Rubber-band addiction recovery – No shame

There’s a specific issue that keeps coming up with nearly every addiction client I work with who is in early recovery. Regardless of whether they’re trying to stop unhealthy alcohol or drug use, sex or gambling behavior, or anything else, this issue keeps returning. It doesn’t even seem to matter if this is their first attempt at addiction recovery or if they’ve already been here many times before.

The issue: Shame about a desire to return to old behaviors and stopping their recovery.

At the Matrix Institute on Addiction where I see some clients, they call this “The Wall” suggesting that it usually comes right after a relatively easy period of recovery in which clients are self-assured and confident that they’ve got their addiction beat. “The Wall” is supposed to be marked by anhedonia, depression, severe cravings, irritability, and more fun stuff like that. After the wall is the promised land of long-term recovery. By identifying the specific stages of recovery addicts are supposed to gain more understanding of their process and experience less shame. I love the Matrix method, but I see things a little differently.  The way I see it, “The Wall” is far from a single point in time, but is instead part of a larger pattern I like to call Rubber-band Recovery.

Rubber-band Recovery in Addiction

Addiction recovery is similar to letting go of a stretched rubber bandI’m sure everyone reading this has at some point played with a rubber band, stretching it and letting it snap back to its original state or pulling it between two fingers and playing it like a string (another name for this approach could be String Recovery, but that might get confused with theoretical physics and we don’t want that). When pulling the rubber-band one way, its internal structure pulls back, trying to get back to its natural state. The body can be thought to do the same when placed under chronic alcohol and drug use in addiction – it has a slew of internal processes that work hard to keep the body in its natural state, at homeostasis. Naturally, due to the pharmacological mechanisms of alcohol, cocaine, methamphetamine, marijuana, and many other drugs, these systems usually fail at setting everything back to normal especially during the use itself, which is why we get high. However, their work in a body that consumes drugs on a regular basis is obvious – reductions in the production of specific chemicals (like relevant neurotransmitters), changes in the structure of the brain itself (like producing less receptors or even removing some from the brain’s cells), and production of chemicals that combat the drugs’ actions.

All in all, the body and brain of a long-time, chronic, heavy user of alcohol and drugs are different from the body and brain they started with in important ways that specifically relate to their alcohol and drug use. They are like the stretched rubber band, similar but obviously not the same as it was in its relaxed state.

Individuals in early recovery from addiction essentially experience what happens when that taut, stretched, rubber band is let loose. Hurrying up to get back to its natural state, to homeostasis, it releases all that pent up energy and rushes through its original state, overcompensating and stretching a bit in the other direction. For the addict in early recovery, this is the process of withdrawal. As we’ve spoken about numerous times before when discussing withdrawal, a brain that has reduced its own production of dopamine because of large amounts of methamphetamine that flood its dopamine reserves will still be left with very low dopamine when the crystal meth stops coming in. Low dopamine will bring about many effects that look exactly like the opposite of a methamphetamine high – a large appetite, low energy, and reduced movement and motivation. For heroin addicts, the drug that’s caused them to feel no pain and become constipated will cause their bodies severe pain, diarrhea, and trembling when it’s removed from the equation. Some withdrawal is actually life threatening due to the extreme changes in body chemistry and structure that happen after long term use. In addition to all of the direct effects of the drugs and alcohol, those internal processes that have been working hard to counteract the effects of the drugs (they’re called “opponent processes” by some addiction researcher like Dr. Christopher Evans from UCLA) are still turned up to 10 and are going to take a little time to get back to their original state as well. All in all, that leaves addicts feeling pretty crappy to say the least during withdrawal, the worst part of early recovery from addiction.

But like that good old rubber-band addiction recovery than quickly turns around. Having overcome the worst part of withdrawal, addicts in early recovery often experience joy, confidence, energy, and clarity they probably haven’t felt in a long time. That along with the environmental influence of loved ones who are extremely happy to see an addict quit (especially the first time around) give those in very early recovery a feeling of great well being and happiness, like a nice pink-cloud they get to ride on for a bit. Remember, the rubber band is moving back in the direction it came from during active addiction and it’s likely that brain processes are doing a little overcompensating the other way now too, turning down those opponent processes and flooding the brain with the chemicals it’s been missing.

