Picking treatment can feel overwhelming, so it’s best to be pragmatic. Here are the basic options and an explanation of how your insurance company funds treatment.

Most of us depend on our health insurance to pay the majority of the cost of treatment. Managed care is very stringent regarding justification for treatment. I often have to explain to folks that just because they believe that they need to go to rehab that doesn’t mean their insurance company will pay for it. Rehabs are expensive and your insurance company will likely insist that less expensive and less intrusive forms of treatment be tried first. The philosophy of utilizing the least intrusive form of treatment is also accepted throughout the healing and helping disciplines.

Managed care generally follows the American Society of Addictive Medicine (ASAM) criteria, which specify levels of care that correspond to a degree of objectively demonstrated need. The levels include:

1. Early intervention
2. Outpatient services
3. Intensive outpatient programs (IOP) / Partial hospitalization programs
4. Residential / inpatient services, and medically managed intensive inpatient services

Early Intervention

Early interventions are typically very brief educational efforts. They tend to be offered and not sought out. Perhaps your primary care physician advises that something is unhealthy and explains why. Public schools and colleges make varying attempts to educate regarding the potential dangers of substance abuse.

Outpatient

Outpatient services generally take place in community clinics or private offices. They include counseling and therapy services for individuals, couples, families, and group treatment. These services tend to be provided once weekly. They are brief in content (50 minutes counseling, 60-90 minutes for a group session) and brief in duration (eight weeks up to a year).

Intensive Outpatient (IOP)

IOPs usually occur in community clinics or hospital settings. They are most often 3 hours per day and between 3-5 days a week. They include a curriculum of sorts in which a person will receive a great deal of information/psycho education, attend group therapy and skills groups and likely get individual counseling concurrently. IOPs are time limited - most often 8-12 weeks.

Rehabs, Residential Medically Managed Inpatient

These addiction treatment options all involve living 24/7 in a facility that has the means to monitor, treat, and ensure the safety of its patients based on their holistic needs. There is a lot of variance amongst rehabs (faith based, medical detox, holistic, 12 step focused and others).

The focus is on ensuring that a person safely withdraws from their drug of choice and engages in intensive treatment amongst peers who are on similar journeys.

Paraprofessionals

Recovery coaches and life coaches have become accepted as legitimate and helpful supports for those making major life transitions. There is a great deal of diversity amongst these paraprofessionals – some are licensed and formally trained and educated, while others simply have a great deal of success in long term recovery, business, health, or other specialty areas.

The advantage of having a recovery or life coach is that there are no externally set boundaries. Because these are not (generally) licensed professions, the parties are free to establish whatever type of working relationship works for them. This may include meeting in each other’s homes, in public, or going to meetings together. It can include a lot of phone contact, web cam contact, texts, and email.

The only true downside of coaching is that insurance companies will not pay for it. Just as there exists a great deal of diversity amongst coaches, there is also a great deal of variance in rates charged. Shopping around can make this a vastly more affordable option.

Peer Support

My favorite word is “and.” Whenever people ask me whether they should pursue one treatment option or another, I’ll suggest they try both.

This is especially true of peer support. I’m heavily biased in favor of groups like Alcoholics Anonymous and Narcotics Anonymous because I’ve seen folks have enormous success. I understand that these groups are not for everyone and that there are indeed many pathways to recovery. Here’s something that we can all agree on – peer support is FREE and its availability is far more extensive than any professional efforts or programs.

My goal is always to put myself out of a job. In order for a successful transition to occur and for folks to move on, it’s vitally important that they have an holistic support system in place. Natural supports (friends, family, peer support in every form whether AA, church, or other organizations) are desirable and sustaining throughout our lifetime.

SMART Recovery has been growing in popularity of late. This is a form of peer support that seeks to incorporate elements of research and psychological treatment. It also supports the use of psychiatric and addiction medicine. Its 4 point system promotes:

1. Building and Maintaining Motivation
2. Coping with Urges
3. Managing Thoughts Feelings and Behaviors
4. Living a Balanced Life

I urge folks to experiment with different forms of peer support and find what seems to work best for them. I also advise that no two meetings of peer support are exactly the same. It’s actually very common that a client will tell me that they enjoyed the AA meeting they went to on Sunday but disliked the AA meeting they went to on Tuesday at a different location. Each peer support meeting has unique aspects and the more willing we are to investigate, the more likely we are to get our needs met.

Continue to the second part of this article to learn more about the benefits of working with an addiction counselor.

Learn to relax with imagery in 7 easy steps; it’s a great skill that protects you from relapse.

No matter who you are or what your situation, improving stress management skills can improve your quality of life.

But if you’re in recovery and fighting to avoid relapse, knowing a few effective de-stressing techniques can make the difference between continuing sobriety and an emotion-driven return to drinking or drugs. Not to get melodramatic here – but for those in recovery, relaxation exercises can be literal lifesavers.

Because they’re so important and because stress levels tend to go up in early recovery, you should learn and practice a few techniques that work for you. Some examples of common stress-busting exercises include deep breathing for relapse prevention, meditation, progressive muscle relaxation, and the topic of this article – imagery exercises.

So take a few minutes now to read through the steps and experiment with imagery for yourself. It doesn’t take long to learn but you will get better with practice – in fact with enough practice, some people can escape to serene relaxation just by thinking of a certain word or image.

A Step-by-Step Guide to Relaxing with Imagery¹

1. Start off by finding a place where you feel relaxed, safe and comfortable – someplace where no one will come in and disturb you for a few minutes.
2. Sit comfortably in a chair and close your eyes. Concentrate on taking slow and deep breaths.
3. When you feel ready, scan your body from your feet to the top of your head looking for any kind of tension. When you feel tension, try to relax it completely, imagining that you expel the tension with each slow exhalation.
4. Now, imagine a place where you feel great – safe, comfortable and at ease. It can be a place that you know well or a place from your imagination. Examples could be a secluded tropical beach, a place from your childhood or even a place you’ve only seen on TV or in a book.
5. Picture yourself in this environment. If you imagine a tropical beach, imagine yourself laying on the sand or in the lapping surf. Try to bring all of your senses into the experience. What does the sand feel like? Imagine the warmth on your skin. What does the air smell like? Try to smell the tropical plants and the smell of the sea. What do you hear? Try to imagine the sound of the waves and birds. What are the colors like? Try to picture the blue of the sky and the turquoise of the water.
6. Enjoy some time in this peaceful place. What do you call it? By giving it a name, you’ll find it easier to return to this relaxation simply by recalling the name and the images you associate with this name.
7. Stay within the scene you’ve created until you feel calm. When ready to leave, take a moment to transition slowly back to the ‘real world’ – keeping your eyes closed for another moment and continuing to breathe slowly and deeply.

Though imagery exercises don’t always come naturally, with a little practice and persistence, you’ll find they offer a pretty immediate antidote to the stresses of early recovery – and of life in general.

Learn what to expect from counseling and find out how a counselor can help you move from use to sobriety and from sobriety to recovery.

People generally have no idea what addictions counseling is about. I’ve had countless people ask me, “I know I’m not supposed to do drugs/drink. What else is there to talk about?” I give them my Mr. Mackey (South Park) impression and jokingly agree, “Drugs are bad, mmkay. You can go now.”

At the opposite extreme, I’m often asked, “How am I supposed to not do drugs/drink?” At face value, the question is, how do I not do something? What’s really being asked is, “What am I going to do instead of doing drugs/drink and how am I supposed to deal with life, problems, and my emotions without them?” So this is often where we start in addictions counseling:

1. How to achieve and maintain abstinence
2. How to move from sobriety to recovery
   
3. How to deal with life on life’s term

Getting Clean & Sober

Keeping it simple, a person who has become dependent on a drug should always consult with their primary care physician (PCP) before they begin to withdraw from a substance. It’s common sense and it ensures safety. In some cases, medical support will be necessary to monitor the body as it goes through detoxification. An addictions counselor will consult with your PCP and can make referrals as needed.

Generally, the first seven days are pretty rough. It gets easier as we go and after 30 days we experience notable improvement physically, emotionally, and mentally. Our health continues to improve for at least twelve months.

Maintaining Sobriety

Relapse prevention plans are a vital piece of addictions counseling. These are very pragmatic and specific plans that describe how we will respond to urges and triggers that tempt us to resume using/drinking. The plans are custom made to suit the individual but should always include:

• Skills & Strategies for maintaining awareness of our thoughts, feelings, and behaviors (remember were accustomed to ignoring much of them).
• Implementing immediate steps to be taken when triggered/feeling the urge to use (phone contacts, coping mechanisms that can be used in any setting/environment, ways to refocus and identify what is needed to avoid further wrestling with the urge).
• Habits and routines that reduce stress and promote healthy actions
• Planning for known stressors. (Times when we have to be amongst people or places that we associate with using/drinking due to work or family obligations).
• Back up plans and emergency plans. (Measures we’ll take to ensure safety and abstinence when all seems lost).

Regardless of your confidence level in your ability to stay abstinent, having a solid relapse prevention plan will serve you well if you view it as an investment in your overall well being. The strategies outlined do more than keep us sober; they improve our overall health and quality of life.

Moving from Sobriety to Recovery

All that is required to be sober is that we not drink/use. By the time a person reaches addiction, there is assuredly wreckage in their lives. Some of us lost friends, family, jobs, money, and/or material possessions. To regain what was lost is a major undertaking and simply must be done with support. For all of us, the wreckage includes the loss of self, the destruction of self, and the emotional fallout of having succumbed to the disease of addiction.

We seek to change, to transform and to become something greater than we are. Most of us are simultaneously overwhelmed and in a hurry. This is a very problematic combination.

Addiction counseling is a process of prioritizing. After sobriety is attained, we need to make choices regarding what’s most important and develop manageable plans on how to attain it.

• Treatment plans are developed collaboratively in counseling and should accurately represent what our goals are. Goals are broken down into short (generally 90 days) and long term (generally one year) measurable achievements. They are further broken down into objectives. Step by step we incrementally achieve the results we seek.

Recovery has been defined as “awareness of the attitudes, beliefs, and behaviors that block change.”

A good addictions counselor will call us out on these. It’s uncomfortable to be confronted, but the use of subtlety or handling a person in recovery with “kid gloves” is ill advised. Those of us in early recovery remain very adept at lying to ourselves. We need to have it pointed out to us when we rationalize or justify because these undermine our ability to trust ourselves and our perceptions.

