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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.”  Many of them died.

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?

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.

How do you separate yourself from friends and family who are using? They’re the only friends I have!

Imagine that we are sitting at a sidewalk cafe in Paris, enjoying a cup of great coffee and a croissant.  Most of the folks around us are speaking French, and since we don’t, it’s not very interesting until we hear some folks speaking English a couple of tables away.  Immediately we’re like, “Where are you from?  How long have you been in Paris?  Where were you before?  Where are you going next?  Oh, me too!  Do you know so and so?”  Perfectly natural.  These are our people and they speak our language.

If a person was looking for a sure thing, as far as relapse is concerned, he couldn’t go wrong by hanging around with active addicts, especially family members.  As addicts we thought in predictable ways, behaved in predictable ways, and we even spoke in ways that identified us — to ourselves and others — as members of “the club.”  In early recovery those are, to a degree still “our people.”  They speak our language, and we’re still trying to learn the language of recovery.  They can get us into a world of trouble.

The old people, places and things are big triggers, and smart people avoid them even when they’re no longer beginners.  Old friends — and especially family members — are the ones who wired our buttons, and they can play us like a barroom piano.  It’s the way we’ve always interacted with them, and they can’t help it.  Nor can we help reacting when they do it.  Add familiar circumstances and places — maybe the local pool hall and bar — to the interpersonal stuff, and even an addict with quite a lot of clean time can be in trouble.

Family is hard to deal with.  Those who use have a vested interest in seeing us get high again, and even the sober ones may find the “new” us a little hard to take.  Sort of a “better the devil you know than the devil you don’t” thing.  If they start the same old stuff, we probably will too, and it’s a sure way to end up relapsing — when we start speaking and thinking in that language again.  That’s why we recommend halfway houses, sober houses and other lodging away from home for beginners, places where the folks around us know where we’re coming from.  When we attend family functions, we make sure we bring a sober person with us.  What host is going to turn down our friend for Thanksgiving dinner?  Then the two of us can sit there and watch the drunks, giving each other an occasional knowing look, and split when things get really rowdy.  “Gee, I’m sorry Mom, but Joe has to go and I need to give him a ride.”

You know how everyone is always talking about developing a support system, going to meetings, getting a sponsor, getting involved in service, and so forth?  That’s because we need to find new people, places and things.  That’s where we meet the sober people, make new friends and hang out with our recovery family.  Then we branch out and have fun in other places, but always with one or more of our new friends.

Sober people do a lot of things besides sit in smoky meeting rooms, drinking coffee, and talking about the program.  Most of us end up having more fun than we did when we were using.  We go scuba diving.  We ride motorcycles in sober motorcycle clubs.  We organize and put on dances, and attend those organized by other sober groups.  Sober cruises are fairly common, and every cruise ship has a meeting (just check the activity boards for “Friends of Bill”).  There is quite literally nothing that we can do loaded that we can’t do sober — except get high.

So, the answer to the question in the title is simple.  We don’t separate, we just back off.  Chances are that we make our old buds nervous anyway, and they’re not likely to pursue us very hard.  We hang with our new friends in recovery, and that takes care of the second part.  Our using friends are no longer our only friends, and it’s a safe bet that our new, sober, friends will become just as important in our lives as those others were — and they won’t be trying to get us to poison ourselves, either.

Is it possible to have a healthy life right after detox?

The smart-aleck answer to the question “Is it possible to have a healthy life right after detox” is “What…are you kidding?”  However, the straight answer is “What do you mean by ‘healthy?’”

When it comes to recovery, we speak of at least two kinds of health: physical, and emotional.  Some folks would add spiritual health (which has nothing to do with religion) to that list.  We need to remember that our bodies and minds were subject to the effects of chemicals more-or-less continuously for months — in most cases, for years.  Major changes took place due to the effects of drugs on our brains, as well as their effects on other body systems, especially in the case of alcohol.  It would be unreasonable to expect these changes to reverse and return to normal overnight.  Just as it took years to create the problems, so may it take months to recover from them.  The good news is that it rarely takes anywhere near as long for repairs as it took to do the damage, and improvements begin to show up relatively soon if we’re patient.

Our physical health depends on what condition we were when we came to detox (young, older, fit, couch potato, etc.), what residual effects we may experience from the drugs (post-acute withdrawal), and what other health problems we brought with us.  Many, if not most, addicts suffer from a variety of problems that can range from cirrhosis of the liver and/or viral hepatitis to diabetes, malnutrition, or general poor physical conditioning — often several issues of varying severity that need to be addressed.  Even those of us who styled ourselves athletes during our addiction may find that the reorganization of our internal chemistry leaves us with less get up and go than we figured, or that the drugs were covering up some condition that is revealed by a physical exam when we’re sober.  These things aren’t inevitable, but the possibility of some problems should be anticipated.

