Detox and early abstinent recovery: make it easier

“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 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.

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