Detox

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

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!

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!

How Do I Deal With Old Relationships In Recovery?

The question of dealing with old friends, drinking buddies and family once we’re in recovery is one of the most vexing (and sometimes complicated) things about getting clean and sober.  How we handle it can be critical to our ability to avoid relapse.

Until we have learned new ways of dealing with pressure and old feelings, we need to keep them minimized.  That’s why professionals recommend treatment and halfway houses that are well away from our home turf.  Too many times they have seen what happens when people in early recovery try to deal with old relationships too soon.  Our continued sobriety is essential to our being able to deal with those issues and get our lives straightened out.  If we relapse, we will only make things worse and we’ll still have to deal with the mess when we get sober again, if we don’t die first.  So it comes down to common sense.

Old buddies who still use or booze — we just stay away from them.  Chances are we no longer have much in common anyway.  Later on — much, much later — maybe we can hang out if they aren’t drinking or using while they’re with us.  Otherwise, it needs to be sayonara.

Family members must understand that recovery comes first.  If they can’t understand that, get a little knowledge about recovery under their belts, and support our program, then we need to stay away until we have the skills to cope with them.

This is especially true of those people we perceive as having the most  power over us: parents, siblings, wives and children.  When it comes to family, we’re with the people who hard-wired our buttons and who can push them without even intending to.  These are the people who can arouse the old feelings, resentments, insecurities and emotions with a word or a look.  Those are powerful triggers, until we’ve learned to handle our own emotions and impulses.

Because we’re addicts, accustomed to short-term solutions to our difficulties (oblivion, after all, was always just a few minutes or drinks away), it’s hard for us to realize that the solution for some of our problems is time.  In the case of relationships, that sometimes includes time away from the problem.

This is not only hard for us to swallow, but often goes against the plans and expectations of the others involved.  Nonetheless, our recovery is paramount.  We have no chance of resolving old issues and improving relationships if we can’t stay clean and sober.  Getting back on the horse too soon, in this case, makes getting bucked off again a pretty sure thing.

Why Should I Stay In Treatment?

Bored In Treatment

If you hang around treatment centers for any length of time, you will eventually hear someone say (or say yourself) something on the order of “I already know this stuff.  Why should I stay here?”

This makes perfect sense, from the standpoint of someone in very early recovery.  In treatment, there are things that get repeated over and over.  That’s because we learn by repetition.  If we were studying for a part in a play, we would think nothing of going over our lines and actions repeatedly.  In recovery, we’re trying to replace old ways of instinctive thinking with new ones.  Repetition helps, but it can be the “same ol’ same ol’” after a while.

We know, however, that addicts often need a second or third trip through treatment before they actually learn what they need to know to change old behavior and stay clean and sober.  It takes some people that long to absorb some recovery principles, and apply the insight they bring to the changes they need to make.

Sometimes the things that we are asked to think about in therapy are painful, or involve feelings that we’ve suppressed so long that we can’t even identify them when asked.  The old “Yeah, yeah, yeah, I’ve heard it all before” reaction is often a form of denial to help protect us from the pain of confronting issues that may be hampering our recovery.

We need to pay attention to the details, and grab hold of new ideas when we can.  No one, not even an old-timer, knows all there is to know about recovery.  The more we know about how our own heads work, the easier it is for us to know when they’re leading us in the wrong direction.  If we listen to other clients when they share, pay attention to outside speakers, and instead of criticizing actually consider how their experiences and solutions might apply to our own situation, we can remain not only interested, but actually engaged in our own treatment.

The same is true of new ideas and therapies that may be suggested by staff.  We need to give those things a fair chance.  If we had cancer and the doctor said she thought we needed to try a new therapy, we’d at least give it a long, hard look.  Why shortchange ourselves when it comes to getting clean and sober?  After all, addiction is a deadly disease too, if left unchecked.

If we keep an open mind, treatment can not only be tolerable, it can be fascinating as we learn more about who we are, and about how to become the people we would like to be.

Exercise helps strengthen addiction treatment recovery — Addiction Treatment Magazine

Research suggests that adding exercise in with addiction treatment might be a good way to increase and strengthen the effects on the path to recovery. When addicts are trying to recover from their addiction, their body and mind crave the endorphins that cause that “high” feeling. According to a recent Huffington Post article, exercise causes endorphins to be released into the body along with endocannabinoids, which both produce a natural high and therefore can help the individual cope better in their recovery. Read More…

Romancing the Relapse: Relationships in early recovery

U. S. Library of Congress

One of the first things we hear in recovery, both in treatment and around the rooms of the support groups, is “No new relationships in the first year.”  If it’s not one of the first things we hear, it’s certainly one of the first things that get our attention.