But alas, this little turn doesn’t last too long and back we go into the darker place of negativity, low energy, anhedonia, and more. But instead of calling this stage “The Wall,” I understand it as one of the inevitable turns in what is sure to be a back and forth, seesaw like trip of recovery ups and downs. Periods of confidence in our ability to overcome our demons are followed by others that make us feel week and irritable. The good news is that just like with a rubber-band, each successive cycle on this seesaw gets a little less intense, which means that confidence, elation, depression, and anger turn into comfort, contentment, and ease – our new homeostasis. After a ride like that most addicts really need a little rest and when we reach this stage (no matter what it looks like specifically for each person), long-term recovery feels like the norm instead of an effort. This is the real end goal of recovery – a state of being that feels normal and that doesn’t involve unhealthy alcohol or drug use, sexual acting out, or gambling.

At the end of the rubber-band game we get back to just a good old unstretched rubber-band, and it feels good. In the process, it makes little sense to feel guilty, or ashamed, at all the intermediate stages. They’re part of the game of recovery and they’re essentially impossible to avoid completely. Intense cravings come during specific parts because of internal, biological, and external, environmental influences. Being ashamed of that would be essentially the same as being ashamed of extreme hunger when you haven’t eaten in 5 hours and see a commercial for your favorite food – silly and useless. I can guarantee that the rubber band doesn’t feel ashamed about they way it behaves when snapping back…

One day at a time, but not forever!!!

If you’ve ever gone to a 12-step meeting, you’ve heard the phrase “one day at a time,” so often as to make it a mantra. Personally, it always left me wanting more.

Is “one day at a time” enough?!

I think the notion is a correct one… when it comes to early recovery. However, once the initial excitement of staying sober has worn off and life without the crutch of drugs, alcohol, or any other addiction, begins, I believe that there is great value in planning.

Thinking ahead is exactly the sort of thing that addicts don’t do well. As far as I know, there’s only one way to improve a lacking skill – practice.

If a recovering addict truly takes things “one day at a time,” never making plans that take the not-so-near-future into account, where does that leave him except for being sober for one more day? As far as I’m concerned, that’s simply not enough.

I had a lot of learning to do when it came to living a normal life after I cleaned up. I barely knew how to function in the simplest ways without the crutch I’d become so comfortable with. I’ll never forget the single sentence lesson my dad gave me over the phone regarding handling my mail.

“Most people pick up their mail, open it up on the spot, throw away what they don’t need, and handle the rest immediately” he told me.

To me, that was more than a foreign concept; it just sounded strange. You see, I would let mail pile up for weeks, eventually throwing it away when it simply seemed overwhelming. The notion of taking care of my mail, or anything else for that matter, on the spot, sounded so simple as to be impossible. But guess what – it works!!!

Fortunately for me, by the time my dad had shared those pearls of wisdom, I’d been clean for six months and ready to put the lesson into action.

Making plans the right way

Recently, my fiance introduced me to an exercise that requires you to write down your plans for next week, next month, next year, and five years from now. I liked it because it made me think concretely about where it is I’m going in life both in the very short, and relatively long, future. By writing down how I saw different aspects of my life play out in the next five years, I got to think about them more directly than I ever had before.

I’ve adapted the exercise for addicts in recovery. I think that you should try it as early as you feel comfortable with it. The trick early on is to just complete it. Once the first draft is finished, you should go back and change it every once in a while.

Given how quickly things change in early recovery, the second draft should be completed after a week. Since you’ll be getting better, and more realistic, every time, the third draft should probably be done about a month later. From that point on, further edits can be done whenever life calls for it.

I think you’ll find that simply going through the exercise will tell you a lot about where you are in your recovery.

