After spending years in Australia locked into an addiction to amphetamine, cannabis and alcohol, Adam’s recovery leads him to the UK where he marries. His life spirals out of control after traumatic experiences, before he continues on his recovery journey and moves back to the other side of the world. (11,648 words)
The Drug Experience: Heroin, Part 6
January 18, 2023 by
In the last Briefing, we started to look at the recovery process for people who become dependent on heroin. Analysis of the interviews with 70 recovering addicts in Scotland emphasised the importance of the person wishing to restore a ‘spoiled identity as being key to a successful recovery. The person must not only desire a new identity, but also want a different style of life. They must also believe that this is feasible.
Nearly all the interviewees described previous attempts at trying to stop taking drugs which ended in failure. These failed attempts are not simply a waste of time and they may play a significant role in the process of recovery.
A period of abstinence can clarify and highlight the extent their identities have been damaged. During abstinence, addicts can examine their drug-using lifestyle from the perspective of a non-user. Also, the addict’s residual identity (non-using identity) can re-emerge and comparisons can be made between it and the drug-using identity.
Addicts not only acquire first-hand experience of an alternative lifestyle, but also potentially see its feasibility. If they can abstain from taking heroin for a time, why not for good?
Despite knowing that they need to stop taking heroin, a person may continue because they fear the pain and discomfort of withdrawal. Ambivalence is a striking feature of addiction, particularly when the person has made a rational decision to stop using and makes attempts to do so. There is a conflict between wanting to change on the one hand and a reluctance to give up the drug on the other.
In people who have become dependent on heroin, the vast majority of periods of abstinence are followed by relapse (mind you, this is the same with smoking!). It is much easier to stop taking drugs than it is to stay stopped.
Factors that are known to precipitate relapse include: craving or continued desire for drug; negative emotional states such as depression, boredom and loneliness; the experience of stressful or conflicting situations; and pressure from others to resume drug.
However, these risks, or predisposing factors, do not lead inevitably to relapse. Many addicts recover successfully despite these negative experiences. Why?
McIntosh and McKeganey emphasise that ‘… the key to successful recovery from addiction is the construction by the addict, of a new identity incorporating non-addict values and perspectives of a non-addict lifestyle.’
The construction of a new identity, or a renewed sense of self, has to be built and constantly defended against a variety of often-powerful opposing forces.
‘One of the reasons why the transition is so difficult is because the individual has to get used to an almost entirely different way of life. The drug using lifestyle has provided much of the meaning, structure and content of the person’s life, often for many years, then all of a sudden it is gone and something has to take its place.’
It is generally very difficult for addicts to re-enter conventional life—they often feel strange, incompetent and lacking in important practical and social skills. They have been detached from mainstream activities and culture for a long time, and have often done ‘every-day’ things under the influence of the drug.
‘The second thing that makes managing the transition out of drugs so difficult for addicts is the unrelenting nature of the task of ensuring that they remain abstinent.’
In establishing a new identity, addicts have to distance themselves from their past lives and their drug-using networks. Interviewees emphasised that a continuing desire for drugs—which does abate over time—and a lack of confidence in being able to resist, makes them vulnerable. They wanted to put as much distance as possible—socially and physically —between themselves and those who might seek to tempt or pressurise them into using again.
Recovering addicts also have to develop a range of new activities and relationships both to replace those that they have given up and to reinforce and sustain their new identities.
One of the major problems that addicts face when giving up drugs is how to occupy their time. The drug-using routine —getting the money, acquiring and then taking the drug – took up a major part of the day.
Interviewees recognised how important it was to keep themselves as fully occupied as possible, both mentally and physically. However, simply occupying their time was not enough. They want to do something that provides a sense of purpose and gives their life some meaning. The ideal solution is paid employment.
Recovering addicts also need to develop new social relationships in order to fill the social vacuum. These relationships must reinforce the new identity, support the alternative lifestyle, and help provide the recovering addict with a new sense of purpose.
The acceptance by non-addicts of the recovering addict’s new identity is especially important in sustaining its development and, thereby, maintaining abstinence from drugs.
Once the person’s new life begins to develop—with new activities, relationships and commitments—this creates a powerful barrier against temptation to revert back to drug taking.