Emotional Immaturity

Courage is the choice not to allow fear to stop us from learning, growing, and healing. For most of us, we don’t know what we don’t know. We feel much older than we are due to the impact of past experiences and we feel much younger than we are due to our development being arrested by abuse, neglect, and substance abuse.

Addiction treatment supports us in learning to be more mature in our perception and behavior. We learn that we have emotional reflexes and that we must get to a place in which we respond instead of reacting.

Integrating Addiction Treatment & Natural Supports

The goal of any good addictions professional is to put themselves out of a job at the earliest safe juncture. This is achieved most readily when natural supports are integrated into treatment.

• Involving family, friends, and supportive others (sponsors, contacts, recovery coaches) in the process of implementing change ensures mutual understanding and cohesion toward shared goals.

When progress is made in this direction, we move away from the need for professional service and toward living more authentically. It’s common that folks fear this loss of support and so this can be done incrementally.

Moving On

Aftercare plans are a compilation of resources, ongoing goals and planned steps to be taken following discharge from treatment. There should be contingencies in place for returning to treatment if needs arise.

Addiction treatment is simply a linear progression. It’s common that folks come in and out as they meet new challenges and milestones.

Check out part 1 of this article - Choosing the best alcohol addiction treatment for your needs.

Are you self-medicating to cope with stress, anxiety or depression? If abstinence is impossible right now, consider a harm reduction approach to limit the consequences of your self-medication choices.

A lot of the people I treat for depression, anxiety, and stress management tell me that they’re becoming concerned about their use of “drugs, alcohol, pot, and cigarettes.” All of these are drugs and yet they’re distinct categorically in the mind of the user. They represent very different threats to the individual. It’s telling that the order in which they’re presented is consistently the order in which they do the most amount of damage in the least amount of time.

Assessing the Situation

When the subject of self-medication comes up, rather than give an opinion on whether someone may be developing a pattern of abuse or addiction; I encourage folks to do some self screening:

• Do you tend to take things to extremes/have an addictive personality?
• Are you depending on a substance to cope with stress and/or negative emotions?
• Do you tend to make high risk choices while under the influence?
• Do you have a family history of alcoholism or addiction?

The next issue to consider is willingness. For those who are unwilling to explore life without substances, I advocate minimizing potential harm. In simple terms, what are we willing to do to reduce risk?

Understanding Harm Reduction

Harm reduction can be conceptualized as removing vices in the order in which they make life most unmanageable.

Self medicating is based in the belief/experience that dealing with life without substances and established forms of coping (no matter how unhealthy) is either undesirable or impossible.

The intersections of harm reduction and self medicating have not been meaningfully explored as combined approaches.

Self-Medication - Addiction and Other Risks

We’re still ignoring the progression of self medication, experimentation, and substances that carry high risks when abused:

“Soda pop and Ritalin…
alcohol and cigarettes
and mary jane to keep me insane,
doing someone else’s cocaine.” 

- Green Day “Jesus of Suburbia”

Taking Stock of What We Use & Why

If we want to lower our risks, we must recognize that morality and legalities do not belong in the criteria of what’s safe (body and mind) and what isn’t. Alcohol is completely legal for those over 21 and it not only kills people every day, it’s also amongst our most abused and addictive substance.

If we’re going to make changes to our drug use, we need to stop using categorical approaches like “meds”, “drugs”, “drinking” or “smoking.” These distinctions are arbitrary and make it far easier to rationalize why it’s okay to continue using them. Look at each of the substances as what they are – chemically mood altering substances.

Be brutally honest:

Pros:

• What’s the overall effect of the drug?
• What do I enjoy most about using it?
• What do I gain from the use?

Cons/Risks:

• Is the substance addictive?
• What are the possible drug interactions and side effects?
• How is impulsivity, decision making and regulation of emotion and behavior affected?
• Does the drug have the potential to kill (overdose, poisoning)

Self-Medicating without Substances

Instead of simply considering what to eliminate or reduce (which leads to a feeling of denying ourselves) we can also consider what to add. Seeking outlets for stress and negative emotion can be combined with activities and pursuits we enjoy. If we want a safe chemical to use; we’re free to try adrenaline. Skydiving is comparable to stimulant use at about the same cost and with far fewer (statistical) risks.

Choosing the Lesser of Evils

When we are completely honest with ourselves, we know that using any mood altering substance involves ingesting toxins and compromising our health. Measuring the pros and cons gives us a clear view of what we’re seeking and how it can be attained with the least amount of harm. In the grand scheme of things, nicotine, caffeine, and marijuana are as close as we can come to safety without abstinence.

Marijuana?

I recognize that for some folks, abstinence from Marijuana is not a choice that they’re willing to make. In these cases, while I don’t recommend using cannabis, I see that it is far less dangerous than using alcohol or other drugs.

The real challenge in using marijuana is that once we’ve medicated or used recreationally, the temptation becomes stronger for some to then ingest another substance to heighten the experience. However, this dynamic is far more common with alcohol due to the impact on our inhibitions. The best approach is to make these decisions before using pot and resisting any temptations that may arise afterwards.

Building a Satisfying Life

The greatest opportunity is to invest in not only the emotional health we want, but in our lives holistically. We all know that drugs simply offer instant gratification. The challenge is to consider what would be far more gratifying in the long term. To work toward these ends is the most important piece of achieving emotional maturity and ultimately toward having the life we most want.

Does the true cost of resentment go beyond taking up room in our hearts and mind? Learn how to let go of bitterness and baggage.

Resentment is best understood as pain and/or anger that we carry with us from the past. It's what folks refer to as their "baggage."

By taking up room in our hearts and mind, resentment has the ability to limit our perspectives and what we allow ourselves to receive in the here and now, including good relationships. In this light, the past is never truly over.  As from time to time we relive it.

Resentments can be triggered when what we're experiencing connects us to feelings we've buried. We feel overwhelmed when this occurs: Sometimes a particular memory surfaces and at other times we can't make the connection, we only know that our emotions are disproportionate to what we're faced with. If we choose not to release and seek resolution, we create a cycle of triggering and re-stuffing.

Resentment Is Toxic

I'm fond of the following recovery adage:

"Holding on to resentment is like drinking poison and expecting the other person to die."

Resentment has the ability to create and perpetuate unhealthy expectations, insecurities, and fears. It becomes part of the lens through which we judge others and ourselves.

In a sense, resentment is almost literally toxic:

• Burying feelings often culminates in anxiety
• Anxiety has a negative impact on the body (most notably within the gastro intestinal system)
  

I have consistently found that becoming free of the past holistically improves health.

Letting Go

We're afraid to let things go because that means we have to bring them out into the open. Many of us remain afraid of expressing our negative emotions because we've always associated them with unhealthy behavior. We learned as children that when people are hurt or angry they behave hurtfully.

We came to not only deny ourselves the right to express our emotions, but many of us do not even tolerate feeling them. 

Counselors call it "dissonance". It means we maintain distance between what we know and what we feel through avoidance. As my friends in recovery say, "No matter where you go, there you are."

We slowly come to accept that we cannot run from ourselves without paying a high price. It gets harder as we go because the weight is cumulative. There comes a time for each of us when we can no longer run or hide. I encourage folks to take action before this happens. Doing this work with a counselor or sponsor is much more manageable when we choose to than when we're forced to.

Resentments and Resolution in Recovery

Becoming free of resentment and character defects are part of the 12 step journey. Most approach Step Four in AA with great trepidation ("Made a searching and fearless moral inventory of ourselves"). Looking at both our shortcomings and the skeletons in our closets lead many of us toward relapse.

My advice to those approaching this part of the journey is twofold:

• First, make sure you have an excellent support system in place and that you're accessing them frequently. You'll need them to deal with the skeletons and the changes you seek to make.
  
• Secondly, consider how you're doing at not forming new resentments today. It's never made sense to me to go digging for past resentments if we continue to live in such a way as to develop new ones today.

The key to not developing new resentments is to deal with things as they happen. Through the course of recovery, we become more aware of what we're feeling and what we need. We learn to set limits and boundaries with others to ensure that we are protective of ourselves and to let others know when they hurt us.

Do I Have to Forgive?

Many of us get hung up on the idea that releasing resentment means we have to forgive those who hurt us. I have learned that forgiveness can be selfish. If I forgive those who harmed me in the past, I am not in any way condoning what they did. I am not saying it was okay. I am saying that I am sick and tired of feeling hurt or angered by them.

I've also learned that the hardest person to forgive is me. Maintaining resentments against myself was an unhealthy form of self control. The prospect of forgiving myself left me fearful that I might repeat past mistakes. I have learned that self-acceptance and forgiveness offer me far greater self-control.

NIDA researchers explain food addiction by showing how overeating can lead to changes in the dopamine pathways of the brain, and showing how these changes alter our ability to regulate impulses to eat

From the perspective of an MRI scanner, food addiction and drug addiction look similar.

Numerous brain imaging experiments have shown that drug addiction and food addiction lead to very similar changes to the functioning of the brain’s dopamine systems. Based on this, researchers at the National Institute on Drug Abuse (NIDA) have developed a neurological model to explain how brain changes can lead to very unhealthy eating (food addiction).

Beyond eating from hunger, people eat to feel pleasure – and when we look at things at the neural level, we can see that eating highly palatable foods leads to activation of the brain’s reward circuitry, similar to the activation that is seen with the use of drugs and alcohol, along mesolimbic dopamine pathways.

Drug users who repeatedly stimulate these dopamine reward systems cause changes to the functioning and structure of the brain and these changes lead to behaviors and experiences which characterize addiction, such as compulsive drug taking, an exacerbated emotional response to drug cues (triggers and cravings) and a lessened ability to inhibit behaviors (an inability to resist urges to use). Addiction is considered a brain disease because of these neural changes which lead to compulsive negative behaviors.

In the NIDA food addiction model, vulnerable* people who repeatedly consume large amounts of highly palatable sugar or fat laden foods also over-stimulate dopamine reward systems and  cause structural and functional changes to the brain which lead to a heightened response to food cues, compulsive eating and an inability to regulate intake.

*As some people experience food as more rewarding than others, are less able to resist temptation to eat appealing foods even in the face of potential weight gain and develop greater conditioned responses to food cues – some people are known to be more vulnerable to develop food addictions than others.

