Mental & Emotional Self Care

I already talked about physical self care in a previous post. Mental and emotional health self care is even more important. Why? Because if you are a person with a substance use disorder then this part of you is very unbalanced and has contributed to your disorder. Sometimes it is the root cause of substance misuse. Since we are body, mind, spirit, all aspects of ourselves must be treated at the same time. This area might need a little more work to become balanced and whole. 

Again, it starts with you...the real you. Not the person you pretend to be at school, work or even home. The real you without any masks. Some people don't really know who they are since they have pretended and used substances for so long. So, the first step is to acknowledge your feelings. This takes time. What you feel is NOT who you are. It is a temporary uncomfortable place. Maybe you are angry or bitter that life dealt you so many difficulties. Maybe you are scared to get help; fear of the unknown. Perhaps you think it means being judged. It could be that you don't like or love yourself. You have self blame and guilt for getting into this situation and having this disorder. Well all that can get better and those feelings can go away! How? First, make the phone call for help. Entire cities are getting together and each agency near you may have a common goal of supporting you, guiding you towards treatment and recovery, and being there for you every step of the way. Gone are the days of going at it alone! Even if your family and friends are not supportive, these agencies are being taught on how to manage your care according to all your specific needs and be your support system. If this is not the case, then find an area that is adopting this type of care. It will be well worth it.

After you start treatment and feel safe and supported, let all those negative feelings melt away. Cry if you need to....it is therapeutic. Then it is time to get to know yourself. Self reflection is needed. Counseling is recommended. In most treatment programs it is mandatory since it is so crucial to success. Also do things on your own such as taking a walk every day and think about yourself: your dislikes, what you like about yourself such as your positive qualities. Think about happy times in your past and what you can do to make happy memories in the future.  Make an appointment for a Reiki session which is energy work that facilitates balancing and healing all aspects of you. Reflect while you paint or do color therapy. Besides walking, it is one of the best activities for self reflection and it can be fun! Work on a jigsaw puzzle. Go out and sit in nature without distractions. Listen to a  guided meditation in a place where you won't be disturbed. Sit in the Sun. Do some gardening or get some houseplants and take care of them (yes talk to them!). Listen to meaningful music. Journal by writing or drawing every day. Join a peer support group. Recovery is successful when you have multiple support sources. Plus you might make a friend or two.

Now that you know yourself a little it is time to love yourself and express who you are. Forgive yourself.  No more self blame!  Do one thing for yourself  EVERY day. It is so important to love yourself and to show yourself that love. Practice positive affirmations every day and say them out loud. Learn a new hobby that always intrigued you. Dance while no on is looking! Hug a pet or a friend and share your love. Watch a comedy and engage in laughter which is very therapeutic. Read a self help or spiritual book. Go out and listen to live music. Join a social club of some sort. There is a social club for every type of interest such as sports, art & culture, photography, book club, dinner & movie, dog walkers, singles, chess, cribbage, billiards, gaming , arts and crafts, etc...

As I said before, it starts with balancing the physical, mental/emotional and spiritual aspects of yourself. All this is needed for a successful recovery.

WHAT IS BUPRENORPHINE? WHAT IS METHADONE?

Buprenorphine is an "analgesic", aka pain medication, aka narcotic. It is man made from something "natural" and altered chemically to become a semi-synthetic compound. Yes it is considered a narcotic and treated as such by the DEA. It is in the "Opioid" category. When taken, this medication will merge with opioid receptor sites just as morphine, heroin or methadone does. But this med has other slightly different properties. 

