Here’s how early recovery and romance can feel…

1. Recovery is difficult and exhausting. Romance, on the other hand, can feel great.
2. The past is depressing. The possibility of a new “healthy” relationship is uplifting.

Unfortunately, our feelings can deceive us, and short-term happiness can turn to long-term sorrow and disappointment. Let’s state the sad fact: relationships formed during early recovery almost always end in relapse.

Real romantic loves consists of intimacy, passion, and commitment. It’s a three-legged stool of sorts. If one leg is taken away, the stool can’t stand up. Let’s take a look at how an incomplete romantic relationship can fall apart.

If two people enjoy honestly and open communication in their relationship – in other words, intimacy – but they do not commit to one another, someone is going to get hurt. It is devastating to open yourself up to another person only to have them walk away from the relationship or enter a romantic relationship with someone else because there is no commitment.

If two people share the passion of romantic love and commit themselves to one another, but they do not communicate openly and honestly with one another – in other words, authentic intimacy is missing – the relationship will always remain superficial and unfulfilled.

If two people are honest and open with one another and commit themselves to the relationship, but there is no passion or chemistry, the relationship risks becoming stale. Over time, boredom and disappointment may set in and the two people may drift apart.

Now, it isn’t our goal to make everyone question the perfection of their marriages and romantic relationships. After all, every relationship takes work. No relationship is perfect. Furthermore, we can all grow in our ability to be intimate, passionate, and committed. But here’s the thing:

A recovery addict – particularly in the phase of early recovery – is not capable of attaining the true intimacy, passion, and commitment that a healthy romantic relationship demands.

Intimacy: Some of the most common symptoms of addiction are dishonesty and secrecy. Dishonesty and secrecy are totally opposite of intimacy. A recovering addict may detox and rid their physical body of harmful substances, but the rehabilitation of ugly character traits like deceit and manipulation will take time. People in early recovery aren’t yet ready to trust and be trusted on a meaningful level.

Commitment: For a person in early recovery, the process of self-rediscovery or perhaps discovery of oneself for the first time has just begun. Someone who has been trapped in a destructive cycle of substance abuse has seen their addiction rob them of their dreams, ambitions, hobbies, families, careers, and more. Rebuilding one’s life will take time. It’s as if, for addicted people, their preferred substances were all-consuming and replaced anything of importance in their lives. Here’s a common question once a person successfully reclaims his or her life from drugs or alcohol:

“Who am I?  Who am I without drugs and alcohol?”

This is a vulnerable and uncertain condition. How can someone in this phase of recovery truly commit to another human being?

Passion: A person in early recovery can experience passion to a degree, but imagine the dangers of passion without intimacy or commitment. We’ll leave the topic of risky sexual behavior and its prevalence among addicted people to another day. But needless to say, a relationship built on passion alone is not built to last. Passion can burn out, and when it does, what will a person seek to replace those feelings of excitement? Relapse is a serious risk when romantic relationships fall apart.

Why Romantic Relationships are Tempting

Many people believe that there is a soul mate waiting for them and that fate can deliver this person into their lives at any time. People in recovery enjoy the companionship of others who fully understand and empathize with what they’re going through. Friendship, of course, can be helpful to recovery. But the entanglements of a romantic involvement can turn the person’s focus away from their recovery goals.

Every new relationship requires a significant amount of time and focus. But for those in recovery – especially during the early stages – there is a need to be somewhat selfish. That sounds bad, but here’s what we mean. People in recovery must fully devote themselves to learning the strategies and coping mechanisms of recovery. Recovery is priority one. This is something a recovering addict should accept. Two recovering people who are truly embracing that truth will acknowledge that they are not ready to enter a committed romantic relationship.

Let’s use an analogy: you’ve been drowning in your addiction. Another drowning person cannot help you find safety. Sadly, both of you may drown. Find the shore… then find a relationship.

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We explore this topic in greater depth in an online video/web recovery curriculum soon to be released by Stepworks Media. For more information about successfully recovering from addiction, call us toll-free – 1-888-982-1224 – and speak live with a member of the Stepworks team.

Now, before going any further, we need to make something clear: Anyone connected to StepWorks in any way knows that we are not judgmental. Our treatment team meets addicted people wherever they are. We don’t judge people or count them out. We encourage them; we lift them up; we help them renew their lives. Our mission is not to judge or condemn. But when it comes to naming what is essentially a poolside bar “Rehab” and joking that “you’ll need rehab” after going there, we feel this crosses the line. To be very generous, we’ll say it’s tacky.

The majority of us do not struggle with addictions to alcohol, sex, or illicit substances. But we need to be sensitive to the millions of people who do. For them, the word “rehab” or “rehabilitation” has gravity. Real people with real problems go to real rehabs and get their lives back on track. Conversely, real people with real problems have gone to places like Hard Rock’s Rehab and further wrecked their lives.

