withdrawal

From A Drunk Who’s Ready To Dump Alcohol

On a different site, I often get comments and letters from folks with questions about alcohol and their recovery.  The one I'm reproducing below, along with my answers, was especially interesting.  Since the writer gave me permission to use it, in the hope that it might help others, I answered with publication here in mind.  As they say around the Interwebs, “I hope it helps!”

Bill: Dear Joy,

Thanks so much for writing, and for your thoughtfulness in specifically making your letter available to others.  It is so long, and so chock-full of commentable (word?) material, that I’m departing from my usual format of simple Q&A and will address each paragraph or so as they come.

Joy: I’m a 38 year old female with a long history of being a drunk. I started drinking in college and it was often binge drinking. After college, I continued to drink, sometimes binging, but usually mostly on weekends. I was in a bad relationship for 2 years and drank more often than that. Then my relationship after that was better, but I still drank. This was still weekend binges and sometimes during the week as well. My next relationship was with a non drinker, so my drinking was cut way down, but that was only for a year. Then for the next 2 years (about age 26-28), I was more of the weekend binge drinker with sometimes some drinking during the week.

Then from 28-38 (now), I’ve basically drank every night. My boyfriend of a decade is also a drinker. The first 5 years it was mostly beer (5-6 a night), with some hard liquor on the weekends. Some weekends I would drink more than 5-6 a night. Then I developed a wheat allergy (so bloated and horrible stomach and digestion problems, as well as infections), and switched to vodka about 5 years ago. I also have a history of bladder and yeast infections. I would have 6 or 7 shots a night, pretty much nightly (often mixed with club soda because it’s without calories). Sometimes I would take 1 or 2 days off and felt even worse, so started drinking again. I continued to have bad digestion and stomach problems, but not as bad and the bloating went away quite a bit. But I continued to have infections, and almost 4 years ago was sick with one for 2 months. They think it was my colon. No antibiotics worked and I got a yeast infection in my mouth. I should also mention I had infections even as a kid (ear and acne) and was frequently on antibiotics. So that history mixed with the booze equals disaster.

Bill: Your progression down the road to alcoholism closely parallels my own, except that it took me about another five years to catch on to the fact that I had a problem. That’s not unusual, BTW. Alcohol damage progresses more rapidly in women, because you don’t produce as much of the enzyme that breaks down alcohol. Your BAC rises faster, and the drug stays in your system longer.

Four things: [Read more…]

Why Do Addicts Keep Using Despite The Consequences? — Part 2

Previously we mentioned that the pleasure center is a portion of the brain over which we have no conscious control, and that it can be stimulated by a variety of chemicals — some of them produced inside our bodies and some that we introduce from outside.  We said that the pleasure center rewards us for activities that it interprets as contributing in some way to our survival, whether they be social interactions, exercising, or more prosaic things such as eating.  We also stated that these pleasurable feelings, when pursued too far or for too long can create problems.  Now we need to examine how that happens.

While the actual mechanism of addiction is terrifically complicated, the underlying principles are reasonably simple.

  1. When we use drugs or are involved in pleasurable activities, they stimulate (or cause the stimulation of) receptor sites in the pleasure center and other areas of the brain. This causes us to feel good.
  2. With constant stimulation, the brain begins to adjust to the higher levels of brain chemicals by making physical changes that involve, among others, the growth of additional receptor sites to accommodate the excess neurotransmitters.  This leads to tolerance: needing more stimulation in order to achieve the same effects.  Tolerance is one of the first signs of developing addiction.
  3. As tolerance develops, we reach a point where our brain needs the presence of the stimulation in order for us to feel normal.  If we cease whatever is causing the stimulation, whether it be alcohol, other drugs or stimulating activity, for very long we begin to feel uncomfortable because all those extra receptors are telling us they need to be filled up.
  4. Eventually, we reach a point where any pleasure is short-lived, and we simply need the stimulation to keep going.  When we don’t have it, we experience withdrawal, feelings that, as a general rule, are the opposite of whatever good feelings the stimulation caused.  If we were using cocaine or other central nervous system stimulants, we feel depressed; if using downers, agitated; if we are a thrill junkie, bored and/or depressed, etc.  Because of the changes in other parts of the body there are often other symptoms.  For example, opiate withdrawal is like the worst case of flu you can imagine, doubled, combined with overpowering anxiety, nervousness and generally feeling terrible both physically and emotionally.
  5. At the point of marked, prolonged withdrawal in the absence of the drug or activity, we are definitely addicted.

But why can’t we quit?  We know using is causing us life problems, and we know withdrawal doesn’t last forever.  There are even medications to help.  What’s with the constant failures to stop using?

Remember that we said the pleasure center is a part of the brain over which we have no conscious control.  This part of the brain, because it is survival-oriented, interprets failure to meet its needs as survival issues.  We have created an artificial situation in which the brain needs extra stimulation to feel normal.  Therefore, when it does not get the extra stimulation, it sends messages to our subconscious that our very survival is threatened.  Addicts continue to use because their subconscious, over which they have no control, tells them that if they don't they're liable to die.

Those messages alone are enough to make it extremely difficult to stop using.  When reinforced with physical withdrawal, they are sometimes impossible to overcome with conscious effort because — again — we have no control over the feelings or the symptoms except for the use of more drugs.

Of course there is more to it.  The stresses created in our lives by addiction-related problems (and perhaps problems that preceded the addiction) make it even more difficult for us to allow ourselves to return to reality.  We must first detox from the drug, and then we need a lot of support and help while normalizing our social, emotional and health issues during the first months and years of sobriety.  We also need help getting through the “post acute withdrawal syndrome” (PAWS) that occurs while the brain and rest of the body are rebuilding and getting back to something like normal.  This can take a long time, and the issues associated with PAWS are a frequent (if not the most frequent) cause of relapse.

That, however, is a subject for another article of its own.  For now, understanding that addicts are subject to powerful emotional and physical experiences over which there can be no direct control will clarify a lot about addiction and the problems of getting clean.

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 allow us to detox from our opiate of choice, 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 and emotionally more comfortable, removing one of the biggest obstacles to getting clean and sober.

Suboxone and Opiate Detox

Suboxone (buprenorphine & naloxone)

Some detox centers do not medicate their patients during withdrawal. This is known as “cold turkey” and Sunrise Detox doesn’t believe in it. Opiate withdrawal symptoms can produce potentially dangerous health situations, including high blood pressure and dehydration. Left untreated, the pain of the withdrawal symptoms can make it psychologically difficult to stay in the detoxification facility, and makes the client more likely to leave prematurely.

At Sunrise Detox we use Suboxone®, buprenorphine-based medication that effectively manages opiate withdrawal symptoms. Read More…

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

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.