Buprenorphine is a partial agonist opioid. Heroin and methadone are full agonists. I mention this since you might hear those terms, not to conduct an opioid course. Because it is a "partial agonist" Buprenorphine can give pain relief same as the other opioids but it doesn't affect your breathing as much as methadone would. It is faster and easier to get stable with this medication and when you are ready, faster and easier to detox off.  It is considered to be less addicting and with fewer side effects. It is shorter acting compared to methadone. You can't be on any benzodiazepine prescriptions (or illicit) such as xanax since it is not medically safe. You must be illicit drug free after you are stabilized or usually you get terminated. Remain illicit drug free and you get "take home" doses for several days or a week so you don't have to go everyday. Some clinics have you go every other day. Of course there is a catch: buprenorphine has what is called a "ceiling" effect. Meaning, once you reach a certain dose, taking additional doses does not give you more pain relief and it is not suppose to get you euphoric or high. Once you reach a certain level, that is it. Okay if your drug use has been 5 years or less or your daily use is not real high. For some people with substance use disorder  this works very well!  If you are taking buprenorphine and still have cravings then you need methadone. With the carfentanil, it is hard to judge if this treatment would work well with heroin users until one tries it. Doesn't hurt to try. 

Heroin users usually need methadone; WHY? Because of the large amount of daily use and recently because of the carfentanil potency. Methadone is a full agonist. It has no ceiling effect. It gives full pain relief but take too much and you will stop breathing and die. Plainly put. It affects your breathing so anyone with a respiratory disease such as asthma or COPD must be monitored and must be very careful in taking this medication. Methadone can also affect your heart rhythm. A very high dose (> 200 mg) or a dose above 80 mg in combination with certain prescribed meds such as clonidine or seroquel can be deadly. That is why methadone clinic patients are monitored so closely. For medical safety. Methadone is dispensed by nurses only (not counselors) and you are assessed before you take that daily dose, for medical safety. Methadone has a very long half life....it lasts for days in your body until it is totally out of your system. When you take it at a methadone clinic daily, as you should, it builds up in your body to a therapeutic level and then it is maintained at that level. A therapeutic level is when you have no physical withdrawal symptoms at all AND no cravings. You almost forget that you take it because you feel "normal". Not high. Not sick. No cravings. Just live and enjoy life. When I say methadone clinic, I mean methadone for addiction NOT pain. Methadone for pain is a totally different program, different approach and different rules. 

LIST OF MEDS RECOMMENDED AND OK TO ***FLUSH***

Source is FDA.GOV so this is the official word on this subject! 
As you will see, narcotics of all kinds are on this list along with one benodiazepine:
DIAZEPAM OR VALIUM

WHY FLUSH?
In past the concern was all about the water. Now, with the opioid crisis, it was determined that it doesn't affect the water supply enough to make a difference compared to the lives SAVED by flushing all pain medications. You see, once you cross over from tolerance to dependence to addiction, you are willing to do anything to get your next fix. This includes dumpster diving and trash hunting. Nurses used to crush it and mix with kitty litter and detergent. But even this measure is not good enough. The addiction is stronger than any offense from detergent or garbage! To do this properly it is recommended to crush the tablets then flush them twice. Whether they are capsules or tablets, put them in a bag, put your boots on, and STOMP them to powder then flush them twice. If it is just a couple and you have a pill crusher or hammer then you can use that. **If it is a fentenyl patch then *PUT GLOVES ON*, TAKE THE PATCH APART AND CUT IN TINY PIECES THEN FLUSH MULTIPLE TIMES. A fentenyl patch is made to be absorbed through the skin over a period of time such as 24 hrs or more. If a child, pet or maybe even an adult were to ingest part of this patch by mouth then it would definitely be deadly! Here is the official list from fda.gov., A-Z