Perhaps we’re being a little too sensitive. We’re pretty passionate about addiction recovery, so that’s certainly possible. But when you’ve seen what we’ve seen…

• An alcoholic who couldn’t walk into the StepWorks treatment center without assistance is detoxed and begins therapy. He learns about the science of addiction. Gradually, he understands his life story and why he was susceptible to alcoholism. He gains confidence. He gains tools to prevent a future relapse. He returns home to become a productive employee, faithful husband, and loving father.
• A methamphetamine addict and dealer has seen his life, finances, and standing in the community utterly ravaged by addiction and crime. Because he is court-ordered, he enters drug treatment reluctantly. Through a process of group and individual therapy, his emotional barriers finally break down and he acknowledges—to himself and his peers—that he has been completely dead inside and is ready to start living again. His legal struggles are behind him, he has a relationship with his kids, and he is now on staff at a substance abuse recovery center. He calls us regularly to say thank you.
• A family struggles diligently for weeks to convince their addicted daughter to come to treatment. They are willing to finance her treatment out of pocket. Finally, she agrees. But she overdoses on heroin the night before her admission.

When you’ve seen these stories and countless like them first-hand, you become passionate and maybe a bit sensitive about the topic of rehabilitation. You start to appreciate the meaning of the word “rehab,” and you don’t want to see it abused.

To lay some groundwork, we need to make a couple of quick points:

1. There is a difference between spirituality and religion.
2. It is widely believed (and proven by research) that there is a positive relationship between a person’s spirituality and their recovery process.

Let’s progress one step at a time. Question: What is the difference between spirituality and religion?

Spirituality is the part of ourselves that goes beyond the physical. It includes our thoughts, beliefs, perceptions, emotions, and how we assign meaning and purpose to our lives. Spirituality is the values that we teach our kids. Spirituality is how we decide whether a decision is good or bad. Spirituality is at the core of who we are. Spirituality forms the foundation of how we interpret the world around us.

Religion is more defined. Religion is a commitment to a particular faith: such as Christianity, Judaism, Islam, or even Humanism.

Consider the following points:

Spirituality…
- involves the person discovering a sense of mission and purpose in their life.
- is a personal set of values regarding what is sacred.
- is unrelated to a specific dogma, belief system or particular defined roles – that is, unrelated to any specific church.

Religion…
- is a commitment to a particular faith or observance (Christianity, Judaism, Islam, etc.).
- is a defined set of institutionalized practices, attitudes, and beliefs regarding what is sacred.
- has defined roles that usually include religious leaders (ministers, rabbis, etc.).

It is important to acknowledge that–for many people–spirituality can develop into religious beliefs; so admittedly, spirituality and religion are related. Bu they are not the same.
The physical world is governed by physical laws (such as gravity). The spiritual world is also governed by laws (for example that lying and stealing are wrong, that honesty and respect are good). You’ve been developing laws and expectations of how you should live since childhood: your interactions with friends, parents, teachers, bosses, and children have all been silently structuring your set of values and what you consider to be “right.” You may not always adhere to these laws, but you’ve always been aware of them. These spiritual laws may be different for each person, but surprisingly, these laws are usually very similar for everyone.

In fact, many theologians believe this is the most compelling evidence for the existence of a Higher Power. If, in spite of all of our differences, people all over the world have a very similar sense of what is good and what is bad, where did that come from? Where did we get that? (We encourage you to think about that question for a moment before you read further.)

When people live their lives in accordance with spiritual laws, they find contentment and peace. People who act out against these laws find confusion and disappointment. Many times, people will try to avoid spiritual realities by abusing alcohol and drugs.

It is a well-known fact that most recovery programs stress the importance of spirituality. The difference is that some stress more traditional or religious spirituality, while others stress a non-religious or more open-ended approach to spirituality.

Traditional recovery programs incorporate something called a “mystical spirituality”, or in other words, a religious spirituality that relies on the belief of a Higher Power. These programs believe that our meaning and purpose in life comes from a relationship with the Higher Power, and that our spiritual laws are simply a continuation of laws set down by the Higher Power. In these programs, people’s goal is to form a meaningful relationship with the Higher Power and then to understand—and embrace—the Higher Power’s will for their lives.

A second type of recovery program believes in what is called a “non-mystical spirituality.” This spirituality does not rely on the belief of a Higher Power. In this program, the addicts are encouraged to believe that each person exists in two worlds: the physical world where we live, breathe, and live; and also a separate world made up of our thoughts, beliefs, desires and emotions. When defined this way, spirituality is closely linked to psychology since both advise that people use their own mental and emotional powers to derive meaning and purpose in their lives. In this view, it is only up to you, and not a Higher Power, to direct your recovery.

Many people in recovery incorporate aspects of both of these systems.  Many recovering addicts wish to…

1. sustain a relationship with their Higher Power, understand the Higher Power’s will, and accept the guidance of the Higher Power.
2. actively work toward their personal responsibility, growth, and recovery, taking full responsibility for their progress and setbacks.

Again, many recovering addicts successfully navigate their recovery by accepting and leaning on a Higher Power, but at the same time, also taking personal responsibility for the recovery process.

