Recovery from Opioid Addiction

Recovery from opioid addictionI’ve written several times about recovery from opioid addiction, but it’s a complex subject and requires a great deal of explanation. Most people now have likely heard the horror stories of addiction, overdose and death, but not so much about recovery. The horror stories sell and recovery stories don’t. There are more and more recovery stories as opioid addiction treatment improves, but there are still millions who aren’t in treatment or don’t stay in treatment. The reason opioid addiction is difficult to treat is because of the way it’s been treated in the past. Methadone programs were once the major treatment for opioid addiction. As clarification, I use the term opioid to describe all opiate-like drugs, but, technically, opioids are synthetic.  It’s common now to talk about all of it, opium and opiates, as opioids. 

The hardest part of recovery from opioid addiction is withdrawal. The recovery rate for opioid addiction was low for a long time because addicts couldn’t get past the withdrawal or detox. Now there”s medicine like Suboxone to help ease withdrawals. The second hurdle is to get the chemically dependent person to understand the need for group therapy and counseling. Usually,  Suboxone does such a good job stopping the craving, the person doesn’t think they need further help. The problem is that addiction rewires the brain, and it takes a long time to reverse that process.

If the chemically dependent doesn’t receive some form of treatment, and doesn’t develop a long term recovery management plan, relapse is likely. There are certain triggers that set off psychological craving, and if a person doesn’t know how to deal with the overpowering desire to use again, the brain will become overloaded and the person will use opioids just to stop the madness. Addiction affects body, mind and spirit. It’s relatively easy nowadays to stop the physical craving for opioids, but spiritual emptiness an psychological turmoil are different and not so easy to make healthy and whole.

In treatment, recovery from opioid addiction is taught. The person in treatment is exposed to others who are in recovery, so they can learn from one another and support one another. Spiritual rejuvenation and psychological healing take time — recovery is about taking time to get better, understanding the addicted mind and finding ways to prevent relapse. It’s not easy, but it leads to amazing changes over time. Time is the essential for recovery from opioid addiction. There’s a saying around recovery groups- “Don’t give up before the miracle happens.”

 

Anxiety, Depression and Addiction

Often, chemical dependence presents itself as anxiety or depression, so someone having trouble with alcohol or some other drug might think that, say, anxiety is the main problem, when in reality the addiction is generating the anxiety. Sometimes anxiety and addiction can co-exist, but many times addiction is creating an anxious state of mind that tends to get worse and worse as the addiction grows out of control. It’s generally thought among the public that chemically dependent people are driven to addiction by some underlying psychological disorder or condition – this is not true. Addiction can happen to anyone, regardless of their psychological condition. Once a person starts moving through the stages of addiction, psychological problems often develop, but this is usually due to the nature of addiction and behavioral consequences that are at odds with reality. Addiction causes much confusion and emotion/mental turmoil.

The same thing goes for depression. In fact, alcohol is a depressant drug that initially has a stimulative effect. Most social drinkers don’t drink enough for the alcohol to become a depressant, so they enjoy a few drinks for relaxation or stimulation. The alcoholic, though, is often depressed from the alcohol itself and the consequences that attend alcoholic drinking. When an alcoholic goes to seek counseling, they’ll often minimize the drinking and highlight the depression. The alcoholic’s brain is slowly being rewired and he/she believes alcohol is vital to existence. The alcoholic protects the alcohol, concentrates on the depression, along with the magical thinking that maybe if they deal with the depression they’ll be able to drink without dire consequences.

Counselors trained in anxiety, depression and addiction disorders will recognize chemical dependence as the primary problem, if, indeed, the person is chemically dependent. The trained addiction professional will determine if anxiety or depression are likely caused by the addiction, or if there’s a long history of anxiety or depression. If it’s determined that addiction co-exists with either an anxiety disorder or a depressive disorder, then both conditions require treatment.