"Medicines Recommended for Disposal by Flushing Listed by Medicine and Active Ingredient  There is a small number of medicines that may be especially harmful and, in some cases, fatal with just one dose if they are used by someone other than the person for whom the medicine was prescribed. This list from FDA tells you what expired, unwanted, or unused medicines you should flush down the sink or toilet to help prevent danger to people and pets in the home. 
 [the one with]* These medicines have generic versions available or are only available in generic formulations.
FDA continually evaluates medicines for safety risks and will update the list as needed. Please visit the Disposal of Unused Medicines: What You Should Know page at www.fda.gov for more information.
Medicine Active Ingredient
Abstral (PDF - 1M), tablets (sublingual) Fentanyl
Actiq (PDF - 251KB), oral transmucosal lozenge * Fentanyl Citrate
Avinza (PDF - 51KB), capsules (extended release) Morphine Sulfate
Belbuca (PDF – 44KB), soluble film (buccal) Buprenorphine Hydrochloride
Buprenorphine Hydrochloride, tablets (sublingual) * Buprenorphine Hydrochloride
Buprenorphine Hydrochloride; Naloxone Hydrochloride, tablets (sublingual) *
Buprenorphine Hydrochloride; Naloxone Hydrochloride
Butrans (PDF - 388KB), transdermal patch system Buprenorphine
Daytrana (PDF - 281KB), transdermal patch system Methylphenidate
Demerol, tablets * Meperidine Hydrochloride
Demerol, oral solution * Meperidine Hydrochloride
Diastat/Diastat AcuDial, rectal gel [for disposal instructions: click on link, then go to "Label information" and view current label]
Diazepam
Dilaudid, tablets * Hydromorphone Hydrochloride
Dilaudid, oral liquid * Hydromorphone Hydrochloride
Dolophine Hydrochloride (PDF - 48KB), tablets * Methadone Hydrochloride
Duragesic (PDF - 179KB), patch (extended release) * Fentanyl
Embeda (PDF - 39KB), capsules (extended release) Morphine Sulfate; Naltrexone Hydrochloride
Exalgo (PDF - 83KB), tablets (extended release) Hydromorphone Hydrochloride
Fentora (PDF - 338KB), tablets (buccal) Fentanyl Citrate
Hysingla ER (PDF - 78KB), tablets (extended release) Hydrocodone Bitartrate
Kadian (PDF - 135KB), capsules (extended release) Morphine Sulfate
Methadone Hydrochloride, oral solution * Methadone Hydrochloride
Methadose, tablets * Methadone Hydrochloride
Morphabond (PDF – 162 KB), tablets (extended release) Morphine Sulfate
Morphine Sulfate, tablets (immediate release) * Morphine Sulfate
Morphine Sulfate (PDF - 282KB), oral solution * Morphine Sulfate
MS Contin (PDF - 433KB), tablets (extended release) * Morphine Sulfate
Nucynta ER (PDF - 38KB), tablets (extended release) Tapentadol
Onsolis (PDF - 297KB), soluble film (buccal) Fentanyl Citrate
Opana, tablets (immediate release) Oxymorphone Hydrochloride
Opana ER (PDF - 56KB), tablets (extended release) Oxymorphone Hydrochloride
Oxecta, tablets (immediate release) Oxycodone Hydrochloride
Oxycodone Hydrochloride, capsules Oxycodone Hydrochloride
Oxycodone Hydrochloride (PDF - 100KB), oral solution Oxycodone Hydrochloride
Oxycontin (PDF - 417KB), tablets (extended release) Oxycodone Hydrochloride
Percocet, tablets * Acetaminophen; Oxycodone Hydrochloride
Percodan, tablets * Aspirin; Oxycodone Hydrochloride
Suboxone (PDF - 83KB), film (sublingual) Buprenorphine Hydrochloride; Naloxone Hydrochloride
Targiniq ER (PDF - 48KB), tablets (extended release) Oxycodone Hydrochloride; Naloxone Hydrochloride
Xartemis XR (PDF - 113KB), tablets Oxycodone Hydrochloride; Acetaminophen
Xtampza ER (PDF – 67.6KB), capsules (extended release) Oxyccodone
Xyrem (PDF - 185KB), oral solution Sodium Oxybate
Zohydro ER (PDF - 90KB) capsules (extended release) Hydrocodone Bitartrate
Zubsolv (PDF - 354KB), tablets (sublingual) Buprenorphine Hydrochloride; Naloxone Hydrochloride"

Kids and Overdose. Alert to Parents and Kids!