The Dopamine Model of Food Addiction

According to their model, people with food addiction and drug addiction have altered functioning across 4 basic types of brain processes and this altered functioning can be explained by changes to the structure and workings of various areas of the brain. The 4 brain processes altered by both food and drug addiction are:

1. Changes to reward and salience function
2. Changes to motivation and drive functions
3. Changes to learning and conditioning functions
4. Changes to inhibitory control and emotional regulation functions

Reward and Salience Functions

The brain’s reward and salience functions control how we pay attention and respond to positive and negative reinforcers in our environment.

People with food addictions show changes in the workings of this circuit to the effect that they are less able to successfully choose behaviors that will lead to long term positive outcomes and to avoid behaviors that will lead to long term negative consequences.

Food addiction altered reward and salience functions lead people to focus highly on the potentially rewarding aspects of eating and to rank the rewarding feelings of eating above most other potentially rewarding activities, (exercise, sex, etc.). This is very similar to how a person with an alcohol addiction learns to rank the rewarding feelings of alcohol above most other rewarding feelings. Since all people seek rewarding activities, it is not surprising that people who consider eating to be the most rewarding activity are prone to over-eating.

People with food addiction are also less able to focus on the negative aspects of their behaviors. Although an obese person might know of the health consequences of overeating, at the moment of eating the salience of these negative consequences is greatly overpowered by the salience of the potentially rewarding feelings associated with eating some highly palatable food.

So changes to the reward/salience circuit of the brain lead a person with food addiction to rank the pleasures of eating highly palatable foods above other pleasures and to lose the ability to effectively weigh the potential negative consequences of overeating against the likely positive rewarding consequences of eating something tasty.

Brain imaging studies have shown that people with food addiction show differences in the ventral pallidum, medial OFC and hypothalamus which likely account for the changes to the workings of the reward/saliency circuit.

Changes to Memory and Conditioning Functions

The repeated over-consumption of large quantities of highly palatable foods leads to changes in the way the memory and conditioning circuit in the brain functions.

Once food addiction changes the memory and conditioning circuit, exposure to food triggers an emotional memory and the expectation of a pleasurable reward. Exposure to stimuli associated with eating, such as the sight of a fast food restaurant, or sitting down to watch TV can also trigger emotional conditioning and a strong desire for a pleasurable reward.

These persistent emotional memories help to explain the cravings a food addict experiences for ‘pleasurable’ high density foods. Because food cravings are triggered by so many associative stimuli they can emerge with frequency and they can lead to binge eating even among people who are trying to change their eating behaviors.

Brain imaging studies show changes to the hippocampus, amygdala and dorsal striatum which explain the alteration of the functioning of memory and conditioning circuits.

Changes to Inhibitory Control and Emotional Regulation Circuits

People addicted to food show dopamine related changes in the dorsalateral prefrontal cortex, the orbitalfrontal cortex and the cingulated gyrus, all areas which are involved in emotional regulation and our ability to exercise impulse control.

Changes to Motivation and Drive Functions

Food addiction caused changes to the orbitalfrontal cortex, the dorsal striatum and the supplementary motor cortices cause an amplification in the drive to obtain food.

Studies show that when obese people are presented with a meal there is greater activation in prefrontal areas of the brain than is seen when leaner people are presented with that same meal and other studies have demonstrated that showing food cues to obese subjects will induce activation of the prefrontal cortex and the experience of food cravings.

When brain changes result in increased food cravings and an increased drive to get food and when this occurs in parallel with a high expectation for pleasure through conditioned memories, a decrease in the ability to weigh possible negative consequences and a decreased ability to inhibit eating , it is not surprising that food cravings often lead to compulsive eating and it explains in part why some food addicts will continue to eat even when they no longer describe the behavior as pleasurable.¹

Learn how opioids can lead to depression, how depression worsens pain and what to do when you have both pain and depression.

Depression and pain go hand in hand – pain and disability can cause or worsen depression and depression worsens pain and disability… what a mess!

And to further complicate matters, though depression worsens pain perception and analgesic need, people with depression also get less pain relief from opioid medications.

Fortunately, it's not all doom and gloom - here’s the good news:

1. If depression ups your pain, treating the depression will almost certainly reduce pain and disability and improve your quality of life.
2. If you’re on high-dose opioids and suffer with pain and depression, you might find that reducing your daily dose improves both pain and mood.
3. If you have an addiction problem, dealing with your substance misuse generally eases pain and depression.

Read on to learn more about how pain and depression interact and about how to deal with this tough co-morbid situation.

Depression and Opioid Addiction

Longer Opioid Use = Increased Depression

An argument for time-limited opioid use.

In one major study of 50,000 military personal, researchers found that compared to people who used opioids for between 1 and 89 days:

1. People who used for 180 days or longer were 53% more likely to develop a first or new incidence of depression.
2. People who used for between 90 and 180 days were 25% more likely to develop a first or new incidence of depression. 
3. Also, people who used higher doses experienced more depression than people maintained on lower doses.

Depression Ups Opioid Misuse Risk

People with depression – even those with no history of substance abuse, are far more likely to take opioids for reasons beyond pain control than people from the general population.

• In one study, researchers from Western Illinois University found that people with severe depression were 2.4 times more likely to use opioids for reasons other than pain control and 2.89 times more likely to use more opioids than prescribed than people without depression.
  
• A huge Kaiser Permanente study which looked at the medical records of tens of thousands found that pain patients with a history of depression were three times more likely to receive a prescription for opioids than pain patients without a history of depression.
  

Why Are Opioids and Depression So Interlinked?

Opioids systems affect mood – and when things go wrong, this can cause depression.

• Opioids can produce intense pleasure (highs). Long term opioid use may disrupt reward pathways in the brain, making it harder to feel pleasure from normal everyday events like a good meal or the company of friends.
  
• Opioid receptors are located in areas of the brain that regulate emotion and cognition and opioids play a role in mood and anxiety regulation – for example, the brain releases endogenous opioids to self-soothe social rejection. So when opioid systems get dysregulated through over-stimulation, this affects emotional and stress systems as well.
  
• Chronic opioid use can lead to decreased testosterone, which can cause depression.
• People experiencing depressive symptoms are more likely to use opioids to self medicate psychological symptoms. This type of misuse ups addiction risks.
  
• Depression can worsen the perception of pain, causing a need for greater analgesia and higher opioid doses. Higher opioid doses increase addiction risks and can exacerbate depression.
  
• People with depression often have pain that doesn’t respond well to standard pain interventions. This leads to increased medication use - and increased addiction risks.
• People misusing opioids are less compliant on depression treatment directives.
  
• Opioid abuse may lead to life-consequences that worsen depression.

Worryingly, opioids increase the lethality of suicide attempts among people with psychiatric disorders.

Guidelines for Using Opioids when Depressed

According to the Canadian Guidelines for the Safe and Effective Use of Opioids for Chronic Non Cancer Pain, people with depression should:

• Titrate their opioid dose more slowly at the start of treatment.
• If you are working with a psychiatrist or psychologist, ask your prescribing physician to consult with this professional on the use, benefits and risks of opioid therapy for your situation.
• To prevent serious problems (like addiction) ask for frequent doing intervals and other conservative measures that prevent misuse.
• Monitor your mood and consider how opioids affect your functioning.
• Stop opioid therapy unless the medications work well – providing more than 30% pain reduction. 

Consider Lower Doses

If you take a high daily opioid dose, you may actually get better pain relief and experience less depression by slowly tapering down to a lower dose.

• In one study, doctors in California examined a group of patients who were on a very high daily opioid dose (300 mg per day or higher of morphine equivalent). At the start of the study, the average depression score among the patients was 13.5 on the Patient Health Questionairere-9; a score which indicates major depression.
• All patients agreed to a very gradual program of dose reduction, reducing at rates from 4% to 16% per 10 days, to a final dosage of 30% the starting dosage.
• After achieving this final reduced dosage, average patient depression scores dropped to 9.5. Study patients also reported less pain on the lower dose and less pain interference in quality of life.

The results indicate that for some people, chronic high opioid doses may actually worsen pain and depression, rather than alleviate suffering.  

Consider Addiction Treatment

Though lower doses may reduce depression and pain, once addicted, you probably can't control your daily usage. Once addicted, to manage depression and pain, you likely need addiction treatment.

Though the thought of facing withdrawal symptoms, un-medicated pain and depression all at once seems scary and overwhelming, It’s probably not as bad as you think, in fact, most people find that pain and depression get better once they address addiction issues:

• On average, addiction treatment causes reduced depression, particularly maintenance treatment with methadone or Suboxone.
• Results are further improved by supplementing addiction treatment with depression-focused cognitive behavioral therapy. In fact, though reducing opioid use alone can reduce depression, untreated depression ups relapse risks, so it’s important to address both the addiction and the mood disorder at the same time.
  

Take Home Messages

• Since longer opioid use and higher doses are associated with greater depression, be cautious with using opioids for persistent pain. If you must use opioids, make sure to supplement medication with active forms of pain management, such as exercise, relaxation exercises, mindfulness and acceptance techniques.
  
• People with chronic pain and depression commonly use opioids to self-medicate depressive symptoms. However, since depression worsens pain and reduces pain intervention effectiveness, it’s very important to treat the depression and pain at the same time. Simply relying on pain medication to relieve the depression isn’t a good strategy; in fact it’s likely to worsen depression and pain.
• If you find that pain gets worse, even with increasing opioid doses, you should consider whether depression affects your pain management.
• People on high opioid doses may experience less pain and depression by reducing daily dosages.
• Opiate addicted people will generally experience less depression and less pain by getting addiction treatment, especially MAT.

Six effective ways to help a treatment-ready heroin user that you love make positive changes - what to do and how to help.

You can’t make them quit - you cannot do it for them, but you can play an important role in supporting change and through emotional and practical support you can increase their odds of movement in the right direction.

Addiction is a chronic condition that’s characterized by recurrent relapse and treatment need. Though it’s frustrating to watch a person you love fall repeatedly back into the same problems, it’s important to keep working at positive change and to accept that setbacks are an unfortunate reality of addiction.

Here are 6 great ways to offer support and to encourage health and well-being over the course of a lifetime.

