Guinevere Gets Sober

Recovery news, reviews and stories, by Jennifer Matesa.

Is It Easy to Quit Suboxone?

Some of you may know I’ve gone back to graduate school to get licensure to be a therapist. Here is an actual statement made in my textbook in the chapter about substance-use disorders:

[Buprenorphine] does not produce the physical dependence that is characteristic of heroin and can be discontinued without severe withdrawal symptoms.

Statements like this one make me turn into the Tasmanian Devil inside.

Screen Shot 2018-04-22 at 11.05.47 AM

Look, Suboxone saved my life, okay? There is no other way I could have detoxed off fentanyl—what other person do you know who has been on fentanyl for 4 years and lived to tell the tale?

But I had the good sense and sheer luck to take Suboxone for less than 3 months, and at doses much lower than the high-dose therapy that’s common in the U.S. Thank god I had ordinary recovering people rather than doctor, researchers, or expert talking-heads looking out for my welfare—I was tempted to stay on it long-term, because I’d been on major opioids for so long that I didn’t think I could do without them. And whatever the textbooks and “experts” might say,

buprenorphine is a major opioid.

The many, many emails and comments I’ve received from readers of this blog and my books and journalism—people who have suffered or are still suffering severe withdrawal symptoms after discontinuing use of Suboxone or Subutex—witness to the outright falseness of this textbook’s statement, which is inculcating a totally wrong belief (i.e., a lie) in how many graduate students across this country?

There aren’t too many of us out here advocating for more help for people who want to quit bupe. One former buprenorphine user wrote me last week to thank me for all the writing I’ve done over the years advocating for more help for people like him. Currently, the attitude in the medical industry is that opioid “addicts,” despite whatever level of any drug they were taking previously, have permanently wrecked their neurology and will need to take buprenorphine for life. My reader told me to go search YouTube for “suboxone withdrawal.” One of the first videos that came up was the one below: she talks about what Suboxone has done to her skin and hair.

Here’s why the drug is so difficult to quit.

  • Suboxone has a very long half-life, which means its metabolites (the garbage the body turns drugs into while trying to detox it out of your system) also have long half-lives.
  • It’s fat-soluble, so unlike heroin or Vicodin, which are water-soluble and excreted when you pee, buprenorphine and its garbage stick to the body’s fat cells and take just ages to get rid of. As in, months, or years, depending on how much and for how long you used it, and what kind of taper you managed. (Methadone and fentanyl are also fat-soluble, though their half-lives are much shorter—yeah, even methadone’s famously long half-life is much shorter than buprenorphine’s!).

So that’s why you could get problems like this woman’s. Or other things might happen:

  • You might lose bone-density
  • Your ovaries and testes might shut down (meaning, say goodbye to good sex, even with yourself, and maybe even your period if you’re a woman; and if you’re a man, say goodbye to building muscle-mass)
  • Your hair might fall out
  • Your teeth might decay
  • Your gums might become ulcerated
  • Your vision might become blurry
  • You might suffer major depression while on the drug, and major anxiety and persistent insomnia while coming off

Real people have reported these and other problems. But the difficulty is that they’re all “just” anecdotal reports—they haven’t appeared in any research journals because the rich lobbyist-laden pharma corporations that produce this stuff haven’t bothered to test the drug’s effects beyond six months of use, and they haven’t tested drug discontinuation at all.

If you check in here and have had difficulties with getting off Suboxone, message me with your story—I’ve been collecting them for a long time and plan to publish them at some point and in some form, to give you a voice.

And likewise, if you had a totally easy time quitting buprenorphine, message me, because we’d all like to know how you did it!!—it is possible to detox off bupe without huge acute withdrawal, though in general the post-acute symptoms last a long time, again, depending upon how much and for how long you used.

Your best bet to recover is to take very good care of your body, feed it good organic food, give it exercise, get good sleep—but this woman has done all that, and her skin and hair still look like this, and there’s nothing she can do but wait until her body slowly, by millimeters, recovers from the damage done by the insidious drug buprenorphine.

Tom Petty OD’d On Fentanyl. And Other Drugs.

Petty02

Some people think fatal ODs have nothing to do with pain management—they think virtually all people who OD either bought street drugs or stole from other people’s prescriptions (“Medical use surely increased access to the drugs—but the people who got hooked tended to do so while using medication that was either prescribed for someone else or otherwise distributed illegally”). But damn, we keep hearing stories that show this is not true.