Tragically, in the news, you may hear about a child getting hold of an opioid and overdosing (stopped breathing). If the child was very young, then the drug was probably was hanging around, and like kids do, they put it in their mouth or mimic what they see the adults do. If was a preteen or teenager, then most likely they overdosed because they chose to use an opioid of some kind. Once you reach a certain age, it's all about choices. Why would a preteen or teenager decide to use an opiate? The first thing that comes to mind is Peer Pressure. Their friends are doing it and they want to be part of the gang and fit in. OK for maybe one time, but there are root causes for continued opioid use. The one that comes to mind is physical pain: a football injury, cheerleader injury or a sports injury of some kind. Or it could be pain from an accident such as a car accident. So what is the other reason? Emotional pain. Any type of chronic emotional pain such as teasing at school for any reason, poor relationship with parents/siblings, childhood trauma of any kind, ....anything that a kid would consider hurtful that continues on. The kid wouldn't know what to do about it and that could lead to hopelessness. To stop the emotional pain, a kid might drink alcohol or use drugs to temporarily feel better. Dangerous, yes, but kids don't think that far into the future, especially if they are hurting in some way. Now we all have had some childhood issues at one time, but I am talking about months to maybe even years of emotional pain. To a kid that is forever. Parents, what can you do to help prevent your child from falling into this death trap? I call it LOUD. Tell your kids you want to talk LOUD. It stands for:

Let's talk about
Opiate
Use and
Drug abuse

You see, kids like to think they are fooling their parents when taking certain risks. Let your kids and teenagers know that you are AWARE and KNOWLEDGEABLE. It opens the door to drug talk. It is at that time that a kid might say how they are feeling hurt over something in their life or even alert you to the behavior of another kid or teenager. There is a 2017 phrase, "Take 5 to save lives". It is about kids supporting each other to prevent suicide. Well, the same can be done for drug abuse to help prevent overdoses! Parents, tell your kids you want to talk LOUD! Kids, band together and help each other prevent drug use and overdoses. Stay alive, Don't Die! Talk LOUD to your parents! Talk LOUD to your friends! 

Can I die from withdrawal symptoms if they are bad enough? What can I do for withdrawals?

You will not die from the symptoms of opioid withdrawal, no matter how bad they are. You will feel like you are dying and others looking at you might agree. You will not die, but there is no doubt you are suffering :(     What can happen medically is severe dehydration from the sweating, vomiting and diarrhea. Being badly dehydrated is a feeling of extreme weakness, pale skin, sunken eyes, cracked dry lips, possibly even dizziness. If the person cannot drink a large amount of water and Gatorade or Powerade, then go to an Urgent Care for IV fluids to rehydrate. In a dehydrated state you are at risk for injury from a fall due to weakness. How many of us had a real bad flu and nearly fell in the bathroom from feeling weak and dizzy? Be safe.....getting hydrated is necessary whether it is from drinking lots of fluids or getting IV fluids. Always have some Gatorade or Powerade in addition to water and IV fluids to replenish your electrolytes. It will help bring back your strength. Over the counter products can help with other withdrawal symptoms such as Immodium for diarrhea, I would avoid Kaopectate and Pepto Bismol since it contains a substance similar to aspirin and anyone ages 12-18 should not take aspirin since there is a chance it can cause a disease called Reyes Syndrome (serious/ fatal disease) if conditions are right. Imodium takes a little time to work so take it at the first signs of diarrhea. If you are pregnant, go to the Emergency Room since you don't want to risk taking any medication, and dehydration when pregnant is much more serious! For muscle cramps take ibuprofen or naproxen but don't exceed the max dose recommended or you can damage your kidneys. I would avoid acetaminophen unless you are absolutely sure you do not have Hepatitis C Antibody; it might overload your liver. Over the counter magnesium supplements also may help muscle cramping if taken according to directions and you do not exceed the recommended dose. Need some sleep? Only at night, use generic benadryl (diphenhydramine) 2 caps and try some melantonin: anywhere from 3mg - 5 mg any brand, or a 10 mg time release tab by Natrol. Melantonin is a hormone your own body makes which regulates the wake-sleep cycle. Taking a supplement helps some people with sleep disturbances get a decent night's sleep. If you end up going to Urgent Care it is best to have someone with you who knows about why you are in this condition. If ER staff suspect you are in withdrawals then whoever is with you might find out. If the Emergency Room takes blood...if they draw any blood they might do some drug testing......if they get a urine sample they might do some drug testing.....that is all I will say on that. If you are drug tested in any way and you are on probation then your probation officer might find out and have concrete evidence against you. Be wise. Go for IV fluids and don't ask for any narcotics or benzodiazepines (like xanax or ativan) and you should be treated well, be rehydrated, & released. Simple as that.