From experience, I’ve found that most people who’re chemically dependent don’t have problems with anxiety or depression after they’ve been abstinent and in recovery for a while. Then, there’s another possibility — a person might have an anxiety disorder or a depressive disorder, and the person might be misusing alcohol or some other drug to self-medicate, thinking that their drug of choice will alleviate their disorder. In this case, anxiety or depression would be the primary disorder — there would be no addiction diagnosis. The person’s anxiety or depressive disorder would require treatment, and the person would receive counseling on the dangers of self-medication. In order to straighten all this out, an in-depth evaluation is necessary by a trained professional who understands anxiety, depression and addiction. The key it to get good information, which is never easy. It’s always good if a family member attends the evaluation — then maybe the perspective is a little clearer.

Spirituality in Addiction Recovery

Spirituality in addiction recovery has been controversial at times,  especially among those with a more rational, scientific bent. Spirituality in addiction recovery was controversial all the way back to the beginning of Alcoholics Anonymous. The first hundred or so AA members had a split between Christian members who wanted a more religious tone and the agnostic-type members who wanted a clear separation from any religion. The compromise was a higher power of the individual’s understanding, even the power of a group with a common cause.

The underlying idea that made spirituality necessary at all, according to many who were working with alcoholics at the time, was that alcoholism can’t be beat by will power alone — they said it takes all the will power a person has, but it takes more than will power alone. They believed the alcoholic needed a power greater than themselves to overcome the insane obsession with alcohol. Even Dr. Carl Jung, the famous Psychiatrist, told a relapsing alcoholic who’d gone to him for help, and who had tried many sources of self-help and talking therapy to no avail, that in his (Dr Jung’s) experience alcoholics who recovered all experienced some kind of spiritual awakening, a deep desire for transformation.

Today in addiction treatment, for the most part, spirituality is still discussed in broad terms as an important part of recovery from addiction. The best addiction treatment techniques, the best counseling, the best treatment plan, are only effective if the individual in recovery can reach deep enough for inspiration to follow through. I guess it can be called many things, but spirituality is still a good term. Even if we can’t see it or touch it, most of us have experienced that deep stirring which comes from music, art, love, religious ceremonies, or other special moments or life changing events. Even though this deep, strong movement inside is not easily described, it’s powerful and real. And even if science discovers neurons and brain chemicals that are related to this “spiritual awakening”, it doesn’t change the fact that the experience is often transformational. Like Dr. Jung, spirituality in addiction recovery, regardless of what it’s called or how it’s experienced, is what I see that makes the difference between a return to drug addiction and long term recovery.

Why do I need Addiction Treatment?

Why do I need addiction treatment?Most people in the early stages of addiction will ask “Why do I need addiction treatment”? They ask for several reasons – one being they don’t think they’re in the early stages of addiction, and another reason is they most always think that individual counseling will suffice. The idea that alcohol or other drug problems are caused by underlying psychological conditions leads many addicts to try symptomatic solutions, and they never deal with the fundamental problem.

In the minds of most people in early addiction, they still believe they have power over drugs (alcohol is a drug, so it’ll be included where I write “drugs”). A person in the early stage of addiction still has some control, so they naturally think that if they talk with a counselor and resolve their depression, anxiety, anger issues, relationship problems, legal problems, self esteem issues, etc, then they can use their drug of choice without having problems. They think their depression, anxiety, life situation, whatever, is causing the periodic problems with misuse of drugs.

This might be true in some cases where the person is not in the early stages of addiction. But, if the person is susceptible to addiction, this chronic brain disease will not go away just because he/she becomes psychologically and emotionally healthy, if the person doesn’t understand and address the fundamental problem of addiction. A person who is not in any of the stages of addiction and simply misuses drugs periodically to deal with problems can benefit from individual counseling and self-improvement and can learn to drink or use their drug of choice responsibly, or stop using illegal drugs because it’s against the law and they realize it’s not worth the risk.

The person who’s going through the stages of addiction can also benefit from individual counseling and self-improvement, but this will not “cure” their addiction. Psychological and emotional problems are not the cause of addiction — they can complicate and intensify addiction, and addiction can complicate personal problems, but the person suffering from addiction most often needs more than individual counseling. They certainly need to know that if they continue to use drugs, the addiction will progress to middle stage then late stage and that premature death is likely. Addiction requires specialized care — it’s much more serious than temporary drug abuse/misuse. The answer to “Why do I need addiction treatment?” can be found when first the person understands addiction.

