Blood Sugar and Recovery — A Critical Issue

Posted By Bill on March 8, 2010

The farther I got into the mind, body and spirit thing that is recovery, the more I realized how completely the three aspects dovetail. It is possible to be spiritually and mentally healthy while in poor physical condition, but generally the aches, pains and discomfort associated with such things — even with poor nutrition or lack of exercise — will interfere with our overall recovery. As someone so succinctly put it (it may even have been me), “When you feel like s**t, it’s hard to rise above it.”

In recovery we say, “Don’t get Hungry, Angry, Lonely or Tired” (H.A.L.T.). It’s amazing how often those seem to go together. We feel low on energy, may have a dull headache, and become irritable, stubborn, and prone to seemingly irrational fits of anger or even rage. I’ve often wondered how many cases of “Road Rage” could have been avoided if the perpetrator had eaten a decent snack before beginning the drive home after work.

What we’re talking about here is levels of blood sugar. Regulation of blood glucose is one of the many bodily functions that are messed up by alcoholism and addiction.  Roughly 25% of the calories we eat go to keeping our brains operating at their most efficient level. When our blood sugar begins to drop, our brains begin to malfunction for lack of fuel, and that can cause big problems.

Until recently it was thought that each person’s reaction to a given level of blood sugar was pretty much the same, but it has been found that many people are affected emotionally by glucose levels that were once believed to be within the normal range.

To find out if you suffer from mood swings caused by low blood sugar, use this easy way to self-diagnose. Get a small candy bar and a package of snack crackers (not cookies). About three hours after your last meal or snack, eat the candy bar. Begin keeping track of the way you feel. The symptoms of sub-clinical hypoglycemia may include any or all of the following symptoms:

* Irritability, ranging from mild to raging
* Low energy
* Depression
* Rigid facial muscles (can’t smile)
* Muscle tension
* No sense of humor
* Dull headache
* Minor visual disturbances
* A jumpy, edgy feeling
* Difficulty concentrating
* Light-headedness.

These symptoms will normally begin to occur within an hour, often in much less time, and tend to worsen rapidly. Once you have satisfied yourself about the symptoms, go ahead and eat the crackers; they’ll stabilize your glucose and bring you back to normal.

The cure is simple: don’t get that hungry. Our bodies are designed to work best when we eat several small meals a day, rather than three larger ones. We have artificially imposed a schedule on them that they don’t accept well. We should eat a good breakfast, not too heavy on sweets, because we have been fasting for a third of a day.  A low-sweet snack at mid-morning will hold us until lunch, at which time we again avoid heavy sweets. A mid-afternoon snack will take us through the rush hour commute to dinner time, with a reasonable dessert, in a far better mood. A high protein snack before bedtime will help us sleep better.

The big trick is to avoid things that will cause our blood sugar to rise quickly, like our candy bar on the empty stomach did during the test. When our glucose level rises too rapidly, our bodies overreact and bring it down too far and too fast. That’s what causes the hypoglycemic episodes — the blast of sugar. If it was accompanied by caffeine, the result is likely to be exaggerated even more. A low-sugar snack will bring the glucose up slowly and avoid the overcompensation. Obviously another candy bar would bring it up, too, but that will result in chasing our blood sugar curve all over the place. A low-sugar snack is best.

A common complaint is “I can’t eat all those snacks — I’ll gain weight!” You will probably find, if you choose your snacks carefully, that you’ll actually eat less over the course of a day because you won’t be as hungry at meal times. Also, remember that we’re cutting down the sweets. Sweets are OK, but not by themselves. We need to have them after a decent meal, or small amounts with our snacks, to avoid that blood sugar “spike.”

Give up the donuts and coffee for breakfast and the high-sugar snacks between meals. If you can make yourself reduce your caffeine intake, that’s good too — especially if you’re in the habit of drinking sweetened coffee on an empty stomach. Try it for a week, and keep a log of how you feel. You may be amazed at the difference it will make in the quality of your life. I was.

This is also the recommended diet to reduce the chance of developing diabetes, especially when combined with exercise and sufficient rest.

Remember, the Universe will cheerfully refund your misery at any time; all you have to do is ask.