Recovery: The Intake Appointment Part 2

So you already gave you address, phone numbers, emergency contact, paid your fees and have been told countless of instructions and rules. Don't worry about remembering all that. You can always ask and most likely you will be reminded by both staff and other patients. The mindset of patients in recovery seems to vary according to what state or part of the USA you live. I have been told countless of times by "visiting" patients from other states how this is true. So this is straight from the patients themselves. (By the way, in NH, we are very friendly and helpful to all.)
So the Addiction Counselor is the next professional you will see after the business part. This is a long detailed meeting but it is very important! Please do NOT use right before this Intake appointment and do NOT use in the bathroom in between seeing professionals! You nod off, and you have to reschedule! You are cranked up and can't sit still, you have to reschedule! and that postpones your first medication appointment with the doctor so it is pointless. Now, we don't want you vomiting either so plan accordingly....you know what I mean. The appointment is at least 2 maybe 2 1/2 hours. When you see the Addiction Counselor you will be asked everything from the first day you ever used in your life until present day. Questions about every drug you tested including cigarettes and alcohol. Please be honest but don't embellish. No one will be impressed. They will ask about your childhood, your family, employment, legal stuff etc...all this plays a significant role in your recovery. If Uncle Brian beat you every Christmas morning, we aren't going to ask you how your Christmas was. If your friend overdosed in March, we will be on the alert for depressive behavior and possible alcohol/drug use near springtime. All the questions are for a reason. We don't like paperwork that much. A big thank you for being patient with all the questions! The last professional you will see is the nurse in The Intake appointment part 3.
.

Myth: Methadone rots your teeth

FALSE. Teeth do not rot within months of starting a methadone program. It takes time, lots of time to have more than one tooth rot enough to be pulled. It is the amount of time you spent using that is the culprit. Years of not eating properly (and not taking vitamins), years of not brushing, years of not seeing a dentist for preventative cleanings will lead to tooth decay. A poor diet for an extended period of time will leave your body deficient in nutrients. Then your body start taking nutrients where it can, at the least vital place...your teeth. Once you are in recovery, you start noticing what you couldn't see or feel while you were using all those years. Your gums are sore, they might bleed easy, you have uncontrolled bad breath. You start taking care of your health and think you escaped any health issues. Then one day you bite into something and start chewing and....snafoo! A broken tooth. It is easy to blame methadone and since there is some amount of sugar in the liquid form. It might sound like a very logical blame to you. But know it takes years to do that kind of damage. Nothing you can do about it now except take care of what is, and do what you can to prevent any further damage. At the first sign (or before) of trouble with teeth or gums, make an appointment with a dentist. Don't wait until you are in pain, have an infection or break a tooth since there will be a period of waiting until an appointment is available. Worst case scenario:  having a legitimate infection with pain and going to the Emergency Room as an addict asking for an antibiotic and pain med. If they don't want to give you pain med, you suffer. If they give you pain med, you should give the med to a family member who can dispense the correct amount of tablets to you during the prescribed time frame. Until you are further along in recovery it is way too tempting to abuse the prescription. You don't want to make your situation worse, make yourself feel worse or lose any ground you gained while in recovery. If you made progress in recovery, be proud and ask someone to help you with your prescribed med!