Obstacles to Addiction Treatment

Obstacles to addiction treatmentOne of the first obstacles to addiction treatment is stigma. Although society has made great progress accepting addiction as a medical concern that needs treatment, receiving addiction treatment can still cause problems with employers and a person’s social circle. Many employers are aware of Employee Assistance Programs and offer some version of this type of help — they’re the smart ones. But there are employers with antiquated ideas about addiction and they make it hard for employees to ask for help. If an employer is the second type, it might be time to find another job. And if a person’s social circle shames a person with an addiction problem, then that’s not a healthy social circle.

Once a person is past the stigma, then it’s usually the cost of treatment that becomes an obstacle. Inpatient treatment can be as much as 40+ thousand dollars for a month of treatment, but there are government funded facilities that provide treatment on a sliding scale according to ability to pay. Private outpatient will be around 4500-6000 for 8 weeks of treatment. There are also government funded outpatient addiction treatment programs to offset the cost. For someone with a fairly good income, the cost of treatment is a great investment, if the person is serious about treatment. The cost of active, untreated addiction is far greater, and the only return is destruction.

Whether inpatient or outpatient, or a combination of the two, treatment obstacles are easy to overcome once a person has committed. If a person’s willing, they’ll find a way to access addiction treatment. For some people, going directly into AA or NA is enough, although some form of treatment’s usually advised. The keys to addiction treatment and recovery are honesty, openness and willingness. Once a person has committed to treatment, a new world opens up. What seemed impossible is now achievable.

It’s amazing what a person can accomplish when they reach out for help and allow others to help them. When a person has isolated from others and is filled with shame, the sickness gets worse and there doesn’t appear to be a way out, but once the person reaches out it’s a new day and things begin to change. All obstacles to addiction treatment can be overcome with a little help.

More on Understanding Opioids

In this blog post, I’ll use “opioid” to describe all opiates, organic and synthetic. There’s confusion with all the discussion surrounding opioids, opium, heroin, morphine, opiates, etc. Below is a good description to help clarify:

To understand the classification of heroin as a drug, we must first understand its origin. According to National Institute on Drug Abuse, heroin is “an opioid drug that is synthesized from morphine, a naturally occurring substance extracted from the seed pod of the Asian opium poppy plant.” Milky, sap-like opium is first removed from the pod of the poppy flower. This opium is refined to make morphine, then further refined into different forms of heroin (DrugFreeWorld.com).

There is a lot of back-and-forth discussion on the difference between opiates and opioids, but the general consensus is that opiates or opiate drugs “originate from naturally-occurring alkaloids found in the opium poppy plant” (Opium.com). Opiate drugs are best-known for their pain-relieving properties.

Opioids, on the other hand, while similar to opiates in that they are also partly derived from opium, are primarily different because their makeup is manufactured. Opioids are actually synthetic drugs that produce opiate-like effects.

Other definitions choose to lump opiates and opioids together under the broader category of “opioids.” This is the proper medical terminology. According to NAABT.org, an opioid is “any agent that binds to opioid receptors (protein molecules located on the membranes of some nerve cells) found principally in the central nervous system and gastrointestinal tract, and elicits a response.”

So, people start using opioids in all its forms for different reasons, pain relief, experimentation, the euphoric effect, to relieve boredom, but the reason a person eventually uses opioids addictively is because there are brain changes that cause what can be called “insane” compulsion. The opioid addict uses the drug in spite of negatively consequences, and craves the drug after it’s been removed from the body. This obsession with opioids is difficult for most people to understand. Most people aren’t susceptible to addiction, only about 10% of the people who use opioids. The average person is baffled when a friend or family member uses opioids in a way that appears self-destructive, extremely self-centered and irrational.