For every prominent person whose opioid abuse started with real pain, you can bet there are hundreds or thousands of people whose names have not been on marquees who started abusing drugs while seeking relief from what has increasingly become known, in coverage of the opioid problem, as “legitimate pain.”

The Los Angeles medical examiner today announced autopsy results for Tom Petty, who was found dead last fall: it was found that he died of a heart attack caused by an accidental drug overdose. His body had traces of three different kinds of fentanyl—which seems to be ubiquitous in ODs involving opioids, particularly heroin, these days, and which was prescribed to Petty for pain—and also oxycodone (the drug in OxyContin) as well as two different benzodiazepines (Xanax and Restoril).

As they used to say when I was a kid: Enough drugs to kill a horse. 

And a doctor (or doctors) prescribed them all.

He also smoked (see “emphysema” below). If he also drank, that would further have taxed his body’s ability to detoxify itself.

Petty’s wife and daughter issued a statement saying that Petty

suffered from many serious ailments including emphysema, knee problems, and most significantly a fractured hip. . . . Many people who overdose begin with a legitimate injury or simply do not understand the potency and deadly nature of these medications.

Which means it’s entirely appropriate that doctors’ prescribing practices should be more closely monitored. And doctors themselves—even pain specialists—need to get better education, especially in communicating with patients about real-life limitations.

Petty’s wife and daughter further said:

Despite this painful injury he insisted on keeping his commitment to his fans and he toured for 53 dates with a fractured hip and, as he did, it worsened to a more serious injury.

Sounds to me like a commitment not to his fans but to his ego. If he had been committed to his fans, he would have put his health first, so he could be alive today.

And maybe the doctors were a bit starstruck, too. Prince and Michael Jackson had the same problems: chronic pain that led to addiction, and doctors who fed their weaknesses.

“First doing no harm” in such cases would be to tell the patient that he has to quit smoking, and he Has To Stop Fucking Touring. Period.

Recovery Coaches Need Accountability.

holding hands

Years ago when writing a story for one publication or another about addiction, I had the pleasure of interviewing William White, a researcher and clinician whose experiences with healing addiction go back to 1969. Since then, I’ve followed his blog, which invariably offers cogent and thorough analyses of questions and problems in addiction treatment and the fostering of access to healing. And since he has followed these questions for nearly 50 years, his perspective is unmatched.

Today he published a blog on the quality and need for supervision of recovery coaches.

He investigates a couple questions I’ve been asking myself for a long time, about these two support functions: the question of “ownership” of the person seeking help, and the question of accountability.

Ownership

In one of the many papers he’s previously written on the differences between therapists and coaches, this caught my attention:

Where the sponsor and counselor are prone to take “ownership” of an individual (e.g., “my sponsee” “my client”), the recovery coach (RC) encourages those they work with to fully engage with other sources of recovery support. The “prize” to which the RC role is affixed is not the adoration and eternal gratitude of those they have coached, but the recovery of these individuals within a broad network of recovery support relationships.

As a therapist-in-training, I’m interested in the differences between therapy and recovery coaching. I have heard many recovery coaches use the term “my client” when referring to someone they help. And I have seen some recovery coaches post messages from people they help that express those people’s adoration and eternal gratitude.

Mind you, I’ve also seen many recovery coaches—perhaps more than those mentioned above—express abundant gratitude for the opportunity to make their work helping other people.

But frankly, last year a recovery coach who also holds a clinical license boldly discouraged me from seeking a graduate degree in clinical work—a goal I had carefully researched and assessed for a long time.

This person’s reason?

You can make so much more money doing recovery coaching! You can work with wealthier people. You can work over Skype, so you don’t even have to have an office. And you don’t have to fool with insurance companies. Don’t bother getting a master’s in social work!

Wow.

Accountability

This leads to my second question: who is overseeing all these independent recovery coaches?

I have learned in my short time as a therapist-in-training that supervision is absolutely critical for helping professionals—not just at the beginning of a career, but for the duration. Therapists who work inside agencies are overseen by supervisors. Independent therapists pay other more experienced therapists for supervisory consultations—at least twice monthly, according to the informal accounts I’ve been collecting.

And most important, therapists must be licensed. You can’t just put a meme on your IG or blog that says, “Skype me!”

