Question: I have got really bad social anxiety. Should I use kava extract to help me get over it? I am kind of not sure if it is the kind of thing I have to take every day like an antidepressant or, better, if it is something I can just use when I need to go into social situations…like I use a alcohol drinks now….the problem with the alcohol is when it wears off sometimes my anxiety is even worse than ever.

Dr. James Strawbridge Says...:

There are several things you can use to temporarily control your social anxiety. Unfortunately, some of them can end up controlling you such as alcohol. 

Many times people with social anxiety suffer from distorted thinking, including false beliefs about social situations and the negative beliefs of others.

Talking with your doctor about complaints related to your problem would be a good beginning. He would be in a position to recommend a psychologist in your area. 

Question: Does acupuncture really help with opiate withdrawals? My wife is trying to taper off a very nasty vicodin habit. It is really hard for her and it is taking a really long time and she is really suffering with it. She is so determined to make it though and I really admire her for this. I have been researching things that might make it easier for her and I came across some papers that suggested that acupuncture on the ear relieves withdrawal symptoms. If it did anything at all to help her it would be worth giving it a try. I don’t really believe in Chinese medicine but at this point anything that might help is under consideration. If you had any other suggestions for things that might help to alleviate some of the pains she is going through I would really appreciate any info that you could offer.

Dr. James Strawbridge Says...:

Vicodin is a semi-synthetic opioid based prescription drug commonly marketed as either Hydrocodone, Lorcet, Lortab, or generically as Hydromet. Normally prescribed as a pain reliever or cough suppressant, Vicodin’s effects are similar to other opioid derived drugs like, morphine and heroin when abused and as a result of Vicodin’s opioid origins, nearly 40% of Americans that were prescribed some form of this narcotic in the last year will subsequently struggle with addiction causing Vicodin to become the most commonly abused and diverted pharmaceutical in the United States. Addiction to Vicodin will affect every aspect of a person's life.

Your wife's experience brings to mind people who, in the beginning, had a illegitimate reason to use Vicodin. It was prescribed by a physician for a specific reason and for an explicit length of time. However due to the tolerance level of opiates, more had to be used and this became the problem. Something intended for good that turned bad.

Practical Advice

To make detoxification more comfortable, visit a drug store and buy some of the following:

• Over the counter analgesics
  such as acetaminophen, aspirin, ibuprofen, ketoprofen, or naproxen will be
  helpful for body aches. Without an exogenous opiate in her body, the most mild
  aches and pains will feel exponentially worse.
• Benadryl
  (Loperamide), Dramamine, or Dramamine II will help with the inevitable nausea that
  will be experienced. An antihistamine will also help with the sneezing, runny
  nose and eye tearing. The sedative effects may also help combat some of the
  anxiety and insomnia.
• Immodium AD for
  the treatment of diarrhea. It acts on opiate receptors in the intestine and
  stops spasms and therefore diarrhea. It will be a best friend during this time
  and will make life much easier.

Many people who have
struggled with addiction to narcotics have reported that Immodium AD not only
eased their withdrawal symptoms, but abated them all together, allowing for
success and an opiate free life. Take it only if needed, but double the
suggested dose. Remember, the colon is use to a barrage of narcotics, and it
might not respond as strongly to the lower dose. Her colon may still need to wean
off Immodium AD, however, it will be nothing
compared to stopping opiates cold-turkey. 

Stock up on all of these medicines, as there is a need to be ready for up to
two weeks of dope-sickness before all is said and done and one can get back to
life.

Withdrawals

The physiology of opiate withdrawal is not life
threatening but the body will ache and constipation will occur. There may be unpleasant and intrusive thoughts among other symptoms because of these other effects. In effect, the drug does the thinking for you. Willpower is not enough. You become out of control. Vicodin withdrawal does increase the risk for dangerous and self-destructive behaviors
including suicide. If your wife has these thoughts now, or in the recent past a
history of “acting out”, hurting herself or others, she may not want to do it
alone. 