Because we all want to find reasons for things that appear to have no reasonable explanation, loved ones develop reasons — the person is irresponsible, or the person is using to deal with some traumatic incident from the past, or the person is influenced by others. Any of these reasons might be true in the beginning, but when the person’s brain changes the drug use is driven by other forces. Here’s a partial explanation from NCBI:

Brain abnormalities resulting from chronic use of heroin, oxycodone, and other morphine-derived drugs are underlying causes of opioid dependence (the need to keep taking drugs to avoid a withdrawal syndrome) and addiction (intense drug craving and compulsive use). The abnormalities that produce dependence, well understood by science, appear to resolve after detoxification, within days or weeks after opioid use stops. The abnormalities that produce addiction, however, are more wide-ranging, complex, and long-lasting. They may involve an interaction of environmental effects—for example, stress, the social context of initial opiate use, and psychological conditioning—and a genetic predisposition in the form of brain pathways that were abnormal even before the first dose of opioid was taken. Such abnormalities can produce craving that leads to relapse months or years after the individual is no longer opioid dependent.

Read the entire article for a better understanding. At NewDay Counseling, we offer free consultations to help find solutions to opioid addiction.

The Progressive Nature of Addiction

AddictionNo one is born a full-blown drug addict. Addiction is progressive, from early stage, to middle stage, to late stage. In early stage it’s difficult to tell addiction from misuse. Lot’s of people go through periods in which they misuse alcohol or other drugs, but they aren’t necessarily suffering from addiction. The progressive nature of addiction makes addiction easier to diagnose in middle and late stages. Here’s a definition of addiction from NIH:

Addiction is defined as a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences. It is considered a brain disease because drugs change the brain; they change its structure and how it works. These brain changes  can be long-lasting and can lead to many harmful, often self-destructive, behaviors. 

This doesn’t mean that a person can’t control drug use at all. In the beginning, the addict can periodically control the use of drugs, and alcohol is a drug, but loss of control becomes progressively worse. The early stage addict might go to the bar one night with the intention of drinking three beers and leaving, and does so. Maybe the person does this for two or three nights, but then the next time the person winds up drunk and in jail for DUI, not understanding how they lost control and made such a bad decision to drive. Later on, the person will find it difficult to control at all.

A person in early stage addiction has to consider why they need to exert control. Most people who don’t have a problem with drugs don’t have to worry about controlling the use. A social drinker might have a couple of drinks or not, it’s not a big deal — they don’t lose control. There are some drugs, like opioids, that can cause physical dependence if taken long enough for pain, but if the person is not susceptible to addiction, they won’t have the psychological obsession that drives usage in spite of negative consequences, so that would be different from drug addiction or misuse. This person who has become physically dependent on opioids from long usage for pain management will need detox, but they’ll be glad the medication is no longer needed and they won’t crave the opioids after detox.

The structure of the addict’s brain changes, and it takes a while in recovery for the changes to reverse. The addict will often crave the drug months after detox. This is why a recovery plan is needed. Addiction is progressive and it gets worse with continued use, and it gets harder to quit when it progresses to middle and late stages. The progressive nature of addiction can be arrested at any time, but it takes willingness and effort.

Understanding the Opioid Epidemic

OpioidFor someone who doesn’t understand opioid addiction, when media report an epidemic and talk about opioids leading to heroin use, without lots of context and historical, factual information, it causes fear and misinformation. Understanding addiction is important to understanding the opioid epidemic. My fear is that well-meaning public officials will attempt to “fix” the problem and actually make it worse. One such “fix” has been to place too much blame on doctors and prescription use of opioids, which might lead to restrictions on access to opioids, which might lead to more people seeking drugs on the street. Also, demonization of heroin complicates the matter.

Heroin and opioids are powerful drugs, and they can be dangerous. However, opioids, when prescribed for pain, are very effective and useful. The problem is that a certain percentage of opioid users will become addicted. Those who become addicted to opioids have a predisposition to addiction, and there’s treatment for this. The main problem with the opioid epidemic and the use of heroin is when people purposefully seek the drugs to feed an addiction. The addict isn’t treating pain, but rather using opiate-like drugs because they’re physically addicted and have a psychological compulsion to use the drugs even after they’re physically withdrawn from opioids. It’s the mental and emotional obsession that creates the insane use despite severe consequences.