New activities and relationships impart a sense of normality and progress and help to reinforce faith in both the desirability and in the probable success of rehabilitation. They also provide positive reinforcement for the recovering addict’s attempt to develop a more positive sense of self and self-worth.
The new life provides a stake in the future.
Recommended reading:
James McIntosh and Neil McKeganey (2002) Beating the Dragon: The Recovery from Dependent Drug Use. Prentice Hall.
> Part 7
The everyday lives of recovering drug users
June 21, 2022 by
I recently found this very interesting and important piece of research from 2012, The everyday lives of recovering drug users by Joanne Neale, Sarah Nettleton and Lucy Pickering, which was part of a Royal Society of Arts project focused on addiction recovery. Here is what the RSA Director of Research, Steve Broome, said about the research:
‘This is a fascinating, in places touching, and, most importantly, useful book. Seldom heard personal accounts from 40 recovering heroin users reveal the psychological, physiological, and emotional journeys as they overcome their addiction. Ultimately, they are human stories that reveal simple and modest aspirations: recovering heroin users want to participate and feel valued as productive members of society. In the words of several interviewees, they just want to feel “normal”.
Learning About Addiction Treatment, Part 8
July 6, 2021 by
In my third blog post focusing on what I learnt from the treatment agency BAC O’Connor back in 2004, I focus on two themes. Firstly, how staff deal with people who relapse during the treatment programme. Secondly, how the agency works with ‘clients’ to help them integrate (back) into their community.
BAC O’Connor were more realistic about relapse than many other treatment agencies. Relapse was considered part-and-parcel of the recovery process, and was an issue that was addressed in a pragmatic and humanistic manner. Clients who continually relapsed and left the Centres were always given the opportunity to return and receive the help they needed. Noreen Oliver said to me:
Pathways from Heroin Addiction: Recovery Without Treatment, Part 3
April 30, 2021 by
I continue my series of blog posts on Patrick Biernacki’s research from the mid-1980s focused on natural recovery from heroin addiction.
People who have been addicted to heroin report experiencing cravings for the drug long after they have given up using. Many people who have relapsed and gone back to using the drug after a period of abstinence attribute their relapse to their cravings for the drug.
A craving for heroin is used to describe a strong desire or need to take the drug. Craving is often brought about by the appearance of a cue that is associated with the past drug use. These may be cues associated with the withdrawal from heroin, or with the pleasurable effects of the drug.
‘These Three Companies Make a Point of Hiring Recovering Addicts’ by Heidi Vanderlee
May 15, 2014 by
My apologies for being offline twice twice in the past couple of weeks but we were hacked and I didn’t realise our website was closed down by our server company as I was asleep! Hassles of a life online!
‘So you’ve hit rock bottom and now you’re crawling your way back out. But unfortunately the hard work that goes into getting sober won’t pay the bills. Getting hired as a recovering addict isn’t always easy: Many of us have spotty employment histories, and the stigma attached to past criminal or mental health records may deter potential employers.
Addicts in early recovery often find themselves tending bar, waiting tables or working the cappuccino machine at a local coffee shop. But if mixing boozy beverages or making little hearts in foamed milk isn’t up your alley, there are still plenty of other employment options out there.
Growing numbers of non-profit organizations – such as the Doe Fund and the Salvation Army – are going out of their way to find employment for addicts in recovery. And there are places where your history with substances could actually give your CV the boost it needs to get you in the door.
My Favourite Blogs: Beth Burgess – ‘What is Recovery from Addiction?’
February 15, 2014 by
I love this piece of film from Beth Burgess, a recovery coach with Smyls.
There’s a big difference between sobriety and recovery. Beth points out that many people give up trying to stop drinking after a few days because it feels too difficult. They don’t realise that these bad feelings don’t last if you make the journey to recovery.
Beth describes her first experience of sobriety – “It was horrible” – before she relapsed. Now she is in recovery, she doesn’t think about alcohol. She loves her life. How do you get to that stage?
Many Faces1Voice: Phil Valentine
January 14, 2014 by
“I don’t think we’re all that good at handling relapse. We talk about it like, ‘The person wasn’t ready, you know, or it was their fault. And maybe there is some truth to that. But how often does the recovery community, or providers or the system rally behind someone that’s relapsed.