Cautionary note: No matter what type of spirituality you decide to embrace, there is always the possibility that you will one day relapse. It is not your goal or expectation, but it might happen.

If you do relapse, there are some destructive thought patterns to avoid.

Relapse and Mystical Spirituality – Pitfall

One possible consequence of people turning control of their recovery to a Higher Power is that too much reliance can be placed on this Higher Power to solve all of your problems. This essentially means taking no personal responsibility for anything and leaving it to your Higher Power to “fix it.” When things don’t work out the way you would have liked, you experience huge disappointment that your Higher Power didn’t come through for you, which leads to anger and depression, which can then lead right back to drugs and alcohol!

Relapse and Non-Mystical Spirituality – Pitfall

Some people in recovery are so overwhelmed with guilt and shame that they feel unworthy of any effort to improve their lives. They don’t believe that they are capable of using their own intellect in advancing their recovery. On other side of the coin are those people who have delusions of grandeur, who think they are bigger and better than everyone else—even a so-called Higher Power—and can control their addiction by their own resources, not needing any outside help. If they do begin to struggle, they have very little help and no spiritual support. This can result in feelings of isolation and depression, which can lead to relapse.

Establishing a Balanced Spirituality – Goal

Most combine some aspects of Mystical and non-Mystical Spirituality in which they acknowledge a Higher Power but also take responsibility for their lives. People who live according to spiritual principles understand that there are some things in life which they do have the power to change and must change if they are to continue with their recovery. They then seek to guidance and courage they need to make those changes. This guidance can come from a combination of both divine and human sources. They recognize that some things in life are beyond their control. And some things in life are unexplainable. These are the things they fully turn over to a Higher Power, having faith that the Higher Power will provide strength and direction. As a result, they can stop trying to control the uncontrollable. They can then concentrate their energy on things that ARE in their power to change.

People who are successful in recovery also understand that they are in control of their addiction. They have identified the changes they need to make to maintain a sober lifestyle. They realize that they are ultimately responsible for remaining drug-free. They may find help in recovery groups and friendships. They may find support and strength in a Higher Power. But ultimately, the individual is responsible for making good choices and rebuilding a better life.

Conclusion: The Duality of Recovery

Balance is the foundation for spiritual-based recovery. It is the ability to acknowledge the laws and principles of the physical world and live within their guidelines. It is also the willingness to recognize that there is a separate world beyond the things we touch and see. Balance means living, breathing, working, and making choices in the physical world, but also living in harmony with the spiritual laws of love, fairness, honesty, and so on. We can’t see honesty. We can’t touch it. But it’s as real as the clothes you’re wearing. And you’re supposed to take it with you everywhere you go.

This may sound a little strange. But deep down, you know it’s true. We all have to live in the real world. We all have a set of values that our real-world actions must be based on. For many, spiritual peace is the most natural part of their continued sobriety.

You can start a spiritual life by simply saying, “I’m ready. I know there is more to life than drugs and alcohol. I know life has meaning. I’m ready to go deeper. I’m ready to make peace. I’m ready to love more and live more fully. I’m ready.” It’s a prayer of sorts, and it’s a good start. As with all types of goal-setting, it does take a leap of faith in the beginning. It takes courage to trust that we can find meaning and purpose in our lives simply by claiming that we are ready!

But like most things in life, the first step is humble willingness: I don’t know it all, but I’m willing.

You are probably thinking, “OK, I understand the difference between spirituality and religion. Why is this important again?” Here’s why: most addicts live with few rules beyond what helps him or her get their next drink, pill, or fix. They don’t respect the rules, so they lie, cheat, steal, and hurt the ones they love. They don’t value themselves, so they hurt themselves too. We learn very early that life works better with rules… with a sense of right and wrong. Whether we’re born with this sense or we pick it up somehow along the way, it exists. Getting clean and sober requires us to recognize that there is more to life than our addiction and our unending quest to satisfy it.

Note About Stepworks and Spirituality:

You might find it interesting that the creators of Stepworks materials have deeply held spiritual beliefs. In fact, that’s a big motivator for us: to love our neighbors. We do not “push” a specific spiritual agenda. But it is fair to acknowledge that—because of our spiritual beliefs—we deeply desire a better life for you and your family. In other words, we aren’t just telling you that this is important. We really believe it. And through our experiences in addiction recovery, we believe there is significant evidence to support this view.  If you want to talk about it, give us a call:  1-888-982-1244.

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George Harrison:  “Basically it starts with people who just want to get high. You know, like people drink. I mean that’s a big problem. People get– have drink after the show, like I suppose after the show, maybe you have a drink just to get a little high. So musicians, you know, either drink a little bit or maybe they smoke a bit now and then. They want to get a bit high. They’re sort of really looking for something. Because the world is such a hard place to try and make it in, so I mean, they’re all just like buffers, all those drugs and things. And I suppose they get on top of you. They get next to you.”

Dick Cavett:  ”Why, the ones who kill themselves, your colleagues, why heroin?”

George Harrison:  ”Well, that seems to be the big one.”

Dick Cavett:  ”Yeah.”