A psych hospital is the place to be during withdrawal; Notwithstanding, any place is better than being alone.
Ask to be seen by a psychiatrist if the ER staff is gives you a hard time. Your may find it helpful to be in a 12 Step program such as NA (Narcotics Anonymous)
or AA (Alcoholics Anonymous). If she has
been a user for a long time it will be pretty hard to kick addiction without a support
system. This new support system will make it easier to cut off contact with
dealers and friends who use. She can find a listing of local meetings for her
town online. A nice thing about the meetings is that they are generally nonjudgmental
toward new people. Their guiding principles include the idea that the “newcomer
is the most important person in the room” and that the only requisite  for
attending is a desire to quit using

According to an article in Wikihow:

• Do not get on methadone unless you've used drugs
  for a long time. It is a nightmare to kick. If you are on methadone, consider
  reducing your dose slowly to 30mg and switch to Subutex then kick that way.
• Consider the idea that getting off long term
  opiates (methadone, subutex) requires planning. You are more likely to be
  successful with a sane, long term taper. Impulsively jumping off at 20mg
  methadone or 6mg subutex may cause extreme, unnecessary misery and leave you at
  increased risk of relapse.
• Tell yourself you are doing ok, the pains you
  are going through are merely labour pains, you are giving birth to a new you.
• Make sure the fridge is filled with easy to eat
  things like yogurts, mousses, things that are soft and sweet.
• Make sure you have a stack of clean cotton
  sheets and towels and loose comfy cotton garments nearby - you may need to
  change everything often because of sweating.
• Keep the room well ventilated, consider a fan,
  and have a soft warm blanket to hand.
• Make up some fruit flavor rehydration salts and
  keep a big jug of the stuff nearby. Dehydration (from sweating, vomiting etc)
  with make you feel even worse. Keep some good tasting juice handy too.
• Have a stack of light hearted comedy DVDs to
  watch. Nothing heavy at all! Nows the time to watch re-runs of "The
  Waltons", "Happy days", "I love Lucy", etc.
• Keep a laptop handy so you can get support from
  on-line forums - worth their weight in gold.
• Write a notice saying "I'm a fantastic
  person, and I'm doing something amazing" and leave it where you can see
  it.
  

Each step of the ladder can leave you in the
same spot you're in now, but if you have really decided to quit you must first
realize that anything from cheese burgers to sex can lead to a self destructive
lifestyle.

• When you are feeling a little better, have non
  druggy friends around to talk to and spend time with, especially the kind who
  you can't mention that kind of thing to - you will be forced to talk about
  other things, which will take your mind away from places it shouldn't be.
• A little, light exercise - walking, housework
  will help. Don't overdo it.
• Keep your surroundings fresh and pleasant to
  keep your spirits up.
• Plan a little treat for yourself to look forward
  to each day to reward your success.
• Know you are doing something noble - its worth
  it and so are you.
• Be Gentle with yourself, and give yourself a lot
  of love.
• Keep plenty of sweet stuff around just like
  quitting smoking; your body is going to crave something to fill that
  "hole" with.

After about a week she'll start to have an appetite
again and snack cakes, candy, or anything else you like to munch on will be
helpful. You may go through the withdrawals and try to eat everything in my
house from kids cereal to everything Little Debbie makes, but just keep your
head up and focus on the most important things in your own life (as short term
as possible) and enjoy the little things that you see they're what makes the
longest days go by.

Source: WikiHow

Question: I have heard that yoga and meditation can be helpful for people in recovery. I am not really a yoga kind of guy but I know my last relapse was caused by my inability to handle stress very well. I would like to know if practicing martial arts like karate offers the same benefits as activities like yoga and meditation. They seem sort of similar to me, but I am not sure…

Dr. James Strawbridge Says...:

Stress is not all bad. It all depends on how much you have,
how long it lasts, and how you handle it. If you have no stress at all, you
don't grow and learn---there's no incentive. If you have too much, you fold
under it, and suffer a wide range of physical and psychological ills. A
moderate amount of stress in your life seems just right (this will vary from
person to person). But even mild stress-- -if you don't know what to do with it
or if it goes on and on without relief---can triggered a return to substance abuse. 