The First Step: The Phone Call

So you don't want to tell your family or friends you have a problem with misusing substances or medication...OK. It's your life, but if you want to take that next step towards a BETTER life, then you need to talk to professionals who can help you with tackling this disease and head towards recovery. So it is a matter of making that first phone call. NOT always a  simple task!  You might feel a rush of all kinds of feelings that are very uncomfortable. Feelings you have numbed and shoved back inside of you all this time. One way to help minimize this experience is to have someone with you when you make that first call. It can be someone from a recovery group or local community service. Heck it can be a firefighter or a social worker or nurse in the local Emergency Room. All public service professionals will be willing to sit with you for a few minutes as support while you make your first phone call for help with your disease. If you have someone in your personal life with you at the time of the phone call, make sure they are stable, sober, not impaired and have your best interest at heart. FYI:  The first phone call will 1) give you basic info on the service,  2) info on insurances accepted or cash payment and either 3). make your first appointment for an Intake or put your name on a wait list. ***This phone call, entire conversation and any info given is completely confidential.  NO ONE can call and see if you called, NO ONE can check to see if you have appt or are on the wait list. NO ONE, period. Not even your mom! This is the law! A violation of this law can get a person jail time. So congratulations if you made your first phone call :)  I will talk about the first Intake appointment in another section with the word Intake in the title.

Do I have to tell anyone?

Have you ever tried to explain the mechanics of what is wrong with a car and how to fix it to someone who doesn't have a clue?  That is what you will get trying to talk addiction to friends and family who are not educated on the subject. It is a foreign language and a foreign land. Not their fault and not their problem. It's your problem and your recovery. Some family are open to the subject and if they are ....well, you are very lucky!  Not everyone is open to the subject when it comes to family. Could be pride, or maybe they are addicts/alcoholics themselves! Who wants to look in the mirror? If you don't have the support of family and/or friends then there are plenty of support groups and others in recovery you can turn to. If it's one thing I know to be true:  addicts will always accept other addicts and be there for that 2 am phone call when you really want to use. You don't have to be BFF, but some type of support is needed in recovery. Someone who understands exactly what you are going through and can listen without judging. With the opioid crisis going on there are many new hotlines, support groups, treatment centers and professionals in this field. If one doesn't suit you, there are plenty more to try.

"I'm getting clean...now what....I still have problems!"

Problems, problems, problems! You had a problem and turned to drugs/alcohol to fix it, then got addicted. You had a problem and did drugs to distract you or numb you, then got addicted. You did drugs/alcohol, you got addicted, and it caused problems in your life. Addiction ruins every aspect of your life: personal, family, social, employment, legal. It is a vicious cycle: problem....drugs, drugs....problems...back to drugs etc...Your mind makes up excuses and reasons to continue using drugs. In the old day it was called, "Stinkin Thinkin". Your mind wants to win, and your mind is strong! That's where Addiction Counseling comes in with Addiction Focused Problem Solving to break the cycle. It is a specialized approach to .....everyday shit.  You need Addiction Counselor to show you how it works. With focus and 100% effort it can be done!

HOPE

Like the Phoenix, the addict can rise from the ashes of  the old self into the new self!

Misconceptions

"I can detox myself"
If you take another person's methadone or suboxone, you buy it off the street (it is probably diluted or altered somehow). You try detox yourself slowly so you don't go into withdrawals. So, intentions are there...but....can you really do this and wean yourself completely off, and stay off ... off ANY narcotic or alcohol? NO. I know because addiction is an official disease. and even if you don't believe that, think about it: How many addicts have tried but couldn't stop on their own? or if they did, how long could they maintain that? When an addict sees how it destroys their life, they don't WANT to do it but they MUST so they don't get physically ill and can function normally at work, at home etc... and even when an addict physically weans off the drug, there is a psychological component that is not addressed. Therefore the cycle eventually starts over and continues until addressed. That is where outpatient treatment centers come in. Could be methadone or suboxone. The "medication" is an actual prescription by a certified psychiatrist. It is dispensed by Registered Nurses who are trained in Addiction. Yes, you are usually routinely drug tested to check your progress and there is Addiction Counseling. The physical addiction part is easy. It is the psychological component that a person normally cannot do on their own without guidance, monitoring and support. It is the only way to change your thoughts and behaviors long term. Remember, Addiction is a disease and needs to be treated seriously as a disease or it will come back as that awful problem and cause problems.