Drug Addiction

What if someone I knew in rehab relapses?

When I was in treatment, I was convinced that all of our little group of roughly 40 would grow old together in recovery.  By the end of three months I had lost track of most of them, and at least one was dead. Twenty-two years later, I know of five who I'm sure are sober, and at least one of those relapsed but made it back.

At a minimum, three-quarters of us in treatment at any given time will drink or use drugs again.  Most of us will do so in the first three months.  That doesn’t mean that rehab doesn't work, or that we won’t eventually get clean and sober, but it does mean that many from a given group won’t make it that time.  Addiction is a chronic disease, and its most obvious symptom is relapse.  However, the things we learn in rehab are not lost, and they help to build the foundation of sobriety.

There is one thing that can’t be overemphasized: no matter what Junior Therapist qualifications we think we got in rehab, we are in no way qualified to get anyone else clean! Someone a few weeks sober trying to “twelve step” a buddy is a well-intentioned trip back into insanity.  Hundreds of thousands of alcoholics and other addicts who failed to believe that fact have themselves joined their friends back “out there.”

The important questions are, first, how do I stay clean and sober, and how can I help the ones who didn’t.  We’ve covered how to stay sober in these pages more times than I care to count.  We stay sober by utilizing all the tools available to us, honestly, thoroughly and to the best of our ability.  We go to aftercare if it’s available.  We live in halfway houses if we are advised to.  We go to lots of meetings.  We get sponsors.  We do service work, hang out with sober friends, and learn to live a sober life.  Hanging out with someone who’s drinking isn’t service, it’s suicide.  (That goes for anyone who’s drinking, not just people we know from rehab.)

We can most help that buddy from rehab by telling him or her we’ll see them at a meeting.  If our sponsor is willing to go with us, we might pick them up and take them to a meeting — once.  We never go alone!  We don't loan them money, spend a lot of time on the phone with them, let them crash on our couch, or do anything else that will make it easier for them to avoid their bottom.  If they get clean again, we follow the advice of those with more sober time about hanging out.  If they don’t become abstinent, we say we’ll see them at a meeting, that we’ll be glad to support them in recovery, but that we can’t afford to hang around with people who are using.

That’s what we do when someone we meet in rehab relapses.  Remember: we have to take care of ourselves first, or we won’t be able to help anyone else when the time comes.  When we’re newcomers ourselves, it ain’t time yet.



I Don’t Like Identifying Myself As An Addict At Meetings — Do I Have To?

Q.  I do not like identifying myself as an addict. I feel it is something I have, not something I am, and saying it constantly just reinforces the mistake, in my opinion, that we are addicts rather than that we have an addiction. Is it appropriate to abstain from identifying myself that way in AA or NA meetings?

A.  I have diabetes, so I’m a diabetic.  That’s not all of what I am.  I am many other things: a writer, a father, a husband, a photographer, a recovering person, a brother, a geek, a lover of nature, a birdwatcher, a friend, a person who attempts to sustain a spiritual life, and so forth.  However, if I forget that I am a diabetic, I’m in trouble.  If I fail to practice the behavior appropriate to my condition, then the quality of my life will be far less, and its length substantially shortened.

The reasons we in the 12-step fellowships have evolved the tradition of identifying as alcoholics, addicts, or what have you, are several.  We do it to let others in the meeting know that we belong there.  We do it because humans love ritual, and little rituals like that build cohesion in the fellowship, as do others like reading How It Works in AA, the several excerpts from the Basic Text that are read at NA meetings, and similar customs at other fellowships.  We do it because it shows a willingness to identify ourselves as one of the group.  But the most important reason is precisely the one that you allude to above as being an undesirable thing: we do it because it reinforces the self-knowledge that we are addicted — a fact that, should we forget it or begin to question it, could kill us.  It is one more defense against the denial that comes along with addictions of all kinds.

By nit-picking at little details, we distract ourselves from the initially uncomfortable fact that we are, in the most important respects, just like the other people in the room.  We make pious statements about “labeling,” when in fact if we were — for example — a PhD, we would have little resistance to labeling ourselves at the drop of a hat.  So, if saying I'm an addict makes me uncomfortable, I have to ask myself why. Is it because I’m “different?”  Is it because I’m still not convinced that I have a chronic disease?  Is it because, deep down, I don’t want to be associated with “those people” because of pride?