A moderate amount of stress is already into recovery: the
stress of staying abstinent and learning how to live without chemical support.
So it's important not to add more stress on top of this by thinking too much
about the past or trying to undo too much in the present. 

You mentioned practicing martial arts. This means exercise
and this is the perfect replacement of the couple drinks that helped you unwind.
It will improve your self-image, chase away sleep problems, and often alleviate
symptoms of mild to moderate depression and anxiety.  A health-oriented life that builds in regular
exercise usually has no room in it for the use of drugs or the abuse of alcohol. 

You referred to meditation. This too is a good idea. I would
suggest that you get on the internet and click on relaxation meditation,
contemplation meditation, or life-in-order meditation.  This will give an assortment of ideas regarding
meditation. 

Your most useful distressor right now is your
support group. Increase your meeting attendance whenever stress increases

Question: I know there are a lot of Christian drug rehabs but is there such a thing as Buddhist addiction treatment? I am a very spiritual person and am most drawn to the principles of Buddhism and mindfulness in my life. I am addicted to opiates and I hate them because they make me feel so clouded and I need to get off them as soon as possible. I need help but I do not want ‘WESTERN MEDICINE’ help – I have had enough of that for a lifetime. I know there is a temple in Thailand which helps people detox with herbs that make you vomit and then helps you to overcome your addiction through a spiritual contract. Is there anything like that in America?

Dr. James Strawbridge Says...:

All drugs started out in history as medicines, and, like their nonaddictive cousins, they are also poisons. They affect the highest functions of the central nervous system---our intellectual and emotional intelligence.Hence the street language for an addiction: getting "wasted" or "stupid" or "mellow" or "bombed." As the nervous system strives to compensate to these toxin-induced changes, it establishes a state in which these adjustments are automatically activated whenever the substance is taken into system again. Officially, we call that form of neural adaptation tolerance. 

Opiates work by fitting into the receptors for one system of the brain's natural painkillers. These natural painkillers are endogenous (meaning "inside the body") opiates, and their effects are similar of those of the drugs. of the drugs, They are called endorphins (for endogenous morphine). and enkephalins (inside the head). When one takes opiates for a long enough time (the period varies, depending on the strength of the drug and the person'sown constitution), physical dependence sets in. This is believed to result from a mechanism crucial to understanding addiction, caused by the brain's need to maintain a steady state. What this means is that no high last forever--that more of the drug you take, the less effect it will ultimately have as your brain learns to kick in compensatory mechanism more rapidly and intensely.

In the case of opiates, what happens is that as more of the drug is taken, the body reduces its own endogenous opiate production, and mechanisms to cut down on opiate effects are activated. These changes mean that the drug causes less of a high, and the user tends to increase the dose to compensate. Such a user has developed "tolerance." When the tolerant user can't get drugs these "opponent processes" kick in anyway---assuming that they are going to have to fight against a high level of opiates. These opponent processes result in withdrawal symptoms as the body now confronts a shortage, rather than having to deal with a high level of opiates. These opponent processes result in withdrawal symptoms as the body confronts a shortage, rather than having deal with a high level of opiates, i.e., nausea, vomiting diarrhea, insomnia, anxiety, shakes, sweets, and body aches. The worse part of opiate withdrawal typically four days, although in severe cases, they can continue for up to a month. 

Although opiate withdrawal has been dramatized by various authorities in order to aid prevention (and opiate addicts seeking to explain why they couldn't possibly kick the addiction!), in fact, the physical symptoms are not much worse than a bad flu, with added anxiety and insomnia. Any one who has suffered both a severe illness and opiate withdrawal can tell you that most serious illnesses (such as, say, hepatis B) are far more physically debilitating and painful. Unlike withdrawal from alcohol, benzodiazepine, and barbiturates, withdrawal from opiates is not life threatening. The reason it is so uncomfortable for addicts has more to do with fear of being able to survive  emotionally without the drug and with associated depression than with the actual physical symptoms. Fear and depression are not concerns to be taken lightly, but they need a different remedy than simply dealing with physical signs of withdrawal.   