George Harrison:  “I don’t– I’m really unqualified to talk about heroin because I’ve never taken it.”

Dick Cavett:  ”Yeah.”

George Harrison:  “And I really don’t intend to because, you know, I’m sure it’s just– it’s probably just the best high, you know. That’s what it’s down to. It’s the one that gets them the highest the quickest, but it just happens to kill you faster as well. I mean they all sort of kill you in one way or another, and there’s very few people who seem to be able to experience something like heroin and then get away from it because it just gets in the system and they become dependent on it. I don’t know. It’s sad, you know? It’s really sad because they’re all looking for some deep love or something like that and they miss it, you know?”

Dick Cavett:  ”Yeah, yeah.”

George Harrison:  “It’s much better to try and not take any drugs, you know, if you can get straight, really straight, then in a way it’s much higher. I mean, I’m not really qualified to talk about that either. I mean I’m sort–” [audience laughs] “I’m sort of in the middle, you know?”

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The Beatle answered Dick’s questions very plainly and honestly.  But in his casual way, he makes some very keen observations:

1. Drug users are searching for something:  enjoyment, relaxation, escape, love.
2. Heroin is particularly dangerous:  intense high, super-addictive, deadly.
3. The addicted person’s situation is very sad:  drugs are a poor substitute for love, and ultimately, addiction causes addicts to miss out on life.
4. Sobriety is the best-feeling, longest-acting high.

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Are you or your loved ones missing out on life?  Are you or your loved ones unsuccessfully filling “the void” with drugs and alcohol?  If so, please get in touch with us.  We genuinely know about addiction.  We won’t judge you or insult you with a lack of understanding.  Call 1-888-982-1244.  A Stepworks team member will be ready to answer the phone and talk to you.  God willing, we will help you trade in the sorrows of addiction for a sober life of opportunity and joy.

If you search “opiate detox” on Google, the first two suggested searches are “opiate detox recovery” and “opiate detox at home.” This should tell you three things:

1. You or someone you know has an opiate problem that absolutely needs to be addressed. If it’s not a real problem, why are you searching for solutions?
2. Thousands and thousands of people are searching for ways to kick their opiate addictions.
3. Thousands of those searchers are also asking, “Should I try the do-it-yourself method and detox at home, or should I seek professional assistance through a certified opiate detox center?”

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For this blog post, we surveyed five members of the Stepworks treatment team. Here is what we learned:

1. If your friend or loved one needed to detox from opiates, would you recommend that they (A) check into an opiate detox center or (B) detox at home?

Having worked in the field for several years, I would want anyone I cared about to enter a licensed treatment center. Opiate detox is not life threatening, but is very difficult. Folks are much more likely to relapse due to craving during detox and being in a facility where there is both medical and emotional support can really make the difference.

A supervised medical detox is definitely the better of these two options. The detox process can be a scary thing when tried on your own, and the supervision of a trained staff to monitor this process is a great asset.

A detoxing client needs structure in the beginning. They need to be able to let go and let someone with experience guide them through what can seem like a hopeless procedure. The addiction is telling them that it is impossible to live without drugs or alcohol. A trained staff can give encouragement and understanding that they may not get at home.

I absolutely recommend a detox center. Prescribed medications can relieve the discomfort of detox, making it less likley for the person to give in to the pain and go use.

Clients of ours who have shared about their experiences trying to detox at home relate it as “hell” in most cases. They experience not only the physical symptoms that are very uncomfortable, they also say the anxiety that comes with that as a real barrier to their ability to follow through. In many cases, they say that after 2-3 days, they just arent able to do it. The ones who have tried it at home before coming to us are nervous and worried. They tell us it is because it was so horrible at home, and they fear it being that bad again. They take comfort from our reassurances that our medical detox addresses those symptoms. We tell them that, while they will still experience symptoms of discomfort, it will be very manageable. Because they tried at home and failed, the fear of feeling that pain again is a real barrier to successful recovery.

2. Are there exceptions?

I think there are always exceptions. For example, if a person had been using opiates for a very brief period of time, in low dosages… if they had a VERY supportive home environment and were highly motivated to discontinue opiate use… or if they simply were unable to enter a treatment facility for any length of time. In those cases, I might recommend outpatient treatment.

In my opinion, the only exception would be if I completely trusted I would be in no medical danger.

If all else fails and treatment is not a option, at home detox would be a resource that could be considered, but the addicted person and their whole family must be actively involved for motivation, support, and medication monitoring until the person is stable. It will not be easy.

I wouldn’t want to make exceptions when dealing with the detox phase of treatment. Making exceptions can be acceptable in certain life situations, but compromising on the best way for one to detox is not one of those situations.

I imagine there are exceptions to this, but we don’t see them very often. The main thing I would want them to do is realize that trying to detox on their own is continuing to do things “their way.” Unfortunately, “their way” hasn’t been very successful. Addiction is a disease and needs to be treated with professional medical help and ort… not only for the physical symptoms, but for the emotional symptoms as well.