Six Ways to Help

1. Get as educated as you can about the nature of heroin addiction, the brain changes associated with addiction and the difficulties inherent in overcoming opioid addiction. As you learn more about the chronic nature of addiction and the commonality of relapse you may feel less frustrated by setbacks and more able to continue on offering valuable support and encouragement.
2. Accept that it’s not up to you to decide on a treatment goal. Listen to your loved one, respect their chosen objective and help them to achieve their goal – whatever it may be. For example, though you might hope for abstinence, your loved one might prefer a more gradual harm reduction approach. Help them work toward that goal and know that by making some progress today you improve the chances of even greater progress tomorrow.
3. Offer to provide transportation to and from treatment appointments (offer to attend these meetings too, if that’s welcomed).
4. Consider whether your whole family might benefit from family therapy to reduce dysfunctional dynamics that contribute to the problem.
5. Encourage your loved-one to broaden their social networks beyond those associated with drug use. Encourage participation in positive activities in the community.
6. Know what to do in the event of an overdose. The opioid antagonist naloxone can be a lifesaver in the case of heroin overdose. Have naloxone at home and know how to administer it (ask your doctor about acquiring this medication). Unfortunately, heroin users are at elevated risk of overdose during and after treatment attempts, when temporary stoppage leads to a tolerance reduction.
   

More Than Just Abstinence

It doesn’t have to be all or nothing.

Though abstinence and complete recovery from use is the best possible outcome, it’s important to note that even when treatment doesn’t result in full abstinence, it can still improve health and well-being and it is still worth your support – no matter how many times it is needed over the course of a lifespan.

Beyond abstinence, people involved with heroin addiction treatment tend to use less heroin, and the longer a person stays with treatment, the greater the reduction in use.

Reduced Use is associated with:¹

• A decreased risk of overdose, infectious disease and other health complications
• Decreased criminality
• Improved social, emotional and cognitive functioning
• More involvement in drug-free society
• Better functioning in relationships (romantic/familial/parenting, etc.)

Treatment helps people make small improvements that increase their likelihood of full recovery, and significantly, it also helps to keep them alive until the day they become ready to try seriously for full and lasting abstinence.

Image Copyright: Jim Nix

A closer look at the 12 steps of AA, breaking things down and showing you how it can support you to live a clean and sober life.

If you are new to 12 Step programs or are coming back to the program, this two part series takes a closer look at the 12 steps of AA, breaking things down and showing you how, with a little work, it can support you to live a clean and sober life.

Before we get started on looking at the 12 Steps of AA, there are a few things I'd like to touch on, as they could be potential blocks to you doing the work needed, so let's get them out of the way early:

Moving The Road Blocks

1. It is NOT a religious program.

Yes it does mention GOD in 4 places in the steps description. However, GOD can be interpreted as an acronym for Good Orderly Direction. It can also be understood to mean anything we want it to mean within the context of the program.

We do not have to be religious or have any affiliation with a particular religion in order to succeed at working this program. If we do have an affiliation of some kind of faith, good for us, as it becomes a strength that we can use, but it is not necessary in order for us to be successful.

2. We are not broken with a need to be fixed.

We are not sick either. We are not so far gone that we can't help ourselves live more fulfilling lives. It will be and is our choice. Always has been. What we are, however, is human.

We are likely to be...

• hurt
• isolated
• angry
• guilt ridden
• full of shame and
  
• unskilled when it comes to managing our lives and our emotions.
  

We see others doing well and wonder why can't that be us. It can be if we are willing to do the work.

3. We don't get to re-write this program to suit ourselves.

We need to commit ourselves to the program as it is written. That's the only way this works. It was written in 1935 by two men (Dr. Bob Smith and Mr. Bill Wilson) who both had problems with alcohol but somehow understood the benefits of supporting each other when the other wanted to run or hide.

4. We need to understand that alcohol is a drug.

The 12 Steps were developed to help us deal with alcoholism primarily but works just as well for those who suffer from drug addiction. The program can be worked and lived by anyone.

In the end drug and or alcohol use will most likely take us to the same place(s) - those being jails, institutions or funeral homes unless we intervene in that destructive process.

5. This is a plan that becomes a way to live our lives each day.

Some days we will live it better and do a better job of living it than others. We need to understand that as long as we don't pick up a drink or a drug we'll be OK. This is not something you do once and then see yourself as 'cured'. It becomes a lifestyle that you adopt. Most who give this program a chance agree it is much better than the one they left behind.

Lets get started -- real life awaits:

When We Surrender We Win

Step 1

We admitted that we were powerless over alcohol -- that our lives had become unmanageable.

In my mind this first one is the toughest one to deal with. This one requires us to look at ourselves in the mirror and say 'hey man we fought the good fight but we can't beat it.' One of the main tenants of this program is: "when we surrender we win."

Drinking As Others Do

Our problem seems to be that we can't seem to figure out how to drink or use AND live a normal life like everybody else, all at the same time.

We tried:

• using every other day;
• just on the weekends;
  
• stopping at a particular number or
  
• amount or picking a time of the day that keeps us from becoming intoxicated while our kids are still awake.
  

We said that we could quit any time we wanted to. I use to say that I had quit hundreds of times. Proving what? Looking back I was saying that I couldn't stay 'quit' but I could stop for a short period of time. I was powerless beyond that.

Any one can quit -- for a while. The trick is staying quit and that's when we struggle. It cannot hurt you or any of your loved ones if you don't pick it up.

Restoring Sanity

Step 2

Came to believe that a Power greater than ourselves could restore us to sanity.

This means that we need to challenge the idea that we are the most important and intelligent people who have all the answers to all the issues on the planet. This step is about us restoring a sense of sanity to our lives. This isn't about what other people are doing or not doing to help us. This concerns us making poor decisions about how we choose to live our lives.

If we want to stop being overwhelmed with life's issues then we need to stop what we are doing that adds to the confusion. The common denominator in all of this mayhem is our substance use.

If we continue to do the things that drove us to the edge we will continue to experience the same outcomes -- chaos, hurt, disappointment and defeat. Where is the evidence that supports any other explanation? 

Seeing a Higher Power

Regarding the 'a Power greater than ourselves' statement consider these questions:

• When could we stop the sun from shining or the wind from blowing? These are powers greater than we. We can't always see them but we can feel their presence all around us.
• The consciousness of our AA group says that those in attendance are collectively smarter than we are. How can they all be wrong and we be the only one in the room that has it right?

If we look around there are many examples of things that are greater and more powerful than we are. That 26 oz bottle of rye or that case of beer could make us do just about anything no matter how hard we wanted to stop. It also means that we can now recognize there is strength in numbers.

The primary issue here is realizing that, with the help of others, we can regain a sense of control over the choices we make. We do not and often cannot do it all alone.

Making a Committed Decision

Step 3

Made a decision to turn our will and our lives over to the care of God as we understood him.

This step is about being willing to make a decision first and foremost. Just the decision to become willing to look at or consider another approach to changing our lifestyle is immense. Without it, making any kind of move or change in our lives is extremely difficult at best if not impossible.

This could easily mark the first time in a very long time that we made a decision that was in our best interest and we were not under the influence of a drug at the time. This willingness shows a move to allow others to help us re-take some essence of control of our lives from the drugs and alcohol that nearly killed us. We are not sure what a 'power greater than ourselves' looks like but we are beginning to see that there are some things that are bigger than we are - more influential - more powerful. The 2nd and 3rd step allows for the possibility that there are forces in our lives beyond our influence. 

Exploring Our True Selves

Step 4

Made a searching and fearless inventory of ourselves

Now the work becomes more personal. This step is considered by many as the 'turning point' in most recoveries. The first three steps are vital to the success of the rest of the program. If we can understand and feel that there is some hope for a better life out there and if we are willing to take the risk of seeking it out then we become ready to tackle Step 4.

This is where we get to look at ourselves under a microscope of sorts. We begin to see that our approach to managing our lives has flaws in it. We need to take a 'fearless' look at how we have gone about trying to get what we want and ask ourselves how successful we have been to date. The willingness that we have begun to accept in our lives in step three will help us look at what we are doing that isn't working well for us and will help us consider some different approaches.

A Trusted Someone

This is a step that is best done with the help and support of someone we trust in the program -- a sponsor but not a family member.

We have to be willing to hear an 'outsiders' opinion about what we are doing, how we are doing it and the apparent outcomes from our efforts. The idea here is for us to check our behavior and change those behaviors that are not working out with regards to getting us or keeping us more connected to the world we want to be a part of. It is a building step and not a step that is meant to be critical, guilt ridden or demeaning in any way. My sponsor told me to 'keep the good stuff and get rid of the stuff that isn't so good'.

Ownership Of Our Wrongs

Step 5

Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.

Up to now most of the work we have done or needed to do was within ourselves. It was between me and me. Now it's time for us to begin to trust in others and their desire to help us get better. I recognize how difficult this can be for many of us. In the past trust has meant pain, heartache, betrayal, abandonment and isolation.

Now the work that needs to begin is about including those, so called, trusted ones and allow them into our circle of influence. We need to share with these few folks some of those secrets we have been carrying for a long time. But we become concerned that if others really knew certain things about us they may not like us any more or want to share their lives with us.

This step takes a great deal of courage and risk. Always, when sharing who we are with others, we need to weigh the value of complete disclosure with how much they need to know -- to what depth. There is a fine line between honesty and full disclosure. One of the future steps (Step 9) we will cover says that 'we disclose certain things but not if it hurts ourselves or others.'

When we do this step we might want to share our information and our insights of who and what we are with someone connected to the clergy. You may or may not believe in 'God' but we know that ministers are sworn to confidentiality and there can be a great deal of comfort and safety attached to a relationship of this type. In any event we need to feel sure and be sure of the confidants we encourage to be a part of our process with doing Step 5.

Removing Our Character Defects

Step 6

Were entirely ready to have God remove all these defects of character.

It may have taken us a long time to get here -- to arrive at this place where we are feeling as though we may just be able to do this. We need to be reminded that working through the steps is not about how fast we can do it. It is not a race or a sprint but rather a marathon. It doesn't take a specified number of weeks or months or years to work through the program. There is no right or wrong way to do this work. It does however take perseverance, dedication and a willingness to spend the time to achieve times of peace, prosperity and happiness. The important part is that you never give up trying to find a way that makes sense to you. I've worked with clients in the past who spent months just dealing with Step 1. I admit that I struggled here for a bit. 

Change Your Thinking

How could someone or something 'take or remove' these defects of character from me? I still was questioning what my 'Higher Power' was. I didn't understand how to involve my Higher Power in my life. What role was he to play? I had finally identified what behaviors and attitudes I had to change and so I depended on the strength and support of my home group to help me with this step. Actually this part was quite easy once I got by the arrogance of thinking that I was just fine and that it was the rest of the world that had a problem. I had to change my way of thinking about my defects of character and once I had done that they were no longer an issue -- they were gone. Many folks in A/A struggle here so I can only suggest that by giving up something or changing it -- a belief or a mind set for instance -- you take away its power and influence. 