As our denial lessens, and as we begin to identify with the reality of our dilemma and realize the safest path out of it, we become less resistant to calling a spade a spade.  In the meantime, if we need to be just a little bit different, we can identify as a person who “desires to stop drinking,” or is “addicted to smack,” or something that we believe suitable.  They will serve the purpose.

But let’s not kid ourselves about why we’re doing it.

When You Relapse, Do You Lose All Your Sobriety?

I get letters in another venue from people in early recovery, asking for information about the variety of symptoms and problems common to all of us when we were newcomers.  I was quite taken with the following letter, because it illustrates an extremely common issue — family members who don't understand what we need, or who passively try to sabotage our recovery.  I thought I'd share the letter and my response with you here.  It has been redacted to remove some unrelated information, and to protect the identity of the writer.

I have abused opiates on and off for four years. Went through detox two times when I had insurance, just from being so afraid of withdrawal. Went to counceling once. Of course my abuse continued to grow. I got to the point of being just sick of it. I quit and used a recipe I found online using vitamins an amino acids. I went to get change from my husbands “spare change cup” and found eight pills there (he takes them because he needs hip replacement). By the end of the night I had taken eight to ten pills out and took the pills over the next 24 hour period. This was on the 101st day of being clean. I am so disappointed in myself and feel miserable, but I am determined to pick up the pieces and move on. …[Your] article was very helpful to me. I realize I need to be in a program and will look in to it. I guess my question is, Have I lost the time of 100 days I put into sobriety, after a one day binge? Have I lost all recovery ? I so want to be rid of this deamon and your article has helped.



Dear Jen,

Quite the contrary: that 100 day investment may turn out to have been one of the most valuable experiences in your quest for sobriety. You now know that you cannot trust your disease. It is going to be with you — in spirit, as it were — for a long time. Recovery is about learning that, and learning to live without drugs.  Addiction is a disease of relapse.  Those who have done so one or more times are far more common than those lucky ones who made it on the first try.

Your picking up should have taught you three things:

  • You must speak with your husband about keeping strict control of his medication so that you will not be tempted “accidentally” again;
  • You need a support group that you trust enough to call and talk through urges to use, and that will help you learn to cope with life — comfortably — without using;
  • Life goes on. Beating ourselves to death for being human and giving in to temptation is not productive. Learning from our mistakes is, however, imperative.

Relapse occurs long before we pick up; using simply makes it official. If we keep ourselves in a healthy state of mind and body, follow suggestions and generally live our lives as someone who is IN recovery, as opposed to someone who is thinking about being in recovery, we do not reach the state of mind that will make it easy for us to pick up the random pill laying around the house.

As the song would have it, “Pick yourself up, dust yourself off, start all over again,” using the very important lessons you've learned to help avoid further slips.  Addicts have to be extremely careful about falling down to begin with, because sometimes we find ourselves unable to get up. The good news is, as long as we learn not to make the same mistake again (and, hopefully, none similar as well) we can profit from them.

I’m seeing some wishy-washy thinking here: “I realize I need to be in a program and will look in to it” needs to be “I will call and find the location of a meeting immediately and get to it as soon as possible.” Please get to some meetings! You cannot do it alone. Your best thinking got you where you are, and you need some fresh input. The lifelong friends you will make in the process are a bonus.

Remember one other truism: Anything that you place ahead of your recovery, you will eventually lose.

Keep on keepin’ on,


I’ve heard that opiate overdoses often occur when users relapse. Is this true? What’s the deal?

It is true, but in order to give you a good overview, let's talk about overdoses (ODs) in general.

Most overdoses are caused by people mixing drugs such as heroin, alcohol, methadone and benzodiazepines (Valium, Xanax, Ativan and similar “tranquilizers”). These drugs are all central nervous system (CNS) depressants. When used together, there can be a synergistic effect, where the presence of both drugs creates more CNS depression than either could alone — sort of a 1+1=3 effect.

In an OD, they cause unconsciousness, slow the heartbeat and depress breathing. In lethal doses (LD), the user dies from suffocation when breathing ceases entirely. However, a lethal dose of a drug or drugs is not necessary in order for you to die. If you are lying on your back and unable to swallow because of CNS depression, a small quantity of liquid, such as vomit, can cause suffocation. This has killed many people who would probably have survived the OD otherwise.

