the higher-than-normal levels, leading to tolerance: the need for more drugs to fill up the additional receptors so that we can continue to get high.

When we get clean and sober, those extra receptors clamoring to be filled up are what causes withdrawal: acute withdrawal while the drug is clearing out of our system, and post-acute withdrawal during the period when the brain is deactivating the extra receptor sites and returning to normal.  Some authorities believe that it never normalizes entirely, which may be why any use usually leads back to full-blown addiction.

There is a double-whammy effect, too. When the drug is removed, there is a “rebound.” We begin to experience many feelings and physical symptoms that are the opposite of the way the drugs made us feel.  Removal of the drugs’ stimulation causes the production of the reward chemicals to drop to below normal, and they return to their pre-addiction levels slowly. During this period we may be antsy, anxious, depressed, manic, or combinations of those feelings. We may feel as though our recovery is hopeless, and that we might as well use.

That’s PAWS.  The duration  varies depending on the drug(s) used and individual physical differences.  It can — but usually does not — last for up to two years.  Ordinarily it will peak and then slowly subside within the first few months.  During that period (and in most cases for the rest of our lives), use of addictive drugs can put us back on the merry-go-round quickly.  It will also prolong the period of PAWS.  It can even set us back completely, because it interferes with the brain’s repairs.

So, in early recovery we need to be prepared for a prolonged period of slowly feeling better, with setbacks when our bodies need that additional bit of natural feel-good and don’t get enough, usually when we are under stress.  Stress aggravates PAWS symptoms because the natural “drugs” that help us to cope aren’t back to full strength yet.

The good news: it always gets better, slowly but surely.

The best medicine for Post-acute Withdrawal Syndrome is time, aided by mild exercise, good nutrition, rest, stress avoidance, and distractions.  We need to have some fun.  We need the support of people who know where we’re coming from, and who know how to deal with people in early recovery.

That’s why we recommend meetings, fellowship, halfway houses, long-term treatment, and some time away from the old grind and the old stresses.  They help us deal with PAWS, while we’re getting into the habits that lead to long-term recovery.

As George Carlin used to say, “Just because the monkey is off your back, it doesn’t mean the circus has left town.”

If you’ve had your own experiences with PAWS, how about sharing in the comments?  Questions?  Feel free!

Something Similar — Straight Talk About Going Home

May 1, 2012 By 2 Comments

The comedian Dave Gardner used to remark, “Folks are always saying, ‘Let’s do this again!’  But friends, you can’t do anything again!  You can do something similar!”

I think about Gardner’s bit of wisdom when I hear people in early recovery talking about returning to their families and friends and “making it up to them.”  (This also brings to mind the idea of pushing toothpaste back into the tube.)  We say these things with the idea that we will be able to return things to the way they were “before” — if there ever really was a before.

Credit: closetartist – flickr

That’s a lovely idea, but it’s not the way reality works.  We can’t recreate the past in the present.  We can’t  make others feel the way we want them to feel, or make them forget the things we’d like them to forget.  If we return to our friends and families thinking that those things will happen, we are most likely setting ourselves up for terrific, ongoing disappointment and stress.

Stress often triggers relapse.

I’m not trying to shoot down anyone’s hopes and dreams here.  What I want to do is give people in early recovery a realistic view of the past, and what can be done about it.

 First of all, we need to understand that our perception of what happened is not the same as that of our loved ones, and that their perception is what counts.  We can’t change the feelings involved, either: the resentments, the memories of promises not kept, opportunities missed and so forth, and a lot of anger.  We can’t “do it again,” because the people are different now, and we can’t fix them.

If we expect to be welcomed with open arms and step right back into the role of father, mother, son or whatever, without any friction — well, it ain’t gonna happen.  People take on different roles when there is an addict in the family, and sometimes they don’t care to give the power up.  I mean, c’mon!  What reason is there for them to think that we won’t blow it again?  We need to convince them by our actions, because our word became meaningless a long time ago.

When we accept these facts, we are a good part of the way to where we need to be.  All we can do is show them that we are different now, one day at a time.  We need to be willing to accept their right to feel as they do.  We need to demonstrate our reliability, our honesty, and our commitment to sobriety.  We need to be able to admit to ourselves that the forgiveness will have to be earned.  We also need to realize that time is on our side.  These people want to trust us, believe in us, love us again.  We just can’t choose when it will happen.

You see, they’re scared to death.  They’ve heard innumerable promises.  We need to start keeping them.  They’ve had myriad disappointments.  We need to do our best not to disappoint them.  They’ve relied on us in the past, and we didn’t perform.  We need to show that we are reliable.  We’d like to be respected again, and we have to earn that, too.  They love us, but we need to behave in such a way that they won’t be afraid to show that love.

When we say the Serenity Prayer, we ask for “courage to change the things I can” and “wisdom to know the difference.”  We can’t change other people; we can only change ourselves.  We need the wisdom and patience to keep on doing that until others can see that we have changed, and until they begin to believe that we will remain the person that we are becoming.  Even when that happens, we won’t be able to do it all over again and get it right.

But we can do something similar.

In Recovery, How Do I Get People To Treat Me Normally?

April 27, 2012 By Leave a Comment

How do we keep our family and friends from treating us like patients, or walking on eggshells around us, especially around times of celebrations?

First of all, we need to understand that they are doing it because they love us, and are trying to protect us.  It does seem as though they’re attempting to control us in subtle ways, and because we’re feeling something like normal for the first time in years, we want to be treated that way.