When White talks about recovery coaches, he refers strictly to those who work within agencies, alongside therapists. These recovery coaches are accountable to their agency’s policies and supervisors. And those supervisors, he urges, must make sure that recovery coaches are not acting as sponsors. Those roles are very different, too.

I’d like to hear from independent recovery coaches. Do you take ownership of the people you try to help? What are the core competencies of a recovery coach? To whom do you hold yourself accountable to meet or exceed these competencies?

A Sober Thanksgiving.

(Originally published Nov. 25, 2010)


My sister is here for Thanksgiving with her family. We have eight people in the house, and half of them are kids. They’re staying for a week.

A week is a long time to have house-guests.

Especially if you have been raised in an alcoholic family and one of your deepest habits is making your life feel safe by making it the same every day.

Charlie Brown Thanksgiving

My house was built in 1898. It’s a three-story, foursquare brick house with a staircase up the front hall to the third floor and back stairs from the kitchen to the second floor. With four kids here, there are always pounding feet and weird screeching sound-effects echoing throughout the plaster walls and oak floors.

This old house.

This old house.

It’s a different atmosphere from what I was used to as a child. When we were kids, we used to spend Thanksgiving, every single frigging Thanksgiving, with my mother’s parents at her childhood home. My grandfather, who was a violent drunk when my mother was a child, had built his house from scratch in the early 1940s. It was a big ill-designed brick place with a sort-of-Dutch roof and a screened side-porch.

Houae

My mother’s childhood home, via GoogleMaps.

It stood on half an acre of flat land shaded by enormous oaks, whose leaves we spent two days raking during our Thanksgiving visit. We raked leaves. Played endless gin rummy with my grandmother. Occasionally bought a quarter’s worth of penny candy at the corner store a block away, but we weren’t even allowed to walk down the block by ourselves.

The house was a two-and-a-half story place with a full dry basement, but we weren’t allowed to touch anything in it for fear of breaking something or making a mess. There were a few ancient toys in the attic. Mostly, we sat and read. We weren’t allowed to make a racket, except for music. My sister played the piano; I practiced my flute.

We helped in the kitchen. My grandmother always roasted a turkey with plain Wonder-bread stuffing, and made mashed potatoes, corn pudding, and some canned or frozen green beans. Or maybe, as a huge change of pace!!—lima beans (canned). For dessert we’d have pumpkin pie.

Everything was always the same. We always ate at half-past 3. The reason we ate this early was always beyond me—but it was taken for granted that I would never ask why.

Thanksgiving evening would stretch before us, empty.

“Did we ever go anywhere?” my sister asked me this morning as she worked on the turkey.

This house was in Catonsville, a prosperous suburb about 20 minutes from a major historic Eastern seaboard tourist draw, but we only ever once saw the actual city. Once. We visited twice a year for what—18 years?—and we almost never left the property except to go to church.

I can’t remember any real communication over supper. We kids didn’t talk about what we were doing in school, and my grandparents never showed any interest in our lives. My brother sometimes went down to the basement to watch my grandfather fix a radio at his workbench, but I can’t remember ever speaking to my grandfather, though I was forced to sit at his right hand at every meal, and for every family photo I had to sit on his lap, which creeped me out because aside from this requirement, he never showed any interest in me. He no longer drank—he’d given up booze once he was diagnosed with diabetes—but he was not in the least sober. Meanwhile my gregarious dad was dealing with this fucked-up family by putting away can after can of National Bohemian.

Classic alcoholic family behavior. Isolation. Rigidity. Suppression of feelings. Lack of communication.

Addiction is a difficult cycle to break. It’s an intergenerational dysfunction. Its patterns become deeply ingrained from earliest childhood. The deepest, in my case, is taking care of others at my own expense.


I try to do some things differently today.

We open up the entire house to everyone. There are piles of books, toys, cards, and other kid stuff all over the house. Nobody is afraid to touch anything. “This is like my temporary home,” my 9-year-old nephew casually remarked yesterday as he reached into the fridge for some milk. Openness instead of isolation.

Ever since the kids were small I’ve splurged on art supplies, and I pile them onto the dining room table and show them how to make art. It’s like push-ups for the muscles of the imagination. They’re all interested in drawing and painting, and three of them are particularly creatively inclined—so we pay attention to their interests. Flexibility instead of rigidity.