So, until addiction in general is understood, it’s not likely that good solutions will arise to deal with the specific problem of an opioid epidemic. To put all this in perspective, though, let’s imagine a new drug is discovered. Let’s say this new drug is so popular that it’s legalized, yet it becomes the cause of approximately 90,000 deaths a year. Let’s say that around 80% of the population over 18 use this drug. Let’s say that 10 to 13% of the people who use this drug develop a problem of addiction or serious misuse that meet treatment criteria. Let’s say that 30% of all driving fatalities are related to the use of this drug. Let’s say that the consequences of the drug cost the US 250 million dollars a year. Let’s say the following are true:

  • Around 1,825 college students between the ages of 18 and 24 die from causes related to this drug.

  • 696,000 students between the ages of 18 and 24 are assaulted by another student who has been using this drug.

  • 97,000 students between the ages of 18 and 24 report experiencing sexual assault or date rape related to the use of this drug.

  • Roughly 20 percent of college students meet the criteria for treatment for addiction to this drug.

  • About 1 in 4 college students report academic consequences from using this drug, including missing class, falling behind in class, doing poorly on exams or papers, and receiving lower grades overall.

This drug, of course, exists. It’s alcohol. So, while opioid addiction is a serious problem, it’s best understood in the context of addiction in general. It’s strange to demonize a drug like heroin, or emphasize the addiction epidemic to opioids, and to focus most addiction-related resources toward a war to eradicate the demon heroin and restrict pain medication, when alcohol presents a larger problem than heroin, opioids, cocaine, pot and all drugs combined. I understand alcohol is a socially accepted and regulated drug, and I’m not a prohibitionist, but it helps to think about alcohol as just another potentially-addictive drug. The point is to focus attention on treatment. To understand addiction is the key to understanding the opioid epidemic. Opioid and heroin addiction are big problems — addiction, including alcoholism, is a huge problem, and it’s all treatable.

 

Motivation in Addiction Treatment

Motication in addiction treatmentOne of the hardest parts for counselors working in the addiction treatment field is helping clients sustain motivation to continue in treatment. Motivation in addiction treatment has to eventually come from within, but in the beginning, it’s very difficult for the client to resist the mental obsession with their drug of choice. Even if the client claims to desire recovery, the desire for the drug doesn’t leave very quickly.

Addiction treatment is a slow, arduous process, and many clients struggle with day to day commitments required to make treatment successful. The challenge for addiction treatment professionals is to constantly provide positive motivation in the face of resistance. Burn out in the addiction field is a risk, because professionals are working with a clientele that can seem hopeless and ungrateful– they resist, they relapse, they deny, they lie, they minimize, on and on. Yet, recovery is possible and does happen.

It takes someone dedicated to the addiction treatment field who understands the nature of physical addiction and the psychological aspects of addiction that make the first part of recovery so difficult. The addiction professional has to look past the personality to the person. The personality has been twisted by years of addictive behavior, addictive thinking and all the consequences that go along with addiction. The “person” is buried under the addiction twisted “personality”. The task is to reach the person, through all the barriers.

Some new therapists will take the resistance personally, but this is a mistake. The challenge for the therapist is to compassionately and objectively speak to the person and offer recovery. There are certain daily techniques the client in recovery can practice to get past dwindling motivation. Recovery is basically a daily commitment. One way to keep focused and motivated is to keep a daily record of negative thoughts, then look at these thoughts to see if they fit reality — turn the negative around and see how a positive perspective looks and feels. It helps to start the day with a positive reflection and there are many daily reflections books for all types of beliefs. Many clients find it helpful to start the day with quiet meditation, then stop periodically during the day to check their attitude and emotions. Calling someone who understands addiction and recovery and is supportive is very helpful.

Whatever works, a person who gets into a daily routine to keep motivation fresh usually recovers.