Going With Our Gut

Posted By Bill on March 4, 2010

There is nothing mystical about hunches, intuition, and trusting our gut. We are all the sum total of millions–billions–of experiences, and we remember most of them on some level. We are well-equipped to let our subconscious minds help us out with problems, armed as they are with that wealth of experience, but we often force ourselves to ignore those gut feelings, the feeling that something is just sort of “icky.”

We want to do something, say something, buy something, to fill that empty place inside. So we think up all sorts of ways to justify our wants to ourselves and ignore the message that our subconscious mind is sending loud and clear.

Then we go on with the self-deception and make up ways to justify whatever it is to others — our partners, our business associates, our sponsors, our friends — but, ultimately, to ourselves again.

Healthy ideas seldom need justification. Feeling a need to explain, to justify, should tell us that something’s wrong somewhere. It may simply be a neurotic need on our part to assure ourselves and everyone else that we’re really OK, but there’s also an excellent possibility that we’re about to venture where we ought to fear to tread, guided by the child inside who is telling us it’s OK because I Want, I Want, I Want.

In either case, there are two possible clues: the urge to hide whatever it is, or the urge to justify it. Both should set off our alarms, lest we end up back in that nice Sunrise Detox.

One. More. Time.

How long does alcohol detox last, and what can I do to relieve the symptoms?

Posted By Bill on March 2, 2010

Alcohol withdrawal without medical help can, and frequently does, result in some or all of the following: extreme anxiety, disorientation, hallucinations, sleep disorders, hand tremors, nausea, sweating, seizures, blood pressure spikes, and racing pulse. Delirium tremens (DTs — physical and visual hallucinations accompanied by terror reactions) may be present. In the worst cases, untreated alcohol withdrawal syndrome can result in death related to high blood pressure (stroke) and seizures.

Because of the possibility of severe medical consequences, along with the fact that they can turn up unexpectedly at any time during detox (even in people who have self-detoxed without incident before), self-detox for alcohol and similar-acting drugs such as benzodiazepines is not recommended.

To answer your question more directly, acute withdrawal onset is usually between 8 and 20 hours after you stop drinking, and can last for up to five days. There is really nothing you can do unless you have access to certain drugs. Even then, it is dangerous if not medically monitored.

We suggest you investigate to learn what facilities are available to you for a medically-conducted detox.

What is the difference between psychological dependence and addiction?

Posted By Bill on February 27, 2010

“Psychological dependence” is shorthand, used to refer to situations where there is no physical withdrawal, yet there is a compulsion to continue using a substance or carrying out an act. Sex “addiction” is a good example, as is the compulsion to eat sugar. It is not a medical term.

There is a gray area, and not necessarily a wide one, between psychological dependence and addiction. For example, some heavy users of marijuana suffer withdrawal when they stop using, which qualifies them as addicted. Others have no obvious physical symptoms, but become psychologically disturbed.  Also, many activities — gambling, relationships, shopping and so forth — are mood altering, and actually create changes in brain chemistry similar to those that occur when we use drugs. Likewise, many activities that we associate with good health, such as running and other forms of exercise, produce changes in the levels of endorphins in our brains, stimulating the very same receptors that are affected by opiate drugs.

As far as treatment is concerned, there is no real difference, apart from the possible need to detox from an addictive substance.  We are dealing with the need to change behavior that is causing us problems in our lives, but that we seem unable to stop.  The changes we need to make are basically the same, regardless of what we call the circumstances that caused us to seek help.

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Is There A Difference Between “Clean” and “Sober”

Posted By Bill on February 19, 2010

Clean is when the drugs have left our system.

There are three aspects to sobriety:

  • Physical sobriety, where we are abstinent for a long enough time for our brains to begin to recover so that we can think more clearly and make decisions based on reality instead of confusion and fear;
  • Emotional and spiritual sobriety, where we come to terms with who we are, what we have done, and what we must do to right the wrongs we have perpetrated (to the extent possible), learn to re-connect with other people, and begin to get comfortable in our own skins; and
  • Social sobriety, where we re-enter the world by actually making things right with others, and develop socially so that we are re-integrated with the world outside the recovery community.

These things take time.  Physical recovery alone can take a couple of years after we detox, depending on the damage we’ve inflicted on ourselves  Sometimes it takes months before we can even begin to think straight.

We may need help from friends, counselors, even physicians, in order to get our neurological system and lives back in order.

We need to be working on our attitude toward life and toward ourselves and the things we have done. (This is where the support groups like AA, NA and the others can be of profound importance.)