And the native Americans taught me something on their thing, that they, if you truly believe that addiction is a force of darkness or a force of evil or whatever you want to call it, and you’re fighting a battle and once you’re in the light you’re finally fighting a battle against this darkness. Then, in a sense, we’re warriors, aren’t we? Are we? We’re on this side of light, we can be warriors.
You know what this two-word programme is that the native Americans have? Warrior… Down. Do you leave a warrior on the battlefield?” Check out Phil Valentine on Vimeo
‘Warning Signs of an Alcohol or Drug Relapse’ by Matt Kay
October 23, 2013 by
‘Relapse is so common in the alcohol and drug recovery process that it is estimated that more than 90 percent of those trying to remain abstinent have at least one relapse before they achieve lasting sobriety.
But a relapse, sometimes called a “slip,” doesn’t begin when you pick up a drink or a drug.
It is a slow process that begins long before you actually use.The steps to a relapse are actually changes in attitudes, feelings and behaviours that gradually lead to the final step, picking up a drink or a drug.
Detox and early abstinent recovery: make it easier
June 17, 2013 by
“If you are planning a detox, get ready for it. It’ll be much easier if you know what to expect. Don’t do your own detox, let someone else be in charge. Stand alone detoxes will almost all fail: you need detox plus. By that, I mean more has to be added in. Getting onto an intensive treatment programme (either residential or community) at least three months long is likely to help. Stay away from using or drinking friends and delete dealers’ numbers from your mobile. Always remember, you only need to do this once.”
Peapod was one of the most prolific and respected bloggers on Wired In To Recovery before going into ‘retirement’. (S)he wrote a series of must-read blogs containing important hints to facilitate recovery which were very popular. Peapod’s empathy and understanding, as well as experience in the field, shone through in these blogs. I’ve arranged these blogs into what I call ‘Peapod’s Guide to Recovery.’ This is the first of seven articles.
‘Detox and early recovery: what’s it feel like?
‘’Empty’; ‘cored out’; ‘flat as a pancake’; ‘anxious’; ‘aching’; ‘miserable’… all comments I’ve heard from clients after detox. It resonates with my own experience. I’ve been detoxed twice and I found it pretty hard going.
This week, I’ve spotted a few people on Wired In asking if it’s normal to feel so low after a detox. I’ve commented in each case I’ve spotted because I know what a vulnerable time it is. Have ever walked or driven across a salt pan? These are big flat expanses of endless monotony and sometimes used as a metaphor for the post-detox experience. So why is detox and the immediate time after so challenging?
A bit about the brain
Whether you sign up to the disease model of addiction or not, there’s overwhelming evidence to show that addiction causes changes in brain structure and function. As addiction takes hold, several things in the brain start to change.
Various drugs cause the pleasure chemical dopamine (a neurotransmitter or chemical messenger) to be released in large quantities. Cells near the ones that release dopamine pick it up on their surfaces through dopamine receptors stimulating the cell so we feel pleasure. Over time, the body thinks, ‘Wait a minute, with so much dopamine around, I’m feeling a bit over-stimulated; I don’t need all these receptors’ and shuts some of them down.
In addition, some drugs can suppress many of the brain’s activities. They turn the nervous system’s dial down a few notches, quietening nerves, worries and alertness. During detox, the dial gets turned back up suddenly. Lots of different neurotransmitters behave in odd ways. Pulse rises, blood pressure goes up, tremors, sweats and agitation are to the fore. It’s pretty unpleasant admittedly, but the good news is that all of this has a limited shelf life. It does get better.
Life is a bit greyed out
The first part of recovery is a bit of a pleasure desert. Scientists say that one effect of the limited number of pleasure receptors is that it is harder to feel pleasure from ordinary things early in recovery. Spending time with friends doesn’t do it. Having a meal out or going to the pictures hardly gets a blip on the pleasure radar. It’s no surprise that minds turn to the one thing that’s going to flood those limited receptors and create an oasis in the desert. Using or drinking again.