That’s hardly surprising.  Emotions that have been suppressed by alcohol and other drugs are suddenly bubbling to the surface with none of the edges knocked off.   Add to that the fact that we’re feeling at loose ends, with all that time on our hands that we formerly spent using, and the fact that we really don’t want to face life directly yet, and we’re ripe for distraction.  Since rehab romances are one of the most common issues in early recovery, it crosses our minds, “Why not, as long as the other person is in recovery too?  We’ll have so much in common!”

Human beings are hard-wired for romance.  We are wired to be attracted to “our kind of people,” and to become obsessed with them to the virtual exclusion of everything else until we have consummated the relationship and are well along the way to creating a family unit — at least theoretically.  That’s nature’s way of making sure we continue to produce little people.    One of the most basic things we have in common with other people in early recovery is addict behavior.  We speak the same language.  If we find them sexually attractive as well, of course we want a relationship.

Because such relationships are so all-consuming, in early recovery they create the ultimate distraction at a time when all of our attention needs to be focused on learning how to exist and progress without our drug(s) of choice.  Anyone who has been “in love,” (lust) knows how the other person consumes our thoughts and — with opportunity — our time.

The bare facts of the matter are (a.) we need to give our full attention to our program until we have mastered the skills of sober living; (b.) we need to learn to have healthy relationships with ourselves before inflicting them on someone new; and (c.) any relationships we enter so soon after getting clean and sober will almost certainly fail as we grow in different directions from the significant other.  Last, but hardly least, relationships in early recovery are, in the opinion of many, the number-one cause of relapse.  That’s what you’re likely to have most in common.

Make sense now?

Do I Really Need A Program Of Recovery?

If there is one form of denial that is common to most folks who aren’t sure if they really want to stay clean and sober, it’s “I don’t need a program.  I can do it myself; all it takes is willpower;” or, “I have plenty of support at home, I don’t need to go to meetings.”  Hard on the heels of that idea is “I don’t like (insert 12-step program here), it’s too (insert excuse here).”

You don’t have to spend much time in recovery to hear folks make these statements, and if you work in the recovery field, you hear it all the time.  It usually doesn’t take too long for those people to fade out of sight, and sometimes we see them come back, weeks, months or years later, with a better attitude.

Often we don’t.

There are a couple of secrets to making it in recovery.  One is to do whatever we can to get over the habits, both mental and physical, that led us to, or reinforced the use of, our drugs of choice.  Without going into detail, some of those are:

  • using at certain times and in certain places, or with particular people
  • making excuses to justify our using (“I deserve it; If you were married to her, and so forth)
  • “drinking at” people, using booze or drugs to withdraw and let them know we don’t need them
  • always smoking a cigarette when we’re on the phone, if that’s the addiction we’re working on
  • we could continue the list ad infinitum.

The other — perhaps the biggest — secret, isn’t really a secret at all.  It’s bounced around the rooms all the time, but somehow some of us manage not to hear it.  That’s to keep an open mind!  If we don’t like what we’re hearing, we need to remember two things:

  • there are no rules in the 12-step rooms, only suggestions; no right and wrong way to do it, only ways that we have found — through 70-odd years of experience — work for most people; and
  • use common sense.

The common sense part is obviously open to interpretation.  For example, the “no romantic relationships in the first year” suggestion is a good one.  A new relationship is about the most distracting thing that can happen to anyone, and we don’t need distractions.  On the other hand, if we’re already in a relationship that hasn’t soured completely, that suggestion obviously doesn’t apply.   However, if we used with our partner, (or used them as an excuse to use) maybe we need to re-think that, too.

Another example would be the “Higher Power Issue.”  If you want the god of a particular religion as your higher power, that’s fine.  If you don’t, that’s fine too.  The thing is, we need to admit that we can’t do it alone, and surrendering to a higher power has terrific symbolism.  It works for a lot of people.

If it doesn’t work for you, great.  Just remember that part about not doing it alone.  It’s nearly impossible to recover without the support of other recovering people.  We need to remember, too, as long as we’re on the subject, that just as we have a right to choose what we believe is right for us, so do others.  So if they want to talk about their god, that’s OK.  It isn’t catching.  If we can’t be that flexible, we’re in trouble already.  After all, tolerance is the first step toward a spiritual life.

Ask yourself these questions: Do I really want to get clean and sober?  Do I want to have a full, satisfying life?  Do I want to improve my self-esteem, clean up some of the wreckage, and generally become a productive human being — or do I want to die in my active addiction?

That, my friend, is the most important question you will ever ask yourself.  Don’t answer too hastily.