Building a New Future

The remainder of the steps are about the transition from where you are to where you want to be and I will describe and discuss their significance in Part 2 of this article (published on ChooseHelp.com, next week). It is important you get the basics of the first part so that the second part is more easily understood and therefore can have a much greater impact on your life choices. Obviously you are free to do whichever steps you want when you want but it is more meaningful to do them as you come to understand them and to incorporate them into your lifestyle on a daily basis.

I had mentioned previously that this is a 'way of living' program. These are the basics most folks who enjoy their lives try to live by each day. It is what they are conscious of daily and what they eventually come to do each day in order to manage themselves effectively.

For those who are ready to jump into the next phase of their recoveries,
continue with Part 2 (Steps 7-12) of this series.

New to AA? Start here – a list of 9 quick-read articles answering all your important questions on getting started with the 12 steps.

Walking into your first AA meeting takes a lot of courage, especially when you don't know what to expect. Fortunately, a little foreknowledge can ease your anxiety. Read a few of the 9 short articles below (pick and choose those that interest you) and you'll feel better about taking that first important step that precedes all the others – walking into a meeting for the first time.

Getting Started with AA, What You Need to Know

1. What Happens at AA Meetings?

If you’ve never attended an AA meeting, start your reading here. Addiction counselor and in-recovery expert Anna Deeds lists everything you need to know and outlines what to expect at your first AA meetings, such as:

• Where do I find a meeting?
• What are the different types of meetings?
• What happens at meetings (a minute-by minute break-down)?
• Tips for succeeding with AA.

2. How and Why AA Works

What happens at AA that helps you stay sober?

Well, after much investigation, researchers identified a number of individual helping mechanisms, for example, AA helps you: build and sustain motivation, increase coping skills, increase self confidence, facilitate a change in social networks, and more.

3. Debunking Negative AA Myths

Is AA a cult? Do you have to believe in God?....

You’ve probably heard a lot about AA – but how much of it was true? In this article, recovery expert Jim LaPierre presents and debunks 7 common AA myths. 

4. AA for Atheists - Is It Possible?

You don’t have to believe in a Christian God to work a 12 Step program – you define your ‘higher power’ and it can match with whatever spiritual beliefs you hold – even G.O.D. – the power of a Group Of Drunks.

5. At Meetings, Do You Have to Talk in Front of the Group?

Don’t let anxiety about speaking in front of a group of strangers deter you. Alcoholism expert Melissa Borlie breaks down the different types of meetings (at open meetings you won’t be asked to participate) and reminds us that you should never be pressured to contribute if you don’t want to. Different groups have different vibes, and if you’re not comfortable in one group (or are feeling unwanted pressure) there’s always another one to try.

Also read about AA donation etiquette – don’t let an in ability to pitch into the basket stop you from attending. 

6. Are You too Smart for AA?

You may be pretty smart, but arrogance and over-thinking can end your recovery efforts before they get started – and if your ways were working so well, you probably wouldn’t need help in the first place!

You don’t have to stop thinking and questioning, but in the early days, keeping an open mind opens you up to a new way of being. Read this article and prevent a high I.Q. from derailing your efforts. 

7. AA in Rehab – Why It’s Useful

Experts often use the toolbox analogy to describe addiction treatment – you go to treatment to learn new tools that you can add to your toolbox – and the more tools you have at your disposal, the better your long-term recovery odds.

Rehabs that offer 12 step facilitation offer a powerful tool for long term recovery – an introduction to the power of community-based support. Research shows that people who get introduced to the 12 steps in treatment attend more meetings post treatment and have better overall outcomes. 

8. Why Helping Others Helps You Stay Sober

To keep it, you have to give it away…

You can attend meetings, or you can attend meetings and get involved with helping out, such as by sponsoring, sharing experiences, taking on 2 month service positions, etc.

Getting involved certainly helps others, but research shows that it probably helps you even more – in fact, people who get involved with 12 steps ‘helping’ develop a stronger connection to the program and are more likely to stay sober over the long-run.

9. Don’t Worry about Making Amends!

Not at first, anyway. Making amends is an essential component of 12 step recovery, and by striving to make up for your past wrongs you free yourself from a lot of relapse-provoking guilt and shame..

However, if you’re just starting out with the steps, it’s not something you’ll have to worry about for a while – not until you’re ready. You do the steps in chronological order and it can take some people years to get to steps 8 and 9.

Never let amends apprehension deter you from getting the help you need.

Try to Keep an Open Mind

If you haven’t yet tried a meeting, what do you have to lose? They’re free, they’re everywhere and millions swear by the steps as literal lifesavers.

That being said, not everyone feels comfortable with the AA program, and there are some great alternatives, but don’t dismiss the 12 steps after a single meeting, to give it an honest try you have to go a few times and keep an open mind. You should also try out a few groups – since different groups can have very different atmospheres, and while one might feel awkward, the next might feel just right.

A how-to guide to tramadol tapering - What to expect from tramadol withdrawal, how to taper, example tapering schedules to minimize your discontinuation symptoms and practical advice on low dose reduction tapering.

This is the 1st article in a series on tramadol withdrawal and addiction. Also read part 2, on coping with tramadol withdrawal symptoms and part 3, on tramadol addiction and the health risks of chronic use.

Some people have little difficulty with tramadol withdrawal symptoms, some people find them excruciating - but no matter who you are, you can ease the discomfort greatly with a sensible tapering schedule.

• Tramadol affects the brain’s opioid and serotonin/norepinephrine systems. Sudden stoppage can induce opioid withdrawal symptoms and antidepressant-like withdrawal symptoms – at the same time.
• You are more likely to experience severe withdrawal symptoms when discontinuing from lengthy use at a high daily dose.
• By tapering sensibly you can minimize your withdrawal symptoms.

Read on for a how-to guide to tramadol tapering that should answer your questions on:

1. What to expect from withdrawal (symptoms, duration, etc.)
2. How to taper (with example schedules)
3. How to handle small-dose reductions

Tramadol Withdrawal: Basic Info

Why are the withdrawals so tough?

Since tramadol isn’t as strong an opioid agonist as true opioids you’d think that tramadol withdrawal would be milder than withdrawal from these stronger drugs (heroin, OxyContin, Vicodin, etc.).

However, tramadol works as an opioid and as an antidepressant-like drug, so when you stop too suddenly after chronic use, you experience opioid and antidepressant withdrawal symptoms together - which can make for a synergistically very difficult few weeks.

There are two classes of withdrawal symptoms associated with tramadol withdrawal:

1. Opioid-like withdrawal symptoms associated with under-activation of opioid receptors
2. Atypical withdrawal symptoms associated with under-activation of serotonin and norepinephrine receptors

Typical opioid based withdrawal symptoms include:

• Insomnia
• Anxiety
• Pain (muscle aches)
• Nausea
• Tremors
• Diarrhea
• Cold or flu-like upper respiratory symptoms
• Sweating
• Piloerection (hair on skin standing on end)
  
• Restless leg syndrome (Tips on Coping with Withdrawal RLS)
  
• Agitation
• Abdominal cramping
• Yawning¹

Atypical withdrawal symptoms include:

Symptoms associated with the discontinuation of serotonin and norepinephrine reuptake inhibitor drugs.

• Paranoia
• Hallucinations
• Anxiety
• Panic
• Confusion
• Numbness and tingling in extremities
• Psychosis²
• Dysphoric mood
• Irritability and agitation
• Dizziness
• Sensory disturbances (such as brain zaps...get more info at Coping with Brain Zaps)
• Headache
• Lethargy
• Emotional instability
• Insomnia
• Hypomania
• Tinnitus³

People coming off a high daily dose are more likely to experience atypical withdrawal symptoms. Widely quoted research from 10 years ago suggests that 1 person in 8 experiences atypical withdrawal symptoms during tramadol withdrawal, though logically, since there’s some overlap between the symptoms, you have to wonder how people tapering at home - except in extreme situations - could differentiate between the atypical and opioid based symptoms.⁴

Cold-Turkey Tramadol Withdrawal Duration

Tramadol withdrawal symptoms last longer than withdrawal symptoms from true-opioid medications.

• Acute withdrawal symptoms will persist for about a week after stoppage but secondary and atypical withdrawal symptoms can persist for much longer.⁵
  

Your expectations and state of mind can also play a significant role. Studies show that people feeling very anxious about opiate withdrawal symptoms tend to experience more difficult withdrawals than people who feel less worried about the period.⁶

Can Cold-Turkey Withdrawal Cause Seizures?

This is a tough question to answer with certainty.

• No authoritative source (that I could find) lists seizures as one of the possible withdrawal symptoms (authoritative sources such as Medline, medication package inserts, etc.)

However...

• The Wikipedia page currently lists seizures as a possible tramadol withdrawal syndrome (but provides no citation for this fact!)
• And if you spend much time browsing through internet forums discussing tramadol withdrawal, you will read that cold-turkey withdrawal can provoke seizures - and you’ll see this often enough to give you pause for concern.
• If you stop tramadol suddenly while also withdrawing from another drug or alcohol, this assuredly does raise the seizure risk.⁷
  

Take-Home Message:

• So this remains a disconcerting gray area. In any case, hopefully you’ll have the time and inclination for a tapered withdrawal - which is probably safer and certainly more humane.

(If any reader can answer this question with certainty, please contact me so I can amend this section.)

Tramadol Tapering Guidelines

Pharmaceutical companies that sell Tramadol caution against an abrupt stoppage after chronic use and recommend tapering as the best way to avoid or minimize withdrawal symptoms.

Unhelpfully, they offer no guidance whatsoever on the optimum taper rate.

To start with then, let’s break tramadol down into its 2 basic parts and look at tapering recommendations for these individual components.

Tramadol is composed of 2 primary component halves – both of which can induce a syndrome of withdrawal, even in isolation:

1. An opioid-like half (which stimulates mu opiate receptors)
2. An antidepressant-like half (which increases serotonin and norepinephrine levels through reuptake inhibition – similar to SSRIs and SNRIs)

So with tramadol you have to taper off an opioid and an antidepressant, at the same time.

In the following sections we will...

1. Examine opioid tapering and then antidepressant tapering guidelines.
2. Combine these 2 sets of guidelines into a series of example tramadol tapering schedules.

Opiate Tapering Guidelines

Let’s look at how to taper off opioids.