There is also the matter of misjudging the amount of drugs in your system. Most drugs taken by mouth reach their highest levels in the body quite some time after they begin to have a noticeable effect — as long as 30 minutes to as much as 4 hours. You can easily become dissatisfied with the effects and continue to swallow more, then down the line the blood levels continue to rise and give you more than you bargained for. It is not uncommon for this to happen when mixing oral and injected drugs. The pills aren't getting the job done, so you crush and inject and — whammo!

Finally, we get to the issue you asked about. Opiate tolerance drops rapidly when you're not using. People who have abstained from drugs during detox and treatment, or while in jail or prison, end up with a very low tolerance in comparison to what they had when they stopped using.

If a person who has been abstinent for several weeks relapses, they will require much smaller doses in order to get high. This kills thousands of addicts every year, because the lethal dose (LD) drops as well. If they go back to using anything close to what they used previously, an OD is not only possible, but likely. People most at risk are those getting out of detox and treatment, or out of prison.

The best defense, of course, is to hit meetings, use your supports and stay clean. But if you think you need another run, be really careful or it may be your last.

Hawaii Big Island study on fetal alcohol, drug exposure

The…group surveyed 2,300 women across the Big Island surveyed over the past three years and found that 1,158 admitted to drinking alcohol or other substance abuse while pregnant, the West Hawaii Today ((http://bit.ly/mOQcV4) reported. There is no known safe amount of alcohol to consume while pregnant.

Alcohol-exposed pregnancy is the leading cause of miscarriage, stillbirth, birth defects and other disorders, said Naomi Imai, child and youth program specialist for the state Family Health Services Division.

Big Island study on fetal alcohol, drug exposure | CanadianBusiness.com.

Is Medical Detox Really Necessary?

I received an email from a hard-nosed recovering addict/alcoholic who stated, in essence, that inpatient detox isn’t necessary, that he did it on his own, and that all anyone needs is a (little of this, little of that) to get through it just fine, and he knows a bunch of folks who did it that way, and…blah, blah, blah.

I replied, politely, that everyone is different, and that just because it worked for some does not mean that it will work for everyone, and that detox is too important to take a chance on getting it wrong (or killing someone).  I refrained from asking how many of his acquaintances had a successful detox, culminating in long-term happy sobriety with no relapse.

In my years around the 12-step rooms I’ve heard similar comments every now and then.  Some guy (it’s nearly always a guy) makes some remark to the effect that if it was good enough for him and Christopher Columbus, it ought to be good enough for all these young whippersnappers.  Somehow I don’t see how surviving the threat of seizures, heart attack, stroke, DTs, profound depression and a variety of other jackpots (depending on the drug or mixture of drugs) proves anything, except that you were one of the lucky ones, but maybe that’s just me.

Just about any drug that will alter your mood noticeably can be addictive, including weed.  Getting off any of them can create enough withdrawal symptoms that it can be really difficult to make it through a self-detox, although not all are physically dangerous.  (Of course you could argue that things like possible psychotic episodes and profound depression are physically dangerous, but we'll let that go for another time.)

The bottom line, though, is this: Under the supervision of medical personnel who are trained to administer the proper medication and equipped to handle any problems, detox can be surprisingly comfortable.  Lacking that, there can be some nasty surprises.  Not everyone has complications, which explains the position of the scoffers, but enough folks do that it’s not worth taking a chance if you don't have to.

Recovery Month

National Recovery MonthThis September marks Recovery Month's 22nd year. NRM  “promotes the societal benefits of treatment for substance use and mental disorders, celebrates people in recovery, lauds the contributions of treatment providers, and promotes the message that recovery in all its forms is possible. Recovery Month spreads the positive message that behavioral health is essential to overall health, that prevention works, treatment is effective and people can and do recover.”

If you're interested in getting involved with some Recovery Month activities, here's a link to SAMHSA's page of activities, organized by state.  In addition, you might want to check with local treatment centers and recovery clubs to see if they have anything planned.  Those of you who blog might like to mention it, as well.  If every recovering person promotes a better understanding of the process — even with one person — there will be millions of new advocates.