The exercise itself

The first thing you’ll need is a piece of paper. Divide the paper (you can use one side or both depending on how much you like to write) into five sections and title them as follows: “Tomorrow”, “Next week”, “Next month”, “Next year”, and “Five years from now.”

Under each one of the headings, answer the following questions for each of the time periods. Be as specific as possible. Feel free to add, or replace, any of these questions with ones you see as more relevant to your life.

  1. Where will you be living?
  2. What will your job be?
  3. Will you be in a relationship? If so, with who?
  4. How much money will you be making?
  5. What car (or other mode of transportation) will you have?
  6. List your five most important relationships – Describe the quality of each.
  7. What special trips, events, or occasions, will you be taking part in or planning?

That’s it. You’re done. Take a deep breath and read over the list.

Though it seems simple enough, you’ll see that answering these questions can be quite difficult at first. This is especially true the more specific you try to be (answers like “I’ll be living in a 3 bedroom house in Mar Vista with hardwood floors and a home office that faces east” might take some time for some of you).

Again, the point is simply to complete the exercise that first time. I promise you that it gets easier with time. Since you’ll be repeating it relatively often initially, you’ll be able to adjust your plans according to the changing circumstances of your life. Feel free to go back and redo the list any time.

Having goals, both short and long term ones, will help focus your mind. It will also plant the seed of the direction in which you want to take your life. Without this direction, things can seem chaotic, especially when one has recently given up their best friend (cocaine, marijuana, porn, and chocolate fudge ice-cream can easily be thought of as best friends when one is in the throws of addiction or recently out of it).

One day at a time is great, but when you want more out of life, planning is the only way to go.

Addiction help, exercise, and recovery – Running to stay clean

As we mentioned in recent posts, giving up addictive behaviors can be difficult.

Research on interventions has long shown that it’s a lot easier to reshape existing behaviors than it is to stop them. Therefore, refocusing, or rechanneling, your energy into something that will improve, not devastate your life should prove easier than simply stopping addictive behavior. Addiction recovery help is often centered on stopping the usage of drugs when instead, they should focus on replacing the use with something else.

Addiction help by active replacement

Exercise has been shown to improve mood, especially in the short term (1,2) and can therefore provide the extra emotional boost many addicts need when they first stop using. An article in the Journal of Sport Psychology reveals that running can create a sense of achievement, fulfill intrinsic and extrinsic needs, and provide a natural high (3).

An activity like running can provide a respite from daily life. It can also offer a means to re-direct most addicts’ need for something to obsess about.

Taking on a long-term running goal and getting involved in some training with appropriate short-term achievement markers can help people in recovery feel as if they’re regaining some measure of control over their seemingly chaotic life. Seeing yourself able to run longer distances, faster times, and feeling the health benefits can be very rewarding.

An inspiring story in Runner’s World magazine tells the story of a father and son who did just this, conquering their drug addiction by taking on the challenge of completing a marathon.

Addiction help, not a new disaster

Importantly, a study has found that animals that are prone to drug addiction are also more likely to develop obsessive running patterns (4). This suggests that a link between these behaviors does indeed exist and underscores the importance of being mindful even when performing these more benign activities; the goal is staying healthy after all.

Keeping this in mind, there are a few simple things that will help reduce the chances of injury as you start running:

Stretching is important for injury prevention. Activities such as yoga are beneficial for runners and can stretch out sore muscles, prevent your next injury, and relieve stress. (Runners World)

Make sure to set realistic running goals and not push yourself too far. Taking on too much too early will only lead to injury and burnout and hurt, not help your enjoyment of running.
So instead of just trying to quit, try changing behaviors that you commonly engage in into ones that are more productive.

Question of the day:

Have you found that running, or a similar form of exercise helped you kick bad habits?
If so, would you mind sharing your story?

contributing author: Katie McGrath

Citations:

1. Plante and Rodin. (1990). Physical fitness and enhanced psychological health. Current Psychology: Research & Reviews, Vol 9, Spr 1990, pp. 3-24.