According to the Canadian Guidelines for the Safe and Effective Use of Opiates, when tapering off an opioid:⁸

• You can drop by as much as 10% daily or reduce by as slowly as 5% every 2 weeks.
• People anxious about withdrawals or dealing with addiction issues should choose a slower rate of taper.
• Slow the taper rate by half once you reach a third of your starting dose.
• If experiencing severe withdrawal symptoms, hold on a dose until they subside.

For straight opioids and non-addicted patients seeking to discontinue use, common practice is a 2 to 4 week taper of 25% to 50% of the total starting dose per week.⁹

1. This may be too fast for anyone who is addicted and doing an outpatient self-directed taper (since faster tapers are associated with a higher risk of non-completion).¹⁰
2. Faster tramadol tapers are further complicated by the medication’s antidepressant-like components (see below).

Antidepressant Tapering Guidelines

According to the Royal College of Psychiatrists (UK) for SSRI/SNRI antidepressant tapering:¹¹

1. Go slow
2. If you’ve been using for less than 8 weeks, taper down over 1 to 2 weeks.
3. If you’ve been using for up to 6 months or so, taper down over a 6 to 8 week period.
4. If you’ve been using chronically, don’t reduce your total dose by more than 25% every 4 to 6 weeks

Note – these guidelines are targeted at people treating depression and taking straight SSRI/SNRI medications – not for tramadol.

5 Example Tapering Schedules

Your tapering needs will vary dramatically depending on your age, history, genetics, physical health, addiction status, mental health and other factors – and so you should develop your own tapering schedule in conjunction with your doctor.

Note - It’s easier to taper by percentages, rather than by set amounts. While it might seem logical to taper by 10 mg per week this is hard on your body. If you started at 400 mg a day, a 10 mg reduction would be 2.5% reduction in the first week and by the time you got down to 20 mg and went to 10 mg, you’d be doing a 50% reduction in the last…your brain can definitely tell the difference!

These tapering schedules assume a multi-year history of use and a daily starting dose of 800 mg per day (twice the maximum daily recommended intake). Adjust accordingly based on your own situation and starting dosage point.

Reducing by 10% Per Week (a 35 Week Plan)

• Week 1 – 720 mg per day
• Week 2 – 648 mg per day
• Week 3 – 583 mg per day
• Week 4 – 524 mg per day
• Week 5 – 472 mg per day
• Week 6 – 425 mg per day
• Week 7 – 382 mg per day
• Week 8 – 344 mg per day
• Week 9 – 309 mg per day
• Week 10 – 278 mg per day
• Week 11 – 250 mg per day
• Week 12 – 225 mg per day
• Week 13 – 202 mg per day
• Week 14 – 182 mg per day
• Week 15 – 164 mg per day
• Week 16 – 147 mg per day
• Week 17 – 132 mg per day
• Week 18 – 119 mg per day
• Week 19 – 107 mg per day
• Week 20 – 97 mg per day
• Week 21 – 87 mg per day
• Week 22 – 78 mg per day
• Week 23 – 70 mg per day
• Week 24 – 64 mg per day
• Week 25 – 57 mg per day
• Week 26 – 51 mg per day
• Week 27 – 46 mg per day
• Week 28 – 42 mg per day
• Week 29 – 38 mg per day
• Week 30 – 34 mg per day
• Week 31 – 30 mg per day
• Week 32 – 27 mg per day
• Week 33 – 24 mg per day
• Week 34 – 22 mg per day
• Week 35 – Jump off

Example 2 - A 28 Week Program of Reducing by 20% per week

Reducing by 20% per week and cutting down to a 10% reduction per week once at a third of your original dose.

• Week 1 – 640 mg per day
• Week 2 – 512 mg per day
• Week 3 – 410 mg per day
• Week 4 – 328 mg per day
• Week 5 – 262 mg per day
• Week 6 – 236 mg per day
• Week 7 – 212 mg per day
• Week 8 – 191 mg per day
• Week 9 – 171 mg per day
• Week 10 – 155 mg per day
• Week 11 – 139 mg per day
• Week 12 – 125 mg per day
• Week 13 – 113 mg per day
• Week 14 – 102 mg per day
• Week 15 – 91 mg per day
• Week 16 – 82 mg per day
• Week 17 – 74 mg per day
• Week 18 – 67 mg per day
• Week 19 – 60 mg per day
• Week 20 – 54 mg per day
• Week 21 – 49 mg per day
• Week 22 – 44 mg per day
• Week 23 – 39 mg per day
• Week 24 – 35 mg per day
• Week 25 – 32 mg per day
• Week 26 – 29 mg per day
• Week 27 – 26 mg per day
• Week 28 – 23 mg per day

Example 3 - A 12 Week Program

Reducing your daily dose by 20% every 3 days and then slowing to a 10% reduction every 3 days once at a third of your starting dose.

• Day 1 – 640 mg
• Day 4 – 512 mg
• Day 7 – 410 mg
• Day 10 – 328 mg
• Day 13 – 262 mg
• Day 16 – 236 mg
• Day 19 – 212 mg
• Day 22 – 191 mg
• Day 25 – 171 mg
• Day 28 – 155 mg
• Day 31 – 139 mg
• Day 34 – 125 mg
• Day 37 – 113 mg
• Day 40 – 102 mg
• Day 43 – 91 mg
• Day 46 – 82 mg
• Day 49 – 74 mg
• Day 52 – 67 mg
• Day 55 – 60 mg
• Day 58 – 54 mg
• Day 61 – 49 mg
• Day 64 – 44 mg
• Day 67 – 39 mg
• Day 70 – 35 mg
• Day 73 – 32 mg
• Day 76 – 29 mg
• Day 79 – 26 mg
• Day 82 – 23 mg

Example 4 – A 7.5 Week Program

Reducing by 20% every 3 days.

• Day 1 – 640 mg
• Day 4 – 512 mg
• Day 7 – 410 mg
• Day 10 – 328 mg
• Day 13 – 262 mg
• Day 16 – 236 mg
• Day 19 – 189 mg
• Day 22 – 151 mg
• Day 25 – 171 mg
• Day 28 – 155 mg
• Day 31 – 121 mg
• Day 34 – 97 mg
• Day 37 – 77 mg
• Day 40 – 62 mg
• Day 43 – 49 mg
• Day 46 – 40 mg
• Day 49 – 25 mg
• Day 52 – 20 mg

Example 5 - A 5 week Program

Reducing your dose by 10% every day. A program like this might be something to consider if detoxing off a relatively short period of use, such as under 6 months of use.

• Day 1 – 720 mg
• Day 2 – 648 mg
• Day 3 – 583 mg
• Day 4 – 524 mg
• Day 5 – 472 mg
• Day 6 – 425 mg
• Day 7 – 382 mg
• Day 8 – 344 mg
• Day 9 – 309 mg
• Day 10 – 278 mg
• Day 11 – 250 mg
• Day 12 – 225 mg
• Day 13 – 202 mg
• Day 14 – 182 mg
• Day 15 – 164 mg
• Day 16 – 147 mg
• Day 17 – 132 mg
• Day 18 – 119 mg
• Day 19 – 107 mg
• Day 20 – 97 mg
• Day 21 – 87 mg
• Day 22 – 78 mg
• Day 23 – 70 mg
• Day 24 – 64 mg
• Day 25 – 57 mg
• Day 26 – 51 mg
• Day 27 – 46 mg
• Day 28 – 42 mg
• Day 29 – 38 mg
• Day 30 – 34 mg
• Day 31 – 30 mg
• Day 32 – 27 mg
• Day 33 – 24 mg
• Day 34 – 22 mg

Please note - these are example tapering schedules to illustrate how you might set up your own reduction schedule. These are not based on any medical advice, though they are based on common practices and they are fairly conservative.

Increasing Your Odds of Tapering Success

• Modify your plan as needed. You won’t know how you’ll feel on any given tapering plan until you get into it, so just pick a plan that makes sense to you, get your doctor’s OK and try it out, and if it isn’t working for you, then slow or accelerate the reductions accordingly.
• It’s OK to go slow. You are better off taking things slowly and getting to zero successfully than rushing through and giving up when you feel overwhelmed. If withdrawal symptoms are bothering you, give yourself an extra few days or a week on any given dose - time to acclimatize - before continuing with your reduction plan.
• Try to space out your daily doses in a way that keeps your blood plasma levels relatively stable. This facilitates brain recovery and it also helps you curb your addiction to the high. So for example, instead of taking 2 in the morning, 2 at lunch and 4 in the evening (to get a little high) and a couple more before bed, you’d be better off taking doses of 2 pills, every 4 hours or so.
• If you have trouble resisting the temptation to take just a little bit more or a little bit early, put a loved-one in charge of handing out your medications on a set schedule. You provide a written schedule in advance, they know not to deviate from your instructions and you don’t have any pills lying around to temp you.

Practical Matters – Tapering in Small Increments

If you’re tapering in increments of 25, 12.5 or 6.25 mg per reduction, you can probably get by with a pill splitter and a steady hand – splitting pills into 2, 4 or 8 segments. (Though pills segments exposed to open air may oxidize and lose potency, which may be a concern if splitting pills into very small segments for use over many days.)

But if you decide to do a long and slow tapering schedule, how are you supposed to reduce your doses by very minute amounts?

Well, when little kids need very small medication doses, what do they get(?)…syrups with meds in suspension – so when you need very small and easy to measure doses of diluted medications, this is a practical way to do it.

You can either buy tramadol already sold in suspension, or if you can’t get that, you may want to consider making your own suspension (though get medical advice before you do this).

Tramadol in Suspension - Synapryn

Ask your doctor about a possible prescription for tramadol in suspension (sold under the name Synapryn).¹²

This comes in either a 5 or 10 mg tramadol per ml oral suspension. If you get the less potent dose (the 5 mg per ml dose) and you use an accurate small-dose oral medication syringe for medication (easily found in well stocked pharmacies) you can measure a dose out fairly easily to the exact mg.

Note - If you can’t find an oral medication syringe that’s precise enough in your local pharmacy, these can be ordered online fairly easily; even Amazon carries a selection.

Make Your Own Suspension

If you can’t buy Synapryn or if you’d prefer to make a less potent suspension, you can always talk to your doctor or pharmacist about how to make your own suspension.

A Warning!

Please remember that this isn’t medical advice nor are we qualified to provide medical advice. Always talk to your doctor before making any changes to your medication regimen. There’s nothing very complicated about making a simple medication in suspension, but if you do this in your own kitchen you have to be confident in your ability to follow directions and do basic math. This is something you do at your own risk and if you make a serious mistake you put yourself at risk of overdose. If you’re not sure about your ability to do this, don’t try it, or better yet, ask a pharmacist to prepare a suspension for you.