In terms of physical danger, the major risk of opiate use is overdose, which can be fatal if not treated quickly. There is an antidote to opiate overdose, naloxone (Narcan), which can immediately reverse its symptoms. Prompt medical attention can easily mean the difference between life and death in these cases. Opiates themselves do not damage the liver or other internal organs. The ill health of most street-heroin addicts is related to unsanitary injections, malnutrition, and adulterated  drugs rather than the pharmacology of opiates. Nevertheless, the death rate among opiate addicts is extremely high---from 6 to 20 times greater than would be expected for other people the same age. No one has yet determined whether this is because a drug with the reputation that heroin has (the "hardest" drug) attracts suicidal people or because the more you expose yourself to the risk of OD, HIV, and so on, The greater your chances of dying are. Either way,despite its relatively benign pharmacology  at moderate,steady doses,it kills many of its users and kills them young.       

Opiates are particularly attractive to those who are oversensitive to or who suffer high levels of emotional pain and trauma. For such opiate addicts to recover, these issues must be addressed. Also, sometimes, either because long-term use of opiates may permanently damage the system or because some addicts may have been attracted to opiates because they had a preexisting deficiency to this system, some addicts may not be able to live comfortably without long without long-term or even life-long maintenance on an opiate drug.

You said that you are a spiritual person and are most drawn to the "principle" of Buddhism and mindfulness in your life. I am not familiar with Buddhist principles. Perhaps the principal of Buddhism would help you. I am familiar with the gospel principles taught by Jesus Christ. I have seen these principles work for countless addicts once they get the drug out of their system. Getting the drug out of your system is painful. However, the next stage is ;how to live a life with opiates. The real work comes when you begin learning how to live life one-day-at-a-time without your drug of choice. The practice of spirituality is vital to this process. Even this will not work unless you work it. There are not quick answers. It has taken years to get yourself into this "fix," Learning to live life on on life's terms is an exciting journey. Very exciting! 

Question: I believe that some experiences with certain drugs and certain altered states of consciousness have really helped me to come to terms and to understand my own spirituality and my own place in the world. I believe that altered states of consciousness give me a different perspective on life and how I should live it and help me to understand God and my place in the universe. Unfortunately, I have abused drugs and now I am no longer really able to achieve altered states of consciousness through chemical means. Are there any types of therapies that help people grow spiritually through the use of altered states of consciousness without using drugs? Maybe trances or hypnosis or meditation based…not sure – but very interested to find out!

Dr. James Strawbridge Says...:

Many psychologist use hypnosis as a means for treating mental dysfunction. The process of hypnosis is relatively easy, which is surprising considering the power that is associated with the phenomenon. In short the process is one of distracting the conscious mind long enough to implant alternate suggestions to the inner mind. Many people think the process of putting the conscious mind asleep, but this is a common misconception of hypnosis. Hypnosis is not sleep, but rather a form of tightly focused concentration.

Many spiritual traditions use meditation as a vehicle for development. Meditation too, is a process of focusing the mind, but usually at a lower level of intensity. The lower level of intensity makes meditation easier for the individual to attain and control. Once the mind is focused to the degree common in hypnosis, the ability to direct the course of activity is usual. This is one of the major difficulties in trying to use hypnosis by yourself. To reach a deep level, you have to have an outside source of direction. But there are relatively simple methods of overcoming this difficulty. It is possible to create your own recording, and by doing so you also end up with a hypnotic session that is custom tailored to your exact goals. There are tapes you can also purchase to help as well.

Spiritual growth and development takes many forms depending on the culture in which you live. The content of the hypnotic session depends greatly on your beliefs. If you believe that spiritual growth takes place when you live according to a prescribed set of rules without deviation, then you would use hypnosis to instill a 'natural' tendency to live according to those rules.

If you believe that spiritual growth and development happens as you become more like the Supreme Being, then you would use hypnosis to create whatever internal changes that need to happen to bring yourself closer to that state.