And we need to become employed, make amends for the past, renew our relationships and grieve those that are not, for one reason or another, renewable.  We need to remember — or perhaps learn for the first time — how non-addicts live and relate to each other, their jobs, their spirituality and the world at large.

As you can see, looked at this way, there is a HUGE difference between “clean” and “sober.”  Sobriety is a continuum.  It begins the moment we decide that we can no longer live the life of an addict, and continues to where we are again a part of society — and beyond.  It doesn’t happen overnight, and it isn’t easy.  It isn’t even especially simple — but it is possible.

Millions of us have gotten sober in the past, and millions of us will in the future — as long as we stick with the process until it is finished.  If we forget our goals, or fail to continue to reach for them, we are soon on the way down the slippery slope of addict thinking, and a drink or a drug is not far in our future.

How does Suboxone work?

Posted By Bill on February 10, 2010

Sunrise uses Suboxone for opiate detox.  You’d probably like to know how it works, without getting into all the fol-de-rol about agonists, antagonists, mu opioid receptors and all that.

Buphrenorphine (Suboxone’s just a stage name) doesn’t quite act like other drugs.  It stimulates one place in the brain the same as heroin, methadone, oxycodone and the other opoid (opium-like) drugs, but it has the opposite effect on most of the other receptor sites that opiates use where, instead, it neutralizes the opiates’ effects.

In addition to buphrenorphine, Suboxone contains a drug called naloxone.  It is also an opiate antagonist, and it enhances the neutralizing effect of the  buphrenorphine.

What this all boils down to is pretty simple, once you get past the neurology and chemistry: Suboxone’s neutralizing effects get the drugs out of the system, while its stimulating effect eliminates withdrawal symptoms.  If you give someone a dose of naloxone alone, it throws them into immediate and severe withdrawal.  However, the two drugs working together clean up the system, and allow it to happen in relative comfort.

Completely changing our brain chemistry around can never be symptom-free, and if you’ve ever done an opiate detox “cold turkey,” you know that it’s one of the most miserable experiences imaginable.  No one wants to go through that again.  With Suboxone, you don’t have to.  Along with the medical and emotional support of a first-class detox facility, Suboxone treatment makes the early stages of recovery from opiate addiction physically comfortable as well, removing one of the biggest obstacles to getting clean and sober.

Why Outpatient Detox Doesn’t Work Very Well

Posted By Bill on January 25, 2010

In order to understand why outpatient detox rarely gives satisfactory results, we have to review a couple of things about addiction.

Addiction is a compulsion to use a substance or behavior to alter the way we feel. However, it is more than that: it is a physical, and emotional way of living our lives that, over time, becomes ingrained and seems to be the normal way to live — for an addict or alcoholic. Addiction makes changes in our brains that cause us to believe that we need the drug or mood-altering experience — be it a prescription medication like Xanax, an illegal drug such as heroin, multiple sex partners, alcohol (the most commonly-abused drug of all), or something else. We believe that we need it to feel normal, to be comfortable — to live — and every time we try to get the monkey off our backs we have those beliefs reinforced by the discomfort of withdrawal.

Living like this for long periods, we begin to view it as normal. No creature willingly goes from situations that seem normal into those that seem different, at least over the long term. We may step out of our comfort zone briefly, but we always try to duck back in. We instinctively hate change. We seek conditions in which we feel most comfortable — not necessarily good, or happy, but whatever is “normal” for us — and we attempt to keep things that way. Scientists call this “homeostasis,” which means, roughly, “standing still.”

It is a natural thing for all creatures to attempt to maintain homeostasis. Even an amoeba in a dish will remain in one spot, assuming that it has something to eat and comfortable conditions. If we apply heat to the part of the dish where the amoeba is resting, it will remain there, despite the increasing heat, until the water becomes so hot that it has no option but to move. Only then will it make its way to the other side of the dish.

So, consider us addicts, who are — almost by definition — people who don’t know that it’s OK to feel uncomfortable occasionally. We may not be happy in our addiction. Our lives may be falling apart around us as our little dish heats up, but still we resist changes. We may move to another part of the dish where things are more comfortable, but if conditions there aren’t totally to our liking, we tend to move back to our comfort zone after the heat has dissipated. Sound familiar?