Here are directions for making a 5mg/ml tramadol oral suspension from Nationwide Children’s Hospital in Columbus Ohio.¹³

Ingredients

1. Six 50 mg tramadol tablets (not extended release)
2. 60 ml of Ora-Blend SF*

*This is a suspension vehicle that keeps the active ingredient (in this case tramadol) evenly distributed throughout the suspension. It also prevents the degradation of the active ingredient through oxidization, for a longer shelf life. You can buy Ora suspension products either as a neutral flavor or as a sweetened flavoring on Amazon or at well stocked pharmacies.¹⁴

Directions

1. Use a medicine mortar and triturate to grind the pills to a fine powder. (If you don’t have a mortar and triturate you could probably use a bowl and the back of a spoon to good effect – or you could pick up a medical set for only a few dollars at a well stocked medical supply store.)
2. Once you have a fine powder, add in a small amount of the suspension liquid and then stir that around until you get a completely smooth paste.
3. Continue adding the suspension liquid in small increments, stirring well after each addition, until you’ve added the whole 60 ml amount.
4. Transfer to a storage container with a tight fitting lid. Refrigerate for up to 90 days.

Precaution: you have enough medication in this mixture to seriously harm a small child. Label well and secure out of the reach of little-ones!

To use this suspension:

• 1 teaspoon or 5 ml = 25 mg tramadol
• 1/5 teaspoon or 1 ml = 5 mg tramadol
• 0.2 ml = 1 mg tramadol

With a good oral medicine syringe you should be able to use this suspension for dose reductions to as small 1 mg.

Water Taper (Liquid Taper)

There is no information (that I could find) endorsing the validity of a water taper for tramadol, but it should logically work. Please consult with your doctor before making any changes to your medication regimen and specifically before trying the water taper method. This is a hypothetical tapering method.

On internet forums and lay-person websites, water titration is commonly recommended for benzodiazepine tapering (given the difficulty inherent in making minute dose reductions you have to dilute the medication to make tapered reductions at all possible.)¹⁵

Tramadol is soluble in water, so you should be able to make a solution of water and tramadol for easier dose reductions (instant release forms of tramadol only).

An example 1mg/ml tramadol solution

Ingredients

1. Two 50 mg tramadol tablets (not extended release)
2. 100 ml water

Methods

1. Crush the two 50 mg tramadol tablets in a mortar into a fine paste
2. Add a small amount of water to make a paste and then continue to add water slowly while stirring.
3. Transfer to a lidded container and shake vigorously for a few moments, or until the tramadol is completely dissolved into the water.
4. Measure out an appropriate dose. 1 ml of the solution equals 1 mg of tramadol.

Cautions

• Since this would not look like medicine you have to be very careful to keep your finished mixture well labeled and out of reach of children.
• The shelf life for such a mixture is unknown.
• Please remember this is lay-information, not medical source information. Talk to your doctor about the safety and practicality of a liquid taper and get educated before you start. This method is commonly used for Suboxone, so if you Google ‘suboxone liquid taper’ you’ll find more info that might help.

Image Copyright: (OvO)

Supporting those who keep going back out: how to maintain hope and effectively cope when a loved one just can't seem to stay sober.

I've always hated it when folks refer to themselves as a "chronic relapser." It's not just a statement about their past; it's also a prediction of their future. For as much as I seek to challenge the thinking of those active in addiction, I have sympathy for the overwhelmingly painful form of powerlessness experienced by those who love them.

After a sufficient number of crises, treatments, rehabs, and heartbreaks, many of us reach a point where continuing to have hope just feels like we're asking for disappointment. This is an easy place to get stuck emotionally.

Assuming that we're not enabling, how do we maintain hope and effectively cope when our loved ones just can't seem to stay sober?

Cumulative Recovery

Every period of sobriety matters. I've served countless folks who have a number they can't get past. It's a pattern that gets perpetuated by relapse at a relatively fixed benchmark. For some it's 30, 60 or 90 days. The most common interval I've seen is six months. There's only so far a person can go in recovery without meaningfully soliciting and accepting support.

Relapse:

It's quick, efficient, and we do it very well. It's like hitting a reset button. I've gone as far as I'm confident going.

I'm left with the choice of going into unchartered waters or returning to my comfort zone.

The addict and affected other (those who love the addict) tend to take an extremely negative view of this cycle. The opportunity is to consider that something is gained in every period of abstinence and nothing that is learned, healed or implemented is ever more than temporarily lost. The question becomes:

What's Going to be Different This Time?

This must not be a rhetorical question. Breaking recurring patterns has to be done with careful planning and a high degree of accountability. Expecting that your loved one demonstrate responsibility is healthy. Demanding that they ensure a different outcome is not. None of us can offer guarantees.

At the same time, we are free to ask ourselves what we need to change:

• Have we set healthy boundaries?
• Are there forms of support we could be offering?
• Most importantly, are we getting support for ourselves?

This is the most overlooked aspect of the journey for most of the families I've served. Many seek professional support but fail to recognize the value of accessing Al-Anon and Nar-Anon.

It's Ok to Be Angry

In fact, whatever you feel is okay. A lot of us feel ashamed to find how upset we are with our friend . It's uncomfortable to resent someone you love. Many of us go to great lengths to hide it, which means resentments fester and pressure builds within us. This is not only a disservice to ourselves, it is also a very subtle form of enabling. Better to:

Communicate Clearly & Honestly

One of the best services we can provide for both active addicts and people in recovery is to simply be honest and direct. It's very healthy for us to share our experiences and hopes as long as we do so without expectations. This means no nagging, no coercion, and no pleading. I suggest giving straightforward feedback when asked, and asking permission to share in other circumstances.

Using "I statements" is often our best strategy. Counselors recommend these because they are the least likely to elicit a defensive response. When we say, "You need..." or "You always..." we can watch the walls of our loved ones go up. When we talk about what we want, feel, and need, defenses are not necessary (though sometimes they come up any way). The best we can do is control our delivery.

When You Just Want to Give Up

First and foremost, it's understandable. I encourage people in recovery and affected others alike to stay away from words like "always" and "never." Doing things once and for all is rarely a good idea. If we need to take some time for ourselves, that's very healthy and it's good to communicate that we will be unavailable for a time. We can offer either a fixed amount of time or simply indicate that we will be in contact when we are ready to communicate again. I urge folks to consider what needs to change so that we can feel safe in reaching out again.

Alas, there are times when we must "detach with love." We sometimes come to a point where the person we once knew is no longer at all present. The disease of addiction claims many long before death. Even here, my bias is not to give up. If we can offer any lifeline at all, this is preferable.

If your loved one has become violent, abusive, or otherwise unsafe, I urge you to wait for evidence that they are approachable. Sadly, this often means a call from jail, prison, hospital or psych ward. May your hopes and prayers be answered soon!

For the next 10 seconds, try not to think of a pink elephant…Impossible, right?! The fact is, the more you try to suppress an impulse to use drugs or alcohol the more fixated your mind becomes on that very impulse, and this is bad news for anyone serious about maintaining their sobriety. Fortunately, you don’t have to drink or use and you don’t have to fight or suppress your cravings, all you have to do is surf over them and they’ll disappear – using a proven mindfulness technique known as urge surfing.

Trying to ignore or suppress your cravings doesn’t work very well – the more you try not to think about having that drink or hit, invariable the more you do think about it!

So you don’t ignore them… you fight them, right?

Well, battling against your cravings doesn’t always work that well either. Sometimes your cravings are just too strong for you to fight, and you relapse. Other times you are able to resist your urges for a while, but you find yourself spending a lot of time and energy each day engaged in an internal back and forth debate about whether or not to give in to your cravings – it’s like by resisting your cravings you feed them with your mental energy and in response they grow stronger and occur with more frequency.

So, if fighting against the craving doesn’t always work either - what can you do?!

Try just going with your cravings using a mindfulness technique known as urge surfing and you might find that though you still experience cravings, they no longer have the power over you they once did and you can literally glide over and down a craving as naturally as if you were surfing a wave on the ocean.

Urge Surfing

As the intensity of a craving builds it feels like it is going to keep on getting worse and if you don’t give in to it, it will last forever. In actual fact, if you can just wait it out it will peak in intensity after a few minutes and then gradually subside into nothingness; just as a wave crests and falls. Cravings very rarely last for longer than half an hour and are generally briefer in duration.¹

The trick is to forget fighting or suppressing cravings but instead to learn a technique that asks you to experience a craving fully so that you rob that craving of its power over you.

Mindfulness

Urge surfing is a relapse prevention technique based on the principles of mindfulness meditation. By paying great attention to what a craving actually feels like, by maintaining awareness on the craving on a second by second basis and by avoiding passing value judgments about what you are experiencing (this is good, this is terrible, this will never end etc.) you learn to ride over waves of cravings and you rob these cravings of much of their power.

To get started with urge surfing try these three steps:

1. When you feel a craving coming on, sit down in a  comfortable chair (ideally in a place where you won’t be disturbed), put your feet flat on the floor and take a few deep breaths to relax yourself. Close your eyes and look inward into your body. Try to feel where in your body you experience sensations of cravings and describe to yourself what these cravings feel like in different parts of your body (for example "I feel a tightness in my legs and my stomach is kind of jumpy…").
   
2. Pick one area in your body that seems most affected by sensations of craving and focus deeply on these sensations as they pass by. To keep your mind from wandering, describe the sensations you experience in your chosen part of the body as they arise (for example "my arm is kind of itchy, now it’s almost like a pins-and-needles sensation just below my elbow in my inner arm…It feels warm too now…")
   
3. Next move to another affected part of the body and repeat the focused attention there, and then repeat with another part of the body. After a while, you will notice that the craving will have passed by.²
   

By learning a new way to experience cravings you learn a valuable skill in overcoming them, and as you learn to experience your cravings in a mindful way, without judging and without giving in, you will find that in time the frequency and intensity with which you experience them will diminish.

Image Copyright: DavidRphoto

If you aren’t meditating already, here are 8 very good reasons for you to consider taking it up. Whether you’re still drinking or using and trying to control yourself, just starting off with treatment or long down that winding and difficult recovery journey, stopping yourself from taking that next drink or line or hit is always going to be a challenge. Fortunately, while you may never be able to erase temptation from your life, you can take some steps to build up your resilience against cravings as you also build up your overall levels of health and happiness.