However, we need to remember that, to a great degree, we are responsible for those eggshells.  It is probably going to be a while before we can expect to be treated like a normal person.  We need to earn trust and respect by being trustworthy and respectable; we are not entitled to them just because we’ve been sober for a few weeks, or even months.  As the AA saying goes, “Don’t expect a medal just because you’re finally doing what you should have been doing.”

On their part, our families need to understand that hearing eggshells cracking all the time is irritating, and that the best thing they can do for us in early recovery is to try to treat us as normally as possible — apart from putting temptation in front of us.

That may be hard for them, though.  Remember that for however long we were using, they got used to treating us in certain ways.  Nowadays, our total reality has been turned inside-out, but theirs hasn’t changed much at all.  Change takes time, understanding and trust. Because they do love us and want us to succeed in our recovery, they naturally feel awkward around us because they don’t know what to do.  While that can be really annoying, it’s generally not all that hard to deal with.

We need to sit down with them, discuss our recovery, and honestly let them know how we feel.  If we’re not able to do that yet, we can write them a respectful letter.  If we’re seeing a counselor, we can try to arrange a family session.  We need to tell them that while we appreciate their concern, we’d like them to try to relax and be themselves.  They need to know that we’re not going to head for the street or a bar just because someone mentions drinking, or refers to things that might remind us of the past.

We need to let them know that we don’t want to “forget the past, nor wish to shut the door on it,” and that we’ll be bringing it up ourselves from time to time.  They need to know that we don’t expect them to change their lives to accommodate us.

One of the things we can do is ask them to read this article.  Regarding the celebration issue, we can refer them to this article about parties that I publish every year around the Winter Holidays.  Finally, in the case of those who were most affected by our using, we can suggest that they consider a few Al-Anon or NarAnon meetings to learn a little more about living with people in recovery.

Most of all, we need to remember that these people love us.  They want to trust us.  They want us back in their lives.  They want what’s best for us.  They always have.  If we remember these things, and that they’re just doing the best they can — the same as us — it makes getting along a lot easier.

Depression In Early Recovery

April 24, 2012 By Leave a Comment

Vincent Van Gogh, "At Eternity's Gate"

I have lost pride in myself, including personal hygiene. Will that change?

Why do I feel alone; like I don’t know who I am any more; worthless?

You are suffering from depression.  Alcohol and other drugs affect us by stimulating the brain’s reward system.  Generally speaking, this causes higher levels of dopamine, serotonin, and some other chemicals that cause us to feel pleasure, contentment, and have extra energy, or that calm and relax us, depending on the drug(s).

Over time, our brains change in an attempt to bring us back as close to normal as possible.  This results in tolerance, meaning that we need more and more of the drug to get the same effects.  The more drugs we use, the more our brains compensate.  Eventually we reach a point where we are unable to get high, and unable to feel good no matter what we do.

When we stop using, we usually experience acute withdrawal that can, in the case of alcohol, benzodiazepines and a few other drugs, be potentially fatal.   Fatal or not, it can convince us that we’re dying.  However, even the most severe acute withdrawal lasts only about three weeks, and we begin to feel much better.  If we have had the services of a good medical detox facility, we may not find the acute phase of our withdrawal to be all that uncomfortable.

But that isn’t the entire story.  While our bodies are rebuilding damaged systems and getting our brains back to normal, we may experience a prolonged period of reduced and intermittent — but often still severe — symptoms called Post Acute Withdrawal Syndrome, or PAWS.  Depending on what drugs we used and our individual body chemistry, those can include jitters, anxiety, depression, mood swings, and a variety of less serious symptoms, and can last for quite some time.   PAWS can occur even when there is no acute withdrawal, and it can occur with any drug or combination, including marijuana.

Especially if we have used stimulants such as cocaine, methamphetamine and similar drugs, we may find that we become seriously depressed.  If we happen to be one of the many people who tend towards depression and (perhaps unknowingly) used drugs to fend off those feelings, we may end up in more severe or prolonged depressed episodes.  These can be  life threatening because of the dangers of not caring properly for ourselves, increased likelihood of relapse and using again, and, in extreme cases, suicidal thoughts and acts.

It is normal to feel down at times.  Everyone does, and people who are experiencing PAWS may feel down more often.  Usually those periods are brief, and in a day or so things look up.  When they don’t, we need to talk to a physician or addiction counselor about it.  Depression is nothing to fool with.  Anyone who has lost a family member to depression (this writer has), or who has experienced the feelings of worthlessness and hopelessness that it can bring (I’ve been there, too), will tell you that — if they survive.

Some of the best treatment for depression in recovery is self-care, with particular attention to the things we can do to reduce PAWS.  See this article for more information about PAWS.  We need also to have some fun if possible, go to meetings, mix with other people, and try to have as normal a life as we can, even though we may not feel like doing those things.  Sitting around and being miserable is dangerous emotionally and physically, and we must avoid it at all costs.  Our support groups and people are critical for us at this point in our recovery.

If we are feeling severely depressed, we must talk to someone about it!  At the very least, we need to talk about it in meetings and with our supports.  We must force ourselves to get out and see people, do things, get exercise, feed ourselves properly, and try to get enough rest.  If that doesn’t help, then we may need to speak to our physicians about treatment with antidepressants.  When it comes to depression, we must not let the idea of taking a drug put us off.  Antidepressants (with the exception of benzodiazepines) are not addictive, and we may not have to take them for long.  Until our brains get back to normal, though, they may be essential.