Mentally and emotionally, most of us addicts (alcohol is a drug, and alcoholics are addicts) find that for the first few weeks and months we run the gamut of emotions, from manic highs — where we believe recovery is the most wonderful thing that could happen to anyone — to bouts of depression and the thought “If this is all there is, I might as well use.”

But there is good news!  For one thing, though we may feel lousy, physically and emotionally, these things slowly improve if we stay clean and sober and work on a program of recovery.  Furthermore, we have the assurance that, even though it may seem as though it’s happening at a snail’s pace, people who remain abstinent and take care of themselves otherwise always improve eventually.  For us addicts, accustomed to feeling good in a matter of minutes whenever we feel like it, these periods may seem endless.  But they are not, and periods of feeling good eventually occur, increasing in frequency and quality as the repairs take place and we get back into the swing of living.

As time passes, we begin not only to feel better, but to think about getting back to what we perceive as our normal lives.  We want to clean up some of the messes we made, right some of the wrongs, find jobs, begin to save a little money, and try to earn the respect and trust of others.  These improvements are immensely aided by the support and help of other recovering people.  Put succinctly, people who go to meetings and develop a support system, learning to follow directions and do the next healthy thing, tend to recover if they persevere.  Those who don’t rarely remain clean and sober for long.

So the answer is that it is possible to live a healthier life immediately after detox.  A healthy life may be further down the road, but it is attainable.  Millions of people have gotten through the first weeks and months of abstinence, and achieved lasting sobriety.  The secrets are, first, to want it more than anything else, and second to stick with it and — as they say — wait for the miracle.

What Should You Look For In A Sponsor?

There is a line in the Big Book of Alcoholics Anonymous that reads, “If you have decided you want what we have and are willing to go to any lengths to get it, then you are ready to take certain steps.” It is accepted in the rooms of the 12-step fellowships that the way we achieve lasting sobriety is by making changes in our lives. The steps are the basis of those changes. They provide a framework for action that we take to begin to get our lives back on track and on the way to normal living. They are based on ideas that have been found to work – if we work at them.

In order to “work” the steps we need guidance, and that is the purpose of a sponsor. A sponsor’s job is not to lead us around by the hand, or counsel us in our relationship problems, or lend us money, or provide transportation, or be our friend – although some sponsors do some of those things. Emphatically, it is not the job of a sponsor to tell us how to live our lives. The purpose of a sponsor is to guide us through the steps. Many of us continue to use our sponsors as sounding boards and develop lasting friendships after we complete the steps, but that is a bonus. If a sponsor has taken us through the 12 steps carefully and thoroughly, then he or she has completed the job. Anything else is secondary to that duty.

That said, the sensible thing for us to do is to choose sponsors based on how carefully we believe they seem to have done the steps. We want sponsors who are clearly sober, who have obviously worked through most of their issues, who are living sober lives in the community, and who are generally the sorts of people that we would like to become.  And last — but far from least — we want people who know how to laugh, and how to laugh at themselves.

That means that, among other things, we want sponsors who won’t become distractions from our program. If we are male, we want male sponsors. If we are female, we want female sponsors. If we are gay, we carefully choose sponsors to whom we are not likely to become attracted, of whatever gender. Sponsors and sponsees work closely together, share confidences, and develop extremely close relationships within the context of the program. It is all too easy to fall into the trap of carrying those relationships too far. In that case, we no longer have a sponsor/sponsee relationship, regardless of how we may try to fool ourselves, we will be distracted from our program, and we are risking not only our sobriety but that of the other party as well.

Another common trap is to choose sponsors who are “right for us.” We are in no position to make those decisions. If we knew what was right for us, we wouldn’t need meetings. My advice is to choose the person in the room who has a quiet, solid sort of sobriety, the person that the chair calls on when no one else wants to share, the person who talks about how he or she did it, not about how others should do it. The person who doesn’t necessarily share all that much, but who invariably leaves us thinking “Yeah!”

Another indication of a good sponsor is to take a look at their sponsor, the one who will become our “grand-sponsor.” A string of two (or three) solid individuals who seem really to have it together will virtually guarantee not only that we will get a good sponsor but that we will have good resources to fall back on if needed.

Finally, remembering the reason for getting a sponsor to begin with, we want one who talks about the steps – about their understanding of them, what they have meant in their life, how they continue to incorporate those ideas into their daily living, and so forth. High-falutin’ ideas about spirituality, or religion, or New Age ideas have nothing to do with sobriety. Spirituality is about being a good person and doing the next right thing. Religion and New Age ideas have no bearing on the steps, and should be pursued separately if one desires. It is easy to be swayed by big talk. Look for the person who lives the steps, and you won’t go far wrong.