3. What is the “main thing” you would encourage the person to do?

Let trained professionals be trained professionals when it comes time to detox. Could you detox at home and be okay? Maybe. Would it be a safer, more effective, smoother transition if you did a medical detox? Absolutely.

After detoxing, go to NA Meetings, and of course, pray.

The main thing I would encourage you to do is go to detox center for professional care. If I cut my arm, I wouldn’t try to give myself stiches. I wouldn’t set my own leg if I broke it. And really, addiction is a lot more life-threatening than an arm or leg injury.

Don’t stay stuck in denial that there is a problem. Seek a recommendation from a qualified professional, and heed the advice of that professional. There are many resources available to help in matters like these. Folks don’t have to make uninformed or unsupported decisions on their own.

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Obviously, there is a consensus. At Stepworks, our position is that it is safer, wiser, more comfortable, and more effective to seek professional medical assistance. We strongly believe in what we are doing.

At Stepworks, our goal isn’t just to get people off of drugs and alcohol–our goal is to restore lives and help people STAY clean and sober. Call 1-888-982-1244 to speak with a member of our team.

1. Recognize the importance of a doctor who truly knows you.
2. Understand the dangers of hiding information from the doctor.
3. Find a doctor comfortable with the treatment of pain and addiction.
4. Develop a pain relapse prevention plan.

The sad fact is that most doctors are not well trained to treat addiction. They are trained to be trusting. They are dedicated to relieving pain and emotional distress. Since there are a lot of medications available to treat pain and suffering, doctors are readily willing to prescribe these medications.

Most opiate addicts know which doctors give pain medications and which do not. Many addicts will have a list of doctors that they visit on a regular basis to get their supply of opiates. They may even convince themselves that, since the doctor gave them the medication, it is somehow okay.

But you are now in recovery, and you want to stay in recovery. To do this, you will need to have a very honest discussion with a primary care doctor. It is up to you whether this is your old doctor or a new one. If you have been kicked out of a practice for drug-seeking or if you quit going to a doctor because he was “on to you,” then that MAY be just the doctor you should choose. You need a doctor with a strong sense of ethics.

It is absolutely essential that you are honest with the doctor. You need to be honest about your addiction, your history of lying to doctors to get medicines, and your desire for the doctor to help you make good decisions in the future. This will take some courage, but remember: 9 times out of 10, your doctor will sincerely want to help you.

In other words, it is important to find a doctor that truly “knows” you… warts and all. This includes any medicines that you may take for your addiction such as Suboxone or Vivitrol. You should keep a list of all your current medicines in your wallet.

It may be easier to write your doctor a letter and take it with you to your appointment. Do not just mail it. Your doctor will need to match your face with the letter and its contents. Here is a sample letter:

Dear Dr. Jones,

Sincerely,
A Person Devoted to His/Her Continued Sobriety

Obviously, this is a general letter. Notice that the letter includes not only your history of addiction, but more importantly a plan should you relapse. If you have a particular chronic pain issue, include ways that your doctor can help when that pain worsens. It is much easier to develop a plan when you are not hurting rather than when you are in pain. This is called a pain relapse prevention plan.

Not every doctor will be comfortable handling your condition. Feel free to ask your doctor whether there are any addictionologists in your area. You can check this website for a directory of board-certified addiction specialists: asam.org.

If you suffer from chronic pain, you can also research pain management doctors. Be very careful, however, because many pain specialists are more interested in procedures or opiate management than non-opiate pain management.

Lastly, it’s up to you to find the right doctor… a doctor who knows how to help someone who struggles with addiction. Just any doctor will not do. You need to do your homework and see them before you get into trouble. We both know that it is easy to find a doctor who will give you anything you want. But what you really want now is sobriety and a better life. Find a doctor that will help you achieve these goals.

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StepWorks’ medical director, Dr. Thomas Ingram (Elizabethtown, KY), is a SAMSHA-certified addiction doctor and family physician. For further information about StepWorks, call 1-888-982-1244 and speak with a member of our treatment team.

You have heard the old saying, “There’s more than one way to skin a cat.” Well, it’s unimaginable why someone would want to do something so horrible. But the principle contained in that old saying still rings true: there are a number of ways to reach any given objective. That is certainly the case with alcohol detox. There are a number of ways someone can be detoxed from alcohol.

In the old days, alcohol would be given intravenously in a hospital. Sadly, when this outdated method of alcohol detox was being used, some patients died of alcohol poisoning.

More recent detox protocols involve giving medications to prevent or treat alcohol withdrawal symptoms. These medications are usually from the class of benzodiazepines including Librium, Valium, Ativan and Serax. All of these medications work. They differ only in their half-life (which is a fancy way of saying how long they stay active in the body and how quickly they take effect). Arguably, any of these medications can be used effectively, as long as the physician is comfortable with how to properly administer them.

There are two general ways that benzodiazepines are used to detox from alcohol. The first way is to administer regular doses to “prevent” withdrawal and gradually taper over time. The doctor would usually start with high doses (causing a lot of sedation) and then decrease over a few days. While this method works, it takes a long time. In addition, over-sedation can lead to problems such as falls and infections like pneumonia. (It is also important to keep in mind that not everyone needs medicines for alcohol withdrawal symptoms.)

