Last week, we looked at Sapphire’s Story, with the aim of showing the importance of person-centered treatment. Along Sapphire’s journey into and out of addiction, things went well when Sapphire was intimately involved in decisions about her treatment, but poorly when professionals took sole control.
We left Sapphire’s Story after the Community Drugs Treatment had reduced her prescribed methadone dose against her will and she started to use street drugs again. She eventually became addicted to crack. This drug took over Sapphire’s life, until the day she ended up in hospital: “I’m not sure what actually happened one particular day. I know that I had been up for about five days smoking crack and I think I had a fit and was taken to hospital.”
Sapphire was transferred to the drug and alcohol unit of the hospital and put on a high dose of methadone. When she left this unit, she did not go back to the controlling and abusive man she had been living with since she was 16 years old. Her parents had found out about her drug-taking and became very supportive.
‘Just prior to leaving hospital, I was being prescribed over 200ml/day of methadone. When I left hospital, I explained to the head doctor at the CDT that as I had previously been buying so much methadone on top of what I had been prescribed, if he were to prescribe (for example) 75mg/day, then I would be back to square one and topping up my dose illicitly.
The doctor was concerned that if he did prescribe the large dose I was requesting, it would still not be ‘enough’, and that in six or so months I would be back to buying methadone illicitly. However, I emphasised to him that I had no desire to continue my current lifestyle. I wanted to sort myself out, but unless I was prescribed a reasonable dose of methadone I would be stuck in groundhog day.
After a two-hour consultation, during which time he checked my hospital notes and saw that I had been prescribed over 200ml/day as an inpatient and had shown no signs of sedation, the doctor agreed to start me on a dose of 220ml/day, with the proviso that if I let myself, or him, down in any way that things would have to be reconsidered.
I was really grateful that the doctor believed that I was not just drug-seeking, and genuinely needed a higher than average dose.
Once I was stabilised on my high dose of methadone, I found that my cravings for crack diminished over time, although I still wanted to use the drug on occasion. I know that methadone is not supposed to be used for crack addiction, but lots of drug users have reported that if their methadone dose is increased significantly it can help curb their cravings for crack.
In my case, the higher than normal dose of methadone gave me the ‘space’ to be able to start working again and to distance myself from the drug lifestyle, so I could begin to think like a ‘normal’ person again. I dread to think where I would be now if I had not been prescribed this dose of methadone. (I should point out that I was still using benzos at this point, but only as prescribed by my GP).
Two other factors contributed significantly to my staying away from cocaine. Firstly, I cut myself off from my circle of‘friends’. I say friends, but really they were only people I used drugs with, and the only thing we had in common was drugs. Secondly, I had had a really supportive partner and parents.
I was able to talk to Jim – Sapphire’s new boyfriend – about everything. As he has experienced addiction issues in his past, he really understood where I was coming from. He helped me feel settled and I knew that someone cared for me without wanting to control me. The fact that my family now knew about my addictions was a blessing in disguise, as they became a key part of my support system. I thought they would totally disown me, but they educated themselves about addiction and became my rock. They supported me emotionally, talking to me about anything that was bothering me.
Finally, I should say that I don’t think that the CDT was well-equipped to know how to help me get off crack. The service was very much focused on opiate and alcohol addicts, and there wasn’t really a lot of support for poly-drug users or stimulant users.
6. The agony in successfully coming off benzos
Jim and I moved house at this point, as the area we lived in was renowned for drugs, and I just couldn’t see myself getting well with all the negative influences around me. Mum and Dad provided financial assistance and helped organise the move.
Now that I had an equal relationship with a supportive partner, and a lovely new house in a fab area, I felt able to say that I wanted to detox off the benzos and then reduce my methadone maintenance dose. I’d been stable for around a year, with no drug or alcohol use, and I felt strong enough to try and take some steps forward, although I knew that trying to detox off both benzos and methadone at the same time would have been a recipe for disaster.
At the time, I was being prescribed nitrazepam for sleep problems and diazepam for anxiety. My GP suggested swapping to one daily dose of diazepam, as the tablets come in smaller increments and are therefore a bit easier to taper from. Moreover, as they are a long-acting benzodiazepine, they are supposedly easier to come off than the shorter-acting benzos, although they certainly didn’t feel ‘easy’. I started on 40mg/day of diazepam and reduced by 1mg a week.
The detox from benzos was one of the worst things I have ever been through. I continued being reduced by 1mg a week until I got to 2mg a day of diazepam, and then my GP stopped the script.
I have since found out that this wasn’t really the best thing, for my mind or body, to be stopped cold turkey still on 2mg a day. I had some seizures and terrible headaches, and I couldn’t sleep properly for months. The first time I had a seizure I was out in town and knocked myself out on a wall. I was taken to hospital where they gave me some diazepam, as they were sure that the seizures were from the doctor reducing me too quickly.
I ended up in hospital about nine times with seizures, but I would not take more benzos as I didn’t want to go through the withdrawal again. I was worried that I would feel awful forever, and never escape from my addiction, but after about eight months it seemed that the worst of the withdrawals was over.
Once the seizures were under control with some non-addictive epilepsy medication, I tried to get back to a normal day-to-day life, but I was so nervous about literally anything and everything. I found it difficult to learn how to deal with anxiety and stress without having benzos to help.
I thought I would never lead a normal life. It took almost a year after the detox before the anxiety and sleeplessness had subsided to a manageable level, so it was difficult to plan anything for the future as my head was all over the pace.’
We’ll continue with Sapphire’s ‘treatment history’ tomorrow. One important point to note from this part of this Story is what was happening for Sapphire outside of treatment, in her personal life. The supportive relationship she had with her new boyfriend Jim and her parents clearly played a massive role in her recovery.
Sometimes, people focus so much on the role of treatment, they forget that a person’s recovery occurs in their community, not in a treatment office.