I try to be sensitive to the kids’ feelings. Since they were small, I’ve always taken them on my lap and given them a great deal of physical affection. I want them to know they can rely on me. … Now they’re too big to sit on my lap. My eldest niece, at 13, is taller than I. When I see clouds or tears pass over their faces, I put my arms around them and try to be present to their feelings—or I try to be aware of times to leave them alone.

Most of all, I’m talking with my sister. We were not given the tools to get along with each other when we were young. Growing up in an alcoholic family makes a person emotionally dependent and denies a child the equipment to accept reality: it’s like we’re always wishing for some other life, trapped in some illusion. We always want things to be different—more perfect; closer to some ideal we have in our heads.

Just sharing our experiences has been such a gift. Even disagreeing with each other and remaining close is a gift.

I sit back and give my sister permission to do whatever she wants in my house. She’s a wonderful cook. If she wants to take over the kitchen, I tell her to go ahead. If she wants to get up at 7 and make a cheesecake, I tell her to go ahead. I’m trying for flexibility instead of rigidity. Freedom instead of imprisonment and dependence. Watching her feel comfortable in my house is awesome.

Our menu:

  • Brined turkey
  • Glazed ham (because the boys don’t like turkey: some flexibility is good)
  • My sister’s special stuffing
  • My husband’s amazing oven-roasted potatoes
  • Fresh carrots, green beans, and brussels sprouts
  • My sister’s cheesecake
  • My cherry pie, which my niece helped make

I remember a couple years ago, just after I detoxed, my sister said, “It’s just not Thanksgiving without Mom here to complain about what a shitty job Dad’s doing carving the turkey.”

This year, there has been some anxiety—but no arguing or fighting, no throwing food or objects across the dining room, the way there was after my grandfather died; no gritting teeth; no days-long resentful silences about who’s making what, who pays for what, or who won’t eat what and how that makes that person uncooperative and stubborn and worthy of criticism for daring to express preferences.

A week is a long time to have family in the house, but I’ll tell you what: it seems way shorter than the two days we spent for Thanksgiving each year with my grandparents.

She Recovers in NYC: Healing Alongside Our Sisters

She Recovers in NYC

The She Recovers in NYC conference is the first-ever international meeting to pay attention to the particular needs of women in in all kinds of . Aside from being one of the happiest celebrations of recovery on the planet, She Recovers in NYC is built to help us heal from serious problems that compromise our recovery.

It’s just real that, as women, we face some challenges that are different from those of our male counterparts. One of the most prevalent and important is the level of trauma in our histories.

Whereas no more than 20 percent of men in recovery have experienced trauma, one reliable study found trauma in the histories of roughly three-quarters of women. About two-thirds of those have experienced physical trauma, and a significant fraction have experienced sexual trauma, including childhood sexual abuse.

Five hundred of us will cross state and international borders to gather in New York, and three out of four of us will be dealing with trauma in our pasts. And as the long-running Adverse Childhood Experiences (ACE) Study has pretty definitively shown, trauma is highly correlated with the ways we drank and used drugs.

We have to take care of this trauma. We can’t pretend it doesn’t exist, and we also can’t allow its fallout to tempt us back into that life.

When I heard that Dawn Nickel and Taryn Strong and their team were putting this conference on, I knew I had to go. I wanted to be with my sisters who are struggling with the same problems I and so many others grapple with.

I know what those problems are. I’ve heard about them firsthand. For my last book, Sex in Recovery: A Meeting between the Covers, I interviewed more than four dozen ordinary people in recovery about their sexual histories inside both addiction and recovery.

Men talked about physical abuse, usually from their fathers. But woman after woman—one of my sisters after another—talked about sexual trauma: rape, sexual assault, sexual harassment, performing sex-work to get drugs.

I also heard from women in recovery who have been celibate for up to 12 years, who desire relationships and sexual pleasure but have no idea how to go about getting there without drinking or using a drug.

Talking with so many women convinced me that substance abuse has roots in a lack of healthy touch in society and in our failure to talk in reasonable ways to our kids—or even with each other—about sex.

Recovery awakens desires for healthy and loving sexual relationships, but because we don’t talk about sex in the culture, we have no language to talk about any of this.

She Recovers NYC is not just a party—it’s also a balls-out effort to help women heal from serious problems that may compromise our ability to stay clean and sober. Interactive workshops are designed to help women begin to talk about sexuality, desire, trauma, numbing ourselves with sugar, and fear of abundance. Yoga sessions are designed to help us stay inside our bodies. No way could I resist going.

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