How do we choose?  Don't choose right away!  We get a lot of phone numbers, and call those people.  We talk to them.  We go out for coffee and “audition” them.  This is one of the most important choices of our sobriety, but it doesn't have to be a grim selection.  And we remember to look for the sense of humor, and ability to laugh at self.  We don't want someone who takes him or herself too seriously.  That's one of our problems, after all, and we're asking for help.

Aren't we?

How Do We Earn Respect And Trust When We Get Sober?

One of the common issues facing us in early recovery is the lack of trust and respect from others in our lives, whether family, friends or employers. While some — especially family — are often willing to accept our new, sober selves and welcome us back into the fold, there will always be some who find themselves unable to trust, and others who will continue to think of us as they did when we were active in our addictions — as worthless drunks and junkies.

And why shouldn’t they? Compared to the chaos that we created when we were using, and the length of time involved, why should a few weeks or months of new found sobriety impress them? Most of us used for years, eroding the trust and often respect of practically everyone around us. How many unkept promises, how many financial fiascoes, how many drunken escapades, how much despair, worry and heartache did it take to damage those relationships?

That being the case, it’s not the least bit surprising that it might take quite a while for folks to trust us, and to see that we really are trying to do the next right thing. The remains of our addict personalities (which certainly don’t disappear simply because we put down booze and/or other drugs) don’t help the situation, either. Defenses built up over years against our behavior can’t be expected to disappear overnight. If we were in their positions, we’d behave the same way.

So, what can we do about it? Simply continue to live our sober lives. The only way that we can reasonably expect others to begin trust and respect us again is by earning that respect and trust — the same way anyone else would — by showing ourselves to be worthy of it. This doesn’t happen overnight, just as it wouldn’t with a stranger that we happened to meet. We would watch that person, trusting them a little more each day, until we came to consider them a friend we could count on. Is it not reasonable to expect that the same would be true of people who knew and were affected by us in our addictions? Where we have no reason but caution to be leery of strangers, those folks have plenty of reasons to worry about us. Most will get over it in time; others may never feel the same way about us as they used to. If that is the case, and if we have been unable to repair the relationships despite our best efforts, then we have to accept that things may never be the same. That can be painful, but we have to live with what is, not with what we might wish it to be. We need to remember that while we are responsible for making amends and righting wrongs to the extent that we can, we are not responsible for the way that others react to our efforts.

So we live our sober lives. We take care of our recovery by sticking with our support groups and doing what we need to do. Then we get jobs, pay bills, go back to school, carry out our obligations to our families and others, and generally live trustworthy lives that command respect. This isn’t going to happen overnight — but the chances are good that it won’t take nearly as long to regain people’s regard as it did to damage it to begin with. Remember – most of them want to give us the same regard they used to, they’re just afraid. It’s up to us to show that it’s safe for them to do so.

It’s amazing how we often get what we are looking for in recovery, simply by living clean and sober, one day at a time.

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.

Are alcoholism and other addictions curable?

There a bit of controversy over this issue, particularly in the case of alcohol addiction, where there are powerful social pressures to drink.  The best information seems to indicate that people do recover from the physical effects of addictions if they stop soon enough, but that some of the changes that take place in the brain during the addiction process will remain. If that is the case (and experience seems to prove it out), “recovered” alcoholics and other addicts who use their drugs are risking a rapid return of the addiction.

We need also to consider the psychological aspects of someone’s wanting to use drugs when they have already seen what can happen.  One could argue that such people have to be especially careful, since they are not committed to sobriety to begin with.  (Of course, denial being what it is, they will be the first to argue the point.)

This matter is complicated to some small degree by the variables among individuals.  A few people seem to be able to drink or drug heavily, then stop or cut back with little difficulty.  They do exist, but they are rare.  The best advice is to stay away from drugs and alcohol completely if they have previously caused problems in your life.  The possible price of taking them up again is too high to take the chance.

What are the chances of an alcoholic's children developing a drinking problem?

Unfortunately, they're pretty good. Alcoholism has a strong genetic component. In addition to that, the example of parents drinking and the trauma associated with living in an alcoholic household make it even more likely that children of alcoholics will drink, and that they will become addicted if they do.  Statistically, a child with two alcoholic parents has roughly a 50% chance of becoming alcoholic if he or she drinks.  The chances of a child with one alcoholic parent are about one in four.

Note: These are not exact statistics, because there seem to be multiple genes associated with alcoholism.

Can I smoke at Sunrise?  I don't want to try to detox from cigarettes along with everything else!

A. Certainly. State Law prohibits smoking indoors, but we provide an air conditioned patio for the comfort of smokers. Most of the staff are in recovery, and we do understand!

How Does Suboxone Work?

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.