The “modern” detox protocol uses a very standardized approach. In this method, the signs and symptoms of alcohol withdrawal are recorded and scored according to the Clinical Institute Withdrawal Assessment. We refer to this as the CIWA (ky-a-wah) or (see-a-wah). The CIWA measures 10 items and a score is calculated. Medicines are then given according to the CIWA score.

Using the CIWA means that no matter where you are in the United States, you can be detoxed in a standard way. This has been shown to decrease the amount of medications given, the length of stay in a hospital setting, and the complications associated with benzodiazepines. In a residential setting like Stepworks for example, this means that the client can start going to groups sooner and get back to work sooner.

The take home message is this: If you are considering a facility for alcohol detox, ask if they use the CIWA. If they say “no,” then you should evaluate other places first. The CIWA is becoming the standard of care for alcohol detox, and facilities not using the CIWA are not up-to-date in their approach. If you are admitted to a facility using the CIWA, you will not be given a benzodiazepine right away. Don’t panic. This is good. Trust the process. The CIWA really does work.

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If you want to learn more about the CIWA and how it might apply to you or your loved one, call us toll-free at 1-888-982-1244 and speak with a member of the Stepworks team.

This article is adapted from an addiction recovery curriculum we are developing at Stepworks. This particular excerpt is aimed at people who (1) struggle with addiction, and (2) may potentially experience pain and desire pain medications. (Note: If this situation describes you and you are currently caught in a cycle of active prescription drug abuse, click opiate detox centers for details about our treatment program.)

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Everyone experiences pain. Pain actually serves a purpose. It is a valuable indication that something is wrong.

Did you know that there is a disease that prevents people from sensing pain? People suffering from leprosy do not feel pain. Because of this, they die sooner than those of us who do sense pain. The disease makes it impossible to tell when something is wrong, so they lose fingers and hands and feet. Pain doesn’t tell them to guard their bodies and protect themselves from harm and injury. Ultimately, they can die of infection or even heart attacks. Pain serves an important purpose.

For other people, their reaction to pain is exaggerated. What most would consider normal levels of pressure will cause agonizing pain. For others, opiate abuse damages their nervous system, negatively altering the way they experience pain. Here’s something interesting to think about… something that might possibly be relevant to you: people with chronic pain who will often experience LESS pain when they QUIT their pain medication.

For now, the point is that pain is an individualized experience. The experience of pain differs from person to person. We can’t say whether your pain is “real” or not… whether it is severe or only mild. There is no objective way to measure your pain.

But if you’re addicted to opiate medications, these are some facts:

1. It is easy for you to get prescription pain pills since doctors are trained to relieve pain and suffering. Pain and suffering is treated with pain medicines, and most doctors will write you a prescription, assuming that you are telling the truth.
2. You may be a good liar. Sadly, dishonesty and addiction go hand in hand.
3. Like your reward system, your pain system is broken.
4. Opiate pain medicines pose a significant risk to your happiness and health.

Even if you remain committed to your sobriety, there will be a time when something painful will happen… something that—under normal circumstances—would result in a doctor prescribing you pain medicine. It may be a pulled tooth, a sprained ankle, surgery, or something else. You will be experiencing pain, and your healthcare provider will offer some sort of prescription. What will you do? After all, most people “need” medications in these circumstances. Right?

Well, maybe not. You will always want an opiate pain medication. You’ll be tempted to take prescription medications even for a small injury. You may understand that you don’t NEED it or that it will be harmful to you, but you will still want it. You may not even plan to use it, but you will still desire to have it… just in case things change and you find yourself needing it. This is your addiction talking.

It is extremely rare that you will ever actually “need” an opiate pain medication. Having a tooth pulled or breaking your leg is painful. There is no doubt about that. But there are non-opiate pain medications that can help you. Do they work as well as opiates? Well, not always, but sometimes they do.

Here’s what you must remember: you need to stay clean and sober. Your addiction has caused you severe pain and consequences. Yes, it would be nice not to experience pain, but you don’t want to throw away your sobriety either.

At Stepworks, our medical director shared the following true story…

The Banana Story:

I once treated a lady who suddenly started experiencing bouts of severe shortness of breath. She was hospitalized a number of times and was admitted to intensive care on a breathing machine on the verge of death. Her episodes seemed to occur randomly. She was under a lot of stress with a business failing and an unsupportive husband, but stress can’t make you stop breathing. It just didn’t make sense. After almost a year of these unexplained bouts, we finally discovered the reason: she was allergic to bananas. A single bite of a banana would send her into a life-threatening anaphylactic response. The crazy thing is that she KNEW it, but she would intentionally eat bananas. Whenever the stress was too much or her husband was too mean, she would go out and eat a banana and be hospitalized. The family would then rally around her and feel sorry for her while she struggled in intensive care.