This does get better
As time goes by, the brain starts to readjust. Receptor production is switched on. The nervous system activity dial that’s been on max gradually gets turned back down again. We feel calmer, less empty and more hopeful, but only if we stick with it and get through the tough bit.
Clear and present dangers
There are three things to watch out for that might trip you up in those early weeks (or indeed at any time).
Stressful situations. Brain stress hormones can trigger the desire to use drugs or to drink. We need to find new ways of managing or avoiding stress. Sharing the journey with others is an effective way to deal with life’s stressful events.
Triggers and cues. Because drug memories and experiences end up engraved on the brain and because they encompass not just the pleasure, but the sensations, the context, where we were and who we were with, anything that reminds us of drinking and using can be a trigger to pick up again. Avoiding triggers and cues is a good idea.
The first drink or drug. It’s highly likely that this thought will pop into your mind at some point: “Maybe I’ll be all right now that my system has had a rest. Perhaps I’ll be able to drink and use normally.” Anything that floods those dopamine receptors can trigger off a powerful desire to have more. A glass of wine at the weekend, or a line of coke as a treat, are bad ideas for folk trying to recover. This kind of experiment easily leads to relapse.
What helps?
The brain’s function begins to recover in those early weeks and by two years is mostly back to normal. There are some things that you can do that are associated with making detox more comfortable, that make dealing with early recovery less grey and which reduce the risk of relapse.
In a nutshell it’s this: get connected! By that, I mean get connected to other recovering people. There’s research to show that increasing the number of sober people in your social network is associated with reduced relapse. Research from Connecticut has shown that simply by introducing one more sober person to your sober network you can reduce your risk of relapse by 27%. That sounds like a good deal to me.
If you are planning a detox, get ready for it. It’ll be much easier if you know what to expect. Don’t do your own detox, let someone else be in charge. Stand alone detoxes will almost all fail: you need detox plus. By that, I mean more has to be added in. Getting onto an intensive treatment programme (either residential or community) at least three months long is likely to help. Stay away from using or drinking friends and delete dealers’ numbers from your mobile. Always remember, you only need to do this once.
If you want success, then get involved with mutual aid groups. There are thousands of AA, NA, CA and SMART groups up and down the country. Almost everybody is nervous about going along, so phone the helpline first. If you know a member, ask them to take you along. Keep going back and check out lots of different meetings; don’t judge by your first meeting along. The more meetings you go to the better.
If relapse happens
Many people in long-term recovery will have had experience of lapse or relapse at some point. While you don’t need to use again, some people will and this can be a danger, particularly if you have been addicted to opiates. Loss of tolerance begins very quickly on getting drug-free and your system becomes more sensitive. Hundreds of people die every year in the UK from unintentional overdose.
You can minimise the risk. Do this by:
- Smoking, not injecting
- Using much less than before (as if you were starting for the first time)
- Not using alone, have someone around
- Don’t mix downers, like heroin, valium and alcohol (very important).
And if you do lapse it needn’t be the end of the world. Get help quickly. Get honest about it with your support network and put twice as much work into your recovery.
Important to know
Detox and even treatment are only small parts of recovery: for many of us, recovery is a long-term process. Most of the recovery journey will take place out of treatment environments – in social settings with other recovering people. Recovery is not about the absence of alcohol or other drugs. It’s about all the positives that come in, but you have to work for them and most of that work will be done more easily if you are shoulder to shoulder with other recovering people.’
Beth Burgess: ‘What is Recovery from Addiction?’
June 10, 2013 by
I love this piece of film from Beth Burgess, a recovery coach with Smyls.
There’s a big difference between sobriety and recovery. Beth points out that many people give up trying to stop drinking after a few days because it feels too difficult. They don’t realise that these bad feelings don’t last if you make the journey to recovery.
‘Detox and early abstinent recovery: make it easier’ by Peapod
June 1, 2013 by
Peapod was one of the most prolific and respected bloggers on Wired In To Recovery before going into ‘retirement’.
(S)he wrote a series of must-read blogs containing important hints to facilitate recovery which were very popular. Peapod’s empathy and understanding, as well as experience in the field, shone through in these blogs.
I’ve arranged these blogs into what I call Peapod’s Guide to Recovery. This is the first of seven articles.