That’s the problem with outpatient detox. We’re being asked to move out of a place where we know how to function and continue to feel good (or at least feel less bad), and we’re being asked to do it permanently, without much support, and under conditions where it’s all too easy to move in the other direction.

Here we are. We’ve taken our Suboxone, or methadone, or Valium, and the craving for (whatever) has temporarily dissipated, but what else has changed? We’re still headed home through the same old neighborhood, seeing the same folks standing on the same old street corners, the doors to the same old bars, and moving in the direction of the same old problems.

Nothing has changed, except we are feeling a bit odd, and temporarily have no physical craving to use. But what is going to happen the first time something comes along to stress us? A grumpy spouse who thinks we should suddenly be “fixed.” A notice to appear in court. A car that won’t start. A job interview that goes badly. All of these are wonderful excuses to relapse. In fact, it’s not even really a relapse, because we have been given few or no tools to cope, and are thus not actually in recovery.

Inpatient detox provides the opposite. There is medical care if needed, and experts are constantly monitoring us to be sure that we are reasonably comfortable. (There is no such thing as a perfectly comfortable detox, no matter where you get it.) There are other folks to talk to who are going through the same stuff at the same time. There is good food to help get us back on our feet. There are group and individual therapy sessions, with treatment experts who, most of them, are recovering alcoholics and addicts just like us.

Most of all, there are no pressures. If we allow ourselves to do so, we can relax, be as comfortable as possible, chill for a few days, get our feet under us as the drugs clear from our systems, and become able to make some more or less sensible decisions about the future.

Which of those scenarios sounds like it has the best shot at working? This isn’t about our families. It’s not about our bosses, or our careers. It’s about getting us ready to function in the real world, instead of the shadow world of foggy thinking and perceptions that we’ve been living in. If we can’t learn to take care of ourselves, then all those other things aren’t going to matter much, are they? We need the best shot at staying clean that we can possibly get. Outpatient detox is not the answer.

Hi, My Name’s Bill…

Posted By Bill on January 21, 2010

I’ve been asked to write an occasional article for Sunrise, so I thought I’d begin by telling you a little bit about myself.

I was born at a very early age, drank alcoholically from the git-go, used recreational drugs and some not so recreational, and eventually reached the point where none of that stuff was fun any more.  It was just work: work to stay supplied, work to juggle my reality and everyone else’s, work to keep people from finding out (I thought), work to simply live — and life sucked.  Somewhere along the line I married another drunk and druggie, and for several years that sucked too.  There was no question in my mind that I had a problem.  I just didn’t know the problem had a solution.

Finally, I was unable to keep all the balls in the air, and the world came tumbling down in the form of foreclosures, evictions, pawn shops, beat up old cars with all sorts of garbage on the dashboard, and eventually professional disgrace and the threat of losing my job.

Like many men, the job thing was the last straw for me.  I knew that my wife and I would be living behind the dumpster at The Arches within days, and that was — finally! — my bottom.  I agreed to go into a residential treatment program.  Two weeks later, my wife entered treatment at the same facility.  The rest is not history; it’s more of a miracle.

Now, twenty years later, I’ve had the opportunity to make most of the mistakes that folks can make in recovery, apart from actually picking up a drink or a drug.*  Among other things, I’ve learned that relapse occurs before we pick up — that actually using just makes it official.  I’ve worked in the recovery field.  I’ve had the good sense to realize that it wasn’t for me, and got out of it.  I’ve hit a lot of meetings, talked to a lot of alcoholics and addicts, and learned some of what they had to teach me.

And my wife?  She got her degree in Social Work, Magna Cum Laude, at age 50, and her C.A.P. (Certified Addiction Professional — with international endorsement) a few years later.  She’s also a Certified Mental Health Professional.  She has worked in the field for many thousands of contact hours, and specializes in addiction (of course) and grief therapy.

We should both be dead, but we made it out the other side.  What I’ll be trying to do is sort of give you hints about how I did it, maybe provide some information and answer some questions, and share some of the stuff I continue to learn daily.

Please hang around.  If you feel like reading my stuff, fine, but whatever you do, keep comin’ back.  Don’t die.  Please!

Yours in recovery,
Bill

*I use alcoholism, addiction, alcoholic and addict interchangeably.  They’re the same disease, and we’re all just bozos on the same bus.

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About the author

Bill

Bill has been there and done that...probably a lot of that. He has the ratty t-shirt to prove it.