2. W. De Coverley Veale (1987) Physiological and Psychological Effects of Short-term Exercise Addiction on Habitual Runners, Exercise Dependence Addiction 82 (7) , 735–740.

3. Mark H. Anshel (2005). Applied Exercise Psychology: A Practitioner’s Guide to Improving Client Health and Fitness, Springer Publishing.

4. Werme, M., Thoren, P., Olson, L., Brene, S. (1999). Addiction-Prone Lewis But Not Fischer Rats Develop Compulsive Running that Coincides with Downregulation of Nerve Growth Factor Inducible-B and Neuron-Derived Orphan Receptor 1. The Journal of neuroscience, 19, pp. 6169-6174.

contributing author: Katie McGrath

Thinking straight might help: Modafinil in early recovery from crystal meth addiction

I’ve mentioned before that I believe medications can be a very helpful tool in early recovery, especially for specific individuals who need help getting over the initial, most difficult, period (look here).

If you take a look at my first post about meth and its effects on the brain, you’ll read that crystal meth use can negatively affect the function of a neurotransmitter called dopamine. One of the dopamine’s important roles in the brain has to do with impulse inhibition and control over behavior.

The role of impulse control in early recovery trouble

With a reduced capacity for behavioral control, it’s no surprise that people in early recovery find it especially hard to resist urges to use again. When you consider that it’s already been shown that addicts are more likely to have impulse control problems, like ADD/ADHD, the role of impulsivity becomes even more important for understanding addictions. Having less control over a preoccupation that results in obsessive-thoughts and compulsive-actions means that slips, or relapses, are an almost expected outcome.

If we could only figure out how to give people better control over their impulses, we’d possibly better equip them to prevent their own relapses.

ADHD medication for crystal meth addiction help

Well, a number of drugs used for ADHD have been researched as possible aids for addicts, and it seems like Modafinil (marketed as Provigil) may help with exactly the cognitive deficits that seem to trip meth (and cocaine) addicts in early recovery up. In fact, the results seem to be strong enough to warrant the initiation of some larger scale investigations. This, along with previous findings that reported relatively low abuse-potential for modafinil suggest that this may indeed prove to be a useful medication.

No one is saying that this is the pill that will cure addiction, or even that a pill like that is going to be found. But hopefully, along with other medications (like Bupropion), the number of tools in the proverbial toolbox of addiction specialists will continue to increase, allowing them to better treat a larger proportion of those suffering from addiction.

Citations:

Jasinski, D. R & Kovacevic-Ristanovic, R. (2000). Evaluation of the Abuse Liability of Modafinil and Other Drugs for Excessive Daytime Sleepiness Associated with Narcolepsy. Clinical Neuropharmacology, 23, 149-156.

Ling, W., Rawson R., & Shoptaw, S. (2007). Management of methamphetamine abuse and dependence. Current Psychiatry Reports, 8, 345-354.

About addiction: Exercise, stigma, marijuana, and friendhip.

Here we are again. I’ve been slacking on this, but check out the new crop of great articles about addiction. As usual, if you press the title of this post, you’ll be rewarded with our relevant posts!!!

MSNBC: Exercise may help prevent substance abuse – Here’s an article that reports on some of the findings I’d recently talked about here.

Addiction Inbox: Treating addicts like human beings – About the stigma and shame associated with addiction.

Addiction tomorrow: Marijuana – a gateway drug?

Addiction recovery basic: Friendship in recovery – Having social support and friends is important, especially when trying to make huge changes in lifestyle like quitting an addiction.

About addiction: Weed, early recovery, teens and alcohol, and robotripping

We started this thread last week and I’m going to do my best to keep it up. Here are some links you may find useful on other blogs:

The Addiction News Network – Brain damage in young adults who smoke weed

Spiritual River – The usefulness of social support in early recovery

Breaking the Cycles – A great post about talking to your children about alcohol

Recovery Basics – Robotripping (Or Roboing as we used to call it) is apprently coming back

I hope you enjoy those as much as I did.