That sounds crazy, right? Why would anyone intentionally expose themselves to a substance that could kill them? Your addiction to opiates is no different. You are essentially “allergic” to opiate pain medications. While they may not kill you immediately, relapse can—and does—lead to death.

So, you have a tooth pulled. What then? First, realize that while the dentist may want to give you a prescription for pain, and while you may WANT a prescription for pain, it’s not a good idea. You could easily relapse and lose everything you have worked so hard to obtain. THINK BANANAS. Tell the dentist that you are allergic to all opiates. (You do not have to explain all of the details of your addiction.) The dentist will probably give you a prescription for something like Motrin. Now, you may think, “Motrin doesn’t work for me!” But is that true? The truth is that your addiction has damaged your reward system and your pain system. Motrin or Tylenol DOES work if you will give it a chance. You may still have some discomfort, but it will lower your level of pain.

You may still be thinking, “Yeah, right. You don’t understand my pain.” And that’s true. But this much is true: people with opiate addictions tend to experience pain more intensely than people without addictions. Furthermore, the fear of pain is a major issue for many addicts. In fact, the fear of pain is probably a bigger reality than the pain itself. Sometimes, we take pain medications because we’re scared we might have pain, not because we’re currently experiencing it. So think about it this way: Don’t fear future pain. It’s not a good mental exercise. In fact, if you can relieve the fear, you may relieve the pain. Relieve the fear—relieve the pain. Remind yourself that Motrin will work. And don’t sit around waiting for pain… fearing it. Exercise. Studies show that exercise and moderate activity can decrease pain by releasing natural pain relievers. Act as if you are having no pain.

There are also other non-opiate medications that can be used to help relieve chronic pain. These are called “adjunctive medications.” They work by interfering with normal pain pathways in your spinal cord and brain. Some of these medications include Cymbalta, Neurontin, Elavil, Flexeril, and Lyrica.

Lastly, good sleep is important. If you are not sleeping well, your muscles and tendons will tighten and your pain will increase. Some adjunctive medications—like Flexeril and Elavil—will make you sleepy and are very useful if you aren’t sleeping well.

But what if pain meds are my last resort?

With all of that said, there may be a time when the severity of your condition actually does require the use of an opiate to lower your pain to tolerable levels. These times are rare, but they do occur. Certain surgeries, cancer, and severe injuries may not fully respond to non-opiate therapies. In these conditions, it is very important that you are totally honest with your doctor about your addiction. If this situation happens to you, hopefully the end of your prescription pain pill usage will be a proper doctor-compliant cessation. That is much safer and much healthier than spiraling into abusive patterns, in which case your only successful way out is opiate detox. You will want to put it in your own words, but here is the message you want to give:

• I am addicted to all opiate medications.
• My brain does not work the same as yours. When it comes to pain, I may feel it more intensely, and yet I am unable to be fully honest with you. My craving for opiates is just too strong.
• I am scared of being in pain, but I am even more scared of returning to my addictive lifestyle.
• Regular dosing of pain medications is better than giving it to me as needed.
• I am unable to manage my own dosing. If a prescription is necessary, it should be given to a family member or friend.
• In regards to prescriptions, please give me as few pills as necessary and do not give me refills without seeing me first.
• I want to conclude my use of this medication in a healthy way. I do not want to spiral out of control and require medical detox to “get back to healthy.”

Would you like to talk about this article? Do you struggle with chronic pain and addiction? Call us and ask to speak with one of the Stepworks team members: 1-888-982-1244.

Okay, so that may not be a completely relevant quotation, but it’s humorous… and it gets us started.

We’re all familiar with the following cliche: “Which came first, the chicken or the egg?” The purpose of this article is to ask, “What comes first, psychiatric illness or addiction?”

After reading this article, you will be able to do the following:

- Define the term “substance-induced mood disorder”
- Understand the following conditions: major depression, bipolar depression, anxiety disorder, post-traumatic stress syndrome

Research has shown that over forty percent of people with addictions also suffer from a psychiatric condition. In psychiatric hospital lingo, this is referred to as a “dual diagnosis.”

This linkage between psychiatric conditions and drug use is not surprising. Many patients will begin using drugs in an attempt to self-medicate their symptoms. This is especially common in people who are addicted to alcohol or benzodiazepines like Valium or Xanax.

It can be very difficult to tell the difference between (A) someone who has a psychiatric condition and is self-medicating and (B) someone whose substance abuse is CAUSING their psychiatric symptoms. Again, it can be difficult to tell if someone is using drugs to cope with their psychiatric illness or if their psychiatric issues are CAUSED by drug abuse. This condition is called a “substance-induced mood disorder.”

All abused substances impact the brain in similar ways, including our internal reward system. In particular, drug use leads to the release of dopamine, which causes us to feel good. If this system is broken, normal levels of dopamine will be low. The result is depression. The symptoms of depression include sadness, crying, difficulty sleeping, a change in appetite, and feelings of worthlessness, helplessness, and hopelessness. Opiates can do major harm for people struggling with these issues.

