Aa
Aftercare
Dr. Junig, Thank you for the no-nonsense approach to answering our questions. I think the disease always makes us want things to be either the worst they can be, or the best. Now on to my question. What treatments do you find are best for getting a person physically and emotionally back on track? I am 8 days clean from Sub and have had it fairly easy. Now, I'm looking to alleviate the fatigue, depression and anxiety. On the Addiction Forum we had many discussions on LDN therapy. Where do you stand on that? My Psychiatrist/Sub doctor is wanting to go the antidepressant route but I have sexual issues with most every antidepressant med. Is nutrition and exercise the best option? In a nutshell, what are your suggestions for a newly clean person to get their mind and body back into shape?
MEDICAL PROFESSIONAL
Hi-- thank you for your comments and questions.
You will have to enlighten me on LDN therapy-- I may not be familiar with it, or I may use a different term for the same thing.
With all of the debate over Suboxone in earlier posts, I haven't said much about my approach with the medication. I do NOT agree that it should be used short-term; one of the early mistakes with the medication was suggesting that it be used short-term; most of the experts in addiction are now recommending long-term use of Suboxone. The theory behind Suboxone use has several dimensions; the first is that Suboxone acts as a 'splint' for extinquishing addictive behavior. The course for the use of Suboxone tells docs to have patients dose once per day; unfortunately this recommendation is often ignored-- but the idea is to have the patient dose only once, always in the morning, and to learn to ignore the conditioned urges to dose when physical cravings occur late in the day. Those cravings are always purely psychological-- addicts are conditioned to use much more frequently than every 24 hours, and that conditioned behavior is where the cravings come from. Using Suboxone by dosing more frequently benefits from the suppresion of cravings, but misses out on the retraining of the brain that occurs during the extinguishing process.
Active addiction requires a great deal of mental energy; the addict is essentially focused on using all of the time, leaving little time for 'anxiety'. After starting Suboxone, those urges to use disappear for the most part as you now know; that often results in an increase in 'anxiety'. Another large part of Suboxone treatment is your learning to tolerate things like anxiety and/or depression without using. There are many ways to work on anxiety; for addicts I like to have the person 'check in' with himself frequently during the day, at least during any anxious moments, and 'try on' different feelings to see what the 'anxiety' consists of. Addicts call many things 'anxiety'-- I have them try on the six core feelings of: mad, glad, sad, afraid, ashamed, and hurt. A person usually has multiple feelings at the same time-- including those that appear to be opposite, like sad and glad. Try them on and you will see! I also ask the person to consider that they might be just 'bored', and the 'anxiety' is actually just boredom or 'antziness' (I think that is a word!).
There are many other dynamics to consider during remission-treatment with Suboxone-- that is one reason I protest the 'one-size-fits-all' anti-Suboxone sentiment that can be found here and there. Suboxone is here to stay; as the medical director of a large treatment center that is sobriety-based and anti-Suboxone, I am acutely aware of the changes in expectations of people coming in for treatment. Some of the folks at NA or AA are a bit dogmatic in my approach-- traditional stepwork saved me, but that doesn't mean that there will always be one way to do things. Opiate dependence in particular has always been something that only saves a few people, and generally only after they have lost a great deal; if we can find a way to help people earlier-- that would be great!
I think the best aftercare is group treatment; I like to think about the 'addict inside', and in groupwork each addict has a chance to observe the addict in others, and learn to recognize their own 'addict inside'. That is another reason that NA or AA are so beneficial.
And yes, physical exercise and nutrition are wonderful and important; the sexual side effects of medications are a common problem but if you need medication I would consider something like Remeron (mirtazepine), which doesn't have sexual side effects (although it causes drowsiness and weight gain).
Some of the fatigue and depression will improve just with more time, if you keep doing things right. I have mentioned my blog about Suboxone, Suboxone Talk Zone, where I talk about the theory behind Suboxone and the other things that are necessary to stay clean. Suboxone is no guarantee, and some people get into 'playing' with it, turning it into just another opiate. But if used correctly in concert with other recovery factors it can work quite well for many people. But you are still very early-- your mind is still wrapped up in confusion over not doing what you used to do all the time-- as time passes, especially if you dose once daily ONLY, and always in the morning (so your unconscious isn't thinking all day long, do I need it? do I need it?), you will eventually find yourself forgetting to take it. That is the point where I start considering easing off a bit-- but only if a number of other conditions are met, which I will get into one of these days...
I'm on the road and have to give up this computer-- thanks for your question!
JJ
You will have to enlighten me on LDN therapy-- I may not be familiar with it, or I may use a different term for the same thing.