If only there was something we could do that didn’t take much time each day and didn’t cost any money and almost magically removed much of the stress from life as it also brought more joy and equanimity and a better ability to manage temptations… Hey wait a minute – meditation can do all that!

If you’re trying to control your urges to take drugs or drink alcohol, there are a number of very compelling reasons to add a session of meditation into your daily routine, and not very many valid reasons for not doing so.

Not convinced? Here are 8 reasons why you should consider learning to meditate!

8 Fantastic Benefits of Meditation

1. Meditation reduces your stress level

This alone is reason enough for most of us to get started. Meditation won’t do much to remove stressors from your life (your boss may still be a difficult person even after you meditate) but it will help you to respond to stressful events in your life without feeling as frantic on the inside – and since stress is a major cause of relapse, for those in recovery, eliminating any stress is a very good thing.

Stressful life events can trigger your sympathetic nervous system into a ‘flight or fight’ response which causes an increased heart and respiration rate, a narrowing of the blood vessels and other physical changes – the body gets ready to run or fight in response to a threat. Meditation increases the activity of the sympathetic nervous system’s opposite, the parasympathetic nervous system. The parasympathetic nervous system controls bodily functions in moments free from danger or stress. Increasing the activity of the parasympathetic nervous system results in lowered respiration and pulse rate, improved blood flow and lower blood pressure, better digestive function and a better ability to handle stress without feeling your blood pressure rise.

2. Meditation improves immune function

The abuse of opiates and some other drugs can decrease the effectiveness of the immune system, and few people emerge from drug or alcohol abuse in pristine health. Fortunately, research shows that just a few weeks of daily meditation can improve immune function and keep you feeling as good as you should.¹

3. Meditation can control pain and keep you off opiate analgesics

Meditation is a proven pain management technique that may help you to avoid, or minimize your use of, problematic and addictive opiate drugs.

4. Meditation can lower your blood pressure and stave of heart disease

Anyone who has abused drugs or alcohol for long could do well to treat the heart with a little TLC; after all, all those nights of whiskey and cigarettes and cocaine and whatever else can do a lot of damage. Fortunately, research shows that regular meditation practice can lower blood pressure and even prevent the onset of heart disease.  You can’t go back in time, but you can start taking better care of yourself, starting from today.³

5. Meditation increases your empathy and compassion for others

The behaviors of addiction are necessarily selfish, and this can wreak havoc on relationships with the people we care about most. Fortunately, with kindness and right actions you can rebuild most relationships, and meditation is a great way to improve your relationships with those you love as the practice transforms you into more generous, compassionate and empathetic person.

It’s not only anecdotal evidence which illustrates how meditation can transform you into a nicer-to-be-around person, brain imaging scans done on experienced meditators shows that meditation leads to a greater neural response when confronted with the negative emotions of others. Basically, brain scans show that meditation really does amp up compassion and empathy!⁴

6. Meditation may slow down the aging process

The bad news for those of us who’ve drank more than our fair share over the years is that drinking alcohol has been implicated as something that shortens the length of telomeres, which are the protective caps situated at the end of chromosomes. Shortening telomeres are thought to influence the cellular aging process so anything you do to make your telomeres shorter increases the rate at which you age.

Fortunately, although you can’t undo what’s done, you can take steps now to preserve your telomeres. Preliminary research indicates that meditation may be something that protects against telomere shortening by decreasing things like chronic stress and emotional reactivity that are also thought to accelerate the aging process by shortening telomeres.⁵

7. Meditation can help build up your sense of spirituality

For thousands of years Buddhist monks, Hindu Yogis, Christian mystics and people from a thousand other spiritual traditions have used meditation as a way to connect with the divine and enhance a personal spiritual understanding.

Whatever your religion or spiritual take on the world, meditation can probably help you too become more connected to the powers, joys and mysteries of life. And whether you’re still drinking or using, trying to stop or on an ongoing journey of recovery, building a personally relevant spirituality is a very useful thing to do.

8. Last but certainly not least…meditation will bring joy into your life

MRI scans show what meditation enthusiasts preach to anyone who’ll listen, meditation brings more joy into your life, and it’s pretty hard to argue against more happiness in life, right?

Image Copyright: clearwisdom.net

Getting someone to agree to accept help for a serious substance abuse problem and/or mental illness is really just the beginning of the journey into recovery for everyone involved in the process.

After working with people in crisis all over the country and throughout the world as a professional interventionist for almost the past 20 years, I can completely understand how difficult it might be right now for anyone out there reading this with a loved one currently struggling with substance abuse and/or mental illness to try and think about about life after an Intervention, especially when you can’t even get your loved one to talk about the underlying problem, let alone accept help for it!

However, the simple truth is that getting someone to agree to accept help for a serious substance abuse problem and/or mental illness is really just the beginning of the journey into recovery for everyone involved in the process. And I call recovery a journey because from my personal professional perspective, most people end up going down a whole bunch of long and winding roads before they finally end up on their Freeway Forward, the one that actually helps them heal, especially when it comes down to healing from within.

I have always said that the success of an Intervention lies heavily within the collective loving power of caring friends and family to establish, hold, and then uphold strategically significant healthy boundaries that support the foundation of the recovery process. As a result, my belief is that it is imperative to not only be able to lay down the law with love during an Intervention, but equally as important, to be able to hold the line after it. Therefore, planning a successful Intervention also includes having a recovery-centered plan of action to help you meet your emotional needs, while your loved one is simultaneously getting help to meet theirs in treatment, thereby creating a powerful therapeutic counterbalance.

So, when it comes down to actually drafting your very own Post-Intervention Care Plan, it’s important to recognize that by the time you finally decided to plan an Intervention, you were probably pretty close to hitting your very own emotional rock bottom, well in advance of your loved one in crisis. And if you can accept that premise, once you finally see your loved one head out on the road to recovery after an Intervention, you will probably feel like it’s the perfect time to tend to your own emotional welfare so that you will hopefully never having to go through that experience ever again!

Set Realistic Goals

The first step in any plan is to identify exactly what you want to accomplish, or your objectives. The same holds true when creating a solid Post-Intervention Care Plan for yourself. Start off by identifying what you want to accomplish for yourself as a result of the Intervention, both before and after your loved one is finally out on the road to recovery. Look closely at improving your quality of life as well as your ability to effectively cope and process issues that may have been impacting you the most, such as stress, anger, anxiety, resentment, and depression.

Although you may not have been the one in need of inpatient residential care, I suggest that you start planning your Post-Intervention Care Plan as soon as you actually decide to move forward with the Intervention, if not sooner. It will help you gauge your own interpersonal growth, while building on your strengths, and helping you learn from your weaknesses. As a matter of fact, unless you are already doing so, start taking care of your emotional welfare right now! Why wait any longer? As one of my unsuspecting mentors once told me, “people don’t plan to fail, they fail to plan.” While your loved one is taking care of themselves in treatment, do the same back home so that you can also benefit from the recovery process.

Reinforce Your System of Support

First and foremost, don’t try to go through it all alone. No matter how tough you think that you are, or how powerful you may actually be, your life has been impacted in one way or another by substance abuse and/or mental illness right along with your loved one in crisis. Now, in the same way that you wanted your loved one to reach out and accept help, if you are ready to experience the long-term and life-changing benefits of an Intervention, you will need to do the same.

Right out of the box, I recommend that you attend a support group meeting within in your community, such as Al-Anon or NAMI, so that you can connect with other people who have also been where you are and who are willing to freely share their experience with you. Don’t misunderstand me, there’s nothing wrong with reaching out to your close friends and family for support, it’s that they just may not be able to relate to your particular situation, not to mention the fact that they may also want to avoid giving you the wrong advice. Beyond support group meetings, whether before or after all of the emotional dust finally has a chance to settle, I strongly suggest that you set aside at least one hour a week for individual therapy so that you can effectively process all of your feelings with a well-trained professional counselor.

Redefine Your Role

Arranging  all of the pieces of the Intervention puzzle was no easy task. More than likely you had to mediate a whole host of inter-family squabbles, while simultaneously and secretly putting out all of those unexpected logistical fires. Maybe you have always been the one who was expected to somehow fix all of the problems, come up with the solutions, and make the peace.

After the Intervention, you may want to look at redefining your role, not only within your family, but in every other aspect of your life. Along with everyone else who participated in the Intervention, including your loved one who was struggling with substance abuse and/or mental illness, now is the perfect time for you move on and grow.

Engage in the Process

As I am sure that your are already well aware, addiction and mental illness touches everyone in the family in one way or another. As a result, when the time is right, perhaps like right now, look for a treatment center that strongly promotes family work as part of their core curriculum.They may even sponsor a Family Weekend, in which families are welcome and encouraged to visit their loved ones in treatment and then actively participate in the treatment experience while they attend workshops designed to promote greater insight, understanding, along with constructive communication skills. Whether in person, over the phone, or by Skype, engage actively in the process. Go. Call. Make the time.

Remain in the Solution

Think positive. Good times are ahead. Things are going to get better for both you and your loved one struggling with substance abuse and/or mental illness. Although you cannot actually control your loved one’s progress in treatment or the speed of their recovery, as long as you remain steadfast in the solution you can definitely help to improve the prognosis by continuing to hold healthy boundaries introduced during the Intervention. After hitting your very own emotional rock bottom, you should be more than ready to thrive in the solution, now guided by a tangible plan of action rich in support, and full of demonstrative opportunities for interpersonal growth. Unfortunately, however, rest assured that more unwelcome and unexpected twists and turns are also on the way. Even after a successful Intervention, the proverbial coast may be far from completely clear. When dealing with substance abuse and/or mental health disorders, just when you think that things are moving in the right direction, something as simple as a small disagreement can end up moving months of progress sideways. Stay cautiously optimistic and remain in the solution at all times!

The Intervention is just the beginning of the recovery process. As is the case when battling any other progressive illness or disease, overcoming substance abuse and/or mental illness takes a lot of hard work and determination by everyone involved. Furthermore, the results of an Intervention have the potential to go far beyond sobriety alone. Although I have to admit that it took me a while to accept the fact that most people end up reaching out to me at the very bottom, as a sort of last ditch effort to try and break through seemingly impenetrable walls of resistance and denial, I take great pride in the fact that the bottom is exactly where true healing begins. After the Intervention, you will have the unique opportunity to thrive in the solution, right along with your loved one in recovery.