Some drugs such as cocaine and methamphetamine cause the body to release the chemicals that are useful in fight or flight scenarios. Imagine looking up and seeing a lion staring in your face. Your heart rate will increase, your adrenaline will make you stronger and faster than usual, your pupils will dilate, and you will be keenly focused on what is happening. Cocaine and methamphetamine can cause similar symptoms. As the cocaine and methamphetamine damage parts of your brain, you are no longer able to distinguish dangerous situations from normal situations. Your brain is always at a heightened state of alert. This shows up as paranoia and anxiety.

In addition, drug use will lead to a roller-coaster effect on your mood. You will be up one moment (high) and down the next (withdrawals). These changing moods can be confused with bipolar disease. Bipolar disease – otherwise known as manic depression – is characterized by periods of extreme depression followed by periods of near-normal-moods or very-high-moods (known as mania). That’s bipolar disorder: think “up one minute, down the next.”

A substance-induced mood disorder is a disorder of mood, such as depression or anxiety, but it is caused by addictive substances. Again, a substance-induced mood disorder is a mood disorder that is CAUSED by addictive substances.

Here’s why it matters: it’s impossible for a doctor in a behavioral health hospital to accurately diagnose depression, anxiety, bipolar disorder, or attention deficit disorder when a person is still under the influence of abused substances. In other words, how can the doctor know for sure what is causing the problem? Is the patient’s behavior caused by a psychiatric condition or by substance abuse? It’s impossible to say.

This situation is common. It often happens when an addict is admitted to treatment and they report a history of anxiety. They are almost always being treated with Xanax, which is an addictive substance. When the physician stops the Xanax, the patient complains, “I really need my Xanax. I have a serious anxiety disorder.” While it’s true that the patient may struggle with anxiety, it’s also possible that their anxiety was brought on by substance abuse. When the substance abuse is corrected and the brain is allowed to heal, the anxiety may go away. For people who struggle with anxiety, that may be very difficult to accept, but it’s true.

Of course, substance-induced mood disorders DO require professional treatment. But the first step in treatment is safely removing the abused substance. If the mood disorder continues beyond detox, then non-addictive substances can be used to treat the symptoms.

With opiate abuse, it’s very common to experience depressive symptoms including sadness and insomnia. Many times, these symptoms will respond to treatment with classic antidepressants such as Prozac, Paxil, and Zoloft. Insomnia is often treated with a different antidepressant called Trazadone.

There is one mood disorder that bears special mention: post-traumatic stress disorder. It’s also called PTSD, and it occurs in people who have experienced or witnessed severe trauma. People with PTSD can experience depression, anxiety, flashbacks, and nightmares. Classically, PTSD has been associated with soldiers after they experience combat situations. Any severe trauma, however, can cause PTSD: physical abuse, rape, a severe accident, or witnessing the death of another person.

Studies have shown that over fifty percent of men with PTSD will experience a period of substance abuse in their lifetime. The reason for this is uncertain. Some believe that people with PTSD simply self-medicate with addictive substances to treat their trauma-related symptoms. Others believe that there are common factors that determine who develops PTSD and who develops substance abuse. Regardless, not all people who are exposed to trauma will develop PTSD, and not all people who have PTSD will develop substance abuse, but many do.

When PTSD and substance abuse occur together, both conditions require treatment. While medications such as antidepressants can help with PTSD, counseling is usually required as well. If you’ve been diagnosed with PTSD, we encourage you to seek treatment from a medical professional who has experience with dual-diagnosis patients.

Right now, you may be thinking, “Do I have a mood disorder or a SUBSTANCE-INDUCED mood disorder?” Well, that depends. You also may be asking, “Does it matter?” Yes, it does matter.

If you have ever been diagnosed with depression, anxiety, A.D.D., or bipolar disorder, ask yourself this question:

“Was I diagnosed while I was actively using drugs or alcohol?”

If so, have you ever had an extended period of time – say 6 months – when you were clean and sober? Did you have symptoms of a mood disorder at that time? If not, then you probably had a substance-induced mood disorder. If you stay clean and sober, we would not expect your mood disorder to continue beyond a few months. However, if you were diagnosed with a mood disorder while clean and sober, then it is a true mood disorder that will require treatment in addition to the treatment of your addiction. That’s a lot to take in, but try not to be overwhelmed. Here it is in a nutshell:

If you struggle with addiction AND you struggle with your moods, you fall into one of two categories:

1. You have a true mood disorder.
2. Substance abuse is causing your mood disorder.

Remember, the only way to know the answer is to get clean and sober. That’s the first step regardless.

If you have a true mood disorder, here’s what you need to do:

1. Seek treatment for your addiction.
2. Seek treatment for your mood disorder (remember to find a medical professional who has experience with dual-diagnosis rehabilitation patients).

If substance abuse is causing your mood disorder, here’s what you can expect: get clean and sober, and in time, your moods should become much more manageable. It’s yet another incentive to take your life back from drugs and alcohol.

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Are you struggling to process this information and how it applies to you or your loved one? Call 1-888-982-1244 to speak with one of our team members.