With all of the debate over Suboxone in earlier posts, I haven't said much about my approach with the medication. I do NOT agree that it should be used short-term; one of the early mistakes with the medication was suggesting that it be used short-term; most of the experts in addiction are now recommending long-term use of Suboxone. The theory behind Suboxone use has several dimensions; the first is that Suboxone acts as a 'splint' for extinquishing addictive behavior. The course for the use of Suboxone tells docs to have patients dose once per day; unfortunately this recommendation is often ignored-- but the idea is to have the patient dose only once, always in the morning, and to learn to ignore the conditioned urges to dose when physical cravings occur late in the day. Those cravings are always purely psychological-- addicts are conditioned to use much more frequently than every 24 hours, and that conditioned behavior is where the cravings come from. Using Suboxone by dosing more frequently benefits from the suppresion of cravings, but misses out on the retraining of the brain that occurs during the extinguishing process.
Active addiction requires a great deal of mental energy; the addict is essentially focused on using all of the time, leaving little time for 'anxiety'. After starting Suboxone, those urges to use disappear for the most part as you now know; that often results in an increase in 'anxiety'. Another large part of Suboxone treatment is your learning to tolerate things like anxiety and/or depression without using. There are many ways to work on anxiety; for addicts I like to have the person 'check in' with himself frequently during the day, at least during any anxious moments, and 'try on' different feelings to see what the 'anxiety' consists of. Addicts call many things 'anxiety'-- I have them try on the six core feelings of: mad, glad, sad, afraid, ashamed, and hurt. A person usually has multiple feelings at the same time-- including those that appear to be opposite, like sad and glad. Try them on and you will see! I also ask the person to consider that they might be just 'bored', and the 'anxiety' is actually just boredom or 'antziness' (I think that is a word!).
There are many other dynamics to consider during remission-treatment with Suboxone-- that is one reason I protest the 'one-size-fits-all' anti-Suboxone sentiment that can be found here and there. Suboxone is here to stay; as the medical director of a large treatment center that is sobriety-based and anti-Suboxone, I am acutely aware of the changes in expectations of people coming in for treatment. Some of the folks at NA or AA are a bit dogmatic in my approach-- traditional stepwork saved me, but that doesn't mean that there will always be one way to do things. Opiate dependence in particular has always been something that only saves a few people, and generally only after they have lost a great deal; if we can find a way to help people earlier-- that would be great!
I think the best aftercare is group treatment; I like to think about the 'addict inside', and in groupwork each addict has a chance to observe the addict in others, and learn to recognize their own 'addict inside'. That is another reason that NA or AA are so beneficial.
And yes, physical exercise and nutrition are wonderful and important; the sexual side effects of medications are a common problem but if you need medication I would consider something like Remeron (mirtazepine), which doesn't have sexual side effects (although it causes drowsiness and weight gain).
Some of the fatigue and depression will improve just with more time, if you keep doing things right. I have mentioned my blog about Suboxone, Suboxone Talk Zone, where I talk about the theory behind Suboxone and the other things that are necessary to stay clean. Suboxone is no guarantee, and some people get into 'playing' with it, turning it into just another opiate. But if used correctly in concert with other recovery factors it can work quite well for many people. But you are still very early-- your mind is still wrapped up in confusion over not doing what you used to do all the time-- as time passes, especially if you dose once daily ONLY, and always in the morning (so your unconscious isn't thinking all day long, do I need it? do I need it?), you will eventually find yourself forgetting to take it. That is the point where I start considering easing off a bit-- but only if a number of other conditions are met, which I will get into one of these days...
I'm on the road and have to give up this computer-- thanks for your question!
JJ
I have the same question about the Naltrexone...Also my opiate addition docter now wants me to start using Naltrexone for a month or two, he believes that it can actually speed up PAWS, to that amount of time or close to it, instead of possibly up to 2 years, as it can last that long or even longer in some cases. I am a little scepticle though, i know its a opiate blocker and that not alot of research has yet been done to determine that it can speed up PAWS. Can it really do something like that? Also with my withdrawals come back when i start using it since it blocks out the receptors, even if im around 10-14 days clean or more? Im just not sure i want to even bother, but hes trying to convince me... i want to see if there is a possibility of its actually speeding the proccess and if its worth it for someone getting off opiates...by the way im only a week in, but if i was to start the naltrexone it would be from day 10-14...what do you think?
any help would be great thank you...
any help would be great thank you...
I haven't even mentioned it to my Psychiatrist yet. I doubt he's even heard of LDN therapy. From my own research, the dosages are 3.5 to 5mg taken before bedtime.
Thanks Doc for your detailed and enlightened answer. I'm sorry for not fully explaining LDN therapy. I was referring to Low Dose Naltrexone therapy. I've heard of it used for everything from MS to Crohn's disease, as well as a way of giving a newly opiate free person a proverbial "jump start" to the brain. Just wondering if you have heard of anyone using it for newly clean opiate addicts, or if you have used it in your practice.
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